REPOST: Kidney Stones Raise Heart Disease Risk: Study

A new study links recurring kidney stones to increased risk of heart disease, highlighting the need for further research on the relationship between kidney stones and cardiovascular disease risk and renewed focus on preventive routines including diet and lifestyle changes for those who are at risk. Read the full article below:

Some people who develop recurring kidney stones may also have high levels of calcium deposits in their blood vessels, and that could explain their increased risk for heart disease, new research suggests.

Image Source: jumpandbump.com

“It’s becoming clear that having kidney stones is a bit like having raised blood pressure, raised blood lipids [such as cholesterol] or diabetes in that it is another indicator of, or risk factor for, cardiovascular disease and its consequences,” said study co-author Dr. Robert Unwin, of University College London.

Unwin is currently chief scientist with the AstraZeneca cardiovascular & metabolic diseases innovative medicines and early development science unit, in Molndal, Sweden.

The main message, Unwin said, “is to begin to take having kidney stones seriously in relation to cardiovascular disease risk, and to practice preventive monitoring and treatments, including diet and lifestyle.”

Some 10 percent of men and 7 percent of women develop kidney stones at some point in their lives, and research has shown that many of these people are at heightened risk for high blood pressure, chronic kidney disease and heart disease, the researchers said.

Image Source: medimoon.com

But study author Dr. Linda Shavit, a senior nephrologist at Shaare Zedek Medical Center in Jerusalem, and her colleagues wanted to find out whether the heart issues that can occur in some of those with kidney stones might be caused by high levels of calcium deposits in their blood vessels.

Using CT scans, they looked at calcium deposits in the abdominal aorta, one of the largest blood vessels in the body. Of the 111 people in the study, 57 suffered recurring kidney stones that were comprised of calcium (kidney stones can be made up of other minerals, depending on the patient’s circumstances, the researchers noted), and 54 did not have kidney stones.

Not only did the investigators find that those with recurring kidney stones made of calcium have higher calcium deposits in their abdominal aortas, but they also had less dense bones than those who did not have kidney stones.

Earlier research has shown that calcium buildup in blood vessels frequently goes hand in hand with bone loss, which suggests a link between osteoporosis and atherosclerosis, or hardening of the arteries.

Dr. Steven Fishbane, vice president of dialysis services at North Shore-LIJ Health System, in Great Neck, N.Y., was cautious in interpreting the results. “Patients should not be panicked by the findings, but they are worth discussing with your physician,” he advised.

Image Source: renalandurologynews.com

“Many people who develop a kidney stone will go on to form more stones,” Fishbane said. “There is a risk of recurrence, although it can also be an isolated event.”

Shavit noted that genetic factors are responsible for the development of kidney stones in about 50 percent of cases, but diet and lifestyle also play a part. Not drinking enough water or consuming too much calcium, potassium or salt in your diet are major risk factors for kidney stones, she said.

So, Shavit added, individuals with kidney stones should be monitored for heart disease in various ways, including having CT scans that measure both calcium deposits in blood vessels and bone density, and by counting the number of kidney stones that develop and where they are located.

Dr. Suzanne Steinbaum, a preventive cardiologist at Lenox Hill Hospital in New York City, agreed that CT scans can be useful for these patients. “If you are having recurring kidney stones, it may be worth talking to your doctor about this test since we know that kidney stones can be associated with heart disease down the line,” she said.

The findings were published online Jan. 29 in the Clinical Journal of the American Society of Nephrology.

An accompanying editorial, written by Dr. Eric Taylor of Maine Medical Center in Portland and Brigham and Women’s Hospital in Boston, noted that it’s too early to incorporate a history of kidney stones into screening guidelines for cardiovascular risk factors or osteoporosis.

Dr. Paul Frymoyer is a nephrologist who traveled to Malawi, Africa to provide free medical services and health education for poor communities. Go here to read more about his humanitarian mission in Africa.

Title: REPOST: A Rising Tide of Contaminants

Dr. Deborah Swackhamer, a leading expert in emerging contaminants, was not surprised to discover traces of pesticides and prescription drugs, such as antibiotics and anti–convulsive carbamazepine, drifting through the Zumbro River in Minnesota as a result of poor wastewater treatment systems. The article below discusses the ecosystem health effects of diverse array of organic and inorganic chemicals found in American waterways, sewage systems, and landfills, and the methods to prevent the spread of hazardous pharmaceutical compounds in the environment:

Scientists are concerned by the increasing variety of contaminants in the environment. Traces of pesticides and caffeine were found in the Zumbro River, above, in Minnesota.Credit Brent Frazee/Kansas City Star, via MCT, via

Image Source: nytimes.com

Deborah Swackhamer, a professor of environmental health sciences at the University of Minnesota, decided last year to investigate the chemistry of the nearby Zumbro River. She and her colleagues were not surprised to find traces of pesticides in the water.

