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Democrats Won a Mandate on Health Care. How Will They Use It?

Another idea is for the federal government to provide money to states to help pay the largest medical claims. Such assistance, which provides insurance for insurance carriers, has proved effective in reducing premiums in Alaska and Minnesota, and several other states will try it next year.

In addition, many Democrats say they want to provide more money to help consumers enroll in health insurance under the Affordable Care Act. Over the last two years, Mr. Trump has cut the funds for insurance counselors and enrollment assistance by 84 percent, to $10 million.

Mr. Trump said he believed he could work with Democrats in Congress on “lowering the cost of prescription drugs,” and the Senate majority leader, Mitch McConnell of Kentucky, said the issue was sure to be on the agenda.

Democrats have praised two of the proposals Mr. Trump has advanced in recent weeks. One would require drug manufacturers to include the list prices of drugs in television advertising. The other would reduce Medicare payments for certain high-cost drugs by using the average of prices in other advanced industrial countries as a benchmark in deciding what Medicare should pay.

Drug companies oppose both ideas. They say the price disclosures would confuse consumers, who often pay less than the full list price. And drug lobbyists say Mr. Trump’s proposal for an “international price index” would just import price controls from other countries.

Lawmakers from both parties could also find common ground with the administration on a bill that requires manufacturers of brand-name drugs to make samples available to generic drug companies trying to develop inexpensive copies of those medicines.

Dr. Scott Gottlieb, the commissioner of the Food and Drug Administration, says some drug makers have tried to stifle competition by blocking access to samples.

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Fish-oil drugs protect heart health, two studies say

Lenny Bernstein November 10 at 3:00 PM

Two major studies released Saturday provide evidence that medications derived from fish oil are effective in protecting people from fatal heart attacks, strokes and other forms of cardiovascular disease.

The large, multiyear research efforts tested different formulations and quantities of drugs made with Omega-3 fatty acids on two groups of people: one that suffered from cardiovascular disease or diabetes and another that represented the general population. Both studies found that people who took the drugs every day enjoyed protection against some heart and circulatory problems compared with those given a placebo.

In a look at another commonly consumed supplement, vitamin D, researchers found no effect on heart disease but saw a link to a decline in cancer deaths over time.

The research was released Saturday at the American Heart Association’s 2018 Scientific Sessions in Chicago and published in the New England Journal of Medicine.

About 43 million people in the United States take statins to lower LDL, or “bad,” cholesterol, and the drugs are credited with reducing the risk of heart attacks and strokes. But heart disease remains the leading killer of Americans. In recent years, a long, steady decrease in heart disease deaths has slowed. So researchers are seeking other ways to combat cardiovascular disease beyond known protective factors such as changes in diet, exercise and smoking habits.

One of the studies unveiled Saturday, named by the acronym REDUCE-IT, determined that people with cardiovascular disease who were already taking statins stood less chance of serious heart issues when they were also given two grams of the drug Vascepa (icosapent ethyl) twice a day.

The drug is a purified version of a fish-oil component that targets triglycerides, another type of fat in the blood. Elevated triglycerides can harden or thicken arteries, potentially leading to strokes and heart attacks. People who took the drug were compared with those who were given a placebo. The study involved more than 8,000 people.

The drug is made by Amarin Corp., which sponsored the research. In September, Amarin announced that the study had met its primary goals.

Deepak L. Bhatt, executive director of interventional cardiovascular programs at Brigham and Women’s Hospital in Boston, who led the study, said the results could change the practice of cardiology in the same way that the introduction of statins did more than 30 years ago.

“Honestly, I’ve been doing clinical trials for a long time. And I’ve not been involved in a trial that has this much potential to improve the lives of perhaps tens of millions of people,” Bhatt said.

In 2007, a large study in Japan determined that the same component of fish oil used in the REDUCE-IT study showed promise in protecting against cardiovascular problems. But that research did not compare the substance against a placebo, and was complicated by the large amount of fish in the typical Japanese diet.

The other fish-oil study released Saturday, called VITAL, looked at the effect of a different formulation of Omega-3 fatty acids in a drug called Lovaza. Researchers followed nearly 26,000 people for a median of more than five years. The results suggested that people given the drug were 28 percent less likely to suffer heart attacks than those given a placebo, and 8 percent less likely to have a variety of cardiovascular events. The effect was even more pronounced among African Americans, but the lead researcher said the results need further study before they can be relied upon.

People who ate fewer than 1.5 servings of fish weekly saw a drop in the number of heart attacks suffered when they increased their consumption of Omega-3s by taking the drug. The study did not find a decline in strokes.

JoAnne Manson, chief of the division of preventive medicine at Brigham and Women’s Hospital, who led the study, said it “further supports . . . the benefits of Omega-3 in heart health.”

Manson called the results “promising signals” about fish-oil consumption, but said they are not conclusive enough to compel people to begin taking the drug or fish-oil supplements. The study also showed that the medication is safe enough that people already taking fish oil have no reason to stop, she said in an interview.

People in the study were given 840 milligrams of the key fatty acids in fish oil each day, less than is found in a typical serving of salmon.

“We would encourage starting with more fish in the diet and having at least two servings a week,” Manson said. “One advantage of doing it through the diet . . . is that fish can replace red meat, saturated fat and processed food.”

