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Monthly Archives: November 2016

Judge Tosses Out Healthcare Reform Law

A federal judge in Florida has ruled that the healthcare reform law is unconstitutional, siding with the 26 states that sued to block enforcement of the law.

The lawsuit, filed by 26 states that sued to block the Affordable Care Act (ACA), is considered likely to go all the way to the Supreme Court.

Judge Roger Vinson, of the U.S. District Court in Pensacola, Fla., stopped short of directing the federal government to stop implementing the law. Still, the ruling is the harshest legal action yet against the ACA.

Unlike a ruling last month by a judge in Richmond, Va., stating that the individual mandate portion of the ACA violates the Constitution, Vinson ruled the entire law “void” because the individual mandate provision can’t be separated out from the rest of the law.

Congress “exceeded the bounds of its authority in passing the Act with the individual mandate,” Vinson wrote in his 78-page ruling, which was released Monday afternoon. The mandate requires all citizens to have health insurance by 2014 or else pay a penalty.

“Because the individual mandate is unconstitutional and not severable, the entire Act must be declared void,” he concluded.

He did contend that Congress has the power to address the “problems and inequities in our health care system,” but that Congress overstepped its power in passing the ACA.

“There is widespread sentiment for positive improvements that will reduce costs, improve the quality of care, and expand availability in a way that the nation can afford,” Vinson wrote. “This is obviously a very difficult task. Regardless of how laudable its attempts may have been to accomplish these goals in passing the Act, Congress must operate within the bounds established by the Constitution.”

While it was widely expected that Vinson would side with the states, it comes as somewhat of a surprise that he declared the entire law “void.”

The original lawsuit — which filed just hours after Obama signed the ACA into law on March 23, 2010 — alleged that the “individual mandate” in the law exceeded Congress’ authority under the Commerce Clause of the Constitution, but didn’t argue that the whole of the law is unconstitutional. The Commerce Clause permits the federal government to regulate interstate commerce.

In October, when Vinson ruled the case could proceed, he said the states “had a plausible claim” in their argument that the law’s individual mandate violated the Commerce Clause.

The states argued that the government cannot force individuals to participate in the stream of commerce — in this case, the health insurance market.

The federal government responded that at some point, every U.S. citizen will seek medical care, and if that person chooses to not have insurance, the cost of his or her medical care is passed on to those with insurance. Thus, a choice to not participate in the commerce of healthcare doesn’t actually exist.

Two other judges have rejected challenges to the law, ruling that the ACA’s individual mandate provision is constitutional.

Other states that have joined the lawsuit are: Alabama, Alaska, Arizona, Colorado, Georgia, Indiana, Idaho, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Nebraska, Nevada, North Dakota, Ohio, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Washington, Wisconsin and Wyoming.

Head Injuries Carry Long Term Death Risk

The risk of death after head injury remained significantly increased for as long as 13 years, irrespective of the severity of the injury, results of a case-control study showed.

Overall, patients with a history of head injury had more than a twofold greater risk of death than did two control groups of individuals without head injury.

Among young adults, the risk disparity ballooned to more than a fivefold difference, Scottish investigators reported online in the Journal of Neurology, Neurosurgery and Psychiatry.

“More than 40% of young people and adults admitted to hospital in Glasgow after a head injury were dead 13 years later,” Dr. Thomas M. McMillan, of the University of Glasgow, and coauthors wrote in the discussion of their findings. “This stark finding is not explained by age, gender, or deprivation characteristics.”

“As might be expected following an injury, the highest rate of death occurred in the first year after head injury,” they continued. “However, risk of death remained high for at least a further 12 years when, for example, death was 2.8 times more likely after head injury than for community controls.”

Previous studies of mortality after head injury have focused primarily on early death, either during hospitalization or in the first year after the injury. Whether the excess mortality risk persists over time has remained unclear, the authors noted.

Few studies have compared mortality after head injury with expected mortality in the community. To provide that missing context, McMillan and coauthors conducted a case-control study involving 757 patients who incurred head injuries of varying severity from February 1995 to February 1996 and were admitted to a Glasgow-area hospital.

