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Donald Trump in excellent health – White House doctor

Donald Trump shakes hands with Dr Ronny Jackson after his annual physical exam at Walter Reed National Military Medical Center in Bethesda, Maryland, 12 January 2018Image copyright
Reuters

Image caption

Mr Trump shook hands with Dr Jackson after the check-up

Donald Trump is in “excellent health”, his White House doctor has announced after he underwent his first medical check-up since becoming US president.

Ronny Jackson said in a brief statement that Friday’s three-hour examination of the 71-year-old, conducted by military doctors, had gone “exceptionally well”.

He promised further details on Tuesday.

No psychiatric tests were planned but a recent controversial book fuelled speculation about the president’s mental health.

According to Michael Wolff, author of Fire and Fury: Inside the Trump White House, all his White House aides see him as a “child” who needs “immediate gratification”.

Media captionWhat the world thinks of Trump

Mr Trump responded by saying Wolff’s book was “full of lies”, while Secretary of State Rex Tillerson dismissed suggestions the president’s mental health was failing.

Friday’s announcement echoed the words of Mr Trump’s own long-time doctor, Harold Bornstein, in a pre-election assessment in December 2015, when he declared his client would be the “healthiest individual ever elected to the presidency”.

  • The debate over Trump’s mental health
  • Did Trump forget the national anthem?

Who carried out the latest check-up?

Image copyright
EPA

Image caption

Dr Jackson gave a thumbs-up after the exam

Doctors assessed Mr Trump on Friday at the Walter Reed Medical Center in Bethesda, Maryland,

Among them was Dr Jackson, whose official title is Physician to the President.

A rear admiral in the US Navy, he also tended to Mr Trump’s predecessor, Barack Obama.

What else might we learn?

In the run-up to Friday’s check-up, the White House made clear that it would focus on his physical health.

It is up to the White House what data, if any, it reveals about Mr Trump’s condition.

It has a long history of picking and choosing what to reveal about its occupant’s health, Barbara Perry, director of presidential studies at the University of Virginia’s Miller Center, was quoted as saying by Reuters news agency.

John F Kennedy (1917-63), she pointed out, disclosed war injuries but not the fact that he suffered from Addison’s disease, a degenerative condition.

How can Mr Trump be this healthy?

Experts have been baffled by the capacity of the overweight leader to consume large amounts of fast food and appear to take minimal exercise, while staying fit.

A recent book claimed Mr Trump had “four major food groups” during his campaign, which were McDonald’s, fried chicken, pizza, and Diet Coke.

Co-authored by Corey Lewandowski, his former campaign manager, the “Let Trump Be Trump” book said the president could eat “two Big Macs, two Filet-O-Fish, and a chocolate malted (milkshake)” for dinner.

71

Age

  • 6ft 3in Height

  • 236lbs Weight

  • 29.5 Body Mass Index (classed as “overweight”)

  • 15 – 20lbs What he said, in 2016, he would like to lose

Sara Kayat, a doctor from London, told BBC News before the check-up that his diet sounded “awful”.

He did benefit from not smoking or drinking, she pointed out, but exercise was vital.

“Physical inactivity poses almost as much of a heart disease risk as smoking,” she added. “It’s the kind of thing people overlook, but it shouldn’t be.”

Media caption“I learned because of Fred,” Trump said of his brother, who was addicted to alcohol

Article source: http://www.bbc.com/news/world-us-canada-42676501

Why is health care so damn expensive?


Never has there been more talk of innovation and yet more disappointment in the future than in the health care industry. AngelList shows almost a thousand startups just in the digital health space alone, and VCs invested $3.5 billion in digital health startups in just the first half of 2017 according to Rock Health’s industry analysis. There are dozens of health innovation conferences hosted in the United States every year, with participants chattering, chattering, chattering about this or that “innovation.”

All of that innovation has done practically nothing though to fix the single worst problem of modern American health care: it’s cost. Health care in the United States has never been more expensive. The United States is spending about $3.5 trillion a year on health care expenses, an increase of 12,300% since 1960. In that timeframe, health care spending increased from 5% of U.S. GDP to about 17.5% of GDP.

Despite all of that spending, the age-adjusted mortality rate for Americans has only slowly declined every year since 1980. Even worse, life expectancy for Americans — among the most typical metrics for measuring broad health and wellness outcomes for a country — declined for the second year in a row in 2017.

It’s Juicero innovation at its finest. We’re paying more, way more, than we used to, and yet our outcomes have never been worse.