Lovaza is manufactured by GSK, but is available in generic form. The study was sponsored by the National Institutes of Health.

The VITAL study also looked at vitamin D, which is often recommended to improve bone health in older women and for overall health in other people. It found that the vitamin had no effect on heart attacks or strokes and did not affect the incidence of cancer.

But vitamin D consumption may have some role in reducing the number of deaths from cancer two or more years later, the research showed. Manson suggested that vitamin D may help prevent cancers from metastasizing or becoming more invasive. But she said that idea needs more research.

She said people already taking modest amounts vitamin D, especially on the advice of doctors, have no reason to stop. But she warned against taking huge doses of the vitamin, such as 5,000 or 10,000 international units a day, unless a clinician recommends it, because the safety of that practice is not known.

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Should Childhood Trauma Be Treated As A Public Health Crisis?

Researchers followed a group of kids from childhood into adulthood to track the link between trauma in early life and adult mental health.

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Researchers followed a group of kids from childhood into adulthood to track the link between trauma in early life and adult mental health.

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When public health officials get wind of an outbreak of Hepatitis A or influenza, they spring into action with public awareness campaigns, monitoring and outreach. But should they be acting with equal urgency when it comes to childhood trauma?

A new study published in the Journal of the American Medical Association suggests the answer should be yes. It shows how the effects of childhood trauma persist and are linked to mental illness and addiction in adulthood. And, researchers say, it suggests that it might be more effective to approach trauma as a public health crisis than to limit treatment to individuals.

The study drew on the experiences of participants from the Great Smoky Mountains Study, which followed 1,420 children from mostly rural parts of western North Carolina, over a period of 22 years. They were interviewed annually during their childhood, then four additional times during adulthood.

This study has something other similar studies don’t, says William Copeland, a professor of psychiatry at the University of Vermont who led the research. Instead of relying on recalled reports of childhood trauma, the researchers analyzed data collected while the participants were kids and their experiences were fresh. And the researchers applied rigorous statistical analysis to rule out confounding factors.

Even when the team accounted for other adversities aside from trauma, like low income and family hardships, and adult traumas, the associations between childhood trauma and adult hardships remained clear. The associations remained clear.

The study is “probably the most rigorous test we have to date of the hypothesis that early childhood trauma has these strong, independent effects on adult outcomes,” he says.

For Copeland, the wide-ranging impacts of trauma call for broad-based policy solutions in addition to individual interventions. “It has to be a discussion we have on a public health policy level,” he says.

Nearly 31 percent of the children told researchers they had experienced one traumatic event, like a life-threatening injury, sexual or physical abuse, or witnessing or hearing about a loved one’s traumatic experience. And 22.5 percent of participants had experienced two traumas, while 14.8 percent experienced three or more.

To Head Off Trauma's Legacy, Start Young

The childhoods of participants who went through traumatic events and those who didn’t were markedly different. Participants with trauma histories were 1.5 times as likely to have psychiatric problems and experience family instability and dysfunction than those without, and 1.4 times as likely to be bullied. They were also 1.3 times more likely to be poor than participants who didn’t experience trauma.

When these children grew up, psychiatric problems and other issues persisted. Even after researchers adjusted for factors like recall bias, race and sex, the impact of those childhood psychiatric problems and hardships, the associations remained. Participants who experienced childhood trauma were 1.3 times more likely to develop psychiatric disorders than adults than those who did not experience trauma, and 1.2 times more likely to develop depression or substance abuse disorder.

Participants with histories of trauma were also more likely to experience health problems, participate in risky behavior, struggle financially, and have violent relationships or problems making friends. And the more childhood trauma a person experienced, the more likely they were to have those problems in adulthood.

Copeland acknowledges the study’s limitations—it included mostly white participants in rural settings, and a disproportionately high number of Native American participants compared to the rest of the United States due to the area’s high concentration of members of the Eastern Band of Cherokee Indians. But the study is nonetheless important, says Kathryn Magruder, an epidemiologist and professor of psychiatry at the Medical University of South Carolina.

“I think it should put to rest any kind of speculation about early childhood trauma and later life difficulties,” she says.

Though the link has been shown in earlier research, Magruder says, this new study can help direct future research and policy. “Why are we revisiting it? Because it is time to think about prevention,” she says. Trauma is a public health problem, she adds, and should be met with a public health approach.

Psychologist Marc Gelkopf agrees. In an editorial published along with the study, he writes: “If the ills of our societies, including trauma, are to be tackled seriously, then injustice must be held accountable.”

Childhood Trauma And Its Lifelong Health Effects More Prevalent Among Minorities

The policy implications are clear, says Jonathan Purtle, a mental health policy researcher and assistant professor at Drexel University’s Dornsife School of Public Health. “We need to prevent these things from happening to children and support family and community so that people can be more resilient,” he says. Policymakers can create coalitions around issues like mental health and trauma-informed approaches in contexts like education and healthcare, he says.

One step in that direction comes with the SUPPORT for Patients and Communities Act, a bipartisan bill to address the opioid crisis that was signed into law October 24. The law recognizes links between early childhood trauma and substance abuse. It includes grants to improve trauma support services in schools, created a task force to provide recommendations on how the federal government can help families whose lives have been impacted by trauma and substance abuse, and requires the Department of Health and Human Services to help early childhood and education providers spot and address trauma.

