Gambian leader says to build herbal AIDS-cure hospital

BANJUL (Reuters) – AIDS patients would be offered an herbal cure at a 1,111-bed hospital in Gambia that the president said on Tuesday he plans to build despite medical concerns the treatment is dangerous.

President Yahya Jammeh said in 2007 he had found a remedy of boiled herbs to cure AIDS, stirring anger among Western medical experts who claimed he was giving false hope to the sick.

“With this project coming to fruition, we intend to treat 10,000 HIV/AIDS patients every six months through natural medicine,” Jammeh said in his New Year’s address, adding that he expected the 1,111-bed hospital to open in 2015.

The World Health Organisation and the United Nations have said Jammeh’s HIV/AIDS treatment is alarming mainly because patients are required to cease their anti-retroviral drugs, making them more prone to infection.

Jammeh said in October that 68 HIV/AIDS patients undergoing his herbal remedy had been cured and discharged, the seventh batch since the treatments began five years ago.

Other African leaders have drawn criticism for extolling the power of natural remedies to combat AIDS.

The administration of former South African President Thabo Mbeki was ridiculed for denying there was a link between HIV and AIDS while prescribing meaningless treatments such as beet root instead of internationally proven medicines.

The HIV rate in Gambia is relatively low compared to other African states, with 2 percent of the country’s roughly 1.8 million people infected, according to the United Nations.

Jammeh came to power in Gambia, a sliver of land on Africa’s west coast that is popular with sun-seeking European tourists, in a bloodless military coup in 1994.

He is accused by activists of human rights abuses during his rule, and most recently drew international criticism for executing nine death-row inmates by firing squad.

(Reporting by Pap Saine; Writing by Richard Valdmanis; Editing by Michael Roddy)

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New Year’s Resolutions For Better Health

New Year’s resolutions are typically so singular, self-focused and private. How about making a resolution or two this year that has benefits beyond yourself? Here are some suggestions with lots of links to get you started.

You can help stop the spread of disease. Resolve to get up-to-date on your vaccines. While children have a full slate of vaccines, many adults don’t realize they have regular immunization obligations, too. Getting flu, pertussis, human papillomavirus and other vaccines can protect you and help stop the spread of diseases that harm others. Here’s a great guide to adult immunizations from the federal government. If the cost of vaccines is an issue, check into free or low-cost immunizations through your county’s public health department. Here’s a guide to finding your local office. Volunteer with an organization that needs your help. A group called Catchafire matches professionals who wish to volunteer their skills to organizations that need the help — including many important health organizations. The idea is to give great organizations access to top talent while respecting the professionals’ schedules and making their volunteer work meaningful. Here’s the link. Influence a healthier food climate. Americans spend about half of their food budgets eating out. So we had better demand thorough nutritional information about what we’re getting. Under healthcare reform, many restaurant chains will soon carry nutritional information. But the law has loopholes. If you don’t see the information you’re looking for on salt, fat, calories or other nutrients, ask the restaurant’s manager where you can find it. Nutritional information should be easy to access. Until it is, speak up and ask for it. Do your part to keep down healthcare costs. The Affordable Care Act will bring many consumers into the insurance healthcare system for the first time. But that doesn’t mean we can ignore the cost of care. Rising healthcare costs remain a huge issue that could drag down the economy and bedevil some reform efforts. You can help by being a wise healthcare consumer. Read your insurance policy and know what it does and doesn’t cover. Take advantage of free preventive care services and screening tests under the ACA. Shop around for prescriptions to find the cheapest prices. Ask your doctor for generic equivalents. Finally, use your health savings account if your employer offers one. These accounts provide incentives for using your money wisely, shopping around to find the best healthcare prices and weighing the costs and benefits of certain drugs, tests or procedures.  Here’s a guide to understanding how HSAs work. Be responsible about the prescription drugs you store at home. You can reduce your own risk of addiction and lower the risk for others, too, if you are careful about medications kept in your home. This year marked a turning point in the nation’s epidemic of prescription-drug abuse and addiction.  Admissions to addiction treatment centers for use of narcotic painkillers rose 569 percent in the past decade, according to the federal government. More people now die from drug overdoses than from traffic accidents. More than six million Americans abuse prescription drugs, and more than 70 percent of addicts get their drugs through family or friends or by raiding a home medicine cabinet. Dispose of unused medications. The Drug Enforcement Agency operates a National Prescription Drug Take-Back Day a few times a year (the next one is in April), that makes it easy to dispose of dangerous substance.  Go through your home today and collect unused medications. You can take them to a pharmacy for disposal or even flush them down the toilet. Some drugs carry disposal instructions on the label. Here’s information on how to dispose of prescription medications. Be a safe driver. One of the biggest safety issues on the nation’s roads these days is driver distraction. A large share of the distractions come from talking on a hand-held cell phone or text messaging while driving. You’re 23 times more likely to crash if you text while driving. Most states now prohibit texting while driving, but there are still many people who do it while knowing it’s unsafe. Break yourself of this terrible habit. The federal government has a website that provides people with information and tools to discourage distracted driving. Included in this package is a simple pledge sheet you can print out, sign and post on your refrigerator door or bathroom to help you make the commitment. There are a couple of other things you can do, too. Speak out if the driver you’re riding with is distracted. Encourage family and friends to drive phone-free. Run a race for the greater good. Who doesn’t love a good 5K walk or run? You benefit from the exercise and, if you choose a charity race, others reap rewards, too. There are thousands of charity races each year. Pick one and invite your friends to participate with you. Here’s a website to help you find a race.  Apply for a grant. There’s money out there for doing good. Saucony’s Run for Good Foundation aims at preventing child obesity by promoting running as part of a healthy lifestyle for kids. The foundation issues grant money to organizations that want to organize a kids’ running group. You can find information on how to apply at the foundation website. Sign a petition. Concerned about flame retardants in consumer products? Gun safety? Funding for research to fight a particular disease? There’s probably a petition for that. It’s an easy way to make your voice heard. Both change.org and thepetitionsite.com are good places to look to find a petition close to your heart.

Question: What resolutions can you make to help others? Tell us what you think in the comments.

---

Shari Roan is an award-winning health writer based in Southern California. She is the author of three books on health and science subjects.

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Tumor boards may add little to VA cancer care

NEW YORK (Reuters Health) – Getting doctors together to discuss the best treatments for cancer patients in U.S. Veterans Affairs hospitals was only linked to a minor improvement in care in a large new study.

Analyzing the records of 138 VA medical centers, researchers found that the presence of a so-called tumor board – a group of cancer treatment experts – only affected seven out of 27 measures of quality and processes in patient care, and not always for the better.

“This does not support the hypothesis that tumor boards are doing a lot to improve care,” said Dr. Nancy Keating from Boston’s Harvard Medical School and Brigham and Women’s Hospital, the study’s senior author.

Tumor boards are a standard part of medical care in the U.S. and are generally made up of several different types of doctors, including surgeons and radiation oncologists, who review patients’ cases and make recommendations for their treatment.

The study’s authors write in the Journal of the National Cancer Institute that previous research found hospitals dedicate about 50 hours per month of their doctors’ time to participation in tumor boards.

“It is interesting that despite the fact that tumor boards seem like a good thing and they are so well established, there is so little literature on them,” said Keating.

She and her colleagues wanted to know whether tumor boards actually made a difference.

To do that, they linked together information and records from the VA’s 138 medical centers on cancer patients treated between 2001 and 2004.

The team found that 75 percent of the medical centers had at least one tumor board that discussed most of the conditions the researchers were interested in: colorectal, lung, prostate, breast and blood cancers.