This is the problem known as “cost disease” — the rapidly escalating costs of basic human services like health care, housing, education, construction, and infrastructure. It’s a problem that plagues the developed world, but none more so than in the United States. Scott Alexander, who blogs at Slate Star Codex, wrote a masterful summary of the problem a year ago that’s worth reading for how this pattern seems to emerge across all of these industries.

It is one thing though to identify the pattern, and it’s another to start to tease out the reasons why costs have spiraled 123x in just a few decades. The pithy answer is that there is no pithy answer: industries like construction and healthcare are simply too complicated to have a simple response to the question of cost disease. It’s literally all the answers and none of them at the same time.

There is a slowly growing understanding in policy circles that cost is the fundamental challenge to improving America’s human services and infrastructure. The tradeoffs required in American medicine — offering better care or offering more care to more people would simply be moot if the overall cost of health care was 9% of GDP instead of 17.5% — the median percentage in the OECD group of industrialized countries.

Call me cynical, but having talked with dozens of digital health startups over the past few years, this basic fact so rarely seems to register with founders. Entrepreneurs are trying to digitalize medical records, or improve operating room efficiency through better analytics, or create a new (and expensive!) robotic medical device. These innovations are important, but they are a bit like rearranging the deck chairs on the Titanic to try to right-size the ship: actions far too small to make a difference.

This problem is thankfully starting to be addressed by startups head on. One startup is Avant-garde Health, which publicly announced a $4 million seed round led by General Catalyst, Tectonic Ventures, and Founders Collective this week (the round was closed mid-last year).

I chatted with Derek Haas, who is the founder and CEO of the company and who has spent the last few years completely immersed in the challenges of controlling the rampant cost disease in American hospitals.

If you are wondering what one of the main drivers of cost disease in health care is, it likely starts with the fact that few hospitals and providers actually know what their costs are except for aggregated numbers. We can cue a facepalm emoji, but the reality is that it is really hard to do this sort of analysis with existing management systems.

The company’s solution is to use a technique called “activity-based costing” and apply it to the health industry. The idea is to try to accurately assign every expense of an organization to the exact activity that created that cost. In the healthcare context, Avant-garde uses “time-driven” costing to assign expenses to treatment. The goal, Haas explained, is “to understand for each patient what care is delivered, who delivered that care, and how much time did it take to deliver that care.”

So, for instance, every health professional that sees a surgery patient needs to assign exactly their time to that patient so that the true cost of that surgery can be calculated and analyzed. A nurse who spends 20 minutes in the room needs to assign one third of their hourly rate to the patient.

Now, this sort of costing can sound like an MBA’s godsend or a patient’s worst nightmare (let alone the providers who need to input their timecards). However, Haas’ data from the last few years though shows that the tradeoff between quality of care and cost often doesn’t have to be made. “What we frequently observe is that the biggest drivers of cost and delivery of care is the volume of care,” he explained. In other words, surgeons who conduct more surgeries both have more experience — improving outcomes — while also cutting the cost of each surgery by amortizing their income across more patients.

In addition to volume, standardized treatment is also key. “When you look at organizations with more standardization in how care is delivered, those organizations are getting better outcomes and are often more cost-effective” to boot Haas said.

For example, Avant-garde worked with the Penn State Hershey Medical Center to improve the efficiency of Total Hip Arthroplasty surgery (i.e. a hip replacement). What the hospital found is that different surgeons were using different hip components at different rates, increasing the total supply cost of the surgery. With improved analytics and physician education, the hospital was able to save $842 per surgery with minimal change to outcomes.

Today, Avant-garde is focused on just collecting and analyzing cost data. Its long-term goal though is to attach those costs to actual patient outcomes so that administrators can understand when additional spending is helping patients, and when it doesn’t. “People are often making decisions based on perceived quality, rather than actual outcomes,” Haas said. By getting better outcomes data, hospitals can start to help consumers get better treatment at lower expense.

Avant-garde is not a panacea to our healthcare cost disease. But it is a step in the right direction. By quantifying aspects of the healthcare business that are today opaque, management is being given the tools to actually make the right decisions on behalf of patients and payers.

That in many ways is the story of cost disease in every industry. What looks like a tradeoff can often be recast as a win-win situation. Lowering infrastructure costs can suddenly mean not choosing between three subway routes, but doing all of them. We suddenly don’t have to choose between new technology in classrooms and lower class sizes. And we don’t need to choose between limiting treatment and offering insurance to more people. For founders thinking about making an impact, there’s a trillion dollar idea right here.