Bills like the SUPPORT Act enjoy bipartisan and are a promising start, says Purtle — but they don’t go far enough. To really reduce trauma and mitigate its effects, he says, policymakers must pursue community investment and policies like minimum wage laws that reduce economic pressure on people who are struggling.

“It’s more than just ‘toughen up and deal with it,’ ” he says. “A lot of it comes down to people not having to live their lives in a state of chronic and constant stress.”

Erin Blakemore is a science writer based in Boulder, Colo.

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Google names Verily’s engineering VP Linus Upson as interim head of health, Feinberg to join next year

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Google employees arriving after bicycling to work at the Googleplex in Mountain View, CA.

Google is moving forward quickly with its newly-formed health organization led by former Geisigner CEO David Feinberg.

Before Feinberg officially starts next year, the company has named an interim leader: Linus Upson, the former engineering lead for Google Chrome and now an engineering head at Verily, the Alphabet subsidiary focused on life sciences. That appointment was announced in an internal email to Google employees on Friday, two sources familiar with the hiring told CNBC.

Upson was selected for the job because he has already been a key figure behind-the-scenes in helping drive coordination and strategy across the various Alphabet health units, the sources said.

At Verily, Upson is responsible for “Debug,” the company’s project to curb the spread of mosquitoes that carry disease, along with a variety of other initiatives.

Vivian Lee, another high-ranking Verily employee, will also work closely with Feinberg once he joins Google, sources said.

Alphabet has broadly been trying to improve communication and coordination across its various health teams. Employees have been told that Verily and other Alphabet groups won’t be impacted by Feinberg’s hire and will work closely with the new health team instead, sources said.

Feinberg will report to Google’s AI chief Jeff Dean, who ran the hiring process and took input from other Alphabet health executives to help define the scope of the role, the sources said. It’s essentially a coordination and strategy effort, they said, rather than a company re-org across Alphabet.

Sources said that the decision to hire Feinberg was driven by some external confusion in the marketplace, with some health customers unclear about the difference between Alphabet and Google’s health efforts.

Google declined to comment.

Update: The story has been updated to reflect that this new role will not carry a “CEO” title.

Google CEO: Google has a very transparent culture compared to other companies


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Building a Culture of Transparency in Health Care

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In health care today, the conversation around transparency centers on the consumer. The consumer is empowered to ask for treatment options and costs, potential treatment risks, realistic outcomes, and much more. Health care providers must respond with as much information as possible to ensure appropriate care is delivered, quality and safety are top of mind, and patients and their care team can make thoughtful care decisions.

I believe it is impossible to have complete transparency with patients without first developing a strong culture of internal transparency — among all team members, at all levels, on all issues — throughout the health care organization itself.

When team members are open and honest with each other, without fear, it leads to mutual trust, collaboration, and sharing of best practices across disciplines. Patients are the ultimate beneficiaries.

Insight Center

Shining a Light: Safer Health Care Through Transparency, a 2015 report by the National Patient Safety Foundation’s Lucian Leape Institute, states that “if transparency were a medication, it would be a blockbuster, with billions of dollars in sales and accolades the world over.” The report defines transparency as the free, uninhibited flow of information that is open to the scrutiny of others.

Barriers to internal transparency. A culture of internal transparency does not come about overnight. There can be many barriers, some of which can be quite complex. For example, employees may be reluctant to report safety issues or errors for fear of being reprimanded by their managers or shunned by their colleagues.

The Lucian Leape Institute report states that “from the quality and safety perspective, transparency is foundational for learning from mistakes and for creating a supportive environment for patients and health care workers.”

At Virginia Mason Medical Center in Seattle, for example, every employee is considered a safety inspector regardless of job or title. All our team members are expected and encouraged to file a patient safety alert whenever he or she sees anything that poses an immediate or potential safety risk. This level of internal transparency is necessary because leaders and team members cannot correct problems unless they know they exist.

Internal transparency is hindered when lessons learned aren’t shared freely across the enterprise. While many organizations have routine team huddles, it is critical to prioritize multidisciplinary huddles and encourage clinicians to break through silos by sharing information with their colleagues in other specialties and departments.

Providers are often hesitant to disclose mistakes to their patients even though a 2006 study in the Journal of General Internal Medicine concluded that full disclosure is associated with a lower likelihood of changing physicians, higher satisfaction, and greater trust.

Leaders must create a no-blame culture. The most effective way to build a culture of transparency begins with those in leadership positions. It is the responsibility of the leadership team to develop an atmosphere in which there is balanced accountability and continuous improvement and this is everyone’s shared duty. Leaders must lead by example.

A 2013 article in The Ochsner Journal, titled “Just Culture: A Foundation for Balanced Accountability and Patient Safety,” concluded that “a fair and just culture improves patient safety by empowering employees to proactively monitor the workplace and participate in safety efforts in the work environment.”

A new paradigm. When something isn’t working in health care, it can take a long time to change, but providers can reach their own unique breakthrough moment that serves as the catalyst for long-term transformation.

