People who walk enough to meet or exceed physical activity recommendations may be less likely to die early than those who only walk a little, new research shows.
The American Heart Association (AHA) recommends adults be physically active for at least two and a half hours per week. Previous research has shown exercising more than that may bring extra benefits.
ALERT: Frankenfoods, Protect Yourself From the Hidden Dangers Now
"An important question left to be answered is how much walking is beneficial," study author Paul Williams, from the Lawrence Berkeley National Laboratory in Berkeley, California, said.
He analyzed data from 42,000 mostly middle-aged people who enrolled in the National Walkers' Health Study between 1998 and 2001. They had all subscribed to a walking magazine or attended walking events before the study.
Walkers filled out questionnaires about their health and lifestyle, including exercise and eating habits. Williams then used death records to track who in the study was still alive at the end of 2008.
Based on their questionnaire responses, 23 percent of participants didn't walk enough to meet physical activity guidelines. Another 16 percent met the guidelines, and the rest exceeded them.
Over an average of nine and a half years, 2,448 people died - almost 6 percent.
Compared to people who didn't meet the guidelines, those who walked more than the basic recommendation had a one-third lower chance of dying during the study period.
Those who met but didn't exceed the recommendation had an 11 percent lower chance.
That was after taking into account other differences between people who walked various amounts, like diet and education levels.
Participants who walked more had a reduced risk of dying from a stroke, diabetes and heart disease, in particular.
Walking provides plenty of health benefits. But it's important to note that people who walk more may do so because they are healthier and therefore more able to be active, Williams said. So the new study doesn't prove walking will extend a person's life.
"There is always the question of the chicken and the egg - whether people who are healthier are able to walk farther or, conversely, whether the longer distance they walk may translate into better health benefits," Williams told Reuters Health.
Based on the results, he suggested changing current guidelines by bumping up the minimum amount of physical activity to five hours per week and developing a two-tiered recommendation system that encourages people to exercise more than they do currently.
One tier would aim to get people active, and the other to add to the activity people are already doing, Williams said. That would underscore the point that for couch potatoes, starting to exercise is a healthy move - but the benefits don't stop there.
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"Achieving the weekly exercise guidelines is good," Williams said, "but exceeding them is even better."
"When it comes to walking, more is obviously better," María Simón agreed. She is a fitness trainer and national spokesperson for the AHA and was not involved in the new research.
But, Simón said, the current physical activity guidelines are appropriate.
"The AHA has been very clear in specifying that the recommended guidelines are ‘minimum' requirements to reduce the risk of heart-related diseases and death and has even provided guidelines for increased activity," she wrote in an emailed comment.
"Nevertheless, I believe the take-home of this and similar studies is a positive one: ‘Move . . . Just get up and move,'" Simón said.
Wednesday, January 8, 2014
9 Powerful Foods That Fight Aging
Ponce de Leon never found the Fountain of Youth, but scientists around the world still pursue the magic elixir. Until they find the miraculous substance that will stop the aging process, however, the safest, most effective way is to seek the many common foods, including tea and nuts, that fight inflammation. Scientists believe that chronic inflammation, which is caused by many factors including a lousy diet and smoking, triggers symptoms of aging.
ALERT: Frankenfoods, Protect Yourself From the Hidden Dangers Now
Add the following nine foods to your diet . They have special nutrients to help fight inflammation to help you turn back the clock:
• Green tea. People who drink more than three cups of green tea each day live longer, according to a Japanese study. Green and white teas contain generous amounts of EGCG, a powerful antioxidant linked to a lower risk of heart disease, Alzheimer's disease, and numerous types of cancer. Catechins, which are antioxidant compounds found in green tea, may also protect aging eyes from glaucoma.
• Fish. Fatty fish, like salmon, tuna, and mackerel, contain large amounts of omega-3 fatty acids that fight many of the diseases of aging, including cardiovascular disease. The American Heart Association recommends two servings a week.
• Nuts. A handful of nuts any kind of nuts daily — one to two ounces — contains liberal amounts of inflammation-fighting omega-3 fatty acids. One study found that those who ate nuts every day had 60 percent fewer heart attacks than those who ate nuts less than once a month. Nuts also help the production of elastin and collagen, compounds that keep skin looking young.
• Chocolate. Studies show that chocolate boosts brain function and lowers blood pressure. A German study found that small amounts of chocolate daily could reduce the risk of heart attack and stroke by almost 40 percent. Amounts as small as those in two Hershey's Kisses have been found to be effective, but most experts recommend 1 to 1.5 ounces of dark chocolate.
Editor’s Note: Get Dr. Fuhrman’s Super Immunity for Only $4.95. Click here.
• Coffee. Rich in antioxidants, one study found that three to five cups daily lowers the risk of dementia by 65 percent. Other studies have found coffee lowers the risk of many diseases of aging including heart disease, gout, prostate cancer, colon cancer, and Type 2 diabetes.
• Wine. A moderate amount of wine each day — two glasses — can protect against many of the diseases of aging including heart attack, Alzheimer's, diabetes, obesity, tooth decay, and several types of cancer. Wine can also protect skin, reducing the number of precancerous skin lesions called actinic keratoses.