Featured Image: DANIEL LEAL-OLIVAS/AFP/Getty Images

Article source: https://techcrunch.com/2018/01/13/why-is-health-care-so-damn-expensive/

After a miserable 2017, VCs offer predictions on digital health IPOs for 2018

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Proteus Digital Health

At the end of every year, investment fund Rock Health asks the venture and start-up community to vote on the top digital health IPO of the year.

In 2017, Tabula Rasa Healthcare won — even though the company actually went public in September 2016. It was such a drought that Rock Health couldn’t find a single nominee for the calendar year.

Tabula Rasa, which is focused on medication safety, almost doubled in value last year, but still has a market capitalization well south of $1 billion.

Will the industry fare any better in 2018?

With investors gathered in San Francisco for the annual J.P. Morgan Healthcare conference, the industry’s biggest event of the year, CNBC asked a dozen investors for their take.

Don’t expect many IPOs

Nina Kjellson, a health investor with Canaan Partners, doesn’t expect to see more than three digital health IPO’s in 2018. She said there’s a deep malaise surrounding the lack of public offerings last year, a higher bar for IPOs and a lack of contenders that are far enough along in terms of revenue and partnerships.

Kjellson polled the audience at this week’s conference to name a single start-up that could file in the next two quarters.

“An audience member said they may have one, but otherwise the room was crickets,” she said.

Investors said digital health companies considering an IPO need about $100 million in annual recurring revenue, and the vast majority aren’t there.

“The public market wants to see three to four quarters of predictable sales and ideally moving towards or at profitability,” said Canaan’s Julie Papanek. “Very few companies are pacing like that right now.”

It’s all about MA

However, there are plenty of opportunities to get acquired.

“MA is the new IPO,” said Bill Evans, Rock Health’s managing director, who closely tracks the industry.

But who will be the buyers of digital health companies in 2018?

Some investors are betting on big pharma. Companies like Merck and Johnson Johnson are increasingly talking up machine learning and artificial intelligence. Digital health companies, particularly those focused on clinical trial matching or that track how patients are responding to treatments, could be prime targets.

Other venture capitalists, like Bessemer Venture Partners’ Steve Kraus and Norwest Venture Partners’ Robert Mittendorff, said that tech giants Alphabet, IBM, Apple and Microsoft will start to acquire digital health start-ups. UnitedHealth’s Optum business, which describes itself as technology-enabled services, is also expected to make some strategic bets in the digital health sector.

These acquisitions could result in a more active IPO pipeline for next year.

“If they (tech companies) make a real big splash with some kind of acquisition, this could crack open the IPO markets and public market investor interest in the space sooner than maybe any of us think,” suggested Kraus.

It’s all about 2019 

For most investors, 2019 holds more promise.

Investors named a handful of companies including Health Catalyst, Welltok, American Well, Grand Rounds Health, GoodRx, Oscar Health, Doximity and Zocdoc that they see entering the public markets by then.

Growth will be fueled by “robust business development deals among life sciences, medical device, payer, provider, employer, consumer and tech companies with leading digital health companies,” said Flare Capital’s Bill Geary.

Those types of deals mean real revenue, rather than just hype.



2017 best year for global IPOs since the financial crisis


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Trump gets ‘excellent health" report from WH doctor

President Donald Trump’s White House physician declared him in “excellent health” after the president received his first medical checkup at Walter Reed military hospital on Friday, undergoing a physical examination amid suggestions in a recent book and by his detractors that he’s mentally unfit.

Dr. Ronny Jackson, in a statement released by the White House, said the examination “went exceptionally well. The President is in excellent health and I look forward to briefing some of the details on Tuesday.” Trump spent about three hours at the medical facility in Bethesda, Maryland, outside Washington, for the Friday afternoon checkup, his first as president, before departing for Florida for the weekend.

The fairly routine exam for previous presidents has taken on outsized importance in the age of Trump, given the tone of some of his tweets, comments attributed to some of his close advisers and Trump’s recent slurring of words on national TV.

Some of the comments were published in a new book about Trump’s first year, “Fire and Fury: Inside the Trump White House” by Michael Wolff, which White House press secretary Sarah Huckabee Sanders has denounced as “complete fantasy” for portraying her 71-year-old boss as undisciplined and in over his head as president.

Trump himself has pushed back hard against any suggestion that he’s mentally unfit, declaring himself “a very stable genius.” He told reporters on Thursday that he expected the exam “to go very well. I’ll be very surprised if it doesn’t.”