At Virginia Mason, we began nearly 20 years ago to create a culture in which our team members could believe zero-defect care is possible and have the tools to make this happen. We recognized that to achieve such a transformation, a paradigm shift was needed. Our management approach at the time was not nimble enough to keep up with the changing health care environment: We needed to eliminate wasteful elements from patient care, and we wanted to empower our employees to be stewards of patient safety, regardless of their job title.

To find an innovative way forward, we looked beyond our own industry because traditional approaches in health care management had not evolved much over the previous decades. In 2002, we implemented the Virginia Mason Production System (VMPS), a management method that employs basic principles of the Toyota Production System for eliminating waste (i.e., anything that lacks value from the patient’s perspective), improving quality and safety, and controlling cost.

This change did not happen easily. There were doubters and naysayers, as well as enthusiasts who were open-minded about exploring a new path. Some team members adopted a wait-and-see attitude. A few decided to leave our organization. There was a mix of optimism and a feeling of loss as it became clear that doing things as we’d always done them was no longer good enough.

By openly sharing information in employee forums and during one-on-one conversations over several months, we worked to help our team members understand that change was necessary for the future of the organization. We developed compacts with our physicians, board members, and leaders at all levels that clarified organizational expectations and what, in turn, they could expect from the organization. Our leaders — including department directors and managers — are required to practice VMPS methods and teach them to their teams. Completing a course in VMPS basics is an important part of the onboarding process for newly hired employees.  The result is a safer environment for patients and staff.

I believe all of us in health care have a moral imperative to make health care better and more affordable. Safety is the foundation of quality.

In 2004, one of our patients, Mary McClinton, died because of an avoidable error while she was in our care. That mistake shook us to our core as an organization. It also served as an inspiration to create an environment that is safe for every patient and team member, and to be open with our patients, staff, and the community about our work to continually improve safety. To honor Mrs. McClinton’s legacy, we created an annual award that recognizes a team that improves quality and safety through innovation. Their projects are shared broadly across the Virginia Mason organization so everyone understands how patients and care givers will benefit from the award-winning initiatives. Members of Mrs. McClinton’s family attend the award ceremony that is named for her.

In the United States, we have more information than ever about how to provide appropriate, high-quality care and keep patients safe. Transparency with internal and external stakeholders is essential for quality, safety, accountability, and informed decision making. As the Lucian Leape Institute report explains, transparency between clinicians and patients, among clinicians and health care organizations, and between health care organizations and the public produces safer care, better outcomes and more trust among all the involved parties.

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6 Things Your Sweat Can Tell You About Your Health

Sweat can indicate a lot of things: you’ve just run a marathon, you’re overheated in a sauna, you’re nervous at a job interview. But if you’re not sweating bullets, you probably aren’t paying *tons* of attention to your normal, everyday sweat. What you probably don’t realize is that sweat can tell you a lot of things about your health, from underlying issues to metrics about your overall wellness.

Sweat isn’t just water, of course; it contains minute quantities of a lot of things, including urea and trace amounts of various metals, and everything from how we sweat to what we sweat can give us indications about our overall health. Wearables are starting to be able to track sweat and its components, and analyze what that says about your health; in the future, elite athletes and hospital patients alike might be fitted with wearable patches that analyze the composition of their sweat and help doctors and trainers draw conclusions from it. But for now, though, the tech is a little bit more low-fi; checking out your sweat, how it smells, and using that info to stay in-tune with your body. Here are a few things that your sweat can tell you about your health.

In the future, as sweat sensors become more common, we’ll be able to look at the messages our sweat is sending with the touch of a button. Right now, though, we can still understand our bodies better by knowing our sweat inside out. While your sweat on its own can’t indicate a particular health issue, if you notice something off with your sweat, that could be good info to bring to your doc.

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Baker, Gonzalez diverge on visions for health care

Jay Gonzalez used to run a health insurance company. Now he wants to put health insurance companies out of business.

The Democrat running for Massachusetts governor in Tuesday’s election is promoting an idea championed by liberals but unproved anywhere in the country: If elected, Gonzalez plans to completely overhaul the state’s health care system and move to a government-run single-payer program. Everyone would have the same coverage and the same access to care — and costs, he insists, would be lower.

Gonzalez and Governor Charlie Baker have similar backgrounds — Baker, too, used to run a health insurer, and both are former state budget chiefs — but their approaches to health care diverge sharply.

Unlike his opponent, Baker has not laid out a grand vision for the state’s health system. His approach has been more measured, targeted, for example, on attacking the opioid crisis and tamping down spending in the state Medicaid program.

The candidates are also on opposite sides of this year’s most controversial health care issue, a ballot question to limit the numbers of patients assigned to hospital nurses. Baker plans to vote “no,” while Gonzalez supports the proposal, backed by a nurses union.

Massachusetts has the highest rate of health coverage in the nation, but medical costs remain a challenge for patients, employers, and the state budget.

“I really believe going to a single-payer health care system will reduce the cost overall,” Gonzalez said in an interview. “It’ll cut out a lot of the administrative waste and inefficiency. . . and it will radically simplify the system for people.”

He laid out an ambitious timeline. If elected, he said, he would assemble a working group or commission to develop a plan, within about a year, for moving Massachusetts to a single-payer system. He would hope to implement that plan by the end of his first term.