Then, using established national guidelines, the researchers developed a list of 27 markers for the quality and type of care patients received.

For example, the researchers checked whether patients with stage II or III rectal cancer got the recommended dose of chemotherapy and radiation before surgery to remove the cancer.

Overall, the researchers found the presence of a tumor board was only linked with differences in seven of the 27 markers.

“And some of those seven were actually a situation where the tumor board was associated with worse care,” Keating said.

In addition, recommended care for specific types of malignancies, such as blood cell cancers, was more often seen in centers with no tumor board (56 percent) or only a general tumor board (61 percent) than in centers with tumor boards specializing in blood cancers (39 percent).

“This is a little bit off-putting because it challenges the conventional wisdom that tumor boards are a good thing,” said Dr. Douglas Blayney, a professor of medicine at the Stanford School of Medicine in California.

“I think the main issue that remains to be answered: Did the recommendations of the tumor boards actually get carried out?” added Blayney, who wrote an editorial accompanying the study.

“We think patients benefit from having their cases reviewed at the outset, but we leave it to the medical system to get acted upon,” he said.

Keating said researchers need to do a “deep dive” into tumor boards to find out more. She said they still need to know how the tumor boards are structured, and what types of cases are discussed.

Until then, “I do think that people and centers who are investing time and energy in their tumor boards should really think about how they are structured, and if they’re set up in a way to improve patient care,” she said.

Blayney told Reuters Health that he doesn’t think hospitals should scrap their tumor boards based on these findings, because there are new possibilities with new technology.

“The promise of telemedicine technology makes extra use of academic centers available to patients who may live in rural locations and doctors who are remote from the academic centers,” he said.

For example, the rural doctors of a woman with breast cancer can conference with a tumor board that specializes in breast cancer at a large, urban academic center.

“Again it’s tapping into the knowledge and experience of a broad range of physicians,” Blayney said.

SOURCE: http://bit.ly/UckC33 Journal of the National Cancer Institute, online December 28, 2012.

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State’s first flu death is Tulsa County resident

A Tulsa County resident between the ages of 19 and 64 is the first person in Oklahoma to die from the flu this season.

Since Sept. 30 there have been 24 hospitalizations due to flu reported in Tulsa County, the most for any county in the state.

Oklahoma County has reported 10, according to the Oklahoma State Department of Health.

There have been 75 flu hospitalizations throughout the state. Twenty-one of those were reported last week. The age range with the most hospitalizations was 65 and older with 28. Children under 4 accounted for 20 cases, according to the department.

Nationally 1,013 people have been hospitalized and eight children have died, according to the Centers for Disease Control and Prevention.

Flu activity has been increasing, particularly in the south central and southeastern regions of the county. Oklahoma reported regional flu activity last week while 29 states had widespread activity, according to the CDC.

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Few tests done at toxic sites after superstorm

OLD BRIDGE, N.J. (AP) — For more than a month, the U.S. Environmental Protection Agency has said that the recent superstorm didn’t cause significant problems at any of the 247 Superfund toxic waste sites it’s monitoring in New York and New Jersey.

But in many cases, no actual tests of soil or water are being conducted, just visual inspections.

The EPA conducted a handful of tests right after the storm, but couldn’t provide details or locations of any recent testing when asked last week. New Jersey officials point out that federally designated Superfund sites are EPA’s responsibility.

The 1980 Superfund law gave EPA the power to order cleanups of abandoned, spilled and illegally dumped hazardous wastes that threaten human health or the environment. The sites can involve long-term or short-term cleanups.

Jeff Tittel, executive director of the Sierra Club in New Jersey, says officials haven’t done enough to ensure there is no contamination from Superfund sites. He’s worried toxins could leach into groundwater and the ocean.

“It’s really serious and I think the EPA and the state of New Jersey have not done due diligence to make sure these sites have not created problems,” Tittel said.

The EPA said last month that none of the Superfund sites it monitors in New York or New Jersey sustained significant damage, but that it has done follow-up sampling at the Gowanus Canal site in Brooklyn, the Newtown Creek site on the border of Queens and Brooklyn, and the Raritan Bay Slag site, all of which flooded during the storm.

But last week, EPA spokeswoman Stacy Kika didn’t respond to questions about whether any soil or water tests have been done at the other 243 Superfund sites. The agency hasn’t said exactly how many of the sites flooded.

“Currently, we do not believe that any sites were impacted in ways that would pose a threat to nearby communities,” EPA said in a statement.

Politicians have been asking similar questions, too. On Nov. 29, U.S. Sen. Frank Lautenberg, D-N.J., wrote to the EPA to ask for “an additional assessment” of Sandy’s impact on Superfund sites in the state.

Elevated levels of lead, antimony, arsenic and copper have been found at the Raritan Bay Slag site, a Superfund site since 2009. Blast furnaces dumped lead at the site in the late 1960s and early 1970s, and lead slag was also used there to construct a seawall and jetty.

The EPA found lead levels as high as 142,000 parts per million were found at Raritan Bay in 2007. Natural soil levels for lead range from 50 to 400 parts per million.

The EPA took four samples from the site after Superstorm Sandy: two from a fenced-off beach area and two from a nearby public playground. One of the beach samples tested above the recreational limit for lead. In early November, the EPA said it was taking additional samples “to get a more detailed picture of how the material might have shifted” and will “take appropriate steps to prevent public exposure” at the site, according to a bulletin posted on its website. But six weeks later, the agency couldn’t provide more details of what has been found.

The Newtown Creek site, with pesticides, metals, PCBs and volatile organic compounds, and the Gowanus Canal site, heavily contaminated with PCBs, heavy metals, volatile organics and coal tar wastes, were added to the Superfund list in 2010.

Some say the lead at the Raritan Bay site can disperse easily.

Gabriel Fillippeli, director of the Center for Urban Health at Indiana University-Purdue University Indianapolis, said lead tends to stay in the soil once it is deposited but can be moved around by stormwaters or winds. Arsenic, which has been found in the surface water at the site, can leach into the water table, Fillippeli said.

“My concern is twofold. One is, a storm like that surely moved some of that material physically to other places, I would think,” Fillippeli said. “If they don’t cap that or seal it or clean it up, arsenic will continue to make its way slowly into groundwater and lead will be distributed around the neighborhood.”

The lack of testing has left some residents with lingering worries.

The Raritan Bay Slag site sits on the beach overlooking a placid harbor with a view of Staten Island. On a recent foggy morning, workers were hauling out debris, and some nearby residents wondered whether the superstorm increased or spread the amount of pollution at the site.

“I think it brought a lot of crud in from what’s out there,” said Elise Pelletier, whose small bungalow sits on a hill overlooking the Raritan Bay Slag site. “You don’t know what came in from the water.” Her street did not flood because it is up high, but she worries about a park below where people go fishing and walk their dogs. She would like to see more testing done.

Thomas Burke, an associate dean at the Johns Hopkins School of Public Health, says both federal and state officials generally have a good handle on the major Superfund sites, which often use caps and walls to contain pollution.

“They are designed to hold up,” Burke said of such structures, but added that “you always have to be concerned that an unusual event can spread things around in the environment.” Burke noted that the storm brought in a “tremendous amount” of water, raising the possibility that groundwater plumes could have changed.

“There really have to be evaluations” of communities near the Superfund sites, he said. “It’s important to take a look.”

Officials in both New York and New Jersey note they’ve also been monitoring less toxic sites known as brownfields and haven’t found major problems. The New York DEC said in a statement that brownfields in that state “were not significantly impacted” and that they don’t plan further tests for storm impacts.