Neither were they shocked to find prescription drugs ranging from antibiotics to the anti–convulsive carbamazepine. Researchers realized more than 15 years ago that pharmaceuticals – excreted by users, dumped down drains – were slipping through wastewater treatment systems.

But though she is a leading expert in so-called emerging contaminants, Dr. Swackhamer was both surprised and dismayed by the sheer range and variety of what she found. Caffeine drifted through the river water, testament to local consumption of everything from coffee to energy drinks. There were relatively high levels of acetaminophen, the over-the-counter painkiller. Acetaminophen causes liver damage in humans at high doses; no one knows what it does to fish.

“We don’t know what these background levels mean in terms of environmental or public health,” she said. “It’s definitely another thing that we’re going to be looking at.”

Or, she might have said, one of many, many other things.

The number of chemicals contaminating our environment is growing at exponential rate, scientists say. A team of researchers at the U.S. Geological Survey tracks them in American waterways, sediments, landfills and municipal sewage sludge, which is often converted into agricultural fertilizer. They’ve found steroid hormones and the antibacterial agent triclosan in sewage; the antidepressant fluoxetine (Prozac) in fish; and compounds from both birth control pills and detergents in the thin, slimy layer that forms over stones in streams.

“We’re looking at an increasingly diverse array of organic and inorganic chemicals that may have ecosystem health effects,” said Edward Furlong, a research chemist with the U.S.G.S. office in Denver and one of the first scientists to track the spread of pharmaceutical compounds in the nation’s waterways. “Many of them are understudied and unrecognized.”

In an essay last week in the journal Environmental Science & Technology, titled “Re-Emergence of Emerging Contaminants,” editor-in-chief Jerald L. Schnoor called attention to both the startling growth of newly registered chemical compounds and our inadequate understanding of older ones.

The American Chemical Society, the publisher of the journal, maintains the most comprehensive national database of commercially registered chemical compounds in the country. “The growth of the list is eye-popping, with approximately 15,000 new chemicals and biological sequences registered every day,” Dr. Schnoor wrote.

Not all of those are currently in use, he emphasized, and the majority are unlikely to be dangerous. “But, for better or worse, our commerce is producing innovative, challenging new compounds,” he wrote.

Dr. Schnoor, a professor of civil and environmental engineering at the University of Iowa, also noted rising concern among researchers about the way older compounds are altered in the environment, sometimes taking new and more dangerous forms.

Some research suggests that polychlorinated biphenyls, or PCBs, are broken down by plants into even more toxic metabolites. Equally troubling, scientists are finding that while PCBs are banned, they continue to seep into the environment in unexpected ways, such as from impurities in the caulk of old school buildings.

PCBs have long been identified as hazardous, but not every contaminant is so risky, Dr. Schnoor emphasized.

“Out of the millions of chemical compounds that we know about, thousands have been tested and there are very few that show important health effects,” he said in an interview.

But, he added, the development of new compounds and the increasing discovery of unexpected contaminants in the environment means that the nation desperately needs a better system for assessing and prioritizing chemical exposures.

That includes revisiting the country’s antiquated chemical regulation and assessment regulations. The Toxic Substances Control Act went into effect in 1976, almost 40 years ago, and has not been updated since.

The law does require the Environmental Protection Agency to maintain an inventory of registered industrial compounds that may be toxic, but it does not require advance safety testing of those materials. Of the some 84,000 compounds registered, only a fraction have ever been fully tested for health effects on humans. The data gap includes some materials, like creosote and coal tar derivatives, which are currently manufactured at rates topping a million pounds a year.

Not surprisingly, Dr. Schnoor and other scientists want to see the act updated and transformed into a mechanism for science-based risk assessment of suspect compounds. Indeed, everyone from researchers to environmental groups to the American chemical industry agree that the law is frustratingly inadequate.

“Our chemical safety net is more hole than net,” said Ken Cook, president of the Environmental Working Group, an advocacy group. The Food and Drug Administration, for instance, doesn’t regulate the environmental spread of pharmaceuticals. And the toxic substances law ignores their presence in waterways.

“Where does that leave us in terms of scientific understanding of what drugs to regulate?” Mr. Cook said.

Anne Womack Kolton, vice president for communications at the American Chemistry Council, an organization representing chemical manufacturers, agreed. “Think about the world 40 years ago,” she said. “It was a vastly different place. It’s common sense to revise the law and make it consistent with what we know about chemicals today.”

The two sides don’t agree on what standards for chemical testing are needed or what kind of protective restrictions should be put in place for chemicals deemed hazardous. And they are in deep disagreement about whether a revised federal law should preempt actions taken by tough-minded states like California.

The council argues for federal standardization as the most efficient route; environmental groups believe that such an action would weaken public protection. Legislators have so far not been able to resolve those differences. This month yet another proposed update to the act stalled in a Senate committee.

“Congress has not sent an environmental law to the president’s desk in 18 years,” Mr. Cook said. “And in the current environment, it’s very difficult to get something through.”