Gonzalez shared few specifics about his vision. How much would it cost? How would the system be funded? How would consumers pay into the program — and how much would they pay?

“Those are the details we would need to work out,” said Gonzalez, the former chief executive of CeltiCare Health Plan, which no longer operates in Massachusetts.

And what about the thousands of residents who work for private health insurers, whose jobs would disappear under his plan? Gonzalez said his administration would help transition them to other jobs.

“There definitely would be some disruption . . . but that’s not a reason not to do it,” he said.

Vermont made a serious attempt at moving from a private-insurance-based health system to a government-run one. But Vermont officials abandoned their plan in 2014 after projecting that it would nearly double the size of the state budget and require large tax increases.

“It always most significantly falls apart on the finances,” said John E. McDonough, a professor at the Harvard T. H. Chan School of Public Health. “While the [single-payer] issue is very popular among the Democratic base . . . no one has figured out in the US how to translate this to a general election audience.”

Baker, a former chief executive of Harvard Pilgrim Health Care, has shrugged off his opponent’s single-payer plan as costly and unnecessary, noting that Vermont couldn’t make the switch even though it’s “not that big and not that complicated” compared to Massachusetts.

Baker’s campaign officials did not make him available for an interview to discuss his health care plans. In a televised debate Thursday, the governor laughed when Gonzalez claimed that a single-payer system would save money.

Baker said in October that one of his top health care priorities in a second term would be to rein in the soaring costs of prescription drugs in the state Medicaid program, which covers low-income residents.

“It’s pretty clear that . . . the rising cost of health care in Massachusetts is driven by pharmaceuticals, especially by specialty pharmaceuticals,” he said in response to a question from the Globe.

Baker’s earlier plan to slash prescription drug costs in the Medicaid program, known as MassHealth, was rejected by federal officials this year. Another idea to save money in MassHealth, by shifting thousands of people out of the program, rankled advocates for the poor, and it was eventually nixed by federal officials and the state Legislature.

But the Baker administration has managed to better control costs in the MassHealth program — where spending actually dipped 0.2 percent
last year — in part by removing people from the rolls when they were no longer eligible for benefits.

In 2016, administration officials also secured five years of federal funding for MassHealth, allowing them to launch the biggest restructuring of the program in decades. The redesign includes new accountable care organizations, or networks of doctors and hospitals, that work together to manage patients’ care.

When President Trump and Republicans in Congress tried to repeal the federal Affordable Care Act last year, Baker broke with his party and defended the law, including in front of senators in Washington.

Baker has called for greater transparency in health care costs in Massachusetts, and in May, state officials launched a long-delayed website with cost and other health care information for consumers.

His administration also smoothed the enrollment process for residents who buy medical coverage through the Massachusetts Health Connector, after the agency’s website broke down in 2013 and 2014, causing chaos for thousands.

Baker leads Gonzalez by about 40 points in the latest polls, and his supporters include many Democrats. But if Gonzalez were to pull off an upset and follow through on his single-payer plan, he would face the massive challenge of persuading health care executives, elected officials, and residents to back the move.

(In 2014, gubernatorial candidate Dr. Donald Berwick also campaigned for single-payer health care; he lost the Democratic primary to Martha Coakley.)

Gonzalez, as a former insurance executive, sat on the board of the Massachusetts Association of Health Plans, an insurance industry lobbying group. Even then, he said, he felt that insurance companies didn’t have much value to offer consumers, but he didn’t share his doubts with his fellow board members at the time.

“Most of what our company did was facilitate a bunch of useless transactions,” such as processing medical claims, Gonzalez said.

Health insurers, unsurprisingly, oppose the concept of a government-controlled health system.

“We have made substantial advances in this state in covering our residents. . . . Our next challenge is really to control costs,” said Lora M. Pellegrini, chief executive of the insurers association. “I think the whole conversation around single-payer is really a distraction.”

Contact McCluskey at priyanka.mccluskey@globe. com.

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How diet impact health and well-being

Also minimal is the incidence of Type-2 diabetes. Which leads scientists to consider the role of diet in the Tsimane’s cardiovascular health — and how it might be impacted over time as the population becomes more exposed to globalization and market forces.

That’s where UC Santa Barbara anthropologists Thomas Kraft and Michael Gurven come in. They are part of the Tsimane Health and Life History Project, supported by the National Institutes of Health, which conducted the first systematic study that examines what the Tsimane consume on a regular basis and compares it to that of the Moseten, a neighboring population with similar language and ancestry, but whose eating habits and lifeways are more impacted by outside forces. The researchers’ findings appear in the American Journal of Clinical Nutrition.

“Our prior work showed that the Tsimane have the healthiest hearts ever studied, so naturally there’s a lot of interest in understanding why and how,” said Michael Gurven, a professor of anthropology at UC Santa Barbara, co-director of the Tsimane Health and Life History Project and the paper’s senior author. “The obvious first contender is, what are they eating? And are they eating what we think is best for heart health?

“We conducted a detailed analysis of the Tsimane diet and then compared it to what modern Americans typically eat, and to the diets that claim to be heart healthy,” he continued. “Maybe the Tsimane just happen to follow one of those without knowing about them.” These diets — Paleo, Okinawan and DASH, among others — are often promoted because of their proposed health benefits, and in the case of Paleo, that our bodies have evolved to benefit from particular types of food.

