HHS News Release
Individuals’ genetic information will have greater protections through new regulations issued last week, by the U.S. Departments of Health and Human Services (HHS), Labor, and the Treasury.
The interim final rule will help ensure that genetic information is not used adversely in determining health care coverage and will encourage more individuals to participate in genetic testing, which can help better identify and prevent certain illnesses.
“Echoing the late Senator Ted Kennedy, our efforts to protect Americans undergoing genetic testing from having the results of that testing used against them by their insurance companies is one of the ‘first major new civil rights’ of the new century,” said HHS Secretary Kathleen Sebelius. “Consumer confidence in genetic testing can now grow and help researchers get a better handle on the genetic basis of diseases. Genetic testing will encourage the early diagnosis and treatment of certain diseases while allowing scientists to develop new medicines, treatments, and therapies.”
The interim final rule with request for comments and the notice of proposed rulemaking implement Title I of the Genetic Information Nondiscrimination Act of 2008 (GINA). Under GINA, and the interim final rule, group health plans and issuers in the group market cannot: increase premiums for the group based on the results of one enrollee’s genetic information; deny enrollment; impose pre-existing condition exclusions; or do other forms of underwriting based on genetic information. In the individual health insurance market, GINA prohibits issuers from using genetic information to deny coverage, raise premiums, or impose pre-existing condition exclusions.
Further, under GINA and the new interim final regulations, group health plans and health insurance issuers in both the group and individual markets cannot request, require or buy genetic information for underwriting purposes or prior to and in connection with enrollment. Finally, plans and issuers are generally prohibited from asking individuals or family members to undergo a genetic test.
“Today’s genetic technologies yield data that are vital to helping Americans make personal, medical decisions. It is essential that we protect such information and ensure it is not misused by health plans or insurers,” said Labor Secretary Hilda L. Solis. “The rules issued today protect individuals against the unwarranted use of information related to their personal health because no one should have to fear that disclosure of their medical data will put their job or health coverage at risk.”
Additionally, HHS, through its Office for Civil Rights (OCR), issued a notice of proposed rulemaking with a 60-day comment period, to propose changes to the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule to prohibit health plans from using or disclosing genetic information for underwriting purposes.
The proposed rule published today modifies the HIPAA Privacy Rule pursuant to GINA Title I to clarify that genetic information is health information and to prohibit the use and disclosure of genetic information by covered health plans for eligibility determinations, premium computations, applications of any pre-existing condition exclusions, and any other activities related to the creation, renewal, or replacement of a contract of health insurance or health benefits. In combination with the new penalties for violations of the HIPAA Privacy Rule, as provided for by the American Recovery and Reinvestment Act of 2009, a use or disclosure of genetic information in violation of the HIPAA Privacy Rule could result in a fine of $100 to $50,000 or more for each violation.
Please visit http://www.federalregister.gov/OFRUpload/OFRData/2009-22504_PI.pdf to view the new regulations and www.dol.gov/ebsa for more information about them. For additional information on the OCR notice of proposed rulemaking, please visit: www.hhs.gov/ocr/privacy.
By Gabe Mirkin MD, Autumn 2009 — Many people can control high blood pressure with diet and other lifestyle changes if they are sufficiently motivated. If you suffer from high blood pressure, go on my modified DASH diet and start an exercise program to help you lose weight. If that doesn’t reduce your blood pressure to normal, I think that the drugs of choice are angiotensin II receptor antagonists. If your blood pressure is still high, add a calcium channel blocker.
The American Heart Association recommends beta blockers and diuretics as treatments for people with high blood pressure. However, beta blockers can cause impotence, tiredness at rest and during exercise, and weight gain; and they increase risk for diabetes. Diuretics make you tired. Furthermore, a study from Sweden shows that beta blockers increase risk of strokes. There is no data to show they prevent heart attacks in healthy people.
Several studies show that the drugs of choice to treat high blood pressure for most North Americans are calcium channel blockers or angiotensin II receptor antagonists.
Other studies have recommended different combinations and the combination with the fewest side effects includes a calcium channel blocker and angiotensin II receptor antagonists. Long-acting calcium channel blockers relax blood vessels, while angiotensin II receptor antagonists block a blood vessel-constricting hormone released by the kidneys (4). Check with your doctor.
BETA BLOCKERS include: Betapace, Blocadren, Brevibloc, Cartrol, Inderal, Kerlone, Levatol, Lopressor, Sectral, Tenormin, Toprol, Zebeta.
ANGIOTENSIN II RECEPTOR ANTAGONISTS: Atacand, Avapro, Cozaar, Diovan.