Larry Ragonese, a spokesman for the New Jersey Department of Environmental Protection, said the agency has done visual inspections of major brownfield sites and also alerted towns and cities to be on the lookout for problems. Ragonese said they just aren’t getting calls voicing such concerns.

Back at the Raritan Bay slag site, some residents want more information. And they want the toxic soil, which has sat here for years, out.

Pat Churchill, who was walking her dog in the park along the water, said she’s still worried.

“There are unanswered questions. You can’t tell me this is all contained. It has to move around,” Churchill said.

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Colorado Woman Billed Medicaid for Dead Father

A Colorado woman was convicted this week for felony forgery for submitting fraudulent documents to Medicaid regarding personal health care services provided to her father after he died. It was the second announcement of Medicaid fraud-related convictions made by the Colorado Attorney General’s office in less than a week. Here are the details.

* According to the office of Colorado Attorney General John Suthers, 52-year-old Viola Kwong pleaded guilty to felony forgery in Denver District Court on Tuesday. She was sentenced to pay $ 16,000 in criminal restitution and perform 50 hours of public service. The restitution reflects all of the money illegally received by Kwong.

* Kwong will also be placed on supervised probation for four years, is responsible for all court costs and probation supervision fees associated with her case, and will pay a civil penalty of more than $ 37,000 to the Colorado Medicaid program, the Attorney General’s Office stated.

* The Attorney General’s Office stated that Kwong had requested services for her elderly father through a Medicaid program that allows the Medicaid client to direct his or her own home-based medical care.

* Because Kwong’s father was too ill to manage his care, Kwong was authorized by the program as his personal representative, in charge of obtaining those services for her father.

* Kwong’s father died on July 23, 2010, but Kwong continued to submit documents about personal health care services that were being provided to her father until Nov. 8, 2010.

* Suthers stated that the restitution ordered was “another significant recovery for Colorado’s Medicaid program.”

* Colorado Department of Health Care Policy and Financing initially referred the case to the Attorney General’s Medicaid Fraud Control Unit.

* Last week, the Attorney General’s Office announced the conviction of occupational therapist Cheryl Moss, 47, for felony theft and felony forgery. Moss pleaded guilty to forging treatment records and fraudulently billing the Colorado Medicaid program for services she did not perform.

* Moss agreed to repay the program $ 54,332, serve 60 days home detention and perform 300 hours of community service. She was also ordered to pay an additional $ 46,000 to resolve any potential civil issues and to report her conviction to the agency charged with licensing occupational therapists in Colorado.

* According to the Attorney General, Medicaid is health insurance for qualifying low-income, disabled individuals, and children and families. Covered services include hospital care, skilled nursing home care, residential adult family care services, hospice, mental health, dental and eyeglass services. Each state administers its own Medicaid program.

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Lauded cancer researcher, Springfield native, dies

A Springfield High School and Wittenberg University graduate whose research transformed the treatment of breast cancer and saved and prolonged the lives of women afflicted by it died Sunday in Cincinnati.

Elwood Jensen was 92.

Known as the “Father of the Nuclear Receptor Field,” Jensen was one of three researchers to share the 2004 Lasker Award for Basic Medical Research, what some call the American Nobel Prize.

The University of Cincinnati, where Jensen was a distinguished professor of cancer biology, noted that just one other of its graduates had won the honor, Albert Sabin, who developed a vaccine for polio.

“Some have estimated that his work annually saves or prolongs the lives of more than 100,000 women,” the university said in announcing his death.

A 1936 graduate of Springfield High School, Jensen was honored in 2008 as one of the Springfield City Schools Alumni of Distinction and he made periodic visits and lectures at Wittenberg University, one of five institutions to award him an honorary doctorate.

A 1940 graduate of Wittenberg, he went on to earn a Ph.D in organic chemistry from the University of Chicago, where he enjoyed a long career as a teacher and researcher. His interest in studying hormones began during 1946, when he spent a year as a Guggenheim Fellow at the Federal Institute of Technology at Zurich.

After his 1990 retirement from the University of Chicago, Jens also taught at Cornell, the University of Hamburg and the Karolinksa Institute in Stockholm and did research at the National Institutes of Health.

In 2003, the University of Cincinnati honored him by organizing the Jensen Symposium on Nuclear Receptors and Endocrine Disorders, which drew more than 300 top researchers from around the world.

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Experts: Kids are resilient in coping with trauma

WASHINGTON (AP) — They might not want to talk about the gunshots or the screams. But their toys might start getting into imaginary shootouts.

Last week’s school shooting in Connecticut raises the question: What will be the psychological fallout for the children who survived?

For people of any age, regaining a sense of security after surviving violence can take a long time. They’re at risk for lingering anxiety, depression, post-traumatic stress disorder.

But after the grief and fear fades, psychiatrists say most of Newtown‘s young survivors probably will cope without long-term emotional problems.

“Kids do tend to be highly resilient,” said Dr. Matthew Biel, chief of child and adolescent psychiatry at MedStar Georgetown University Hospital.

And one way that younger children try to make sense of trauma is through play. Youngsters may pull out action figures or stuffed animals and re-enact what they witnessed, perhaps multiple times.

“That’s the way they gain mastery over a situation that’s overwhelming,” Biel explained, saying it becomes a concern only if the child is clearly distressed while playing.

Nor is it unusual for children to chase each other playing cops-and-robbers, but now parents might see some also pretending they’re dead, added Dr. Melissa Brymer of the UCLA-Duke National Center for Child Traumatic Stress.

Among the challenges will be spotting which children are struggling enough that they may need professional help.

Newtown’s tragedy is particularly heart-wrenching because of what such young children grappled with — like the six first-graders who apparently had to run past their teacher’s body to escape to safety.

There’s little scientific research specifically on PTSD, post-traumatic stress disorder, in children exposed to a burst of violence, and even less to tell if a younger child will have a harder time healing than an older one.

Overall, scientists say studies of natural disasters and wars suggest most children eventually recover from traumatic experiences while a smaller proportion develop long-term disorders such as PTSD. Brymer says in her studies of school shootings, that fraction can range from 10 percent to a quarter of survivors, depending on what they actually experienced. A broader 2007 study found 13 percent of U.S. children exposed to different types of trauma reported some symptoms of PTSD, although less than 1 percent had enough for an official diagnosis.

Violence isn’t all that rare in childhood. In many parts of the world — and in inner-city neighborhoods in the U.S., too — children witness it repeatedly. They don’t become inured to it, Biel said, and more exposure means a greater chance of lasting psychological harm.

In Newtown, most at risk for longer-term problems are those who saw someone killed, said Dr. Carol North of the University of Texas Southwestern Medical Center, who has researched survivors of mass shootings.

Friday’s shootings were mostly in two classrooms of Sandy Hook Elementary School, which has about 450 students through fourth-grade.

But those who weren’t as close to the danger may be at extra risk, too, if this wasn’t their first trauma or they already had problems such as anxiety disorders that increase their vulnerability, she said.

Right after a traumatic event, it’s normal to have nightmares or trouble sleeping, to stick close to loved ones, and to be nervous or moody, Biel said.

To help, parents will have to follow their child’s lead. Grilling a child about a traumatic experience isn’t good, he stressed. Some children will ask a lot of questions, seeking reassurance, he said. Others will be quiet, thinking about the experience and maybe drawing or writing about it, or acting it out at playtime. Younger children may regress, becoming clingy or having tantrums.

Before second grade, their brains also are at a developmental stage some refer to as magical thinking, when it’s difficult to distinguish reality and fantasy. Parents may have to help them understand that a friend who died isn’t in pain or lonely but also isn’t coming back, Brymer said.

