Providers are reimbursed for some effective prevention measures. For instance, Medicare is expanding its Diabetes Prevention Program, a proven, low-cost counseling intervention currently run by the YMCA. By reducing obesity in people with elevated blood sugar, the DPP slows or eliminates their progression to full-blown diabetes.
But the income providers derive from counseling is far less than what they get for treating acute-care episodes associated with the poor management of diabetes. The worst effects of persistent high blood sugar—kidney failure, neuropathy and eye failure—are treated with some of the most expensive interventions in medicine: dialysis, amputation and pricey eye drug injections.
The toll is enormous. The CMS estimates that 25% of Medicare beneficiaries who are diabetic consume an additional $42 billion more a year in services than non-diabetic beneficiaries. Given that an estimated 86 million Americans are now pre-diabetic, according to the CDC, that total is expected to grow to an alarming half of the Medicare population by 2050.
To ensure the program’s long-term financial stability, Medicare must find a cost-effective way of reducing the number of people on the glide path to diabetes. This would be especially beneficial to states such as Alabama, Louisiana, Mississippi and West Virginia, which already have obesity rates over 35%.
This requires reaching out to people—many of them uninsured—before they reach 65 and join Medicare. Finalizing the rules for an expanded DPP is just step one. Another strategy is for the government to give grants to health systems to hire nurse practitioners to do community outreach in states at the epicenter of the obesity epidemic.
Their job would include fanning out to diabetics’ and pre-diabetics’ homes to offer dietary advice, counseling and help with medication adherence. Small pilot projects have demonstrated that locally hired, culturally sensitive community outreach workers can be an effective weapon for reducing disease incidence and improving chronic disease management among those who are already sick.
Such a program wouldn’t come cheap. My back-of-the-envelope estimate is that a small army of 20,000 nurses would cost about $3 billion a year. But with reasonable caseloads, they could reach as many as 2 million people a year with monthly visits and make a major dent in the problem.
A National Institutes of Health-funded study released last week provided a road map on how to raise the funds for such a program. A comparative-effectiveness trial of the three eye medicines on the market for diabetes-related macular edema showed each was equally effective in treating the disease.
Previous trials have shown that the three drugs are also equal when it comes to treating diabetic retinopathy and age-related macular degeneration, which is the major cause of sight deterioration and blindness in the elderly. These results aren’t surprising since each of the drugs has the same mechanism of action—they are biologics that inhibit the hormone that stimulates blood vessel formation in the eye.
There is a major difference in cost, however. Two of the drugs—Eylea from Regeneron and Lucentis from Roche—are priced at about $1,850 per monthly shot. The other—the off-label use of the cancer drug Avastin—costs about $60 a shot.
If Medicare were to require that all physicians use Avastin instead of the pricier drugs, it would reduce its costs by over 96%. Medicare paid over $3 billion for the more expensive drugs in 2015.
The healthcare system needs to stop paying exorbitant prices for medicines that have cheaper alternatives. It needs those resources to make the cost-effective, job-creating investments in public health that are the best hope for reversing the chronic disease epidemic in America.
Smoking , alcohol, meds/drugs and poor lifestyle (absence of exercise, clean water, air and whole foods) contributed to poor health in the southern part of the United States.
Dear Bay area Pharmacists and Pharmacy operators,
Your experience and expertise will help us reduce chronic health care cost. I would like to set up a few minutes of your time on the phone or in person to learn from you and together we can develop a way to help streamline drug delivery, management and operations to the patient level to help reduce health care costs.
Please email me your availability.
Connie Dello Buono
Health author and blogger
Owner of Motherhealth Senior care agency providing caregivers to homebound seniors
1708 Hallmark Lane San Jose CA 95124
Taking heartburn medicines during pregnancy may increase the risk for asthma in the baby, a review of studies has found.
The analysis, in the Journal of Allergy and Clinical Immunology, combined data from eight studies that included more than 1.6 million patients. Follow-up ranged from five to 14 years.