• Berries. Raspberries, blueberries, and other berries contain antioxidants called anthocyanins which give berries their deep color and slow the aging process — the darker the berry, the higher the amount of antioxidants. A daily cup of fresh or frozen berries fights the inflammation that leads to aging.
• Tomatoes. Lycopene, the antioxidant that gives tomatoes their vibrant color, keeps skin looking young and may also lower the risk of heart disease and several cancers. A study found that men who ate 10 servings of tomato-based foods weekly reduced their risk of prostate cancer by 45 percent.
• Broccoli. Broccoli is loaded with vitamins and minerals, including chromium, that slow the aging process and boost brain function. The sulforaphane found in broccoli and other crucifer vegetables, including cabbage and Brussels sprouts, reduces the risk of heart attack and stroke as well as cancer. Some experts recommend two servings of crucifer vegetables daily.
ALERT: Frankenfoods, Protect Yourself From the Hidden Dangers Now
Add the following nine foods to your diet . They have special nutrients to help fight inflammation to help you turn back the clock:
• Green tea. People who drink more than three cups of green tea each day live longer, according to a Japanese study. Green and white teas contain generous amounts of EGCG, a powerful antioxidant linked to a lower risk of heart disease, Alzheimer's disease, and numerous types of cancer. Catechins, which are antioxidant compounds found in green tea, may also protect aging eyes from glaucoma.
• Fish. Fatty fish, like salmon, tuna, and mackerel, contain large amounts of omega-3 fatty acids that fight many of the diseases of aging, including cardiovascular disease. The American Heart Association recommends two servings a week.
• Nuts. A handful of nuts any kind of nuts daily — one to two ounces — contains liberal amounts of inflammation-fighting omega-3 fatty acids. One study found that those who ate nuts every day had 60 percent fewer heart attacks than those who ate nuts less than once a month. Nuts also help the production of elastin and collagen, compounds that keep skin looking young.
• Chocolate. Studies show that chocolate boosts brain function and lowers blood pressure. A German study found that small amounts of chocolate daily could reduce the risk of heart attack and stroke by almost 40 percent. Amounts as small as those in two Hershey's Kisses have been found to be effective, but most experts recommend 1 to 1.5 ounces of dark chocolate.
Editor’s Note: Get Dr. Fuhrman’s Super Immunity for Only $4.95. Click here.
• Coffee. Rich in antioxidants, one study found that three to five cups daily lowers the risk of dementia by 65 percent. Other studies have found coffee lowers the risk of many diseases of aging including heart disease, gout, prostate cancer, colon cancer, and Type 2 diabetes.
• Wine. A moderate amount of wine each day — two glasses — can protect against many of the diseases of aging including heart attack, Alzheimer's, diabetes, obesity, tooth decay, and several types of cancer. Wine can also protect skin, reducing the number of precancerous skin lesions called actinic keratoses.
• Berries. Raspberries, blueberries, and other berries contain antioxidants called anthocyanins which give berries their deep color and slow the aging process — the darker the berry, the higher the amount of antioxidants. A daily cup of fresh or frozen berries fights the inflammation that leads to aging.
• Tomatoes. Lycopene, the antioxidant that gives tomatoes their vibrant color, keeps skin looking young and may also lower the risk of heart disease and several cancers. A study found that men who ate 10 servings of tomato-based foods weekly reduced their risk of prostate cancer by 45 percent.
• Broccoli. Broccoli is loaded with vitamins and minerals, including chromium, that slow the aging process and boost brain function. The sulforaphane found in broccoli and other crucifer vegetables, including cabbage and Brussels sprouts, reduces the risk of heart attack and stroke as well as cancer. Some experts recommend two servings of crucifer vegetables daily.
Common Knee Surgery Ineffective
NEW YORK — One of the most common types of knee surgery performed in the U.S. is no more effective than fake surgery, at least for the first year, according to a new study.
The new evidence should give doctors pause before they try to repair the meniscus, which cushions the bones of the knee, according to the Finnish doctors behind the research published in the New England Journal of Medicine.
The experiment involved 146 volunteers whose knee pain appeared to be caused by wear and tear of that cushion. None of the participants had a recognized injury or osteoarthritis, both situations for which the surgery is already known to be ineffective.
After 12 months, the average improvement among the people who received real surgery and those who got "sham" surgery was essentially the same, said the research team, led by Teppo Jarvinen, M.D., of the University of Helsinki.
Editor's Note: Top Cardiologist Discovers 'Simple Heart Cure'
There was no significant improvement in knee pain after exercise and no sizable improvement in the likelihood that a patient would require subsequent knee surgery.
But Craig Bennett, M.D., chief of sports medicine at the University of Maryland Medical Center, cautioned that the findings should not be over-generalized. One problem, he said in a telephone interview, is that such "sham" surgery is, in fact, a surgical procedure with potential benefit.
People with knee pain who seem to be candidates for meniscal repair may be suffering because of debris in a swollen knee joint. "If you scope the knee (without touching the cushion), that will often help even if you don't completely address the torn meniscus issue," he said.
During an arthroscopic examination, where fluid is injected to give doctors a good view, "you're taking out the junky, thick irritating fluid that can give a lot of people their pain," he said.