The connection to the Moseten is an added benefit of the study. Ethnolinguistically and genetically very similar to the Tsimane, the Moseten, an isolate in Bolivia, are much more acculturated in a number of ways than are the Tsimane. “They provide a forecast of what Tsimane health might look like 20 years from now,” Gurven said. “They represent what is happening to many indigenous populations over time. To what extent may changes in their diet increase the prevalence of heart disease and diabetes?”

Using the same measurement strategy employed by the U.S. Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey, the researchers interviewed 1,299 Tsimane and 229 Moseten multiple times about everything they had eaten or drunk in the previous 24 hours. Using published and their own nutritional estimates for all items, and a variety of methods to estimate portion size, they provided a detailed breakdown of daily food intake.

The high-calorie (2,433-2,738 kcal/day) Tsimane diet was characterized by high carbohydrate and protein intake, and low fat intake (64, 21 and 15 percent of the diet, respectively). In addition, the Tsimane don’t eat a wide variety of foods, relative to the average U.S. or Moseten diet. Almost two-thirds of their calories are derived from complex carbohydrates, particularly plantains and rice. Another 16 percent comes from over 40 species of fish, and 6 percent from wild game. Only 8 percent of the diet came from markets.

Despite the low dietary diversity, the researchers found little evidence of micronutrient deficiencies in the Tsimane’s daily intake. Calcium and a few vitamins (D, E and K) were in short supply, but the intake of potassium, magnesium and selenium — often linked to cardiovascular health — far exceeded U.S. levels. Dietary fiber intake was almost double U.S. and Moseten levels.

Over the five years of study, the researchers saw the Tsimane’s total energy and carbohydrate intake increase significantly, particularly in villages near market towns. Their consumption of food additives (lard, oil, sugar and salt) also has increased significantly. The Moseten, the researchers noted, consumed substantially more sugar and cooking oil than did the Tsimane.

The conclusion: A high-energy diet rich in complex carbohydrates is associated with low cardiovascular disease risk, at least when coupled with a physically active lifestyle (Tsimane adults average 17,000 or so steps per day, compared to Americans’ 5,100). Moving away from a diet that is high in fiber and low in fat, salt and processed sugar represents a serious health risk for transitioning populations. Evidence of nutrition transition in Bolivia parallels trends in increasing body fat and body mass index among Tsimane, suggesting the low prevalence of cardiovascular disease — as among the Tsimane — may not persist.

According to Gurven, avoiding the pitfalls of changing diets and lifestyles will be critical for groups like the Tsimane. Many other indigenous populations in South America, Africa and Southeast Asia are in similar situations. And rates of obesity, type-2 diabetes and heart disease are high among indigenous groups whose lifeways are no longer traditional — including many North American Indian and Australian aboriginal populations.

And for the Tsimane, change is not far on the horizon. “This is a key time,” said Thomas Kraft, a postdoctoral researcher in anthropology at UC Santa Barbara and the paper’s lead author. “Roads are improving in the area, as is river transport with the spread of motorized boats, so people are becoming a lot less isolated compared to the past. And it’s happening at a pretty rapid pace.”

Anecdotally, Gurven added, the Tsimane Health and Life History Project’s biomedical team is seeing more diabetic patients among the Tsimane than they have previously. That’s likely due to the increased regular intake of refined sugar and fat that occurred over the course of the study. As Kraft noted, with the Tsimane’s ability to buy large kilo bags of sugar and liters of cooking oil, the researchers calculated a 300 percent rise in consumption of those products. “They’re basically deep frying and adding lots of sugar to drinks when they can,” he said.

And consuming a lot of calories. “But they’re also physically active — not from routine exercise, but from using their bodies to acquire food from their fields and the forest,” added Gurven, “which is also an important lesson. You can’t look at what you’re eating irrespective of what you’re doing with your body. If you’re physically active, you can probably get away with more flexibility in the diet.”

Calorie count aside, the high carbohydrate content of the Tsimane diet isn’t “unprecedented,” according to Kraft. “One of the other artery-protecting diets is the Okinawan diet from Japan. It comes out at about 85 percent carbohydrate. But a common feature they share is that pretty much across the board, they’re complex carbohydrates — it’s sweet potatoes in the Okinawan diet; here it’s plantains and manioc.”

The Moseten diet has fewer total calories and less carbohydrates than the Tsimane diet, but the Moseten eat a broader range offoods, including more fruits, vegetables, dairy and legumes. The Moseten also buy more of their food, including soda, bread, dried meat and processed items. The Moseten diet could provide insight into the Tsimane diet of the future, the researchers suggest. “We’re still analyzing their health indicators, but we expect the Moseten to show more risk factors related to diabetes and heart disease,” said Gurven.

In addition to finding that the Tsimane consume more calories per day than the Moseten do, the researchers note the Tsimane are also more physically active (with much of their labor devoted to the hard work of slash and burn farming, hunting, fishing and foraging). They expend more energy activity, but may also have a higher resting energy expenditure due to higher rates of infection and persistent immune activity.

Overall, the findings suggest that no single diet protocol offers the key to health. The picture is much more complicated. “It definitely sheds light on the diversity of diets that are compatible with good cardiovascular health,” said Kraft.