The examination lasted several hours and measured things like Trump’s blood pressure, cholesterol, blood sugar, heart rate and weight. The White House did not provide specific results of those tests. Jackson, who also provided care for President Barack Obama and became a White House physician in 2006, is expected to provide a detailed readout of the exam on Tuesday and answer questions from reporters.

But conclusions about Trump’s mental acuity were not expected. The White House said Trump would not undergo a psychiatric exam. Officials did not address a different type of screening: assessments of cognitive status that examine neurologic functions including memory. Cognitive assessments aren’t routine in standard physicals, though they recently became covered in Medicare’s annual wellness visits for seniors.

While the exams are not mandatory, modern presidents typically undergo them regularly and release a doctor’s report declaring they are “fit for duty.”

Two months before the November 2016 election, Trump released a five-paragraph letter from his longtime physician, Dr. Harold Bornstein, who concluded that Trump “is in excellent physical health.” A year earlier, Bornstein said in a December 2015 letter: “If elected, Mr. Trump, I can state unequivocally, will be the healthiest individual ever elected to the presidency.”

The 2016 letter put Trump’s blood pressure and cholesterol measurements in the healthy range, though he uses a cholesterol-lowering statin medication. His EKG, chest X-ray, echocardiogram and blood sugar were normal.

The 6-foot-3 Trump weighed 236 pounds (107 kilograms), and his body mass index, or BMI, of 29.5 put him in the category of being overweight for his height.

Trump takes Crestor for his cholesterol, a low-dose aspirin for heart attack prevention, Propecia to treat male-pattern baldness and antibiotics for rosacea. The doctor’s 2016 letter stated that Trump’s testosterone level, 441.6, was in the normal range, as were his PSA reading for prostate abnormalities and tests of his liver and thyroid.

Trump was 70 when he took office on Jan. 20, 2017, making him the oldest person ever elected to the nation’s highest office.

How much of Trump’s health information is released to the public is up to the president, but Sanders said she expects the White House to release the same kind of details past presidents have made public.

Obama’s three medical reports included sections on vital statistics; physical exam by system, such as eyes, pulmonary and gastrointestinal; lab results; his past medical and surgical history; his social history; and medications, among others.

Trump has said he gets most of his exercise playing golf. The American Heart Association has said the best types of exercise increase the heart rate and make a person breathe heavily, but that activities like golf don’t provide as much cardiovascular benefit since they don’t require much extra effort. The association suggests players walk the golf course instead of renting a golf cart. Trump drives a cart from hole to hole.

Obama played basketball, lifted weights, worked out on an elliptical machine or treadmill and played golf. George W. Bush traded running for mountain biking to preserve his knees. Bill Clinton was a runner who installed a jogging track at the White House. He also played golf and indulged in Big Macs.

Trump likes fast food, too, along with well-done steaks, chocolate cake and double scoops of vanilla ice cream. He reportedly downs 12 Diet Cokes a day. In their recent book, “Let Trump Be Trump,” former top campaign aides Corey Lewandowski and David Bossie described the four major food groups on Trump’s campaign plane as “McDonald’s, Kentucky Fried Chicken, pizza and Diet Coke.”

———

Associated Press writer Catherine Lucey in Bethesda, Md., contributed to this report.

——

Follow Darlene Superville on Twitter at http://www.twitter.com/dsuperville and Ken Thomas at http://www.twitter.com/KThomasDC

Article source: http://abcnews.go.com/Health/wireStory/trump-excellent-health-report-wh-doctor-52322657

Kentucky Just Made It Harder For Poor People To Get Health Care

“The policy could allow many people to fall through the cracks, including those with chronic health conditions, and those with mental health or substance use disorders such as opioid addiction,” Hannah Katch, a senior analyst at the Center on Budget and Policy Priorities, told HuffPost. “And for those who are eligible for an exemption, the policy could still require someone who is medically frail, for example, to jump through administrative hoops to demonstrate that they are eligible for an exemption.”

Article source: https://www.huffingtonpost.com/entry/trump-kentucky-medicaid-work-requirement_us_5a591c2ee4b03c4189658d23

Trump administration freezes database of addiction and mental health treatments

Federal health officials have suspended a program that helps thousands of professionals and community groups across the country find effective interventions for preventing and treating mental illness and substance-use disorders.

The National Registry of Evidence-based Programs and Practices (NREPP) is housed within the Health and Human Services Department’s Substance Abuse and Mental Health Services Administration (SAMHSA).