Researchers found that H2 blockers, such as Pepcid or Tagamet, were associated with a 46 percent increased risk for childhood asthma. Taking proton pump inhibitors, such as Prilosec or Nexium, was linked to a 30 percent increase in risk. There was also some data suggesting an increased risk for skin allergies.
The reason for the connection is unclear, but animal studies suggest the drugs may interfere with digestion, leaving undigested food allergens that are then passed on to the fetus.
None of the studies accounted for all of the many factors that may influence asthma onset, and the authors acknowledge that no causal connection can be proven.
“Gastric reflux is common in pregnancy,” said the lead author, Dr. Aziz Sheikh, a professor of primary care at the University of Edinburgh, “and in the majority of women, it can be managed with lifestyle or diet changes.”
Where medicine is required, he said, “Milder treatments like chewable antacid tablets are the preferred option.”
This wiki info on Leukemia inhibitory factor details when this LIF cytokine is expressed: LIF is normally expressed in the trophectoderm of the developing embryo.
My mother’s friend is an alcoholic and birthed a daughter who had leukemia later at 20 yrs old and a son with behavioral issues. She has survived leukemia. Her son is working but always fight with her.
I urged all new mothers to lead a healthy life before and during pregnancy since all medications, alcohol and the environment affects the growing embryo. And behavioural issues also happens later in the children’s life including cancer/leukemia.
LIF derives its name from its ability to induce the terminal differentiation of myeloid leukemic cells, thus preventing their continued growth. Other properties attributed to the cytokine include: the growth promotion and cell differentiation of different types of target cells, influence on bone metabolism, cachexia, neural development, embryogenesis and inflammation. p53 regulated LIF has been shown to facilitate implantation in the mouse model and possibly in humans. It has been suggested that recombinant human LIF might help to improve the implantation rate in women with unexplained infertility.
LIF binds to the specific LIF receptor (LIFR-α) which forms a heterodimer with a specific subunit common to all members of that family of receptors, the GP130 signal transducing subunit. This leads to activation of the JAK/STAT (Janus kinase/signal transducer and activator of transcription) and MAPK (mitogen activated protein kinase) cascades.
LIF is normally expressed in the trophectoderm of the developing embryo, with its receptor LIFR expressed throughout the inner cell mass. As embryonic stem cells are derived from the inner cell mass at the blastocyst stage, removing them from the inner cell mass also removes their source of LIF.
Leukemia inhibitory factor is a cytokine expressed in the uterus during the secretory phase of the menstrual cycle, as well as expressed during a normal pregnancy. Specifically, LIF is expressed in uterine endometrial glands and is under maternal control.When the fertilized zygote has reached the blastocyst stage, the stromal cells surrounding the blastocyst produce leukemia inhibitory factor, which needed for the blastocyst to implant into the uterine endometrium.
During pregnancy leukemia inhibitory growth factor is involved in decidualization of the maternal endometrium and implantation of the blastocyst to the endometrium. LIF levels are highest on the fourth day of pregnancy indicating its involvement in implantation.Implantation is critical in pregnancy in order to establish the placenta and maternal-fetal interface. Fetal endothelial cells also express the receptor for leukemia inhibitory factor, indicating it may be involved in placental angiogenesis. There is also evidence leukemia inhibitory factor is involved in the survival and proliferation of primordial germ cells, which are the cellular origins of spermatozoa and oocytes.
Decreased secretion of leukemia inhibitory factor is associated with poor or no implantation and, thus, pregnancy loss. Women with decreased production of LIF and other cytokines are fertile and able to become pregnant, but there is an increased risk for unexplained, recurrent miscarriages.
Use in stem cell culture
Removal of LIF pushes stem cells toward differentiation, but they retain their proliferative potential or pluripotency. Therefore LIF is used in mouse embryonic stem cell culture. It is necessary to maintain the stem cells in an undifferentiated state, however genetic manipulation of embryonic stem cells allows for LIF independent growth, notably overexpression of the gene Nanog.
LIF is typically added to stem cell culture medium to reduce spontaneous differentiation.