Added Gurven, “We’re at a unique point in history where for many of us, our daily decisions are more about what not to eat. We have to work hard not to overeat. Throughout most of human history, it was the opposite. It was so hard to get those calories we needed to survive.”

And in terms of the Tsimane’s eagerness to incorporate sugar and other additives into their diets despite the associated health risks, “Telling folks to watch what they’re eating, don’t eat too much of this or that — that mentality is hard to convey when getting food is unpredictable and a daily grind,” Gurven continued. “Getting calories cheaply with less effort — who wouldn’t?”

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How Daylight Saving affects your sleep and overall health


Daylight saving time ends at 2:00 a.m. on Sunday, Nov. 4. Here’s what you need to know.

Daylight Saving Time ends and clocks will “fall back” an hour this weekend, giving Americans the feeling of an extra hour in the morning, which could negatively affect their health. 

“Ever since the institution of Daylight Saving Time, there has been controversy regarding whether it accomplishes its goals or not, and if so — at what cost,” Timothy Morgenthaler, Mayo Clinic’s co-director of the Center for Sleep Medicine, said in an email.

Morgenthaler has reviewed about 100 medical papers related to how the time change could affect health.

Here’s what you should know:


Gaining or losing an hour will likely affect sleep patterns, often for about five to seven days, Morgenthaler said. The most notable changes are in those who regularly do not get enough sleep. People who are sleep-deprived might struggle with memory, learning, social interactions and overall cognitive performance.

“People have more changes in how sleepy they feel or how it affects the quality of their sleep when we ‘spring forward’ than when we ‘fall back,’” Morgenthaler said.

More: 10 things you didn’t know about daylight saving time

Heart attack or stroke

According to a study led by a University of Colorado fellow in 2014, when Americans lose one hour of sleep in the spring, the risk of heart attack increases 25 percent. When the clock gives back that hour of sleep the risk of heart attack decreases by 21 percent. (The limited study looked at hospital admission data in Michigan over a four-year period.)

A preliminary study presented at the 2016 American Academy of Neurology meeting suggested turning the clock ahead or behind an hour could increase risk of stroke. That’s because disrupting a person’s internal body clock might increase the risk of ischemic stroke, the most common type of stroke, according to researchers. The data showed risk of ischemic stroke was 8 percent higher two days after a Daylight Saving Time. 

These studies are two of several on these negative health effects, and they don’t always paint the whole picture, Morgenthaler said. 

“Of several published between 2010 and 2014, three studies showed that DST increases the risk of acute myocardial infarctions (AMIs), however, two others demonstrated that the timing (but not the incidence) of strokes and AMIs may be influenced by DST,” Morgenthaler points out. 


Many have also studied the time change’s impact on vehicle crashes and fatalities. The largest studies that correct for volume and driving activity as well as time of day “show no significant effect” on Daylight Saving Time changes, Morgenthaler said. Still, he cautions to remain aware while driving or walking near a road, especially early in the morning or late at night, after the change. 

Follow Ashley May on Twitter: @AshleyMayTweets

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To Control Health Care Costs, US Employers Should Form Purchasing Alliances

Tim Robberts/Getty Images

When it comes to health care costs, America’s employers are at a crossroads. Competing for scarce labor in a tight market, they will have trouble continuing to shift medical bills onto employees as they have for several decades.

That means that to control costs going forward, employers may have to confront the true underlying causes of rising health care expenditures: high prices and health care inefficiencies. To address these challenges, they will have to band together in purchasing coalitions that give them the local market power to force health systems to reform.

Employers are the largest single provider and purchaser of health insurance in the United States, covering over 150 million workers and their dependents and purchasing 34% of all health care dispensed in the country. As a potential force for change, only the U.S. government can rival America’s business community.

And in recent years, employers have enjoyed some success in controlling rising health care costs. Their premiums have been increasing 3% to 5% annually, rather modest by historic standards. As a percent of workers’ compensation, employers’ health care spending has held steady at between 8% and 9% since 2010. Much of this success seems attributable to the spread of high-deductible health plans (HDHPs), which have shifted more of the costs of care onto employees. The proportion of workers with HDHPs (deductibles of more than $1,300/$2,600 for an individual/family) increased from 6% to 22% between 2006 and 2018. High deductibles have the dual effect of reducing workers’ use of services and employers’ liability for the services employees use.

Insight Center

So what’s the problem? There seems growing nervousness among employers that they’ve pushed high deductibles about as far as they can. Workers’ increasing out-of-pocket costs are creating widespread discontent with the underlying costs of care — a problem largely driven by the high prices charged to private payers for health services and pharmaceuticals. Data from the Commonwealth Fund’s biennial survey of the American public shows that the percent of U.S. workers who are underinsured — face out-of-pocket health care expenses greater than 10% of their income excluding premiums — increased from 10% in 2003 to 24% percent in 2016. Between 2011 and 2017, employees’ premiums and deductibles grew faster than their median income. Beyond this, studies clearly show that when workers face high upfront payments, they frequently skip services, some of which are critical to their long-term health and productivity, a pattern that must worry responsible employers.