During both sham and regular surgery, small holes are poked through either side of the knee, so doctors can insert instruments to examine the joint. With the surgery, known as arthroscopic partial meniscectomy, damaged and loose pieces of the cushioning material that may be out of place and interfering with the motion of the knee are trimmed away.
Because about 700,000 such surgeries are done in the U.S. each year at a cost of $4 billion, the new findings "will not be welcomed with open arms," Dr. Jarvinen predicted in a phone interview.
The study was done at five medical centers in Finland. All the volunteers had experienced knee pain for at least three months and doctors believed the problem was a tear of the medial meniscus. Nonsurgical treatment had not helped them.
Patients did now know whether they had real surgery because of the way the researchers set up the experiment. Once a doctor had used arthroscopic techniques to examine the knee, if surgery seemed appropriate, the medical team opened an envelope, with the equipment still in place, to reveal whether the patient would receive fake surgery or real surgery.
For sham surgery, the microshaver that is typically used by the surgeon for meniscus removal didn't have a blade.
The patient was not told which option was randomly chosen and neither the orthopedic surgeon nor other operating room staff were involved in further care of the patient. The patients were unable to guess whether they had received real surgery or fake surgery.
On two scales objectively measuring symptoms, there was little difference in outcomes between sham and real surgery.
But patients regarded the treatment as a success whether they received real surgery or not. Surveys showed 89 percent in the actual surgery group and 83 percent in the sham group reported improvement.
Of those who got actual surgery, 77 percent said they were satisfied with the outcome, as did 70 percent of the sham surgery group. And 93 percent who got actual surgery and 96 percent who got the sham treatment said they would be willing to repeat the procedure.
Five patients in the sham-surgery group and two who actually had surgery had such persistent problems that further surgery was required, but that difference wasn't large enough to demonstrate that the operation worked better.
Dr. Jarvien said the lesson for patients is that if you have a sore knee that's not caused by an obvious injury, "it seems we really don't have a quick fix."
"Don't feel an obligation to seek help right away," he said. "You can just treat it with the conventional bag of tricks: painkillers, icing, losing weight, or slightly moderating your activities to make it a bit more tolerable."
"Try to ride a bike, swim, to get you back to what you used to do," he said.
Dr. Bennett, however, said the situation is more complicated. He predicted that if the patients were to be followed beyond one year, younger ones would eventually show a benefit from the surgery.
"If you have a 35-year old and I leave their torn piece of meniscus tissue alone, even though they're doing better at the one-year mark than the person in whom it was cleaned up, what's the story going to be 5, 6, 7, 8, or 9 years down the road?" Dr. Bennett said. "Is that piece in a highly-active 35-year-old person going to rough up and scuff up cartilage that was originally okay?"
"Not every meniscus tear warrants surgery," he said. "There's a lot of factors that go into determining whether someone should have surgery, and you can't get much of that from this paper."
The new evidence should give doctors pause before they try to repair the meniscus, which cushions the bones of the knee, according to the Finnish doctors behind the research published in the New England Journal of Medicine.
The experiment involved 146 volunteers whose knee pain appeared to be caused by wear and tear of that cushion. None of the participants had a recognized injury or osteoarthritis, both situations for which the surgery is already known to be ineffective.
After 12 months, the average improvement among the people who received real surgery and those who got "sham" surgery was essentially the same, said the research team, led by Teppo Jarvinen, M.D., of the University of Helsinki.
Editor's Note: Top Cardiologist Discovers 'Simple Heart Cure'
There was no significant improvement in knee pain after exercise and no sizable improvement in the likelihood that a patient would require subsequent knee surgery.
But Craig Bennett, M.D., chief of sports medicine at the University of Maryland Medical Center, cautioned that the findings should not be over-generalized. One problem, he said in a telephone interview, is that such "sham" surgery is, in fact, a surgical procedure with potential benefit.
People with knee pain who seem to be candidates for meniscal repair may be suffering because of debris in a swollen knee joint. "If you scope the knee (without touching the cushion), that will often help even if you don't completely address the torn meniscus issue," he said.
During an arthroscopic examination, where fluid is injected to give doctors a good view, "you're taking out the junky, thick irritating fluid that can give a lot of people their pain," he said.
During both sham and regular surgery, small holes are poked through either side of the knee, so doctors can insert instruments to examine the joint. With the surgery, known as arthroscopic partial meniscectomy, damaged and loose pieces of the cushioning material that may be out of place and interfering with the motion of the knee are trimmed away.
Because about 700,000 such surgeries are done in the U.S. each year at a cost of $4 billion, the new findings "will not be welcomed with open arms," Dr. Jarvinen predicted in a phone interview.
The study was done at five medical centers in Finland. All the volunteers had experienced knee pain for at least three months and doctors believed the problem was a tear of the medial meniscus. Nonsurgical treatment had not helped them.
Patients did now know whether they had real surgery because of the way the researchers set up the experiment. Once a doctor had used arthroscopic techniques to examine the knee, if surgery seemed appropriate, the medical team opened an envelope, with the equipment still in place, to reveal whether the patient would receive fake surgery or real surgery.
For sham surgery, the microshaver that is typically used by the surgeon for meniscus removal didn't have a blade.