The registry, which was launched in 1997, offers a database of hundreds of mental health and substance abuse programs that have been assessed by an independent contractor and deemed scientifically sound. Getting a program or therapeutic approach included in this registry amounts to receiving federal recognition as an evidence-based practice. Mental health and addiction specialists say they rely on this database as a key source for finding appropriate and effective therapies.

Since 2015, the registry has also included evidence that certain interventions do not work, which helps practitioners avoid wasting resources on those programs.

Administration officials confirmed that the contract for running the database has been terminated. A new entity will take over the program’s duties. A director for that group was announced Monday, but no other staff members are in place. Agency spokesman Brian Dominguez said Wednesday that the new entity is “working closely” with other parts of the agency to “institute an even more scientifically rigorous approach to better inform the identification and implementation of evidence-based programs and practices.”

Officials did not give specifics about how the new approach will work, when it will launch or whether existing validated programs will be included.

Agency officials froze the existing website in September, and no new postings have been added, according to mental health advocacy groups. As a result, about 90 new programs that have been reviewed and rated for their scientific merits since September are not available to the public, they said.

“I know there are quite a number of new studies that could be breakthrough strategies for prevention of psychiatric disorders, opiate addictions, autism spectrum disorders — any number of things,” said Dennis Embry, president of Paxis Institute, a for-profit Arizona organization that helps communities identify evidence-based practices for the prevention of psychiatric disorders.

Asked about the freezing of the website, agency spokesman Christopher Garrett said Wednesday that the agency’s job is to “lead the efforts to rapidly institute evidence-based practices in all behavioral health treatment programs” in the country.

“The federal government should not be in the business of having a single contractor determine winners and losers in behavioral health care,” he said.

In a statement late Thursday, SAMHSA’s top official criticized the registry, calling it a “poor approach to the determination of” evidence-based practices.

For most of its existence, the database “vetted practices and programs submitted by outside developers — resulting in a skewed presentation of evidence-based interventions, which did not address the spectrum of needs of those living with serious mental illness and ­substance-use disorders,” said Elinore McCance-Katz, the agency’s new assistant secretary for mental health and substance use. As currently configured, the program “often produces few to no results” when common search terms such as “medication-assisted treatment” or illnesses such as schizophrenia are entered, she said.

While agency officials work on the new approach, the registry will remain online, officials said.

The possibility of losing the registry, or of having it essentially frozen, has outraged mental health professionals and members of Congress. Mental health professionals are especially concerned that moving the process in-house could politicize the process of evaluating programs.

“NREPP is one of the most important tools we have. Nobody has a financial stake,” said Catherine Tucker, president of the Association for Child and Adolescent Counseling, a membership organization for counselors who work with young people. She added: “It’s an impartial, nonpartisan, trustworthy source that represents thousands and thousands of hours of work.”

That responsibility will now be led by a new entity within the agency, the National Mental Health and Substance Use Policy Laboratory, or Policy Lab. The lab was authorized under a sweeping health-care law passed in 2016. Known as the 21st Century Cures Act, the law increased funding for research into cancer and other diseases, and also made changes to the mental health system, including the creation of the new assistant secretary for mental health and substance use position at SAMHSA.

Trump’s nominee for that position, McCance-Katz, a psychiatrist and former medical director at SAMHSA, was confirmed last summer. In testimony to Congress last month, she said the primary focus of the Policy Lab is to “periodically review programs and activities” relating to the diagnosis, prevention, treatment and recovery from mental illness and ­substance-use disorders. The lab will also identify programs or activities “that are duplicative and are not evidence-based, effective or efficient,” she said.

The Policy Lab will also play a role in awarding grants to state and local governments, educational institutions and nonprofits to develop evidence-based interventions, she said.

The move has unsettled lawmakers from both parties.

Sen. Rob Portman (R-Ohio), who included a provision in the 1997 Drug-Free Communities Act that requires that any prevention programs authorized by the law be certified under the registry, said in a statement that when it came to the suspension, “I’m concerned and looking into it.”

“I’ve long believed we must use federal funds for evidence-based programs that work and we must continue to make this a priority,” Portman said.

Rep. Grace Meng (D-N.Y.), a member of the House Appropriations Committee, sent a letter to McCance-Katz just last week praising the registry as a “critical tool in fighting addiction.”

Earlier this week, “I was shocked to learn that the NREPP contract has been terminated as an opioid epidemic continues to shake our nation,” Meng said. She has sent another letter to ask why. She noted that every mention of the registry in the agency’s budget plan indicates that it will be funded through September 2018.

“I’m determined to find out why SAMHSA has made such a mind-boggling decision,” she said.