Add to this picture the increasingly competitive labor market — which limits the tools companies can use to constrain health spending — and it becomes clear that employers may have to find new ways to tame the health care cost tiger in the future. They may have to address the underlying reasons for rising health care premiums, rather than just shifting more of those expenditures off their own books.

Those fundamental reasons are varied and complex but at least two stand out. The first is that health care providers charge employers very high prices — way higher than those paid by public insurers like Medicare and Medicaid. The second is that our health care system is highly inefficient and wasteful. It has enormous administrative costs. Care is fragmented and uncoordinated. We have too many high-priced specialists and not enough high-quality primary care to keep patients out of emergency rooms and hospitals when they could be cared for in less expensive (and dangerous) settings. In other words, employers need to get better deals on prices and remake our health care system while they’re at it.

Employers are not new to this game. For decades, large sophisticated companies have undertaken pioneering experiments with reshaping the health care system. As far back as the early 1990s, Pitney Bowes focused on patient education and consumerism and prevention and care management to slow cost growth. Companies such as Boeing have experimented with direct purchasing of health care from providers, securing better prices, and eliminating the administrative costs of insurers. Other employers such as Walmart have cut deals to send their high-end elective procedures (e.g., open-heart surgery, hip and knee replacements) to centers of excellence that offered lower prices and higher quality. Employers have instituted wellness programs in the (now disappointed) hopes that health maintenance could lower costs of care. And companies have come together in regional coalitions such as the Pacific Business Group on Health and the Midwest Business Group on Health for the purpose of sharing lessons on how to become better health care purchasers.

The latest venture in employer health innovation is, of course, the alliance of Amazon, Berkshire Hathaway, and JPMorgan Chase. The as yet unnamed joint venture, led by the highly respected Dr. Atul Gawande, is promising to solve the health care conundrum for its parent companies and perhaps for the nation as a whole.

The fact is, however, that until employers switched to high-deductible plans, they enjoyed relatively little success in restraining health spending. This disappointing record reflects persistent challenges to their cost-control efforts.

The first challenge is lack of purchasing power. All health care is local, and efforts to negotiate better prices and reform health care delivery depend on an employer’s ability to force price concessions and behavior change from local physicians and health care institutions. Collectively, employers may constitute an important share of health providers’ market. But individually, with the exception of a few companies in a few markets, such as Boeing and Amazon in Seattle, no one employer has enough leverage to wrangle price concessions from area doctors and hospitals or induce them to reshape the way they do business. This is true even for large national companies because their aggregate workforce is spread across tens or hundreds of localities.

Efforts to form purchasing coalitions in local markets have had modest impact at best because employers have so little else in common and because antitrust laws limit their ability to collaborate. The growing consolidation among providers — 90% of metropolitan areas have highly concentrated hospital markets and 65% have highly concentrated specialist physician markets — also works to employers’ disadvantage.

A second challenge facing employers is lack of sophistication as health care purchasers. Medicine is complicated, and while there are a handful of large employers such as Comcast or Walmart with the funds and motivation to hire sophisticated health benefits specialists, there are 7 million to 8 million mid-size and small employers who have their hands full just managing their core business in turbulent times. Even if they had the leverage to demand delivery system reforms from providers, most CEOs and CFOs largely lack the time and patience to grasp the complex, non-intuitive, and often experimental interventions involved: accountable care organizations, value-based purchasing, outcomes based pharmaceutical pricing and so on. Better to raise deductibles and move on.

A third challenge is that when employers try to reform health care, they can easily alienate employees. To get better health care deals, employers often have to channel their workers to a select group of providers who offer lower prices and/or better quality. This can sometimes mean bypassing prominent but highest-priced local facilities and specialists where workers are already getting their care or want to if they ever need it — for example, the Partners HealthCare system in Boston, Memorial Sloan Kettering in New York City, and MD Anderson Cancer Center in Houston. In tight labor markets, the last thing employers want to do is to get between workers and their doctors.

To achieve the kind of gains in controlling health care costs that employers want, they will have to get bigger and smarter in the future.

They will need to band together in local purchasing alliances, come to agreement on common features of health insurance products, and then, working with local insurers, wrangle price and delivery concessions from local providers. This will likely require newfound willingness on the part of employers to surrender the freedom to tailor each insurance product to their own specific preferences. It will also require that, working together, employers immerse themselves in the complex details of reforming health care delivery systems so that they push insurers to insist on greater provider accountability for cost and quality, better primary care and prevention, improved care coordination, reduction in administrative costs, and a variety of other nitty gritty health care reforms.

Employers will not be able to do this without help from government. They may need antitrust allowances to band together for joint purchasing of care. They will also need state and federal antitrust authorities to break up increasingly dominant local provider coalitions. They will certainly want to strongly encourage federal and state authorities to pursue value-based payment programs for federally insured populations in the hope that employed populations will benefit from these reforms as well. Some employers may even decide — despite innate opposition to government regulation — that the only way for them to stay in the business of providing insurance to employees will be to have government regulate health care prices in their states. This is the tactic that most industrialized countries use to keep health care affordable for their populations.

The alternative to these fairly radical changes in employer behavior is continuing the hollowing out of employer-sponsored insurance. Aside from the pain this will inflict on workers and their families, this trend could cause the American public generally to lose faith in our current system of employer-sponsored insurance, and open the way politically for alternatives, including government-provided coverage.

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