Still, Dr. Swackhamer, who recently stepped down as chair of the E.P.A.’s science advisory board, notes that despite the lack of legislation, scientists have been working toward better ways to assess the risks posed by the increasing numbers of chemicals in our lives. Some may help whittle the inventory of T.S.C.A. compounds down to a priority list that focuses on less than a thousand products.

That’s still a daunting number of chemical unknowns. But given the tens of thousands of materials in the inventory, it’s a start.

Dr. Paul Frymoyer is a nephrologist and a health advocate recognized for his outstanding contributions in the healthcare systems in the African continent. Follow this Twitter account for more information about his medical journeys across the globe.

REPOST: 5 health tips to empower men to man up and take charge of their health

Men face health challenges that can be prevented by manning up and doing the necessary things to take charge of their health.  Here are 5 tips from LA Times:

Image Source: www.latimes.com

(BPT) – Men across the United States are afflicted with a variety of health issues that are often preventable. There are a few simple steps you can take to improve your well-being in the short-term and help you stay healthy in the long-term.

First, remember Your Numbers Matter. Check in with your urologist to learn your numbers, such as your prostate specific antigen (PSA) number, testosterone levels, body mass index (BMI), blood glucose and blood pressure. Knowing these numbers helps patients make smart lifestyle choices while allowing physicians to more easily communicate the need to treat and prevent common, but often overlooked, urological conditions, such as prostate cancer, erectile dysfunction and overactive bladder.

“Many men have the ‘if it ain’t broke don’t fix it’ mentality, which can lead them to avoid annual check-ups,” says Dr. Juan Reyna, president of LUGPA. “This mentality is especially dangerous when you consider the number of diseases that have masked symptoms. Without a routine numbers check, it’s possible these masked symptoms go undetected until it’s too late.”

“Knowing your numbers is critical to detecting a disease early, in its most treatable stages,” says Jamie Bearse, president and CEO of ZERO – The End of Prostate Cancer. “Almost 99 percent of prostate cancer cases can be beaten when detected early, but there are no symptoms for early stage prostate cancer, so a blood test is almost always necessary.”

Your numbers matter, and so does maintaining a healthy lifestyle. Here are four more ways you can improve your health in the short-term while taking care of yourself in the long-term:

Exercise. Many health issues can be either avoided or minimized with as little as an hour or two of physical activity a week. Heart disease is one of the leading causes of death among men in the United States – killing one in every four males, according to the Centers for Disease Control and Prevention. Risk factors for heart disease include high blood pressure and high LDL cholesterol as well as obesity, poor diet and physical inactivity. Stay active and decrease your chances of long term health conditions.

Eat well. Keep your heart and other vital organs healthy by maintaining a balanced diet. Increase your consumption of fruits and vegetables and limit your intake of foods high in salt, fat, added sugars and calories. By doing this, you will decrease your chances of developing chronic diseases such as heart disease. High levels of LDL cholesterol, high blood pressure and triglycerides can all be controlled through a simple change in diet.

Relax. Although some stress is good, severe levels can lead to anxiety and diminish your physical health, resulting in conditions that affect your cardiovascular, respiratory, digestive and nervous systems. Take some time out of your day and do something you enjoy. For example, go for a walk during lunch or meditate.

Be proactive about your health. Studies have shown that men are less likely than women to get an annual physical exam. Screenings and exams can help prevent more serious health problems down the line and detect disease early, when it’s most treatable.

Dr. Paul Frymoyer is a nephrologist from Manlius, New York who has journeyed to Africa to provide medical services to poor communities.  For more health tips, visit this Twitter page.

REPOST: Football off-season and recovering from ‘hits’

Even professional athletes aren’t invincible, as shown in a recent study involving football players. Read this WebMD article to learn more about how the human body recovers from intense activity, such as sports.

THURSDAY, April 17, 2014 (HealthDay News) — New research shows that the brains of some football players who had the usual head hits associated with the sport, but no concussions, still had signs of mild brain injury six months after the season ended.

Image Source: npr.org

“We followed athletes at the beginning of football season, after and for six months later,” said Dr. Jeffrey Bazarian, an associate professor of emergency medicine at the University of Rochester School of Medicine and Dentistry, in Rochester, N.Y.

Bazarian found white matter changes consistent with mild brain injury generally persisted for six months. “When we looked at players individually, there were a few that looked like they did resolve,” he said, but half of the players still showed changes at the six-month mark.

Image Source: blisstree.com

“We didn’t see these changes in those who don’t play football,” he said. “And these are the kinds of changes that are being found in retired NFL players.”

The latest study is published in the April 16 online issue of PLOS ONE.

For the research, Bazarian evaluated 10 Division III college football players and five college students who did not play sports during the 2011-2012 season. All 15 underwent brain imaging in addition to balance, cognitive (thinking) skills and other testing before the season, at the end of the season and after six months of rest. The athletes were told not to play during the six months, he said, although the researchers can’t be sure everyone followed that instruction.