For comparison, the investigators assembled two control groups, both matched with the cases for age, sex, and socioeconomic status and one matched for duration of hospitalization after injury not involving the head.

One control group was comprised of persons hospitalized for other injured and other comparison group included healthy non-hospitalized adults.

The cases comprised 602 men and 155 women who had a mean age of 43, and almost 70 percent were in the lowest socioeconomic quintile.

At the end of follow-up, 305 of the head-injured patients had died, compared with 215 of the hospitalized control group, and 135 of healthy, non-hospitalized adults.

Mortality after one year remained significantly higher in the head-injury group—34 percent versus 24 percent among the hospitalized comparison group and 16 percent for the healthy non-hospitalized adults.

Overall, the head-injury group had a death rate of 30.99/1,000/ year versus 13.72/1,000/year in the community controls and 21.85/1,000/year in the hospitalized-other injury control group.

The disparity was greater among younger adults (15 to 54), who had a rate of 17.36/1,000/year versus 2.21/1,000/year in the community controls. Older adults in the head injury group had a death rate of 61.47/1,000/year compared with 39.45/1,000/year in the community controls.

“Demographic factors do not explain the risk of death late after head injury, and there is a need to further consider factors that might lead to health vulnerability after head injury and in this way explain the range of causes of death,” the authors wrote in conclusion. “The elevated risk of mortality after mild head injury and in younger adults makes further study in this area a priority.”

Global Warming May Pose Health Risks

Medical and public health groups are banding together to explain how global warming has taken a toll on human health and will continue to cause food-borne illnesses, respiratory problems, and deaths unless policy changes are enacted.

In a conference call with reporters, the heads of the American Medical Association (AMA) and the American Public Health Association (APHA) joined with a pediatrician and a scientist to lay out what they say is a major public health issue: climate change caused by global warming.

The “evidence has only grown stronger” that climate change is responsible for an increasing number of health ills, including asthma, diarrheal disease, and even deaths from extreme weather such as heat waves, said Dr. Georges Benjamin, executive director of the APHA.

For one, rising temperatures can mean more smog, which makes children with asthma sicker, explained pediatrician Dr. Perry Sheffield, assistant professor in the Department of Pediatrics and the Department of Preventive Medicine at the Mount Sinai School of Medicine, in New York.

There is also evidence that pollen season is also getting longer, she said, which could lead to an increase in the number of people with asthma.

Climate change also is thought to lead to increased concentrations of ozone, a pollutant formed on clear, cloudless days. Ozone is a lung irritant which can affect asthmatics, those with chronic obstructive pulmonary disease, and those with heart disease, said Dr. Kristie Ebi, who is a member of the Intergovernmental Panel on Climate Change.

More ozone can mean more health problems and more hospital visits, she said.

Aside from air-related ailments and illnesses, extreme weather can have a devastating effect on health, Sheffield said.

“As a result of global warming, extreme storms including hurricanes, heavy rainfall, and even snowstorms are expected to increase,” Sheffield said. “And these events pose risk of injury and disruption of special medical services, which are particularly important to children with special medical needs.”

Extreme heat waves and droughts are responsible for more deaths than any other weather-related event, Sheffield said.

The 2006 heat wave that spread through most of the U.S. and Canada saw temperatures that topped 100 degrees. In all, 450 people died, 16,000 visited the emergency room, and 1,000 were hospitalized, said Dr. Cecil Wilson, president of the AMA.

Climate change has already caused temperatures to rise and precipitation to increase, which, in turn, can cause diseases carried by tics, mosquitoes, and other animals to spread past their normal geographical range, explained Ebi.

For instance, Lyme disease is increasing in some areas, she said, including in Canada, where scientists are tracking the spread of Lyme disease north.

Ebi also recounted the 2004 outbreak of the leading seafood-related cause of gastroenteritis, Vibrio parahaemolyticus, from Alaskan seafood, which was attributed to increased ocean temperatures causing infected sea creatures to travel 600 miles north.

Salmonella outbreaks also increase when temperatures are very warm, Sheffield said.

A 2008 study also projected that global warming will lead to a possible increase in the prevalence of kidney stones due to increased dehydration, although the link hasn’t been proven.

