The study looked at more than 2000 patient visits from members of a Minnesota health plan that paid for patient visits to such clinics for more than five years.  They analyzed how retail clinic patients were treated for: ear infections, sore throats or urinary tract infections.  That information was then compared to data about patients treated for the same problems, but at doctors’ offices, ERs and urgent care centers.

“The costs of care in retail clinics were 30 to 40 percent lower than in physician offices and urgent care centers and 80 percent lower than in emergency departments,” the study found. Ouch.  That’s a lot of dollars.

Meanwhile, the quality scores retail clinics received: “Were equal to or higher than those of other care settings,” according to the study.

CVS, Walmart, and Walgreens are among the companies now running retail clinics.  These new “convenience” medical clinics have been attacked by medical associations around concerns that they might provide poor care.  Apparently, that worry isn’t supported by the data.

Because they are being watched so closely and judged, the staff at these clinics might even be especially cautious. That’s just a theory.

Having all your care at one spot is usually the best idea, as well as forging a good relationship with your doctor. But retail clinics seem offer a valuable option to people who can’t afford the ideal.

For more, see this Time story.

According to a report in The Wall Street Journal today, several challenging varieties of flu could infect people in the coming months.”This season is going to be crazier than ever,” William Schaffner, an infectious-disease expert at Vanderbilt University told the paper.

The H1N1 flu is likely to be the most dominant variety, and it is relatively mild compared to others.  One strain of H1N1 is resistant to the drug Tamiflu, which makes it harder to treat.  Fortunately, that strain has been very rare so far.   Another variety of H3N2 flu is linked to higher rates of hospitalization and death among the elderly.  That strain is also relatively rare.

For more information go to www.flu.gov

After all, some fish are literal depots for the bad chemicals we’ve been dumping in the oceans.  It’s a serious problem because  we also know that eating fish can be good for us. Since motherhood carries so many anxieties with it already, couldn’t we just get some peace over the eating fish thing?

KaBLOOM!  Your wish is answered.  Now there is a site that addresses this dilemma: Fish for Your Health.

State by state, Fish for Health lists the seafood-related advisories you need to be aware of.  It also tells you the nutritional benefits of particular fish, provides details about the specific contaminants that you need to be worried about, and to top it all off, there is a priceless video on how to clean fish.

The site was created by a group at Purdue University that does research on this very topic:  What should you tell pregnant and nursing women about how much and what seafood they should/can eat?

There is also a wallet card with key info that you can print out, or an iPhone application you can download.

Now, if you’re looking for recipes for cooking up that fish, try : LandBigFish,  FishRecipes, or if you want something on the lighter side: CookingLight20SuperFastFishRecipes.

The study looked at three types of patients, the first group was those with no sign of spread to the nodes.  The next group showed very small traces of cancer in their nodes, including “micrometastases” or “isolated tumor cells.”  Half of these patients received more aggressive therapy, including additional drugs and chemotherapy.  The other half did not get aggressive treatment.

The study hoped to answer whether those tiny traces of tumors made a big difference or not.  It seems that they do.  Many more women that were in the second group (i.e. node positive) and got aggressive treatment lived beyond five years.

The authors point out that since the study was begun, doctors are treating this kind of breast cancer more aggressively anyway, so it is likely that most women with these traces of cancers in their nodes are already getting the more aggressive treatment.

If you’ve been diagnosed with breast cancer, ask your doctor about this study and what it means to you.

REFERENCE: de Boere, et al. “Micrometastases or Isolated Tumor Cells and the Outcome of Breast Cancer,” NEJM, August 13, 2009: 653-663.

The House Energy and Commerce Committee finally voted and approved the health care reform bill that had been stalled as moderate democrats objected to some of it’s provisions, according to The Wall Street Journal.  The bill passed the Committee after moderate Democrats won a key amendment that will exempt more small businesses from having to provide coverage.

In the meantime, however, debate about the bill has “devolved” into the usual political battle about “villainous insurance companies versus inept government control of health care,” as Bob Laszewski describes it in a recent blog post.

He goes on to say that both Democrats and Republicans have been suggesting that we can do a big health care fix WITHOUT anyone making a big sacrifice, if we do it their way. But that’s not possible.  As a result, both sides are vulnerable to the same old criticisms they’ve been throwing at each others’ ideas for years.

What’s needed is a fresh and “apolitical” approach to health care reform.  Both Republicans and Democrats have good ideas about health care reform.  The system needs a radical shake up, not to be remodeled according to some political party’s agenda.

Many point to Massachusetts as the model for health reform, because the state has managed to get so many of its residents insured.  In Massachusetts, insurance companies cannot deny anyone coverage and every resident is expected to have insurance, either buying it for themselves or through state subsidies.  The idea behind these dual mandates, was that if everyone was insured, the cost of treating the uninsured would go down, because they would have proper care.  Unfortunately, health care costs have kept rising in Massachusetts, and are threatening to bankrupt the system.

Now, in a surprising move, a special commission has suggested that to keep the health care system afloat, the state needs to abandon the traditional “fee-for-service” method of paying doctors, hospitals, and other providers.  Instead, they would switch to “a system of global payments that combines the approaches of risk-adjusted capitation and pay for performance with a strong focus on primary care.”

Why is this such a critical change? Because “…fee-for-service medicine can be lucrative for providers because of financial incentives to deliver more (and more costly) services, it typically does not offer incentives to improve quality or efficiency or to deliver care that has a low profit margin, such as preventive services or patient education.”

It’s an age-old problem.  Primary care doctors are poorly rewarded, and not rewarded at all, for much of their work, but they are the ones who in the best position to help control costs. Meanwhile, specialists are rewarded for doing more and more, and not penalized for poor quality care.