During the football season, accelerometers mounted to the helmets measured head impacts. The total head impacts for the season ranged from 431 to 1,850, but no one got a diagnosis of concussion.

Image Source: techyville.com

A concussion is a brain injury that disrupts normal functioning. In recent years, experts have told coaches, players and parents that athletes should not return to play until a doctor evaluates them if a concussion is suspected.

In the new study, the athletes had more changes in white matter from the first measurement to the second, and most of these differences remained at the final measure, six months after play had stopped.

The lack of recovery could contribute to the white matter changes that accumulate over the years with repetitive head impacts, the researchers noted.

“We are obviously trying to understand, are these changes the beginning of this process?” Bazarian said. They also need to find out why some brains recover more quickly, he added.

“Inflammation may be at play,” Bazarian said. “If that’s the case, maybe it’s a case of preventing inflammation. Maybe more than six months of rest is needed.”

The researchers can’t say if the changes are “clinically meaningful,” Bazarian said. “We found no changes in balance or cognition.”

Click here for the rest of the article.

Paul Frymoyer, M.D., specializes in a variety of treatments, the knowledge of which helped him treat various ailments during a trip to Malawi, Africa. Visit this Facebook page for more about him and recent developments in the field of medicine.

REPOST: Focus on Kidneys with Free Health Screening During National Kidney Month

In honor of the National Kidney Month, the National Kidney Foundation of Illinois encourages everyone to take advantage of free health screenings and to rethink their lifestyle patterns in order to keep their kidneys in prime condition. Read the article below for more info on kidney disease and prevention.

Image Source: chicagotribune.com

World Kidney Day Event featuring Chicago Dignitaries and Local Legislators

CHICAGO, IL – Each year, kidney disease kills more people than breast and prostate cancer combined. But while the majority of Americans can recite the common tests for breast and prostate cancer, not many know the risk factors and tests that could keep them off of dialysis and the transplant list.

March is National Kidney Month, and the National Kidney Foundation of Illinois is urging all Illinoisans to give their kidneys some attention with a well-deserved check-up. On March 13, 2014, the National Kidney Foundation of Illinois will celebrate World Kidney Day with a press event at 9:30 am and free health screenings beginning at 10:00 am. The event will be held at the John H. Stroger, Jr. Hospital of Cook County, 1969 W. Ogden Ave., Chicago, Illinois.

Because kidney disease often develops slowly with few symptoms, it can go undetected until it is very advanced. Simple steps such as controlling blood pressure and blood sugar, keeping weight down, exercising regularly, quitting smoking and avoiding excessive use of pain medicine, can help reduce risk.

Chicago dignitaries and local legislators, including Cook County Commissioner Robert B. Steele, will be featured at this World Kidney Day press event on the importance of maintaining good health, followed by free health screenings for the public. The screening will also include an optional 1-on-1 question and answer session with the NKFI Professional Advisory Board Chair Dr. Tipu Puri of University of Chicago, and Stroger Hospital’s Dr. Kalyani Perumal and Dr. Peter Hart.

The National Kidney Foundation of Illinois organizes health screenings with the KidneyMobile®, a mobile truck that travels across the state screening community members for diabetes, high blood pressure and kidney disease. Since 2006, the KidneyMobile® has screened nearly 40,000 people throughout Illinois. Alarmingly, almost 75% of those screened were found to have at least one significantly abnormal result.

Quick Facts on Kidney Disease:
• 26 million American adults – over 1 million Illinoisans – already have kidney disease.
• Kidney disease is the 8th leading cause of death in the country.
• Every 30 minutes, your kidneys filter all the blood in your body, removing waste and excess fluid.
• Diabetes and high blood pressure are the two leading causes of kidney disease.
• Of the 120,000 Americans currently on the waiting list for a lifesaving organ transplant, more than 99,000 need a kidney. Fewer than 17,000 people receive one each year.
• Every day, 14 people die waiting for a kidney.

World Kidney Day will be held in partnership with the Cook County Health & Hospitals System, John H. Stroger, Jr. Hospital of Cook County, Stroger Hospital Department of Nephrology and the Illinois Medical District Commission.

The National Kidney Foundation of Illinois improves the health and well-being of people at risk for and affected by kidney disease through prevention, education and empowerment. To learn more, please visit http://www.nkfi.org.

Dr. Paul Frymoyer is a nephrologist whose passion for better healthcare practices brought him to Africa where he immersed in cultural experience and served the natives with his medical expertise. Visit this Facebook page to learn more about his practice and recent journeys.

REPOST: Beauty of ocean captured by three masters of surf photography

With camera in his hand and a surfboard on the other Peter “Joli” Wilson has documented the waves of surfing for 40 years. Read his story in this article from ABC North Coast.

