2018/12 - Older women with excess body fat have higher breast cancer risk - Excess body
fat in postmenopausal women, even those with a normal BMI, may increase the risk of estrogen-
dependent breast cancer, researchers reported in JAMA Oncology. An 11-pound increase in
whole-body fat mass was linked to a 35% increased risk, and an 11-pound increase in fat mass of
the body trunk was associated with a 56% higher risk.

2018/12 - Poor vaccination rates tied to rising measles prevalence - The number of reported
measles cases around the world rose by 31% from 2016 to 2017, affecting more than 6.7 million
individuals, most of whom were young children. The increase is attributed, in part, to inadequate
vaccine coverage, according to a report from the CDC and the World Health Organization

2018/11 - Healthy midlife lifestyle may reduce atherosclerosis in women - Women who
maintain a healthy lifestyle at midlife, including diet, not smoking and physical activity, may have
less subclinical atherosclerosis, compared with those who have less-healthy behaviors, according
to a study in the Journal of the American Heart Association.

2018/10 - US life expectancy falls for 3rd straight year - Average life expectancy for
Americans was 78.6 years in 2017, modestly lower than the 78.7 average the year before and the
third consecutive year of decline. The last time the US experienced declining life expectancy over
multiple years was in the 1960s.

2018/09 - Study links nondaily smoking to higher mortality risks - A study in the American
Journal of Preventive Medicine found lifelong nondaily smokers had a 72% higher risk of all-cause
mortality, compared with people who had never smoked, and also had higher risks of death from
heart disease, respiratory disease and cancer. Lifelong nondaily smokers had a median life
expectancy of about five years less than people who never smoked.

2018/08 - Foods with added sugar tied to increased diabetes risk, study finds - A review of studies
showed that eating too many foods with added sugar, such as baked goods, breakfast cereals,
soft drinks and sweets, may be associated with an increased risk of developing diabetes,
compared with foods that naturally contain fructose sugars, such as fruits, natural fruit juice and
vegetables, which do not lead to increased blood glucose levels. The findings were based on 155
previous studies that followed individuals with and without diabetes for up to 12 weeks.

2018/07 - Evidence Based Medicine was supposed to be the answer and Randomized Control
Trial (RCT) were supposed to be the gold standard.  Perhaps we haven't quite solved the
problem.  In a three part series of articles, Dr, Anish Koka explains why science often falls short of
giving us the answers we need.

 
The EBM Wars: Manufacturing Equipoise (Part 1)     
 
The EBM Wars: When Evidence has a Price – The ECMO Trials (Part 2)         
 
The Evidence Crisis: Causal Inference – Don’t be a chicken (Part 3)                       

2018/07 - India’s Health Insurance Experiment. Who will be the winners?  Healthcare is a peculiar
industry in which a sure way of accelerating healthcare inflation is by subsidizing or paying for
health insurance. Insurance is like Newton’s Second Law of Motion – the velocity keeps increasing
as long as the force is applied.

2018/06 - Why is the United States the most expensive place in the world to get sick?  In the book,
“Overcharged: Why Americans Pay Too Much For Health Care”, the authors argue that the main
reason is that we pay for medical treatments the wrong way. Instead of having consumers
purchase these treatments directly, we route trillions of dollars through third-parties payers – both
government and private insurers.  Relying on third party payers has many consequences — few of
them good. To start with, this arrangement removes the budgetary constraint that would otherwise
cap the amount consumers are willing to spend. By minimizing the direct cost of treatments at the
point of sale, third party payment arrangements fundamentally alter everyone’s incentives .

2018/06 - The verdict is in: All three of CMS’s ‘medical home’ demonstrations have failed - The
Center for Medicare Services (CMS) released final evaluations of all three of its "medical home"
demonstrations. All three demonstration failed. This spells bad news not just for the “patient-
centered medical home” (PCMH) project, but for MACRA. The PCMH, along with the ACO and the
bundled payment (BP), is one of the three main “alternative payment models” (APMs) within which
doctors are supposed to be able to find shelter from the financial penalties inflicted by the MIPS
(Merit-based Incentive Payment System) program which was recently declared to be unworkable
by the Medicare Payment Advisory Commission. Medicare ACOs and virtually all Medicare BP
programs are also failing. Thus, we may conclude what some predicted a long time ago – that
neither arm of MACRA (the toxic MIPS program and the byzantine APM program) will work.

2018/06 -  Exercise is good for seniors' cognition.  A study in Neurology: Clinical Practice showed
that regular exercise of any type -- from aerobic activity to weightlifting and mind-body exercises --
may contribute to cognitive performance among older adults. Researchers evaluated 98
randomized controlled trials involving more than 11,000 participants and found that healthy older
adults as well as those with mild impairment best maintained cognitive performance by engaging in
at least 52 hours of exercise over six months.

2018/05 - Prolonged time outdoors may lower odds of myopia in some children.   Children ages 7
to 10 without myopia who spent prolonged time outdoors had a significantly lower likelihood of
myopia onset at age 14, according to a study presented at the Association for Research in Vision
and Ophthalmology annual meeting. The findings also associated having two parents with myopia
with a higher myopia risk among youths, while time spent reading had no impact.

2018/05 - Fewer people have ideal cardiovascular health.  The number of people with an ideal
cardiovascular health score, based on seven lifestyle and biological measures, decreased from
8.5% to 5.9% from 1991 to 2008, according to a study in the Journal of the American Heart
Association. Researchers said the decrease was due mainly to poorer scores for body mass index,
blood pressure, blood glucose and cholesterol.

2018/04 - The Medicare Payment Advisory Commission (MedPAC) finally urged Congress to end
Medicare's Merit-based Incentive Payment System because it could hamper physicians' transition
to advanced alternative payment models and the program's design flaws will likely not improve
quality of care, according to the panel's March report to Congress. The question now - what will
Medicare try next as it tries to control cost.  
Read more.

2018/03 - Why did we need Accountable Care Organizations (ACOs) in addition to insurance
companies (Part 1)?  What were ACO proponents thinking would happen? We know they thought
ACOs would perform much better than they have. But how much better?  For the full story, read
more in
Part 2 of this article.

2018/02 - The Health-Care Conspiracy of Silence - If the combined resources of Bezos (Amzon),
Buffett (Berkshire Hathaway)and Dimon (J.P. Morgan) want to reduce costs, they will need to focus
on the tax exclusion. Wall Street Journal,2,8,2018.  Note, this article may have access limited by a
pay wall.

2018/02 - MedPAC’s Repeal And Replace MIPs Campaign Will Not End Well - The pay-for-
performance (P4P) scheme imposed on the traditional fee-for-service Medicare program by an act
of Congress is known as MACRA.  After thirteen years, the commissioners finally agreed that P4P
cannot work for multiple reasons, the most important being that the pools of patients treated by
individual doctors are too small to permit accurate measurement of cost and quality.  

2018/02 - Bigger is Not Always Better: How Consolidation in Health Care Hurts Patients - Patients
should worry about consolidation in the health care industry.   Consolidation often limits
competition, and when that happens in market-based systems  the result  is often higher health
care cost.  

2018/01 - Think you know the flu? Ok, let's test your flu IQ.  Click here to view the quiz.



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