The patient was not told which option was randomly chosen and neither the orthopedic surgeon nor other operating room staff were involved in further care of the patient. The patients were unable to guess whether they had received real surgery or fake surgery.
On two scales objectively measuring symptoms, there was little difference in outcomes between sham and real surgery.
But patients regarded the treatment as a success whether they received real surgery or not. Surveys showed 89 percent in the actual surgery group and 83 percent in the sham group reported improvement.
Of those who got actual surgery, 77 percent said they were satisfied with the outcome, as did 70 percent of the sham surgery group. And 93 percent who got actual surgery and 96 percent who got the sham treatment said they would be willing to repeat the procedure.
Five patients in the sham-surgery group and two who actually had surgery had such persistent problems that further surgery was required, but that difference wasn't large enough to demonstrate that the operation worked better.
Dr. Jarvien said the lesson for patients is that if you have a sore knee that's not caused by an obvious injury, "it seems we really don't have a quick fix."
"Don't feel an obligation to seek help right away," he said. "You can just treat it with the conventional bag of tricks: painkillers, icing, losing weight, or slightly moderating your activities to make it a bit more tolerable."
"Try to ride a bike, swim, to get you back to what you used to do," he said.
Dr. Bennett, however, said the situation is more complicated. He predicted that if the patients were to be followed beyond one year, younger ones would eventually show a benefit from the surgery.
"If you have a 35-year old and I leave their torn piece of meniscus tissue alone, even though they're doing better at the one-year mark than the person in whom it was cleaned up, what's the story going to be 5, 6, 7, 8, or 9 years down the road?" Dr. Bennett said. "Is that piece in a highly-active 35-year-old person going to rough up and scuff up cartilage that was originally okay?"
"Not every meniscus tear warrants surgery," he said. "There's a lot of factors that go into determining whether someone should have surgery, and you can't get much of that from this paper."
Surgeons Providing New Hips, Knees to Uninsured
Millions of Americans struggle daily with degenerative, painful and crippling knee or hip arthritis, or similar chronic conditions that can turn the simplest task into an ordeal.
Fortunately, for those immobilized by their disease, hope exists in the form of knee or hip replacement, long considered the best shot at improving quality of life.
The hitch: a prohibitive price tag.
"Unfortunately, I've lost three jobs due to downsizing since 2006," said 51-year old Susan Murray, a Freehold, N.J., resident. Murray has been combating a connective tissue disease that has progressively ravaged her knees. "And about six months ago I lost my health coverage," she said. "I just could no longer afford to pay my bills and also keep up with my insurance payments."
So despite an illness that leaves her cane-dependent and in constant pain, the single mother of three had no way to pay the $50,000 to $60,000 average out-of-pocket cost for both surgical and postsurgical care.
Enter Operation Walk USA (OWUSA).
According to OWUSA, the program was launched in 2011 as an annual nationwide effort to provide joint replacement surgery at zero cost for uninsured men and women for whom such expenses are out of reach.
The initiative is an outgrowth of the internationally focused Operation Walk, which since 1996 has provided free surgery to more than 6,000 patients around the world, according to an OWUSA news release. OWUSA initially solicited doctors and hospitals to volunteer their services one day each December to surgically intervene in the lives of American patients in need.
This year the effort has expanded greatly, as 120 orthopedic surgeons joined forces with 70 hospitals in 32 states to offer joint surgery to 230 patients spanning the course of a full week in December.
"With millions of people affected, we're trying to reach out to those who are underserved," said Giles Scuderi, M.D., an OWUSA organizer and orthopedic surgeon.
The knee arthroplasty specialist currently serves as vice president of the orthopedic service line at North Shore LIJ Health System, an OWUSA participant based in the greater New York City region.
"Now by underserved we're really talking about 'population USA'," he added. "That is, everyday people in our communities, our colleagues, our friends, people who lost their insurance for whatever reason. Maybe they had a job that they could no longer perform because of their illness, and so lost insurance, and couldn't get it again because of a pre-existing condition. Maybe they could still get it but just can't afford it."
Fortunately, for those immobilized by their disease, hope exists in the form of knee or hip replacement, long considered the best shot at improving quality of life.
The hitch: a prohibitive price tag.
"Unfortunately, I've lost three jobs due to downsizing since 2006," said 51-year old Susan Murray, a Freehold, N.J., resident. Murray has been combating a connective tissue disease that has progressively ravaged her knees. "And about six months ago I lost my health coverage," she said. "I just could no longer afford to pay my bills and also keep up with my insurance payments."
So despite an illness that leaves her cane-dependent and in constant pain, the single mother of three had no way to pay the $50,000 to $60,000 average out-of-pocket cost for both surgical and postsurgical care.
Enter Operation Walk USA (OWUSA).
According to OWUSA, the program was launched in 2011 as an annual nationwide effort to provide joint replacement surgery at zero cost for uninsured men and women for whom such expenses are out of reach.
The initiative is an outgrowth of the internationally focused Operation Walk, which since 1996 has provided free surgery to more than 6,000 patients around the world, according to an OWUSA news release. OWUSA initially solicited doctors and hospitals to volunteer their services one day each December to surgically intervene in the lives of American patients in need.