As the start of the new Australian pro-surfing season begins, works spanning 50 years from three of the country’s most prolific surf photographers have been brought together for an exhibition that demonstrates their shared passion for capturing waves.

Image Source: www.abc.net.au

Peter ‘Joli’ Wilson has spent the past four decades documenting the surf.

His career began while living in Torquay during the 1970s surf revolution, and he’s since gone on to capture some of the world’s top surfers from Kelly Slater, Mick Fanning and Joel Parkinson, to big wave riders Mark Healey, Shane Dorian and Ross Clarke-Jones.

This March on his home patch of coast at Kirra, he will be one of the many in the ASP World Tour photographer pack armed and ready to shoot the surfing world’s cream of the crop.

Recently Joli has spent his time chasing huge swells in Fiji, Tahiti and Hawaii.

“In the last two years there were two episodes – one in Tahiti and one in Fiji – that were the biggest waves I’ve ever photographed.”

Images by the globe’s best surf photographers not only capture amazing moments of nature.

They also illustrate the talent of those who have learnt to master the waves.

A close-call during a Code Red swell at Teahupoo is a reminder that people in Joli’s line of business often take incredible risks to get these remarkable shots.

“We’d gone out in a four metre-long runabout, there was only four photographers and a driver in it, the waves were probably in the 20-25 foot range, we were sitting off in a small channel and the boats need to move out of the way all the time,” he says.

“All of a sudden the driver went to put it into forward, and the gearing broke. Luckily another boat dragged us out, but it was a scary proposition.”

Advancements in surf forecasting is one of the biggest changes Joli has witnessed in his career.

Online reports can warn avid storm chasers of big swells in exact locations almost down to the hour, weeks in advance.

“You’ll have the big wave surfers that are sitting wherever they are all around the world going ‘OK, I need to be in Fiji by Thursday evening so I can surf these waves on Friday’, so that’s really changed things,” he says.

Witzig Gallery in Maclean on the New South Wales north coast has brought together a diverse range of works by Joli, John Witzig and Russell Ord that encapsulate a connection between man and the ocean.

Gallery director Paul Witzig, the brother of John, says he is treating the 3 Masters of Surf Photography display as fine art, not sports photography.

It was awe-inspiring images by Western Australian photographer Russell Ord that he says sparked the idea.

“It’s a wild ocean, there are massive sharks down there and he goes way offshore and jet-skis with his water camera and swims into unbelievable positions to get pictures of the ocean, waves and surfing that I don’t think anybody has ever captured before.”

The first-rank men’s world tour will head to Margaret River this year for the first time.

It is little more than a stone-throw away from the home town of Ord, but he’ll be steering clear of the crowds.

Instead he will be venturing out into secret spots on the rugged WA coast or locations more than 15km offshore in the Southern Ocean, where he is at peace swimming into some of the heaviest waves imaginable.

His shots provide a unique view into the depth of the impact zone.

“The last few years I’ve kind of gone away from capturing every single moment, and now I’m just trying to get that one moment that’s challenging to myself.

“So that means swimming right into the thick of things and seeing what we can do.

“Your whole life revolves around that; what you eat, how you breathe and how you train.”

While Ord is the youngest of the three photographers exhibited, he is far better suited to the 1960s when John Witzig made a name for himself capturing surf culture and unknown surf breaks along the Australian coast.

“I would love to have been in his era. Now you’ve got to travel out miles from anywhere and even miles off the coast to have some sort of chance of being on your own.

“I don’t name the photos or locations, because it takes away the adventure for someone else to find the spots.”

3 Masters of Surf Photography is on display at Witzig Gallery until November 2014.

Paul Frymoyer, M.D.is a physician based in Manlius, New York. One of his interests outside his profession is photography. For more articles about photography, visit this Facebook page.

REPOST: Halfway to victory over malaria

The mortality rate from malaria among African children aged 5 and below has dropped by 51 percent from 2000 to 2012. Martin Edlund, CEO of Malaria No More, cites the provision of accessible lifesaving tools like mosquito nets and mobile phones and constant public health education as the main reasons for progess. Read his report on the combat against malaria in his article for CNN.

(Access to tools such as mosquito nets is helping the fight against malaria make remarkable progress, Martin Edlund says.) Image Source: cnn.com

 

Progress against global diseases is typically slow, incremental and hard-won. But there are moments — such as Wednesday’s release of the World Health Organization’s World Malaria Report — when the cumulative effort of dozens of nations, millions of people and billions of dollars adds up to a true breakthrough.

With the new report, we have turned a corner in the malaria fight. We have reduced the rate of deaths from malaria among children under 5 by 51% from 2000 to 2012 — halfway to our goal of ending death by mosquito bite. For the first time, the number of children dying from this preventable and treatable disease fell below half a million.

Progress against malaria is responsible for fully 20% of the reduction in child mortality since 2000. Malaria control has saved 3.3 million lives since 2000 — 3 million of them children under 5.