The agency has been criticized by some outsiders as paying insufficient attention to the treatment needs of the seriously mentally ill. One of its most ardent detractors was former congressman Tim Murphy (R-Pa.), who pushed for changes such as the new assistant secretary position at SAMHSA during bitter hearings several years ago.

The registry itself is not without controversy. In July, a paper in the International Journal of Drug Policy said the database was not “weeding out” ineffective programs. Between September 2015 and January 2017, the paper noted, 113 interventions were added to the registry. Of these, the evidence for 14 percent of them consisted of a single, non-peer-reviewed report, and 45 percent of them relied primarily on a single peer-reviewed article.

Amy Sechrist, a certified prevention specialist at Compass Mark, a Pennsylvania nonprofit that works to reduce substance addictions, said that while the ­registry has had its problems, “we need leadership and clearinghouses for interventions that work.”

“We are always communicating to our clients, the public and legislators that prevention is a science,” said Sechrist, whose group uses interventions in the database. “We look to SAMHSA for prevention science,” she added, saying that if it stops offering it, that undermines how Americans view the programs her agency and others offer.

Agency officials notified the contractor Dec. 28 that they were terminating the contract for the registry “for the convenience of the government,” according to an email sent by the contractor to program participants. All activities have been suspended, said the contractor, Development Services Group Inc. of Bethesda, Md.

Scott Bryant-Comstock, president and chief executive of the Children’s Mental Health Network, said he spoke to a senior agency official about the termination but didn’t get clear answers about what strategies will be considered “evidence-based” under a new system.

Referring to the acrimonious House hearings on mental health that led to the creation of the Policy Lab and other agency changes, he said that “for advocates, it’s really important to ensure this doesn’t just become solely focused on the seriously mentally ill and doesn’t take into account some of the prevention things.”

Amy Ellis Nutt contributed to this report.

Article source: https://www.washingtonpost.com/national/health-science/trump-administration-freezes-database-of-addiction-and-mental-health-programs/2018/01/10/ed421654-f577-11e7-beb6-c8d48830c54d_story.html

Cycling does not harm men’s sexual health, study says

Man cyclingImage copyright
Getty Images

Cycling does not negatively affect men’s sexual health or urinary function, a study has found.

Researchers compared cyclists with runners and swimmers and found their sexual and urinary health was comparable.

The findings contrasted with previous studies that suggested cycling could negatively affect men’s sexual function, the study’s authors said.

They said the benefits to cycling “far outweigh the risks”.

Cycling to work ‘halves cancer risk’

‘Tremendous benefits’

Some 2,774 cyclists from the UK, US Canada, Australia and New Zealand were surveyed, along with 539 swimmers and 789 runners, using a range of questionnaires that measured sexual health and urinary function.

Sexual health and urinary function were comparable in all three groups, researchers said, although some cyclists were more prone to urethral strictures – a narrowing of the urethra.

There was also no statistically significant difference between high intensity cyclists – those who have cycled for more than two years more than three times per week and averaging more than 25 miles per day – and recreational cyclists.

Authors of the study, published in the Journal of Urology, said their findings contradicted previous research that suggested cycling negatively affected erectile function.

These studies lacked comparison groups and were limited by small sample sizes, they said.

“Cycling provides tremendous cardiovascular benefits and is low impact on joints,” lead investigator Benjamin Breyer, from the University of California-San Francisco’s urology department, said.

“The health benefits enjoyed by cyclists who ride safely will far out weight health risks.”

The cyclists did have statistically significant higher odds of genital numbness, the study found.

But by standing more than 20% of the time while cycling the odds of this were significantly reduced, the research found.

The researchers said in future work they would look more closely at those who had reported numbness to see if this was a predictor for future problems.

Article source: http://www.bbc.com/news/health-42651568

Feds freeze mental health practices registry – CNN – CNN.com

Chat with us in Facebook Messenger. Find out what’s happening in the world as it unfolds.

Article source: http://www.cnn.com/2018/01/11/health/fed-mental-health-registry-frozen-bn/index.html

A Gym Chain Is Banning Cable News. It’s for Your Health. – The New …

“I think they’re looking out for everybody’s well-being and truly thinking about the words that they say as a brand,” Ms. Egbuchulam said. “They’re providing opportunities for people to take care of their whole self. This is one way that they’re choosing to do that as a company.”