This year the effort has expanded greatly, as 120 orthopedic surgeons joined forces with 70 hospitals in 32 states to offer joint surgery to 230 patients spanning the course of a full week in December.
"With millions of people affected, we're trying to reach out to those who are underserved," said Giles Scuderi, M.D., an OWUSA organizer and orthopedic surgeon.
The knee arthroplasty specialist currently serves as vice president of the orthopedic service line at North Shore LIJ Health System, an OWUSA participant based in the greater New York City region.
"Now by underserved we're really talking about 'population USA'," he added. "That is, everyday people in our communities, our colleagues, our friends, people who lost their insurance for whatever reason. Maybe they had a job that they could no longer perform because of their illness, and so lost insurance, and couldn't get it again because of a pre-existing condition. Maybe they could still get it but just can't afford it."
Needless Cataract Consultations, Costs Rising
A study of U.S. Medicare claims finds a jump in extra doctor consultations before cataract surgery, but no clear medical reason for the added costs.
"The preoperative medical consultation is an understudied area. It's an intervention that we spend several billion dollars on each year in this country. We know surprisingly little about the process," said Stephen Thilen, M.D.
"What we're studying here is how often do we bring a third provider in — a service that is in addition to the others and it's separately billed. It adds an expense," said Dr. Thilen, an assistant professor of anesthesiology and pain medicine at the University of Washington in Seattle who led the study.
A cataract is a medical condition in which the lens of the eye becomes opaque and causes blurred vision.
Surgery to remove the cataract is generally low-risk, and is the most common elective surgery performed on beneficiaries of Medicare, the U.S. health insurance program for people over 65.
Patients awaiting cataract surgery generally see the ophthalmologist who performs the surgery and the anesthesiologist or anesthetist if one is needed. Both consultations are covered by the flat price Medicare pays those providers for the surgery.
Dr. Thilen's team looked at trends in additional preoperative consultations with the patient's family doctor, cardiologist, pulmonologist, endocrinologist or other physician not directly involved in the surgery.
So far, little is known about the value of these extra consultations when patients are involved in lower-risk procedures, such as most cataract surgeries, Dr. Thilen said.
"There has been more published on high risk patients. Generally we would expect patients coming for heart surgery, liver transplants, vascular surgery — those high risk procedures — we would expect them to often have preoperative medical consultations because they're high risk patients and they have many issues that need to be addressed," Dr. Thilen said.
No national guidelines indicate whether and when cataract surgery patients need an additional preoperative consultation, Dr. Thilen and his colleagues write in JAMA Internal Medicine.
So they looked at Medicare billing data for 556,637 patients who had their first cataract surgeries between 1995 and 2006 and found that the proportion of patients getting preoperative medical consultations rose from 11 percent in 1995 to 18 percent in 2006.
When they analyzed claims for the last two years of that period, they found the patients most likely to have the extra consultations tended to be older and also had anesthesiologists involved in their care. The number of consultations was also higher in urban areas and they were about three times more common in the northeastern U.S. compared to the South.
The researchers did not have access to clinical records so they don't know why any of the consultations were ordered or if they added any value to patient care.
"We're only in the beginning of this. We hope to contribute to more cost effective care and peri-operative management. We will study other procedures, we will look at other types of data beyond Medicare data," Dr. Thilen said.
"Ideally we should have more information on whether these consultations improve outcomes in one way or another," he said.
More than two million Medicare beneficiaries have cataract surgery every year, Dr. Thilen and his colleagues note in their report.
"One approach to improving the value equation is the elimination of unnecessary or wasteful tests and procedures. This forms part of the basis of the Choosing Wisely campaign from the American Board of Internal Medicine," said Lee Fleisher, M.D., in a commentary accompanying the study.
Dr. Fleisher is professor and chair of anesthesiology and critical care at the Leonard Davis Institute, Perelman School of Medicine of the University of Pennsylvania in Philadelphia.
"A major theme within the Choosing Wisely campaign has been the elimination of routine preoperative evaluation in low-risk patients. Given that 30 million Americans undergo surgery annually and approximately 60 percent of them undergo a procedure on an ambulatory basis, the elimination of extensive preoperative tests and consultations represents an area of potentially large healthcare savings," he writes.
But Daniel Albert, M.D., thinks preoperative consultations are more common because the standard of care is higher now than in 1995.
The surgeon's reimbursements for cataract surgery are lower now than in 1995," said Dr. Albert, who is founding director of the University of Wisconsin McPherson Eye Research Institute and a professor in the Department of Ophthalmology and Visual Sciences at the University of Wisconsin. He was not involved in the study.
"The idea that you had to have a more stringent examination and it had to be done within 30 days of the surgery became more widespread over the period they're looking at," he said.
The type of anesthesia may also have something to do with when preoperative consultations or done, he said.
Dr. Albert said most cataract surgeries performed at his institution are done with local (or topical) anesthetics with a "regular" nurse assisting, but some places require monitored anesthesia — the type that requires the presence of an anesthesiologist or nurse anesthetist.
He also points out that the data might be outdated, since the study ended in 2006 and even the surgical procedure has changed considerably since then.
"It's much quicker now and more technologically driven. It's much safer and the complication rate is far lower than it was in 1995," he said.