This progress stands out as one of the great success stories in global health, even in human history. It’s especially impressive when you consider that malaria has been with us since the dawn of man and, by some accounts, has killed more people than any other cause in human history: more than war, famine or any other disease.

Despite today’s progress, malaria remains one of the biggest impediments to saving lives, improving health and unlocking human potential in much of the developing world. It threatens 3.4 billion people — roughly half the globe — and is a leading cause of school and work absenteeism in sub-Saharan Africa. Malaria literally sucks the lifeblood (energy, livelihood and productivity) from the African continent.

I often compare the malaria fight to the moonshot. Both are human milestones, measures of our progress as a species and a society. And both were made possible by U.S. vision and leadership. The seeds of today’s progress were sown under President George W. Bush with the launch of the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2002 and the U.S. President’s Malaria Initiative in 2005.

These efforts have accelerated under President Barack Obama, who has expanded the initiative and recently committed to provide $1 to the Global Fund for every $2 contributed by the rest of the world, up to $5 billion by 2016. These investments are paying off, not only in children’s lives saved but also in promoting stable, productive nations by keeping children in school, workers at their jobs and families financially secure.
As former Secretary of State Hillary Clinton recently said, “fighting malaria is not only the right thing to do, it’s also the smart thing.”

Much of the progress to date comes from expanded access to simple tools such as insecticide-treated mosquito nets, and we must maintain high levels of coverage. But how do we end the other 50% of child deaths? How do we ensure that no child dies from a mosquito bite and that we ultimately eradicate this disease from the planet? The answer comes down to three cheap, revolutionary tools.

The first is a rapid diagnostic test, or RDT. Until a few years ago, there was no practical way to get a timely, accurate diagnosis for malaria. If someone thought they might have malaria, they had to travel to a distant clinic that had an expensive microscope — and a trained lab technician who would examine a drop of blood under a microscope — and hope the doctor read it right.

Enter the RDT. This simple, 50-cent device tells you in a matter of minutes with 99% accuracy if you have the malaria parasite in your body. There are now 200 million of these tests deployed in Africa each year, and they’re transforming the fight against malaria — driving timely treatment and ensuring people who have other illnesses — such as pneumonia or respiratory infection — get the lifesaving care they need.

The second tool is malaria treatment: artemisinin-based combination therapies, or ACTs. It costs less than $1 to deliver a full course of lifesaving treatment to a child in Africa. And the simple fact is: If a child with malaria gets this $1 worth of medicine in time, he or she will not die. At Malaria No More, we’re helping to close the testing and treatment gaps in Africa through our new Power of One campaign, where every dollar provides a lifesaving test and treatment.

The third tool may surprise you: a mobile phone. There’s a mobile revolution under way in Africa. By 2015, there’ll be more than 1 billion mobile phones on the continent. They’re not only transforming communication and commerce but also how we fight communicable disease.

Mobile is helping us solve a whole slew of problems in the malaria fight: address health facilities that have a shortage of lifesaving treatments by providing timely updates on stock levels, fight counterfeit drugs by enabling consumers to text a code to confirm a malaria treatment is authentic, expand the reach of health education to ensure people sleep under their mosquito nets and provide the real-time data on malaria cases that is the prerequisite for strategies to eliminate the disease.

These tools are helping us work faster, smarter and more cost effectively. With their help — and continued investment — we can write malaria into the history books.

 

Dr. Paul Frymoyer regularly travels to Africa to treat locals who are suffering from malaria and other diseases. Get the latest medical alerts and health updates from this Twitter page.

REPOST: Think the E.R. is expensive? Look at how much it costs to get there

Most people are aware that medical care can be expensive. However, most people are oblivious to the fact that the use of ambulance service can translate to even higher medical costs. This article from The New York Times has more on the subject.

When an ambulance arrives, sick patients or injured people often feel they have little choice but to get in, unaware of the potential price tag. | Image source: nytimes.com

Kira Milas has no idea who called 911, summoning an ambulance filled with emergency medical technicians. Ms. Milas, 23, was working as a swim instructor for the summer and had swum into the side of the pool, breaking three teeth.

Shaken, she accepted the ambulance ride to Scripps Memorial Hospital in La Jolla, Calif. The paramedics applied a neck brace as a precaution.

A week later she received a bill for the 15-minute trip: $1,772.42. Though her employer’s workers’ compensation will cover the bill, she still was stunned at the charge. “We only drove nine miles and it was a non-life-threatening injury,” she said in a phone interview. “I needed absolutely no emergency treatment.”

Thirty years ago ambulance rides were generally provided free of charge, underwritten by taxpayers as a municipal service or provided by volunteers. Today, like the rest of the health care system in the United States, most ambulance services operate as businesses and contribute to America’s escalating medical bills. Often, they are a high-cost prequel to expensive emergency room visits.