Republicans and Democrats both know this. They also know that patients too must take more responsibility. The incentives also need to be in place for patients to care about their health and make wise health decisions.  Some employers are already seeing how this works.  Patients who participate in wellness programs can have their co-pays waived.  Hence, they get healthier and don’t have to pay for it.  Patients who smoke may have to pay higher insurance premiums. After all, smokers have a much higher risk of many conditions.

Democrats need to stop worrying about how to make healthcare “fair.”  Giving people free health care with no strings attached doesn’t make them healthier, it just means they get care.  Republicans need to stop worrying so much about market forces.  The health care market is a mess.  The incentives for everyone involved are twisted.  It’s unlikely that overnight we could turn this into a system that responds to market forces.

As Laszewski says in the comments section of his post, “[it] isn’t health care reform if we don’t use reform to actually decrease the deficit and stop the trajectory toward 22% of GDP.’”

The broader bill calls for a new public insurance plan that would compete with private insurers, in an effort to expand insurance coverage. The bill requires all but the smallest companies to provide workers with coverage or contribute as much as 8% of their payroll toward helping them buy it. The Energy and Commerce Committee doesn’t have jurisdiction over taxes, but companion House legislation would raise more than $500 billion by levying a new surtax on the wealthy.

Previous studies with yeast, worms, flies, and rodents have suggested that low-calorie diets can increase longevity, but this study is particularly important because Rhesus monkeys are primates, and so this suggests that humans could also live longer if they ate less calories. The authors note that a reduction of 30% from the baseline diet is not the same as malnutrition.

Of course, you can’t ask monkeys if they were feeling hungry all the time. But this study is one more reason for people to carefully examine their diets.

The study — “Caloric Restriction Delays Disease Onset and Mortality in Rhesus Monkeys,” by R.J. Colman and colleagues, will be published in Science magazine this week.

Francis Collins

According to a White House Press release, Obama said: “The National Institutes of Health stands as a model when it comes to science and research.  My administration is committed to promoting scientific integrity and pioneering scientific research and I am confident that Dr. Francis Collins will lead the NIH to achieve these goals. Dr. Collins is one of the top scientists in the world, and his groundbreaking work has changed the very ways we consider our health and examine disease.  I look forward to working with him in the months and years ahead.”

The nomination has drawn kudos from patient advocates, who see Collins as a strong ally.  “This is a critical time for the science associated with health,” said Sharon Terry, president and chief executive officer of Genetic Alliance, an advocacy group that represents thousands of genetic disease organizations. “We must focus the incredible resources, discovery and intelligence of the NIH on systemic solutions. We have a phenomenal palate from which to paint, and now we need to start creating masterpieces. Dr. Collins is the right ‘artist’ for this task.”

Former director of National Human Genome Research Institute (NHGRI), Collins led the Institute and an international team to sequence the human genome in a high profile race with Celera, a private company. Collins is best known for that race and its dramatic finish, where “a tie” was declared between the two group.  However, for the rest of his stint at NHGRI, Collins focused on helping patients get value from all that genomic data, which cost $2.7 billion to generate.  In its press release, the  Genetic Alliance notes that “As NHGRI director, [Collins] made great strides in putting that [genomic] information to work by creating many teams and projects that not only elucidated the meaning of the raw data, but also transformed systems and paradigms associated with biomedical research. Throughout all of this, Collins kept individuals, families and communities central to the work, focusing on their needs as the driver for scientific discovery”

Collins also has a longstanding interest in the interface between science and faith.  His book “The Language of God: A Scientist Presents Evidence for Belief,” was a New York Times bestseller.  He also has a new book coming out in 2010: “The Language of Life: DNA and the Revolution in Personalized Medicine”. Collins received a B.S. in Chemistry from the University of Virginia, a Ph.D. in Physical Chemistry from Yale University, and an M.D. with Honors from the University of North Carolina. He has been elected to the Institute of Medicine and the National Academy of Sciences, and was awarded the Presidential Medal of Freedom in November 2007.

It’s no secret, Americans are getting fatter and fatter and sicker and sicker because of it.  Employers are worried about the nation’s fat epidemic because, as the LeanWorks site points out “Obese persons spend 77% more money for necessary medications than non-obese persons.” The site also advises that it is not just the mega corporations that can help employees slim down:  “Many types of organizations, including those with few employees and resources, are implementing successful obesity prevention programs.”

Losing weight is one of the toughest things to do, especially in a society where we are constantly assailed by advertisements for, and opportunities to eat, delicious fatty foods.  Since most workers spend about 65% of their time at work, it makes perfect sense for employers to step up to the plate and try to help their staffers exercise more and eat a more healthful diet.

Being overweight isn’t just a matter of self esteem.  Those extra pounds can lead to  chronic conditions such as hypertension, type 2 diabetes, stroke, coronary heart disease, and certain types of cancer.  But even losing a small amount of weight can translate to big health gains.  For example, as the Lean Works site says, “Lifestyle changes that bring about 5% to 7% loss in body weight can prevent or delay the onset of type 2 diabetes for people at high risk for the disease.”  And regular physical activity, which is usually a cornerstone of weight loss, can reduce a person’s risk of heart attack, certain cancer, type 2 diabetes, and high blood pressure. Likewise, eating more fruits and vegetables reduces the risk of heart disease and certain cancers.

Lean Works scores points not just because it’s waving those nasty statistics about obesity at us.  The site also has some inspiring case studies and useful tools to help companies start building their own obesity prevention programs, such as guides to use when interviewing managers and a check list for evaluating a work site.