CALCIUM CHANNEL BLOCKERS: Adalat, Calan, Cardizem, Covera, Dilacor, DynaCirc, Isoptin, Nimotop Norvasc, Plendil, Procardia, Sular, Tiazac, Vascor, Verelan
ALPHA BLOCKERS: Cardura, Dibenzyline, Hytrin, Minipres.
More Healthy Advice From Gabe Mirkin MD (Sports Medicine)
Strength Training Makes You Faster
Lifting weights makes you faster and improves coordination in all sports requiring strength.
Muscles are made of two different types of fibers: the red, slow-twitch fibers, used for endurance; and the white, fast-twitch fibers, used for strength and speed. When you strengthen a muscle, you train the white fibers that also make you faster, so strength training helps you move faster. Strength training can even improve coordination in all events requiring strength. Stronger muscles use fewer fibers for the same task and therefore are easier to control.
Bicycle racers train for strength by climbing hills in very high gears; runners train for strength by running rapidly up hills; rowers and swimmers use pulleys with weights on their ends that mimic the way they use their arms when they swim or row; and football players practice knocking each other down because training is specific.
Diverticula are small, bulging pouches that develop in the wall of the large intestine (colon). Usually they are most numerous in the sigmoid colon. Many people develop diverticula (a condition called diverticulosis), especially after age 50, and in most individuals they cause no problem. However when diverticula become infected or inflamed (a condition called diverticulitis), they can cause pain, fever and nausea. In rare cases, a pouch can rupture, spilling intestinal waste into your abdomen. This is a medical emergency requiring immediate treatment.
Diverticula are small, bulging pouches that develop in the wall of the large intestine (colon). Usually they are most numerous in the sigmoid colon. Many people develop diverticula (a condition called diverticulosis), especially after age 50, and in most individuals they cause no problem. However when diverticula become infected or inflamed (a condition called diverticulitis), they can cause pain, fever and nausea. Diverticulitis ranges from mild pain to life-threatening infection.
Only 15 to 20 percent of people who have diverticulosis develop diverticulitis. The major factors associated with diverticulitis include advancing age and lack of dietary fiber. In many cases people can help prevent this disease simply by including more high-fiber foods in their diet.
Mayo Clinic gastrointestinal specialists have extensive experience diagnosing and treating diverticulitis. Mayo Clinic doctors evaluate and treat more than 1,000 patients who have diverticulitis each year. This experience, coupled with ongoing research, helps Mayo doctors stay at the cutting edge of diagnosis and treatment.
Mayo Clinic in Rochester, Minnesota, is ranked No. 1 in Digestive Disorders in the U.S. News & World Report Best Hospitals rankings.
Since other conditions may mimic diverticulitis, accurate diagnosis is an important first step to treating the condition. Initially, gastroenterologists seek to rule out diseases that cause similar symptoms, such as irritable bowel syndrome. Computed tomography (CT) scans provide images to diagnose diverticulitis and help physicians locate the inflammation. Doctors may check a patient’s abdomen for tenderness and use blood tests to check for elevated white blood cell counts, a sign of infection.
Mild cases of diverticulitis can be treated with changes in diet, rest and antibiotics. But recurring diverticulitis and more serious cases may require surgery to remove the diseased portion of the colon.
Diverticulitis is common in industrialized nations such as the United States, where the average diet is high in refined carbohydrates and low in fiber. Physicians first observed the condition in the United States in the early 1900s, around the time processed foods became a mainstay of the American diet. Too little fiber contributes to small, hard stools that cause increased pressure in the colon.
Treatment of diverticulitis depends on the severity of symptoms and how many acute episodes the patient has experienced. If symptoms are mild, a liquid or low-fiber diet and antibiotics may be recommended. Those at risk of complications, or who experience recurrent attacks of diverticulitis, may require surgery to remove the diseased portion of the colon.
The patient’s age at the time of the attack may be an important factor in the treatment plan. Physicians at Mayo Clinic typically recommend that patients younger than 50 receive more aggressive treatment than patients older than 50. Studies have shown that younger patients may be at a higher risk for recurrent attacks and complications such as a perforated or abscessed colon.
If diverticulitis is treatable at home, patients should expect to remain quiet for a few days. Antibiotics will be prescribed to help kill the bacteria causing the infection. Patients will also temporarily need to avoid all whole grains, fruits and vegetables, so the colon can rest and heal. Once symptoms improve (often in 2 to 4 days) patients can gradually start increasing the amount of high-fiber foods in their diet.
About half of those who have diverticulitis require hospitalization and many need intravenous antibiotics. People may need to be hospitalized for vomiting, a fever above 100 degrees Fahrenheit, a high white blood cell count, or high risk of a bowel obstruction, peritonitis or other complications.
Two procedures are used at Mayo to treat serious cases of diverticulitis. They are performed by surgeons who have completed training in both general surgery and colon and rectal surgery.