Dr. Albert also said that co-management in cataract surgery usually is between an optometrist and ophthalmologist and usually the family practitioners or internal medicine physicians are not involved.
"The preoperative medical consultation is an understudied area. It's an intervention that we spend several billion dollars on each year in this country. We know surprisingly little about the process," said Stephen Thilen, M.D.
"What we're studying here is how often do we bring a third provider in — a service that is in addition to the others and it's separately billed. It adds an expense," said Dr. Thilen, an assistant professor of anesthesiology and pain medicine at the University of Washington in Seattle who led the study.
A cataract is a medical condition in which the lens of the eye becomes opaque and causes blurred vision.
Surgery to remove the cataract is generally low-risk, and is the most common elective surgery performed on beneficiaries of Medicare, the U.S. health insurance program for people over 65.
Patients awaiting cataract surgery generally see the ophthalmologist who performs the surgery and the anesthesiologist or anesthetist if one is needed. Both consultations are covered by the flat price Medicare pays those providers for the surgery.
Dr. Thilen's team looked at trends in additional preoperative consultations with the patient's family doctor, cardiologist, pulmonologist, endocrinologist or other physician not directly involved in the surgery.
So far, little is known about the value of these extra consultations when patients are involved in lower-risk procedures, such as most cataract surgeries, Dr. Thilen said.
"There has been more published on high risk patients. Generally we would expect patients coming for heart surgery, liver transplants, vascular surgery — those high risk procedures — we would expect them to often have preoperative medical consultations because they're high risk patients and they have many issues that need to be addressed," Dr. Thilen said.
No national guidelines indicate whether and when cataract surgery patients need an additional preoperative consultation, Dr. Thilen and his colleagues write in JAMA Internal Medicine.
So they looked at Medicare billing data for 556,637 patients who had their first cataract surgeries between 1995 and 2006 and found that the proportion of patients getting preoperative medical consultations rose from 11 percent in 1995 to 18 percent in 2006.
When they analyzed claims for the last two years of that period, they found the patients most likely to have the extra consultations tended to be older and also had anesthesiologists involved in their care. The number of consultations was also higher in urban areas and they were about three times more common in the northeastern U.S. compared to the South.
The researchers did not have access to clinical records so they don't know why any of the consultations were ordered or if they added any value to patient care.
"We're only in the beginning of this. We hope to contribute to more cost effective care and peri-operative management. We will study other procedures, we will look at other types of data beyond Medicare data," Dr. Thilen said.
"Ideally we should have more information on whether these consultations improve outcomes in one way or another," he said.
More than two million Medicare beneficiaries have cataract surgery every year, Dr. Thilen and his colleagues note in their report.
"One approach to improving the value equation is the elimination of unnecessary or wasteful tests and procedures. This forms part of the basis of the Choosing Wisely campaign from the American Board of Internal Medicine," said Lee Fleisher, M.D., in a commentary accompanying the study.
Dr. Fleisher is professor and chair of anesthesiology and critical care at the Leonard Davis Institute, Perelman School of Medicine of the University of Pennsylvania in Philadelphia.
"A major theme within the Choosing Wisely campaign has been the elimination of routine preoperative evaluation in low-risk patients. Given that 30 million Americans undergo surgery annually and approximately 60 percent of them undergo a procedure on an ambulatory basis, the elimination of extensive preoperative tests and consultations represents an area of potentially large healthcare savings," he writes.
But Daniel Albert, M.D., thinks preoperative consultations are more common because the standard of care is higher now than in 1995.
The surgeon's reimbursements for cataract surgery are lower now than in 1995," said Dr. Albert, who is founding director of the University of Wisconsin McPherson Eye Research Institute and a professor in the Department of Ophthalmology and Visual Sciences at the University of Wisconsin. He was not involved in the study.
"The idea that you had to have a more stringent examination and it had to be done within 30 days of the surgery became more widespread over the period they're looking at," he said.
The type of anesthesia may also have something to do with when preoperative consultations or done, he said.
Dr. Albert said most cataract surgeries performed at his institution are done with local (or topical) anesthetics with a "regular" nurse assisting, but some places require monitored anesthesia — the type that requires the presence of an anesthesiologist or nurse anesthetist.
He also points out that the data might be outdated, since the study ended in 2006 and even the surgical procedure has changed considerably since then.
"It's much quicker now and more technologically driven. It's much safer and the complication rate is far lower than it was in 1995," he said.
Dr. Albert also said that co-management in cataract surgery usually is between an optometrist and ophthalmologist and usually the family practitioners or internal medicine physicians are not involved.
Benefit of Knee Supplements Unclear
The dietary supplements glucosamine and chondroitin sulfate might slow joint damage for people with mild arthritis in their knees, according to a new study.
Previous research on the effectiveness of the supplements has been mixed, so experts remain divided on what the findings of this latest study mean for people with knee osteoarthritis, in which wear and tear over time damages the cartilage that lines the joints.
Among more than 30 parts of the knee joint measured in the new study, a handful differed between people who took the supplements and those who didn't over the course of two years.
The results could also be seen as an indication the supplements do not make a significant difference in arthritis symptoms or severity, one researcher said.