Although ambulances are often requested by a bystander or summoned by 911 dispatchers, they are almost always billed to the patient involved. And the charges, as well as insurance coverage, range widely, from zero to tens of thousands of dollars.

“There are a significant numbers of patients who have no coverage for this, and the number of self-pay patients has climbed” since the recession, said Jay Fitch, president of Fitch and Associates, the largest emergency medical services consulting firm in the United States.

What is more, since ambulances companies typically collect only 30 to 40 percent of the amount they bill, they often try to charge more for patients with insurance and those who can pay, Mr. Fitch said.

Part of the inconsistency in pricing stems from the fact that ambulance services are variously run by fire departments, hospitals, private companies and volunteer groups. Some services are included in insurance networks, others not.

“There’s a saying that if you’ve seen one emergency medical system, you’ve seen one emergency medical system — no two are alike,” said Dr. Robert E. O’Connor, a vice president of the American College of Emergency Medicine and chairman of the department at the University of Virginia. Charges and payments, he said, “are all over the place.” Fire departments, which don’t charge for driving to fire alarms, do charge for ambulance runs.

In such a fragmented system, it is hard to know how much high-priced ambulance transport contributes nationally to America’s $2.7 trillion health care bill. And total out-of-pocket expenditures by individuals are hard to tally.
But Medicare, the insurance program for the elderly, does tabulate its numbers and has become alarmed at its fast-rising expenditures for ambulance rides: nearly $6 billion a year, up from just $2 billion in 2002.

That is true even though Medicare’s fixed payments for ambulance rides — ranging from $289 to $481 in 2011 — are far lower than commercial rates. Ambulance companies complain that Medicare rates do not meet the costs of running what are essentially mobile emergency rooms staffed by highly trained professionals.

In a recent study, the federal Health and Human Services Department’s Office of the Inspector General noted that the Medicare ambulance services were “vulnerable to abuse and fraud,” in part because there were lax standards on when an ambulance was needed and how the trip should be billed. The number of transports paid for by Medicare increased 69 percent between 2002 and 2011, while the number of Medicare patients increased only 7 percent during that period. In the last year, two ambulance companies have pleaded guilty or settled claims for overbilling Medicare.

The Affordable Care Act requires policies to include some coverage for emergency care as an essential benefit, including ambulance transport. But the ambulance ride and the care are billed separately. Many Silver plans — a lower-tier plan — require patients to pay an initial copay of $250 for the emergency room and $250 more for the transport, for example.

Every insurance plan evaluates ambulance rides differently for coverage, with many seeking to determine if the service was really needed — a true “emergency.”

That determination can be highly subjective. Some will grant coverage if the destination was an emergency room, regardless of the patient’s status, but others may require admittance to the hospital as evidence that the condition was serious. “Insurers will generally cover if you had good reason to believe there was a serious threat to your life or health,” said Susan Pisano, a spokeswoman for America’s Health Insurance Plans, an industry group.
But when an ambulance arrives, sick patients or injured people like Ms. Milas, often feel they have little choice but to get in, unaware of the potential price tag.

If an emergency call comes to 911, dispatchers decide which ambulance to send, depending on proximity. Most ambulance companies bill according to the level of skill of the team on board, rather than the medical needs of the patients they collect. A team capable of administering Advanced Cardiac Life Support costs more than one with only basic first aid training.

Distance rarely counts for much, although a small mileage charge is added to the fee. Some companies even charge hundreds of dollars extra if a friend or relative rides along with an injured patients.

This fall, Joanne Freedman went to an urgent care center near her home in New York City with a bad headache and a fever. The doctor recommended she go to a hospital for further evaluation and offered to call an ambulance.
“I could have walked, but I’m feeling crummy so I think, ‘ OK, why not?’ ” she recalled.

The two-block ride was billed at $900, and she has not yet learned what her insurer may ask her to pay.
“It was crazy,” she said. “All they did was put a paper mask on me so I wouldn’t infect anyone else.” Ms. Freedman had a spinal tap at the hospital and was admitted for a few days. Nonetheless, she said, for $900, the next time, no matter how ill she will walk up the hill or take a cab.

Paul Frymoyer, M.D. is a NY-based physician who spent some time practicing medicine in Malawi, Africa. Learn more about his experience as a nephrologist in Africa in this blog.

REPOST: The fleet of bikers changing health care in Africa

Reasons like poverty and logistics make it difficult to for people in rural areas of sub-Saharan Africa to obtain proper health care. This is where not-for-profit group dedicated to helping healthcare workers reach far-flung areas in Gambia, Riders for Health, comes in. This recent article in The Independent profiled the organization’s founder, Andrea Coleman.

 

Image source: THE INDEPENDENT

When Andrea Coleman bought her first motorbike six months before her 16th birthday all she wanted to do was escape her “funny little suburb” outside London.

Now, almost fifty years later, she is being credited with using bikes to revolutionise Africa’s transport and health systems.