When problem behaviors or signs of distress continue for several weeks, Brymer says it’s time for an evaluation by a counselor or pediatrician.

Besides a supportive family, what helps? North advises getting children back into routines, together with their friends, and easing them back into a school setting. Studies of survivors of the Sept. 11 terrorist attacks found “the power of the support of the people who went through it with you is huge,” she said.

Children as young as first-graders can benefit from cognitive-behavioral therapy, Georgetown’s Biel said. They can calm themselves with breathing techniques. They also can learn to identify and label their feelings — anger, frustration, worry — and how to balance, say, a worried thought with a brave one.

Finally, avoid watching TV coverage of the shooting, as children may think it’s happening all over again, Biel added. He found that children who watched the 9/11 clips of planes hitting the World Trade Center thought they were seeing dozens of separate attacks.

___

EDITOR’S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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NICE may reject Roche’s Avastin for advanced ovarian cancer

LONDON (Reuters) – Britain’s healthcare cost-effectiveness watchdog said it may reject Roche Holding AG‘s drug Avastin for treating advanced ovarian cancer in combination with two standard chemotherapy drugs.

In the latest of a series of setbacks for the medicine, the National Institute for Health and Clinical Excellence (NICE) said Avastin used with chemotherapy drugs paclitaxel and carboplatin is not a cost-effective treatment for the government-funded National Health Service (NHS).

NICE said the drug costs around 2,500 pounds a month per patient.

Ovarian cancer is the fifth most common cancer in women in the UK and in 2009, the latest year for which data are available, there were nearly 7,000 new cases diagnosed in the country.

NICE rejected Avastin as a first-line treatment for advanced breast cancer in July. This was after drug regulators in the United States came to the same conclusion in 2011.

The watchdog will make a final decision on treating ovarian cancer with the drug, also known as bevacizumab, next year. Its latest guidance could change after feedback from a public consultation that runs to January 22, during which Roche could appeal.

In the meantime, NICE chief executive Andrew Dillon said that although the combination did appear to delay the spread of ovarian cancer in some patients, it was unclear whether it helped patients live longer overall.

“There was no evidence to show that the clinical benefit of the treatment justifies its cost, when compared to existing treatments – an important factor to consider, especially as the NHS has finite resources,” Dillon said in a statement.

Roche said it was disappointed but would work with NICE to win the regulator’s backing.

“Avastin is the first drug for 15 years that has been shown to improve outcomes for women with advanced ovarian cancer, and can halt the progression of the disease for up to six months compared to chemotherapy alone,” the company said.

Roche noted the drug was approved by the European Medicines Agency for treating advanced ovarian cancer in combination with standard chemotherapy in December 2011.

Until the final decision, NICE said the NHS should make decisions locally on funding the treatment but if the final decision goes against Roche, hospitals will not be able to use core NHS funds for the treatment.

(Reporting by Chris Wickham; Editing by Mark Potter)

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Daylight savings tied to bump in heart attack rates

(Reuters) – Setting the clock ahead for daylight savings time may set the scene for a small increase in heart attacks the next day, according to a U.S. study – which suggests that sleep deprivation may be to blame.

Researchers at two hospitals in the U.S. state of Michigan, whose findings appeared in the American Journal of Cardiology, reviewed six years of records and found that they treated an average of 23 heart attacks on the Sunday when the United States switched to daylight savings time. That compared to 13 on a typical Sunday.

“Nowadays, people are looking for how they can reduce their risk of heart disease and other ailments,” said Monica Jiddou, the study’s lead author and a cardiologist at William Beaumont Hospital in Royal Oak.

“Sleep is something we can potentially control. There are plenty of studies that show sleep can affect a person’s health.”

A 2008 Swedish report, for instance, found that the chance of a heart attack increased in the first three weekdays after the switch to daylight savings time, and decreased the Monday after the clocks returned to standard time in the autumn.

Jiddou told Reuters Health that her team wanted to see if their respective hospitals experienced the same increase and decrease in heart attacks seen in the Swedish study.

For the new study, she and her colleagues reviewed records for the 328 patients who were diagnosed with a heart attack during the week after a time change between 2006 and 2012, and for the 607 heart attack patients who were treated two weeks before and after the time shifts.

They found that except for the small increase on the Sunday that daylight savings time kicked in, there were no significant differences in heart attack rates in the first week after the spring clock change or in the fall, when people set clocks back.

The authors note, however, that the small trends they observed suggest shifts to and from daylight savings time may be linked with small increases in heart attacks in the spring, and small decreases in the fall.

They speculate that sleep deprivation resulting from the time changes could raise levels of stress hormones and inflammatory chemicals just enough to trigger a heart attack, especially in those already at high risk.

Though the slight increase in heart attacks in the days following time shifts were so small they could have been due to chance, Jiddou told Reuters Health that she believes the problem was the size of the study population.

“The numbers weren’t necessarily striking, but the trends make you stop and think,” she said.

But Steven Nissen, a cardiologist who is chair of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at the Cleveland Clinic, said that people should be carefully interpreting the findings.

“We haven’t generally thought that missing an hour of sleep causes heart attacks. This may or may not hold up,” Nissen said.

He added that while the study looks at a good question and he applauds the researchers’ efforts, but stressed the limitations of the results and noted that the size of the effect is not huge. SOURCE: http://bit.ly/W391bW

(Reporting from New York by Andrew Seaman; editing by Elaine Lies)

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California home for developmentally disabled faces abuse inquiry

SAN FRANCISCO (Reuters) – California health officials have threatened to shut down part of the state’s oldest home for developmentally disabled adults due to evidence of physical abuse and neglect, in a move that could displace nearly 300 of its residents.

The state-run Sonoma Developmental Center could lose its license to run one unit if it does not fix the problems, according to a letter the state health department sent this week to the director of the sprawling facility in Eldridge.

Monitors this month and last “documented incidents of abuse constituting immediate jeopardy, as well as actual serious threats to the physical safety of female clients in certain units,” the California Department of Public Health letter said.

Among the incidents were physical abuse, a staff member exposing himself to a female client and inadequate monitoring of a patient who had propensity to swallow inedible items, leading to surgery, said Pam Dickfoss, assistant deputy director of the California Center for Health Care Quality.

The threat of sanctions against the board-and-care center in the heart of wine country represents a significant blow to a historic facility that opened at its current site in 1891 next to the bucolic town of Sonoma.

The center is northern California‘s only state-run residential facility for developmentally disabled adults and sits on 1,000 acres of land, including a petting zoo and sports fields.

Closure of the unit under scrutiny, the Intermediate Care Facility, could require moving 290 of the center’s more than 500 residents, officials said. It is unclear where they would be sent and officials say they hope that will not be necessary.

Administrators have vowed to correct deficiencies and said they plan to appeal the move to potentially strip them of federal funding and a state license for the unit under scrutiny.

“We are moving quickly to fix this center and protect our residents,” said Terri Delgadillo, director of the state Department of Developmental Services, which oversees the center.

She said the problems forced the removal of the center’s executive and clinical directors as well as other staff changes.

State monitors identified 57 deficiencies during a July visit, including four that posed an immediate danger to residents, and dozens of other threats to residents in more recent visits, the letter said.

The facility gets $ 117,000 a day in federal funding, said Nancy Lungren, a spokeswoman for the California Department of Developmental Services.

Most of the center’s residents suffer from cerebral palsy, epilepsy, autism, or a combination of those conditions. Many have lived their entire adult lives at the center.