Wilson said the AMA wants to make doctors aware of the projected rise in climate-related illnesses. To combat climate change, Wilson says physicians and public health groups can advocate for policies that improve public health, and should also serve as role models by adopting environmentally-friendly policies such as eliminating paper waste and using energy-efficient lighting in their practices.

“Climate instability threatens our health and life-supporting system, and the risk to our health and well-being will continue to mount unless we all do our part to stabilize the climate and protect the nation’s health,” said Wilson.

Benjamin added that doctors should pay attention to the Air Quality Index. For instance, if there’s a “Code Red” day, which indicates the air is unhealthy, physicians should advise patients (particularly those with cardiac or respiratory conditions) that it’s not the day to try and mow the grass.

“ER docs are quite aware of Code Red days because we know that when those occur, we’re going to see lots of patients in the emergency room,” Benjamin said.

The conference call came as Congress is considering what role the Environmental Protection Agency (EPA) should have in updating its safeguards against carbon dioxide and other pollutants.

7 Foolish Health Rumors You Should Ignore

Urban legends and health myths are certainly nothing new — we’re pretty sure even our Neanderthal ancestors passed some version of them around their cave fires. But the Internet has certainly helped outdated advice die hard, so it’s no wonder these fake facts keep popping up in our inboxes. We picked our favorites from such myth-busting sites as Snopes, the authors of Don’t Swallow Your Gum!: Myths, Half-Truths, and Outright Lies About Your Body and Health, and more. Here’s why you should stop falling for these, once and for all:

Chewing gum takes seven years to pass through your digestive tract.

The truth: Gum addicts can relax. Although your body can’t digest chewing gum, it doesn’t just sit in your stomach, according to Snopes.com. You eliminate it when you go to the bathroom just like other food you haven’t digested.

Plucking a gray hair causes two to grow back.

The truth: It’s fine to tweeze that errant hair. Genetics plays a key role in when you go gray, regardless of how often you pluck. It can take six months from the time a hair falls out until it grows back long enough for you to notice it; during that time, you’ll automatically see more gray hair as part of the aging process, explains Snopes.com.

Antiperspirant deodorants cause breast cancer.

The truth: Going au naturel won’t protect your breasts from cancer. This mythprobably came about because some antiperspirants contain aluminum, which can show up as a false-positive finding on a mammogram. All this means is you should skip the white stuff before a breast cancer screening. Though concerns have been raised about parabens in deodorant raising estrogen levels — and thus possibly increasing cancer risk — there’s never been any conclusive evidence to prove a link, according to the National Cancer Institute and FDA.

Cats can steal the air from a baby’s mouth.

The truth: There’s no need to send Fluffy away when baby moves in. This myth dates back hundreds of years to an era when cats were associated with evil spirits and witchcraft, but KidsHealth.org notes that it’s anatomically impossible for a cat or other animal to suffocate a baby by sealing the infant’s mouth with its own. Still, it’s a good idea to supervise pets around babies and small children — for the kitty’s safety just as much as the child’s.

Mountain Dew can shrink a man’s testicles.

The truth: Mountain Dew-drinking guys everywhere can breathe a sigh of relief. The gist of this ridiculous rumor, according to Snopes.com, is that drinking Mountain Dew can lower a man’s sperm count or cause his penis to shrink. The alleged culprit is food coloring Yellow No. 5, and the myth that it has a harmful effect on the male reproductive system is unfounded, the site says.

You can catch a cold from being outside too long.

The truth: It’s actually a good idea to let your kids spend plenty of time outdoors. “Going outside — with or without a wet head — is one of the best things you can do toprevent catching a cold,” D.J. Verret, MD, a Dallas otolaryngologist, toldWomansDay.com. “Colds are caused by viruses or bacteria, which are more often spread in the winter because of close contact from everyone being indoors.” So spending time al fresco can actually make you less likely to catch a cold.

Cracking your knuckles causes arthritis.

Truth: The sound can be extremely grating, but this uncouth habit won’t harm your joints. Researchers found no difference in instances of arthritis when they compared a group of longtime knuckle crackers with those who left their hands alone, according to Prevention.com. However, the study did find that people who cracked their knuckles had weaker grips and more hand swelling — good reasons to kick the habit.