"This is yet another set of data arguing against any disease-modifying benefit of glucosamine and chondroitin sulfate," said Daniel Solomon, a rheumatologist and pharmacoepidemiologist at Brigham and Women's Hospital in Boston who was not involved in the study.
But another researcher thought the study might indicate a possible role for glucosamine and chondroitin, if only for people with milder arthritis.
"[The results] may reflect that drugs or therapies that affect joint structure in osteoarthritis are likely to have an effect earlier in the course of the disease," said Krishna Chaganti, a rheumatologist at the University of California, San Francisco, who also was not involved in the study.
The report's authors, led by Johanne Martel-Pelletier of the Osteoarthritis Research Unit at the University of Montreal Hospital Research Centre, were unavailable for comment.
They looked at data on 600 participants in an ongoing osteoarthritis study sponsored by the U.S. National Institutes of Health Osteoarthritis Initiative. Some of the study participants were taking bone-building drugs, some were taking pain relievers such as ibuprofen and some were taking glucosamine and chondroitin supplements.
Researchers used magnetic resonance imaging (MRI) to examine the spaces between the joints and monitored the participants' arthritis symptoms and disease progression over 24 months.
The people who took both anti-inflammatory pain medications and glucosamine and chondroitin supplements had less pain and milder changes due to disease in one part of the knee joint than those who took the pain drugs but no supplements.
Yet among those who were not taking pain medication, there was no difference in pain between people taking the supplements and those who didn't.
And overall, the people who took supplements had similar disease progression to those who did not take them.
In addition, given the sheer number of comparisons made at numerous points in the knees of each participant, the few statistically significant differences in knee anatomy that were seen may have been due to random variation, Solomon told Reuters Health in an email.
The study was funded in part by Bioiberica, a Spanish pharmaceutical company that manufactures glucosamine and chondroitin supplements.
In general, Solomon says, the results do not change the bottom line for osteoarthritis patients: glucosamine and chondroitin don't help.
"Few doctors recommend these agents," Solomon said, "and I doubt that (the study's results) will impact treatment in the U.S."
Chaganti thinks people with osteoarthritis can discuss the pros and cons of the supplements with their doctors. But she cautions that aside from questionable effectiveness, the downsides of glucosamine and chondroitin include a hefty price tag and possible safety risks, because supplements such as these are not regulated by the U.S. Food and Drug Administration.
"There are still some uncertainties regarding specifics about these supplements and their use," Chaganti said.
Previous research on the effectiveness of the supplements has been mixed, so experts remain divided on what the findings of this latest study mean for people with knee osteoarthritis, in which wear and tear over time damages the cartilage that lines the joints.
Among more than 30 parts of the knee joint measured in the new study, a handful differed between people who took the supplements and those who didn't over the course of two years.
The results could also be seen as an indication the supplements do not make a significant difference in arthritis symptoms or severity, one researcher said.
"This is yet another set of data arguing against any disease-modifying benefit of glucosamine and chondroitin sulfate," said Daniel Solomon, a rheumatologist and pharmacoepidemiologist at Brigham and Women's Hospital in Boston who was not involved in the study.
But another researcher thought the study might indicate a possible role for glucosamine and chondroitin, if only for people with milder arthritis.
"[The results] may reflect that drugs or therapies that affect joint structure in osteoarthritis are likely to have an effect earlier in the course of the disease," said Krishna Chaganti, a rheumatologist at the University of California, San Francisco, who also was not involved in the study.
The report's authors, led by Johanne Martel-Pelletier of the Osteoarthritis Research Unit at the University of Montreal Hospital Research Centre, were unavailable for comment.
They looked at data on 600 participants in an ongoing osteoarthritis study sponsored by the U.S. National Institutes of Health Osteoarthritis Initiative. Some of the study participants were taking bone-building drugs, some were taking pain relievers such as ibuprofen and some were taking glucosamine and chondroitin supplements.
Researchers used magnetic resonance imaging (MRI) to examine the spaces between the joints and monitored the participants' arthritis symptoms and disease progression over 24 months.
The people who took both anti-inflammatory pain medications and glucosamine and chondroitin supplements had less pain and milder changes due to disease in one part of the knee joint than those who took the pain drugs but no supplements.
Yet among those who were not taking pain medication, there was no difference in pain between people taking the supplements and those who didn't.
And overall, the people who took supplements had similar disease progression to those who did not take them.
In addition, given the sheer number of comparisons made at numerous points in the knees of each participant, the few statistically significant differences in knee anatomy that were seen may have been due to random variation, Solomon told Reuters Health in an email.
The study was funded in part by Bioiberica, a Spanish pharmaceutical company that manufactures glucosamine and chondroitin supplements.
In general, Solomon says, the results do not change the bottom line for osteoarthritis patients: glucosamine and chondroitin don't help.
"Few doctors recommend these agents," Solomon said, "and I doubt that (the study's results) will impact treatment in the U.S."
Chaganti thinks people with osteoarthritis can discuss the pros and cons of the supplements with their doctors. But she cautions that aside from questionable effectiveness, the downsides of glucosamine and chondroitin include a hefty price tag and possible safety risks, because supplements such as these are not regulated by the U.S. Food and Drug Administration.