But Bryan Sieve, a member for more than 10 years, said the change hurt his ability to manage his time and had stirred up “a hornet’s nest” at the branch he goes to in Maple Grove, Minn. As a businessman with a full schedule, he said, it is important for him to multitask during his morning workout, and he enjoyed the large selection of channels on his gym’s TV screens.

The company gave no public notice before making the change, he added.

Mr. Sieve said that he would switch to a competitor if the cable news channels were not restored by the end of the month, and that he had told the Maple Grove manager as much.

“I’ve never seen anybody complain about this, none ever in our club,” he said. “Who are these faceless people that all of a sudden have huge sway over changing a policy at Life Time Fitness without member input, consent or even fair warning?”

Ms. Bushaw, the company spokeswoman, declined to say how many members had requested the change, but wrote: “Suffice it to say, this has been a growing issue over years, not weeks or months. Ultimately, we believe this change is consistent with the desires of the overall membership.”

She noted that the channels in question were still available on smaller screens installed in some cardio machines — a feature she said was being added at more clubs. Members can also use their gym’s Wi-Fi to watch shows on personal devices, she said.

Jennifer Berlanga, a Life Time member in Dallas, called that a reasonable balance.

“I think giving members the choice to watch it on their cardio station or personal devices is a great way to compromise between those who want nonstop news and those who don’t,” Ms. Berlanga wrote on Twitter.

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For her, she said, “it will be nice to enter the cardio room without the barrage from both sides.”

Asked about this option, Mr. Sieve called it “hogwash.” He does not want to carry his iPad or phone around the gym, he said, and none of the cardio machines at the Maple Grove facility have built-in screens. Even if they did, he added, those screens would not be useful when he lifts weights or uses noncardio machines.

In a video message on Twitter, Irene Kistler, a school librarian in Texas, criticized the decision in much grander terms.

“Don’t be afraid of democracy,” Ms. Kistler said. “Put the news back on. Banning the news is really kind of un-American.”

Few, if any, other major fitness chains in the United States have taken similar steps.

Representatives of several companies did not respond to requests for comment on Tuesday afternoon. But McCall Gosselin, a spokeswoman for Planet Fitness, said the issue had “never come up.” No Planet Fitness members have complained about the presence of cable news in their gyms, she said.

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Article source: https://www.nytimes.com/2018/01/10/business/life-time-fitness-cable-news.html

Trump administration freezes database of addiction and mental health programs

Federal health officials have suspended a program that helps thousands of professionals and community groups across the country find effective interventions for preventing and treating mental illness and substance use disorders.

The National Registry of Evidence-based Programs and Practices is housed within the Health and Human Services Department’s Substance Abuse and Mental Health Services Administration.

The registry, which was launched in 1997, offers a database of hundreds of mental health and substance abuse programs that have been assessed by an independent contractor and deemed scientifically sound. Getting a program or therapeutic approach included in this registry amounts to receiving federal recognition as an evidence-based practice. Mental health and addiction specialists say they rely on this database as a key source for finding appropriate and effective therapies.

Administration officials confirmed that the contract for running the database has been terminated. A new entity will take over the program’s duties. A director for that new group was announced Monday, but no other staff is in place. Agency spokesman Brian Dominguez said Wednesday the new entity is “working closely” with other parts of the agency to “institute an even more scientifically rigorous approach to better inform the identification and implementation of evidence-based programs and practices.”

Officials declined to say why the registry was suspended, nor did they give specifics about how the new approach will work, when it will launch or whether existing validated programs will be included.

Agency officials froze the existing website in September, and no new postings have been added, according to mental health advocacy groups. As a result, about 90 new programs that have been reviewed and rated for their scientific merits since September are not available to the public, they said.

“I know there are quite a number of new studies that could be breakthrough strategies for prevention of psychiatric disorders, opiate addictions, autism spectrum disorders — any number of things,” said Dennis Embry, president of Paxis Institute, a for-profit Arizona organization that helps communities identify evidence-based practices for the prevention of psychiatric disorders.

Asked about the freezing of the website, agency spokesman Christopher Garrett said Wednesday that the agency’s job is to “lead the efforts to rapidly institute evidence-based practices in all behavioral health treatment programs” in the country.

“The federal government should not be in the business of having a single contractor determine winners and losers in behavioral health care,” he said.

While agency officials work on the new approach, the registry will remain online, officials said.

The possibility of losing the registry, or of having it essentially frozen, has outraged mental health professionals and members of Congress. Mental health professionals are especially concerned that moving the process in-house could politicize the process of evaluating programs.