The mother-of-three will receive the Barclays Women of the Year award at the 59th annual Women of the Year Lunch tomorrow – where she will join the likes of Fern Britton, Olivia Colman, Sheila Hancock, Sally Philips and Doreen Lawrence in London.

But Coleman is not your usual global health pioneer. She left school at 16-years-old and did not sit one academic exam until her 40s. She gained notoriety in Britain in the early 1970s when, as one of only a few female racers, she took to the tracks in Chelsea FC colour-coordinated leathers.

Now, she wants us to “rethink the way we are going to do development. Too much of it has been, ‘I really don’t like the way you have to live, so I am going to raise all this money and give you this thing.’ But it has to be a partnership, a conversation. It has got to be done differently,” she says.

And people are listening. Coleman’s plans to found a social enterprise blossomed after she swapped the race tracks for Sub-Saharan Africa’s dirt tracks in the late eighties. When she saw how broken-down vehicles were preventing women from accessing healthcare, she realised that maintaining fleets of motorbikes in the region could change lives.

Now, Riders for Health – the social enterprise she founded with her husband Barry Coleman – employs 400 staff worldwide and operates 1700 vehicles across seven countries in Africa, transforming healthcare for 14 million people .

Read the rest of the article here.

Paul Frymoyer M.D. also spent some time working as a physician in Malawi, Africa. Read more about his work on this website.

REPOST: Scientists Awarded Nobel Prize For Studies on Cell Transport Systems

When the body does not receive the proper amount of insulin, it fails to break down glucose into energy and causes eye, kidney and other metabolic disorders. Thanks to the research done by these American cell biologists, it may be possible to develop means to circumvent defective cell “transport systems.”  This article on TIME tells more about their work.

The 2013 Nobel Prize in Physiology and Medicine winners. From left: Randy Schekman, Thomas Suedhof and James Rothman. | Image source: TIME

Three American cell biologists are recognized for discoveries that explain how diseases such as diabetes, immune disorders, and Alzheimer’s work.

“Oh my God, oh my God.” That’s how a world renowned scientist reacts to the news that he has won his field’s top honor, the Nobel Prize in Physiology or Medicine.

It was just after one o’clock in the morning on Monday, but that didn’t stop Randy Schekman, a professor of molecular and cell biology at the University of California at Berkeley, from dancing around with his wife after receiving the phone call from Goran Hansson of the Nobel committee in Stockholm.

Schekman received the prize with two fellow Americans, James Rothman, professor of cell biology at Yale University, and Dr. Thomas Sudhof, a professor of molecular and cellular physiology at Stanford University. Sudhof was driving in Spain when he received the call and had to be convinced that he wasn’t the being pranked by his friends.

“I was actually thinking that my friend was calling me, because I’m a little lost,” he told the interviewer calling from the Nobel Foundation.

The scientists received the Prize for their work explaining how cells transport compounds around the body, and for how agents are actually deposited from one cell to another.

The human body is a thriving biological metropolis of cells, growth factors, hormones, enzymes, nutrients, waste products and more. And just like any hub, its health depends on each one of these various residents zipping along its designated highway and reaching its destination at the right time, and in the right amount.

Rothman, Schekman and Sudhof each contributed to mapping out the key molecular steps that some of these critical components take. Schekman identified the genes that direct the vesicles containing molecular compounds to find their targets; Rothman exposed the proteins involved in fusing vesicles to these targets and Sudhof discovered the signals that allowed the vesicles to deliver their cargo.

By studying yeast with defective transport systems. Schekman first honed in on the genes that regulate the movement of the molecular bubbles that are the buses and subway cars of the body’s transport system. His work revealed three classes of genes that oversee vesicle transport, acting as the molecular switchboard for these bubbles.

Rothman focused on what occurred once these vesicles reached their destination. How did the various bubbles, each containing different brain chemicals or enzymes or proteins, know when they had reached their destination? He identified specific combinations of proteins on the vesicles and their target cells that matched up like a lock and key to ensure that the right compounds went to the right place.

Sudhof concentrated his career on the next step – understanding how the vesicles released their contents. By studying how nerve cells communicate in the brain, Sudhof analyzed the changes in calcium ions to explain how a vesicle binding to a cell could trigger an influx of calcium ions that would direct the cells to open their membranes and accept the vesicle’s contents.

These discoveries lay the groundwork for understanding how the body’s critical agents, from enzymes to hormones, reach the right cells, and what happens in disease states when they don’t. When cells aren’t receiving the proper amount of insulin, for example, they don’t receive the appropriate signals to break down glucose into the energy that the cells need, and the build up of sugar in the blood can lead to the eye, kidney and other metabolic disorders known as diabetes. Understanding where this cell transport goes awry may also lead to better treatments for neurological diseases and immune conditions such as autoimmune disorders as well.

Paul Frymoyer, M.D. is a physician who specializes in nephrology and kidney-related disorders such as diabetes. Read more about these diseases on his blog.