Primary Bowel Resection (also called Sigmoid Resection or Segmental Resection)
In this procedure the surgeon removes the diseased part of the intestine and then reconnects the healthy segments of the colon (called anastomosis). This allows the patient to have normal bowel movements. Depending upon the patient’s condition, laparoscopic methods may be used in place of traditional surgery. Laparoscopic procedures usually require smaller incisions and enable a faster recovery for the patient.
Bowel Resection with Colostomy
Surgeons use the bowel resection with colostomy procedure (also called Hartmann’s procedure) when the colon becomes so inflamed that it is not safe to rejoin the colon and rectum. Surgeons only perform this procedure when the patient experiences a life-threatening infection. The colostomy is usually temporary until the infection and inflammation clear.
To create a colostomy, the surgeon makes an opening in the abdominal wall. The colon is then brought out through the opening, and waste passes through the opening into a bag. A colostomy may be temporary or permanent. Once the inflammation has healed, perhaps several months later, the surgeon may be able to perform a second operation to reconnect the colon and rectum.
Diverticulitis occurs when one or more diverticula in your digestive tract become inflamed or infected. Diverticula are small, bulging pouches that can form anywhere in your digestive system, including your esophagus, stomach and small intestine. However, they’re most commonly found in the large intestine.
Diverticula are common, especially after age 40. When you have diverticula, the condition is known as diverticulosis. You may never even know you have these pouches because they seldom cause any problems, such as diverticulitis.
Sometimes, however, diverticulitis occurs, causing severe abdominal pain, fever, nausea and a marked change in your bowel habits. Mild cases of diverticulitis can be treated with rest, changes in your diet and antibiotics. But serious cases of diverticulitis may require surgery.
Common signs and symptoms of diverticulitis include:
- § Pain that’s often sudden, severe, and located in the lower left side of the abdomen. Less commonly, abdominal pain may be mild at first, and become worse over several days, possibly fluctuating in intensity
- § Change in bowel habits
- § Abdominal tenderness
- § Fever
- § Nausea and vomiting
- § Constipation
- § Diarrhea
Less common signs and symptoms of diverticulitis may include:
- § Bloating
- § Bleeding
Diverticulosis and diverticulitis
Diverticulosis occurs when small, bulging pouches (diverticula) develop in your digestive tract. When one or more of these pouches become inflamed or infected, the condition is called diverticulitis.
Diverticula usually develop when naturally weak places in your colon give way under pressure. This causes marble-sized pouches to protrude through the colon wall.
Exactly how diverticula become inflamed or infected isn’t clear. One theory is that the increased pressure in the colon can lead to breakdown of the wall of the diverticula leading to infection. Another is that the narrow openings of diverticula may trap fecal matter, which can lead to infection. Or, an obstruction in the narrow opening of a diverticulum may reduce blood supply to the area, which leads to inflammation.
In the past, doctors thought that nuts, seeds, popcorn and corn played a role in causing diverticulitis by getting trapped in the diverticula. However, recent research has found that these foods weren’t associated with an increased risk of diverticulitis.
These factors may increase your chances of getting diverticulitis:
- § Aging. You’re more likely to get diverticulitis if you’re over 40, although it’s not known why. It may be that age-related changes, such as a decrease in strength and elasticity of your bowel wall, could contribute to diverticulitis.
- § Too little fiber. Diverticulitis is rare in countries where people eat a high-fiber diet that helps keep stools soft. But it’s common in industrialized nations, such as the United States, where the average diet is high in refined carbohydrates and low in fiber. In fact, diverticular disease emerged after the introduction of steel-rolling mills, which greatly reduced the fiber content of flour and other grains.
- § Lack of exercise. Lack of exercise has been associated with a greater risk of formation of diverticula putting a person at risk of diverticulitis. The reasons for this aren’t understood.
- § Obesity. Being seriously overweight increases your odds of developing diverticulitis and diverticular bleeding.
Complications of diverticulitis may include:
- § Peritonitis, which can occur if the infected or inflamed pouch ruptures, spilling intestinal contents into your abdominal cavity. This can cause an inflammation of the lining of your abdominal cavity (peritoneum). Peritonitis is a medical emergency and requires immediate care.
- § Rectal bleeding
- § A blockage in your colon or small intestine caused by scarring
- § An abscess, which occurs when pus collects in the pouch
- § A fistula, which is an abnormal passageway that occurs between different parts of your intestine, between your intestine and your bladder or vagina, or between your intestine and abdominal wall.
Although there doesn’t appear to be a direct link between diverticular disease and colon or rectal cancer, it may make cancer more difficult to diagnose. And rarely, what appears to be diverticulitis may be colon cancer. Because of this, your doctor will likely recommend a colonoscopy after you’ve recovered from a bout of diverticulitis along with more frequent cancer-screening tests. A colonoscopy is a test that allows your doctor to examine your entire colon and rectum for abnormalities using a long, flexible tube with a tiny video camera at the tip (colonoscope).