Leslie Morrison, director of the investigations unit of Disability Rights California, a watchdog group, said she was troubled by reports from the facility over the past year.

“This has been developing for a long period,” Morrison said. “They have been trying to correct things, but it’s going to take a long time.”

(Editing by Alex Dobuzinskis and Eric Walsh)

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Newtown Shooting: Young Kids Cope With Horror

Witnesses at Sandy Hook Elementary School reported horrific scenes as a shooter took 27 lives today — the shattering sounds of gunshots, children locked in the bathrooms and parents crying outside in the parking lot.

Experts say that the young children who saw events first-hand can have lasting psychological scars, but those whose home lives are stable and supportive will have fewer long-term scars.

“It was horrific,” said Kaitlin Roig, a 29-year-old teacher, who was in a morning meeting when the gunman entered the school.

“Suddenly, I heard rapid fire, like an assault weapon,” the first grade teacher told ABC. She rounded up her 14 students and locked them and herself in the bathroom. “I helped kids climb on the toilet dispenser [so they could all fit in].

“I thought we were going to die.”

CLICK HERE for more on the Newtown, Conn., School Shooting.

Children in such a situation “are terrified, and they don’t have the cognitive or emotional capacities to make sense of this,” said Dr. Nadine Kaslow, professor and vice chair of the department of psychiatry at Emory School of Medicine.

“Not that any of us can make any sense of this,” said Kaslow. “It’s truly inconceivable.”

At least 27 people, mostly children under the age of 10, were shot and killed at the K-to-4 school this morning, federal and state sources tell ABC News.

The massacre drew SWAT teams to the school and the town of Newtown locked down all its schools, authorities said today.

According to federal sources, the gunman was identified as Adam Lanza, 20. His mother, who worked at the elementary school, was one of the victims.

CLICK HERE for more photos from the scene.

One mother named Christine who has a child at Sandy Hook told ABC about the chaos that ensued when she arrived at the school this morning.

“When I got there, there were just parents running into the firehouse because they were directing us there. That’s where children had been evacuating to, and we went in and people were just grabbing their children and hugging and crying. There were lots of children crying.”

She said another parent who had been at the school at the time was “pretty broken up.” Many parents didn’t know where their children were.

In 1996 in Dunblane, Scotland, 15 children and a teacher were killed in a similar massacre.

Parents and caregivers play the most important role in a child’s recovery from a traumatic event, according to Dr. Gene Beresin, director of training in child and adolescent psychiatry at Massachusetts General Hospital.

“Children need to know that they are safe,” he said. “Are people taking care of me? How is this going to affect my life? They need to be reassured.”

“Thinking about kids in all disasters, you think about the airlines — when the oxygen mask drops, you put your mask on first and then help the child next,” said Beresin.

“Parents need to take care of themselves first. [The children] need to know you are calm and in control,” he said.

Adults and community support is critical, according to Beresin.

Young children who witness violence can have acute or post-traumatic stress disorder. “The immediate reaction is shock and horror,” he said.

After events like this, communities typically set up crisis centers in a church or other public place where people can seek professional and spiritual help.

Turn the television off, say experts, but answer your children’s questions. Don’t disregard an older sibling who is watching the news unfold and is worried. They need assurance, too, he said.

According to Beresin, young children may not have “discreet memories” of the event, but they can still have an emotional reaction, experiencing nightmares or, conversely, emotional numbing, said Beresin.

“Some kids shut down,” he said. “They may actually turn off and not want to be hugged or cuddled — that’s a normal response. Some kids are clingy, and others will withdraw.”

Kids can also regress in the aftermath of a traumatic event.

Parents should not force a child to open up, but “don’t let them be alone,” he said.

One way young children can work out problems are through reenactment. “They may be playing a game about shooting and dying, and parents should not stop that,” said Beresin. “Let them do it.”

Young children can also ask questions that don’t directly relate to the event, according to Rahill Briggs, assistant professor of pediatrics at Montefiore Medical Center in New York City.

“They can ask directly or less directly about guns, or heaven or death or about a pet that died,” she said.

In studies of 9/11 one of the findings — not a surprising one — after the terrorist attacks was that those who were most directly affected “suffered the most,” according to Briggs. Coping with grief long-term depended on the cohesion of the child’s family — “how well the caregiving system responds to distress. When it is proactive, by definition the children do better.”

“What was the most incredibly predictive five years out was how everyone was doing before the incident,” said Briggs. “It is the same for mental health in general, those who are coping well in their lives before a trauma are the most likely to cope well afterwards — even if they saw the towers fall.”

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Mandela’s Infection May Be Pneumonia

Nelson Mandela is being treated for a lung infection, a term often used synonymously with pneumonia.

Elderly people are at an increased risk for infections in general – more so if the person has many chronic medical problems, but as people age their immune systems are less capable of fighting off infections.

South African officials say Mandela’s lung infection is “recurring.” The former president is 94 years old.

As elderly people become more and more infirm, they have a decreased cough response and may aspirate oral secretions into their lungs, raising the risk of infections. And if someone is bedridden, their breaths become more shallow, raising the risk even more.

It may seem surprising that it took so long for Mandela’s diagnosis to be made public. However, it’s possible that it took this long to make a diagnosis.

Elderly people respond differently to pneumonia, meaning they might lack common symptoms like fever and cough, and instead show signs of confusion. The evaluation of change in physical or mental condition in someone of Mandela’s age is broad with much testing needed to make a diagnosis.

There are different types of pneumonia including viral (caused by influenza), bacterial (caused by pneumococcus or tuberculosis), fungal and parasitic. I suspect Mr. Mandela most likely has a viral or bacterial pneumonia. If he does, they are likely treating him with antibiotics and providing respiratory support.

Pneumonia is a leading infectious cause of death in the elderly. But with proper treatment, many do recover.

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In Search of a Better Condom

It’s hard to believe, but the condom is still the only way to protect against pregnancy and HIV at the same time. But researchers say they believe they can develop a kind of 21st-century contraceptive that offers superior protection against pregnancy and sexually transmitted diseases and that people will like enough to use consistently.

A paper describing early work on the project was published earlier this month in the journal PLoS One. The research team, led by Kim Woodrow at the University of Washington, received a grant of nearly $ 1 million last month from the Bill & Melinda Gates Foundation to pursue the research.

The product is an electrically spun cloth with nanometer-sized fibers that can dissolve to release drugs, such as medications that prevent pregnancy and HIV infection. The drug-eluting fibers represent “multipurpose prevention technology,” a method that simultaneously prevents sexually transmitted infections and unintended pregnancy through a combined physical and chemical barrier.

MORE: HIV Vaccine Under Study May Last A Lifetime

“Condoms and vaginal rings and IUDs have been around for a very long time,” Cameron Ball, a co-author of the paper and graduate student in bioengineering, told TakePart. “People would like more options. No one option will be the silver bullet. The idea is to have multiple options that people can choose for their lifestyle.”

Improved methods to protect against STDs and pregnancy are needed in both developing and developed countries. The spermacide nonoxynol-9 is highly effective at pregnancy prevention but promotes vaginal inflammation, which then increases the risk of STD transmission.

“What we’re hoping to provide is a method of drug delivery that could be used with a variety of drug compounds,” Ball says. “There are multiple products in the development pipeline to address this need. These are largely vaginal rings, but vaginal rings are limited in what they are able to deliver. They deliver compounds that are less water soluble. Using fibers allows you to work with multiple drugs with different properties. You can have combinations of pharmaceutical agents that you couldn’t necessarily have with a vaginal ring or with a condom.”