“NREPP is one of the most important tools we have. Nobody has a financial stake,” said Catherine Tucker, president of the Association for Child and Adolescent Counseling, a membership organization for counselors who work with young people. She added: “It’s an impartial, nonpartisan, trustworthy source that represents thousands and thousands of hours of work.”

That responsibility will now be led by a new entity within the agency, the National Mental Health and Substance Use Policy Laboratory, or Policy Lab. The lab was authorized under a sweeping health-care law passed in 2016. Known as the 21st Century Cures Act, the law increased funding for research into cancer and other diseases, and also made changes to the mental health system, including the creation of a new assistant secretary for mental health and substance use at SAMHSA.

Trump’s nominee for that position, Elinore McCance-Katz, a psychiatrist and former medical director at SAMHSA, was confirmed last summer. In testimony to Congress last month, she said the primary focus of the Policy Lab is to “periodically review programs and activities” relating to the diagnosis, prevention, treatment and recovery from mental illness and substance use disorders. The lab will also identify programs or activities “that are duplicative and are not evidence-based, effective or efficient,” she said.

The Policy Lab will also play a role in awarding grants to state and local governments, educational institutions and nonprofits to develop evidence-based interventions, she said.

The move has unsettled lawmakers from both parties.

Sen. Rob Portman (R-Ohio), who included a provision in the 1997 Drug-Free Communities Act that requires any prevention programs authorized by the law be certified under the registry, said in a statement that when it came to the suspension, “I’m concerned and looking into it.”

“I’ve long believed we must use federal funds for evidence-based programs that work and we must continue to make this a priority,” Portman said.

Rep. Grace Meng (D-N.Y.), a member of the House Appropriations Committee, sent a letter to McCance-Katz just last week praising the registry as a “critical tool in fighting addiction.”

Earlier this week, “I was shocked to learn that the NREPP contract has been terminated as an opioid epidemic continues to shake our nation,” Meng said. She has sent another letter to ask why. She noted that every single discussion of the registry in the agency’s budget plan indicates that it will be funded through September 2018.

“I’m determined to find out why SAMHSA has made such a mind-boggling decision,” she said in a statement.

The agency has been criticized by some outsiders as paying insufficient attention to the treatment needs of the seriously mentally ill. One of its most ardent detractors was former representative Tim Murphy (R-Pa.), who pushed for changes such as the new assistant secretary position at SAMHSA during bitter hearings several years ago.

The registry itself is not without controversy. In July, Dennis Gorman, a professor in Texas AM University’s Department of Epidemiology Biostatistics, published a paper in the International Journal of Drug Policy saying that the database was not “weeding out” ineffective programs.

Between September 2015 and January 2017, the paper notes, 113 interventions were added to the registry. Of these, the evidence for 14 percent of them consisted of a single, non-peer-reviewed report, and 45 percent of them relied primarily on a single peer-reviewed article.

Amy Sechrist, a certified prevention specialist at Compass Mark, a nonprofit in Pennsylvania that works to reduce substance addictions, said in an interview that while the registry has had its problems, “we need leadership and clearinghouses for interventions that work.”

“We are always communicating to our clients, the public and legislators that prevention is a science,” said Sechrist, whose group uses interventions listed in the database. “We look to SAMHSA for prevention science,” she added, and if they stop offering it, that undermines how Americans view the programs her agency and others offer.

Agency officials notified the contractor Dec. 28 that it was terminating the contract for the registry “for the convenience of the government,” according to an email sent by the contractor to participants in the program. The cancellation means all activities have been suspended, said the contractor, Development Services Group Inc. of Bethesda, Md.

Scott Bryant-Comstock, president and chief executive of the Children’s Mental Health Network, said he spoke to a senior agency official about the termination but didn’t get clear answers about what strategies will be considered “evidence-based” under a new system.

Referring to the acrimonious House hearings on mental health that led to the creation of the Policy Lab and other agency changes, “for advocates, it’s really important to ensure this doesn’t just become solely focused on the seriously mentally ill and doesn’t take into account some of the prevention things,” Bryant-Comstock said.

Dewey Cornell, a professor of education at the University of Virginia and the director of the state’s Youth Violence Project, said it took years to build the database.

“It keeps people up in the field with usable practices,” Cornell said. “Before that, people would go to the journals to look for evidence-based research, but most counselors don’t have the time for that.”

Amy Ellis Nutt contributed to this article.

Article source: https://www.washingtonpost.com/national/health-science/trump-administration-freezes-database-of-addiction-and-mental-health-programs/2018/01/10/ed421654-f577-11e7-beb6-c8d48830c54d_story.html