"There are still some uncertainties regarding specifics about these supplements and their use," Chaganti said.
Hope for Chronic Pain: Relief Without Addiction
Melanie Rosenblatt, M.D., has seen it all too often: A patient is prescribed painkillers for a chronic condition or injury and ends up dependent on highly addictive opiate drugs. But Dr. Rosenblatt, who is featured in a new Discovery Channel documentary called "Pain Matters," says it doesn't have to be this way.
Chronic and debilitating pain, which strikes millions of Americans, can be managed safely without the long-term use of addictive painkillers. New alternatives to opiate drugs — including injections, implants, and non-medical physical therapies can all offer relief without posing a dependency risk.
"I did the film to help look at this problem of chronic pain and how it affects people," Dr. Rosenblatt, tells Newsmax Health. "The film is really designed to show how patients suffer in chronic pain, how debilitating it can be, how it can cause depression, isolation, loss of job, loss of income, and feelings of worthlessness and helplessness, and how it can affect relationships.
"[But] there are many non-opiate alternatives to treating chronic pain."
Story continues below video.
ObamaCare:You Can Win With The Facts
Dr. Rosenblatt, whose South Florida practice specializes in pain management, notes chronic pain "colors everything" in life for people who are afflicted.
"You can't sleep … you have trouble getting out of bed because of the pain … you can't walk your dog or get your mail, and you can't do simple basic tasks for yourself," she notes. "And your entire world becomes consumed with pain. And until you’ve experienced unrelenting chronic pain, I think you can't really appreciate how all-encompassing that is."
Unfortunately, many chronic pain sufferers turn to opiate drugs, such as OxyContin, and become addicted. At some point, the drugs are taken for more than just pain relief.
"What I see happen a lot, particularly down here in South Florida, is patients are prescribed a strong opiate to control acute pain, which is appropriate…in theory once that painful problem , whatever it is – the disease, the broken bone, whatever it is – once it gets repaired or heals with time, the need for opiate pain medicine goes away.
"But often what we see is the opiate pain medicine itself has its own affect and it makes people feel not only less pain, but feel sometimes something else that people have described to me as an energy or a generalized sense of well-being, where they just feel better. So they start taking it for more non-medical uses … and taking a pill to feel better is different than taking a pill to take the pain go away."
One way to reduce the risk of addiction is to treat chronic pain — such as back pain, arthritis pain, or surgical pain — without drugs or less-dangerous medications, she says. The key, she explains, is finding a way to manage chronic pain that doesn’t cause more harm than good.
"Chronic back pain may get better with massage, heat, yoga, physical therapy, other non-opiate medications, other non-steroidal medications, muscle relaxants, other classes of medications," she says. "Some of the anticonvulsants help with chronic pain [as well as] nerve blocks, injections epidurals, and different kinds of injections and implantable techniques."
Chronic and debilitating pain, which strikes millions of Americans, can be managed safely without the long-term use of addictive painkillers. New alternatives to opiate drugs — including injections, implants, and non-medical physical therapies can all offer relief without posing a dependency risk.
"I did the film to help look at this problem of chronic pain and how it affects people," Dr. Rosenblatt, tells Newsmax Health. "The film is really designed to show how patients suffer in chronic pain, how debilitating it can be, how it can cause depression, isolation, loss of job, loss of income, and feelings of worthlessness and helplessness, and how it can affect relationships.
"[But] there are many non-opiate alternatives to treating chronic pain."
Story continues below video.
ObamaCare:You Can Win With The Facts
Dr. Rosenblatt, whose South Florida practice specializes in pain management, notes chronic pain "colors everything" in life for people who are afflicted.
"You can't sleep … you have trouble getting out of bed because of the pain … you can't walk your dog or get your mail, and you can't do simple basic tasks for yourself," she notes. "And your entire world becomes consumed with pain. And until you’ve experienced unrelenting chronic pain, I think you can't really appreciate how all-encompassing that is."
Unfortunately, many chronic pain sufferers turn to opiate drugs, such as OxyContin, and become addicted. At some point, the drugs are taken for more than just pain relief.
"What I see happen a lot, particularly down here in South Florida, is patients are prescribed a strong opiate to control acute pain, which is appropriate…in theory once that painful problem , whatever it is – the disease, the broken bone, whatever it is – once it gets repaired or heals with time, the need for opiate pain medicine goes away.
"But often what we see is the opiate pain medicine itself has its own affect and it makes people feel not only less pain, but feel sometimes something else that people have described to me as an energy or a generalized sense of well-being, where they just feel better. So they start taking it for more non-medical uses … and taking a pill to feel better is different than taking a pill to take the pain go away."
One way to reduce the risk of addiction is to treat chronic pain — such as back pain, arthritis pain, or surgical pain — without drugs or less-dangerous medications, she says. The key, she explains, is finding a way to manage chronic pain that doesn’t cause more harm than good.
"Chronic back pain may get better with massage, heat, yoga, physical therapy, other non-opiate medications, other non-steroidal medications, muscle relaxants, other classes of medications," she says. "Some of the anticonvulsants help with chronic pain [as well as] nerve blocks, injections epidurals, and different kinds of injections and implantable techniques."
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