MORE: HIV-Positive Women Benefit from Human Papillovirus Vaccination

During electrospinning, an electric field is used to launch a charged fluid jet through the air to create extremely delicate nanometer-scale fibers that stick to a collection plate. (One nanometer is about one 25-millionth of an inch.) The stretchy fibers are the platform for delivering medications in the same way that drugs are delivered through pills or gels. The fibers can also carry larger molecules, such as proteins and antibodies, that are hard to deliver through other methods. So far, the team has created a fabric that serves as a physical barrier to block sperm or to release drugs, such as contraceptives and antiviral medications.

The fabric dissolves within minutes, which is considered a benefit because it offers immediate and discreet protection. But the approach also allows for controlled release of multiple compounds, Ball says. Last year, a study aimed at preventing heterosexual HIV transmission using a gel with the drug tenofovir failed—the likely result of the drug’s strength fading by the time of sex.

“If you can have a longer-lasting gel with nanoparticles, that would be beneficial,” Ball says. “We’re trying to fill a niche in terms of product lifespan.”

MORE: Ob-Gyns: Sell ‘The Pill’ Over The Counter

The cloth could be inserted directly into the body or used as a coating on vaginal rings or other products, Ball says. While the primary goal of the research is for products that can be used in places like Africa, where HIV transmission is especially high,  the technology could appeal to a wide range of societies and cultures.

“You could have fibers that stay in place for longer or be shaped in the shape of a diaphragm,” he says. “You could include herpes medication. Herpes prevention is somewhat controversial—it’s not clear whether taking herpes medications prophylactically will help prevent the spread of the virus. That is another application, potentially.”

Question: Do you think people want new ways to protect against pregnancy and sexually transmitted diseases? Tell us what you think in the comments.

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Shari Roan is an award-winning health writer based in Southern California. She is the author of three books on health and science subjects.

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More “fiscal cliff” talks but neither side giving ground

WASHINGTON (Reuters) – The White House and House of Representatives Speaker John Boehner’s office held more negotiations on Monday on ways to break the “fiscal cliff” stalemate, although neither side showed any public signs that they were ready to give ground.

The talks gained urgency after Republican Boehner met at the White House with President Barack Obama on Sunday, raising hopes of progress in averting the onset of tax increases and spending cuts that kicks in on January 1 unless Congress intervenes.

But while striking a more conciliatory tone, both sides kept to a familiar script in the weeks-long standoff. Obama renewed his call for higher tax rates for the richest Americans, which most Republicans oppose, while Republican leaders urged Obama to submit a new offer with specific spending cuts he would back.

Economists say going over the fiscal cliff could throw the U.S. economy back into a recession.

On a road trip to Michigan to drum up support for his stance, Obama said he was willing to compromise on some things but not on his demand that Republicans support an increase in tax rates for the wealthiest 2 percent of Americans.

“What you need is a package that keeps taxes where they are for middle-class families, we make some tough spending cuts on things that we don’t need, and then we ask the wealthiest Americans to pay a slightly higher tax rate, and that’s a principle I won’t compromise on,” Obama said during a visit to an auto plant in Redford, Michigan.

Boehner spokesman Michael Steel said Republicans were still waiting for the president to make a new offer that identifies the spending cuts he will make in the deficit-reduction negotiations.

“The Republican offer made last week remains the Republican offer,” Steel said, adding the two sides were holding staff-level talks on Monday.

Boehner and the House Republican leadership submitted their terms for a deal to the White House last week, after Obama presented his opening proposal. Both sides seek to cut budget deficits by more than $ 4 trillion over the next 10 years but differ drastically on how to get there.

Boehner and Republicans oppose letting any tax rates increase and prefer to find new revenues by closing loopholes and limiting deductions. Republicans also want deeper spending cuts than Obama has offered in entitlements like the Medicare and Medicaid healthcare programs.

Democrats have insisted that tax rates for the richest must be nailed down before negotiating further on how to proceed with tax reform efforts or new spending cuts in entitlement programs.

‘A DEAL IS POSSIBLE’

“I can only say that the president believes that a deal is possible,” White House spokesman Jay Carney told reporters on the flight to Michigan. “But it requires acceptance and acknowledgement in a concrete way by Republicans that the top 2 percent will see an increase in their rates.”

Financial markets have calmed recently after a series of wild swings, when nearly every utterance from a politician about the looming budget crisis caused volatility in stock prices.

Polling shows most Americans would blame Republicans if the country goes over the cliff, and pressure has been building from some Republicans for Boehner to get an agreement quickly, even if it means tax hikes on the wealthiest.

Republican Senator Bob Corker of Tennessee called for a quick deal with the White House to allow an extension of the lower tax rates that have been in place for about a decade, except for the top two rates that Obama wants to raise.

“Right now there is no question in my mind the president has the slight upper hand in the negotiations,” Corker said on CNBC on Monday.

He said there was support among Senate Republicans for taking that step so the fiscal cliff negotiations could then shift to focusing on how to restrain the growing costs of Medicare and other entitlement programs.

“If you did it this week (agree to raising tax rates on the richest) you’d have the rest of this month to have the focus totally on entitlements,” said Corker, who has a record of reaching out to Democrats on major bills.

More conservative Senate Republicans, most notably Senator Tom Coburn of Oklahoma, also have signaled a willingness to let tax rates rise on higher-income groups.

Erskine Bowles, co-chairman of the so-called Bowles-Simpson deficit reduction commission, said he thought chances were improving for a deal.

“I think the atmospherics are getting so much better. We have kind of gotten out of Kabuki theater and gone to dancing the tango,” Bowles told CNBC on Monday. “Any time you start to tango you’ve got a chance.”

Bowles said he did not expect the president to give in on his demand that taxes rise for the top 2 percent of earners.

“I would almost guarantee that rates are going to go up for people in the top 2 percent,” he said.

U.S. stocks edged higher on Monday but moves remained muted as investors looked for any signs of movement on the fiscal cliff front.

The S&P 500 index has nearly retraced the 5.3 percent slide it suffered in the first seven sessions after the November 6 presidential election.

“The sentiment has definitely changed,” said Andrew Wilkinson, chief economic strategist at Miller Tabak & Co in New York. “The market has become somewhat desensitized to headlines out of Washington because the fear of the economy hitting a wall in 2013 if we don’t get a deal done has diminished.”

(Additional reporting by Steve Holland, Jeff Mason, Thomas Ferraro, Susan Heavey and Franklin Paul; Writing by John Whitesides; Editing by Alistair Bell and Eric Beech)

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Health workers march in Spain’s capital against cuts, reforms

MADRID (Reuters) – Thousands of health workers, on strike since last month, marched on Sunday in Madrid to protest against budget cuts and plans from the Spanish capital’s regional government to privatize the management of public hospitals and medical centers.

It was the third time doctors, nurses and health workers have rallied since the local authorities put forward a plan in October to place six hospitals and dozens of medical practices under private management. The plan also calls for patients to be charged a fee of 1 euro for prescriptions.

Workers launched an indefinite strike last month against the plan, which has not been endorsed by the centre-right government of Prime Minister Mariano Rajoy. Health workers in the capital are striking Monday-Thursday each week and seeing patients only on Fridays, while also responding to emergencies.

Spain’s 17 autonomous regions control health and education policies and spending. They have all had to implement steep cuts this year as the country struggles to meet tough European Union-agreed deficit targets.

Dressed in white scrubs, the protesters shouted slogans such as “Health is not for sale” and “Health 100 percent public, no to privatizations”.

“Of course, privatization can be reversed. Actually the question is not if it can be reversed, because privatization should never have a future,” said Luis Alvarez, an unemployed man from Madrid attending the demonstration.

Belen Padilla, a doctor at Madrid’s hospital Gregorio Maranon, said one million citizens had already signed a petition rejecting the plan.

(Reporting by Reuters Television; Writing by Julien Toyer; Editing by Peter Graff)

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When drugs for depression fail, talking therapies help

LONDON (Reuters) – Patients with depression who fail to benefit from antidepressant drugs may do better if they are also treated with a type of “talking” psychotherapy called CBT, according to new research published on Friday.

In the first large-scale trial to test the effectiveness of cognitive behavioral therapy, or CBT, alongside medication for depression, scientists said they found that the combination works where drug treatment alone fails.

Nicola Wiles of Bristol University‘s school of social and community medicine, who led the study, said the findings underline the need to increase the availability of therapy for depressed patients.

“While there have been initiatives to increase access to CBT in both the UK and Australia, worldwide initiatives are rare,” she said in a statement.

Wiles and colleagues recruited 469 adults from across Britain who had not responded to at least 6 weeks of treatment with an antidepressant. For the study, 235 patients continued with their usual antidepressant medication, while 234 patients got their usual care plus CBT and were followed up for 12 months.

The results, published in The Lancet medical journal, showed that after 6 months, 46 percent of those who got CBT as well as their usual care had improved – reporting at least a 50 percent reduction in their depressive symptoms. This compared to 22 percent of those who did not get CBT.

Patients treated with CBT, which involves talking through behaviors and ways of thinking with a trained psychotherapist or psychologist, were also more likely to go into remission and have fewer symptoms of anxiety, the researchers said. Similar effects were reported at 12 months.

Major depression affects around 20 percent of people at some point in their lives. The World Health Organization (WHO)predicts that by 2020, depression will rival heart disease as the health disorder with the highest global disease burden.

While there are many antidepressants on the market, including top sellers such as Prozac and Seroxat, it is widely accepted that many antidepressants work in only half of patients half of the time, and drugmakers are struggling to come up with a new generation of drugs in this field.

Willem Kuyken, a clinical psychology professor at Exeter University who also worked on the study, said its results showed that doctors and patients should be looking beyond drugs.

“This trial provides further evidence that psychological treatments like cognitive therapy can provide substantive and lasting help to people who suffer depression,” he said.

Wiles added, however, that even in wealthy countries such as Britain, where there has been a recent push to invest more into psychological therapies, many people who have not responded to antidepressants still don’t get the chance of trying intensive CBT that take between 12 and 18 sessions.

In the United States, only about a quarter of people with depression have received any form of psychological therapy in the last 12 months, she said.

(Editing by Sonya Hepinstall)

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Medicare emerging as prime target in U.S. “fiscal cliff” talks

WASHINGTON (Reuters) – With rival Democratic and Republican deficit plans increasingly focused on Medicare, experts say the two sides could be edging toward common ground on important changes to the popular health insurance program for seniors and the disabled.

None of the changes are assured and any specific decisions would come only after resolution of the “fiscal cliff,” the combination of tax hikes and spending cuts that’s driving the discussion.

But several ideas that have circulated among policymakers for years are frequently mentioned as the parties get more serious, and ever more specific, about how to control the exploding costs of so-called entitlement programs including Medicare.

The proposals most often discussed that would directly affect Medicare’s 52 million beneficiaries are more means-testing, meaning higher costs for wealthier retirees, and raising the Medicare eligibility age from 65 to 67.

Other proposals on the table would reduce payments for hospitals, nursing homes, drug makers, insurers and physicians.

Medicare, a $ 590 billion-a-year program long seen as an untouchable third rail in U.S. politics, has been augmented but rarely trimmed. A change in eligibility would not alter traditional benefits. But Medicare would not be available to all senior citizens aged 65 and older for the first time since the program’s creation in 1965.

While Medicare has formidable allies who oppose program changes for beneficiaries, including liberal Democrats, large segments of the public and AARP, the powerful lobby for older Americans, deeper sacrifices have moved closer to the center of the public debate over the budget deficit, with some top Democrats leaving the door to compromise ajar.

Cutbacks, along with spending reductions for other healthcare programs including the Medicaid program for the poor, could produce $ 400 billion to $ 600 billion in savings over 10 years as part of a deficit-cutting agreement Congress and the White House must reach to avoid the so-called fiscal cliff.

Potential Medicare savings, combined with the $ 716 billion in reduced payment increases for healthcare providers in the program enacted under President Barack Obama‘s healthcare overhaul, could come to more than $ 1 trillion over the next decade.

“It’s going to hit everybody,” said Joseph Antos, health expert with the conservative American Enterprise Institute.

Senate Minority Leader Mitch McConnell, in a Wall Street Journal interview, said an increase in the Medicare eligibility age would be a prerequisite for Republican willingness to accept higher revenues — though not higher tax rates — as part of a deficit-reduction deal.

Asked during a television interview on Tuesday about McConnell’s proposal, Obama said that McConnell and John Boehner, the Republican House of Representatives speaker, “know that I’m prepared to make some tough decisions on some of these issues,” quickly adding that he can’t ask Medicare beneficiaries “to sacrifice and not ask anything of higher-income folks.”

SAFE ROAD TO RE-ELECTION?

One of the president’s closest allies in the Senate, Illinois Democrat Richard Durbin, broached the subject last week in a speech urging his left-leaning fellow party members to accept the notion of Medicare changes.

“If anybody wants to talk about a later eligibility age for Medicare, what I want to hear is the assurance and guarantee that people … will have access to affordable healthcare and insurance” before they reach the age, Durbin said.

Some Medicare defenders have put forward plans to reduce the program’s spending without affecting beneficiaries. The Center for American Progress, a liberal think tank, has proposed trimming nearly $ 40 billion in healthcare costs simply by requiring product-makers, service providers and insurers to submit to competitive bidding.

Alice Rivlin, a White House budget director under President Bill Clinton and a leading voice for bipartisan solutions in the current deficit debate, says there is potentially a lot of common ground between Republicans and Democrats, particularly on healthcare. “But at the moment, it’s hard to know what they’re talking about. All we’re really seeing is numbers,” she said.

The contours of the healthcare debate have been shaped in part by Obama’s 2013 budget proposals, which would trim more than $ 350 billion from Medicare and Medicaid, and unspecified demands for $ 600 billion in healthcare reductions from House Republicans.

Raising the age of eligibility could save $ 148 billion in Medicare spending over the next 10 years, according to the non-partisan Congressional Budget Office. But critics say the change would only shift costs onto employers and beneficiaries, some of whom might have to forego coverage.

The savings would represent a 50 percent increase over the $ 300 billion in Medicare cost-cuts outlined in Obama’s 2013 budget, which officials describe as the basis for the White House bid to reduce healthcare and entitlement spending by $ 400 billion over 10 years.

The Obama budget would save $ 28 billion by increasing Medicare premiums for wealthier beneficiaries. But the lion’s share of savings would come from changes in payments to drug makers and providers.

Meanwhile, Republican lobbyists, looking to help healthcare providers avoid further Medicare cuts, are also pushing to unify Medicare deductibles and co-insurance rates, and possibly limit the use of private insurance known as Medigap, in exchange for establishing a ceiling on beneficiary out-of-pocket costs. There are different deductibles and co-insurance rates for different segments of the program and the push is to establish a single deductible and single co-insurance rate, presumably at higher rates than people pay now.

“The amount of the spending-reduction targets will determine how far they go in terms of spending cuts and more fundamental changes to Medicare, and secondarily what they do to Medicaid,” said Drew Altman, president of the non-partisan Kaiser Family Foundation.

“Whatever they do, they’ll call reform, because it sounds better. But really they’re talking about cutting spending.”

A Harvard analysis of polling data found that 47 percent of Americans favor a higher eligibility age for Medicare and 54 percent are in favor of more means testing, suggesting that lawmakers who are up for re-election in 2014 may not suffer greatly by altering the equation for Medicare beneficiaries.

“In a world where things are not wildly popular in general, these are the least unpopular things you can do,” said Robert Blendon of the Harvard School of Public Health. “It’s a safe road.”

(Editing by Fred Barbash and Eric Beech)

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Fossil fuel subsidies in focus at climate talks

DOHA, Qatar (AP) — Hassan al-Kubaisi considers it a gift from above that drivers in oil- and gas-rich Qatar only have to pay $ 1 per gallon at the pump.

“Thank God that our country is an oil producer and the price of gasoline is one of the lowest,” al-Kubaisi said, filling up his Toyota Land Cruiser at a gas station in Doha. “God has given us a blessing.”

To those looking for a global response to climate change, it’s more like a curse.

Qatar — the host of U.N. climate talks that entered their final week Monday — is among dozens of countries that keep gas prices artificially low through subsidies that exceeded $ 500 billion globally last year. Renewable energy worldwide received six times less support — an imbalance that is just starting to earn attention in the divisive negotiations on curbing the carbon emissions blamed for heating the planet.

“We need to stop funding the problem, and start funding the solution,” said Steve Kretzmann, of Oil Change International, an advocacy group for clean energy.

His group presented research Monday showing that in addition to the fuel subsidies in developing countries, rich nations in 2011 gave more than $ 58 billion in tax breaks and other production subsidies to the fossil fuel industry. The U.S. figure was $ 13 billion.

The Paris-based Organization for Economic Cooperation and Development has calculated that removing fossil fuel subsidies could reduce carbon emissions by more than 10 percent by 2050.

Yet the argument is just recently gaining traction in climate negotiations, which in two decades have failed to halt the rising temperatures that are melting Arctic ice, raising sea levels and shifting weather patterns with impacts on droughts and floods.

In Doha, the talks have been slowed by wrangling over financial aid to help poor countries cope with global warming and how to divide carbon emissions rights until 2020 when a new planned climate treaty is supposed to enter force. Calls are now intensifying to include fossil fuel subsidies as a key part of the discussion.

“I think it is manifestly clear … that this is a massive missing piece of the climate change jigsaw puzzle,” said Tim Groser, New Zealand’s minister for climate change.

He is spearheading an initiative backed by Scandinavian countries and some developing countries to put fuel subsidies on the agenda in various forums, citing the U.N. talks as a “natural home” for the debate.

The G-20 called for their elimination in 2009, and the issue also came up at the U.N. earth summit in Rio de Janeiro earlier this year. Frustrated that not much has happened since, European Union climate commissioner Connie Hedegaard said Monday she planned to raise the issue with environment ministers on the sidelines of the talks in Doha.

Many developing countries are positive toward phasing out fossil fuel subsidies, not just to protect the climate but to balance budgets. Subsidies introduced as a form of welfare benefit decades ago have become an increasing burden to many countries as oil prices soar.

“We are reviewing the subsidy periodically in the context of the total economy for Qatar,” the tiny Persian gulf country’s energy minister, Mohammed bin Saleh al-Sada, told reporters Monday.

Qatar’s National Development Strategy 2011-2016 states it more bluntly, saying fuel subsides are “at odds with the aspirations” and sustainability objectives of the wealthy emirate.

The problem is that getting rid of them comes with a heavy political price.

When Jordan raised fuel prices last month, angry crowds poured into the streets, torching police cars, government offices and private banks in the most sustained protests to hit the country since the start of the Arab unrest. One person was killed and 75 others were injured in the violence.

Nigeria, Indonesia, India and Sudan have also seen violent protests this year as governments tried to bring fuel prices closer to market rates.

Iran has used a phased approach to lift fuel subsidies over the past several years, but its pump prices remain among the cheapest in the world.

“People perceive it as something that the government is taking away from them,” said Kretzmann. “The trick is we need to do it in a way that doesn’t harm the poor.”

The International Energy Agency found in 2010 that fuel subsidies are not an effective measure against poverty because only 8 percent of such subsidies reached the bottom 20 percent of income earners.

The IEA, which only looked at consumption subsidies, this year said they “remain most prevalent in the Middle East and North Africa, where momentum toward their reform appears to have been lost.”

In the U.S., environmental groups say fossil fuel subsidies include tax breaks, the foreign tax credit and the credit for production of nonconventional fuels.

Industry groups, like the Independent Petroleum Association of America, are against removing such support, saying that would harm smaller companies, rather than the big oil giants.

In Doha, Mohammed Adow, a climate activist with Christian Aid, called all fuel subsidies “reckless and dangerous,” but described removing subsidies on the production side as “low-hanging fruit” for governments if they are serious about dealing with climate change.

“It’s going to oil and coal companies that don’t need it in the first place,” he said.

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Associated Press writers Abdullah Rebhy in Doha, Qatar, and Brian Murphy in Dubai, United Arab Emirates, contributed to this report

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Karl Ritter can be reached at www.twitter.com/karl_ritter

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Diabetes may be linked to hearing loss: study

(Reuters) – Diabetes has already been tied to an increased risk of kidney and cardiovascular troubles, nerve damage and vision loss, and now a Japanese study finds diabetics to be more than twice as likely as those without the disease to have hearing impairment.

In a review of past research on the issue, published in the Journal of Clinical Endocrinology and Metabolism, scientists found that younger diabetics were at even higher risk than older adults, though they could not explain why.

“Current meta-analysis suggests that the higher prevalence of hearing impairment in diabetic patients compared with nondiabetic patients was consistent regardless of age,” wrote lead researcher Chika Horikawa, at Niigata University Faculty of Medicine, and colleagues.

It’s not the first time researchers have found a link between diabetes and hearing loss. In 2008, researchers from the U.S. National Institutes of Health (NIH) saw similar patterns in a sample of more than 11,000 people, with people with diabetes twice as likely to have hearing loss as those without.

It’s thought that high blood sugar levels brought on by diabetes may lead to hearing loss by damaging blood vessels in the ears, said Horikawa.

Horikawa and colleagues collected information from 13 previous studies examining the link between diabetes and hearing loss and published between 1977 and 2011. Together, the data covered 7,377 diabetes and 12,817 people without the condition.

Overall, Horikawa‘s team found that diabetics were 2.15 times as likely as people without the disease to have hearing loss. But when the results were broken down by age, people under 60 had 2.61 times the risk while people over 60 hand 1.58 times higher risk.

Some experts caution that this kind of study does not prove that diabetes is directly responsible for the greater hearing loss rates.

“It doesn’t definitively answer the question, but it continues to raise an important point that patients might ask about,” said Steven Smith, a diabetes specialist at the Mayo Clinic in Rochester, Minnesota.

The researchers note that future studies that take more factors into account, such as age and noisy environment, are needed to clarify the link between diabetes and hearing loss.

Still, Horikawa told Reuters Health in an email, people should recognize that diabetics may be at risk for hearing loss based on their results.

“Furthermore, these results propose that diabetic patients are screened for hearing impairment from (an) earlier age compared with non-diabetics,” said Horikawa, adding that hearing loss has also been linked to an increased risk of depression and dementia. SOURCE: http:.//bit.ly/RIVeeW

(Reporting from New York by Andrew Seaman at Reuters Health; editing by Elaine Lies)

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