By Gabe Mirkin MD, Autumn 2009 — You can tell if you are at high risk for diabetes if you store fat primarily in your belly. Pinch your belly; if you can pinch an inch, you are at increased risk and should get a blood test called HBA1C. Having high blood levels of triglycerides and low levels of the good HDL cholesterol that helps prevent heart attacks also increases your risk for diabetes.
When you eat sugar or flour, your blood sugar rises too high. This causes your pancreas to release insulin that converts sugar to triglycerides, which are poured into your bloodstream. Then the good HDL cholesterol tries to remove triglycerides by carrying them back into the liver, so having high blood levels of triglycerides and low blood levels of the good HDL cholesterol are both individual risk factors for diabetes.
High blood levels of insulin constrict arteries to raise blood pressure, so many people who have high blood pressure are also prediabetic. High insulin levels also constrict the arteries leading to your heart to cause heart attacks directly. People with insulin resistance have an increase in small, dense, low-density lipoprotein (LDL) cholesterol, which is more likely to cause heart attacks than the large, buoyant regular LDL cholesterol. High levels of insulin also cause clotting to increase your risk for heart attacks.
A study from Sweden showed that many people discover that they are diabetic only after they have had a heart attack. Researchers recorded blood sugar levels in men who had had heart attacks and then did sugar tolerance tests at discharge and three months later. They found that 40 percent had impaired sugar tolerance tests three months later. This suggests that 40 percent of people who have heart attacks are diabetic, even though they may not know it. The authors recommend that all people with heart attacks be tested for diabetes (1).
You can help to prevent diabetes and heart attacks by avoiding sugar and flour, exercising and eating lots of vegetables.
- 1) Lancet 2002; 359: 2140-44.
2) Current concepts in insulin resistance, type 2 diabetes mellitus, and the metabolic syndrome. American Journal of Cardiology, 2002, Vol 90, Iss 5A, Suppl. S, pp 19G-26G. JEB Reusch. Denver Vet Adm Med Ctr, 1055 Clairmont St, M-C 111 H, Denver,CO 80220 USA.
3) A rational approach to pathogenesis and treatment of type 2 diabetes mellitus, insulin resistance, inflammation, and atherosclerosis. American Journal of Cardiology, 2002, Vol 90, Iss 5A, Suppl. S, pp 27G-33G. P Dandona, A Aljada. Dandona P, WNY, Diabet Endocrinol Ctr, 3 Gates Circle, Buffalo,NY 14209 USA.
4) Rationale for and role of thiazolidinediones in type 2 diabetes mellitus. American Journal of Cardiology, 2002, Vol 90, Iss 5A, Suppl. S, pp 34G-41G. HE Lebovitz. SUNY Hlth Sci Ctr, Dept Med, Div Endocrinol, 450 Clarkson Ave, Brooklyn,NY 11203 USA.
5) Pathogenesis of skeletal muscle insulin resistance in type 2 diabetes mellitus. American Journal of Cardiology, 2002, Vol 90, Iss 5A, Suppl. S, pp 11G-18G. KF Petersen, GI Shulman. Shulman GI, Yale Univ, Sch Med, Howard Hughes Med Inst, Gen Clin Res Ctr, Dept Internal Med, Dept Cellular & Mol Physiol, 295 Congress Ave, BCMM 254C, New Haven,CT 06510 USA
October 4, 2009
By Gabe Mirkin MD — If you use sunscreens, be sure to reapply them frequently. Many sunscreens contain the filters octylmethoxycinnamate, benzophenone-3 or octocrylene, which reflect ultra violet rays away from your skin to protect it only when they are on the surface of the skin. However, when these sunscreens are absorbed and the skin is not re-coated, they increase skin production of harmful oxidants that can cause skin aging and cancer (Free Radical Biology & Medicine, September 2009). Reapplying the sun screen so some remains on the skin’s surface can prevent this damage.
- Before you go out in the sun, apply sunscreens to the areas with the most exposure to sunlight over your lifetime: the top of your ears, your face, the back of your neck, and your arms and hands. It is the cumulative exposure to UV light that increases skin cancer and aging.
- To meet your daily vitamin D requirements from sunlight, expose your legs or other areas of your body that have received little cumulative sun exposure over your lifetime. Take care to avoid sunburn.
- Reapply sunscreens every hour or two, particularly when you are swimming or sweating.
- Some sunscreens contain stronger UVA filters (avobenzone, mexoryl, titanium dioxide or zinc) that are less likely to be absorbed into the skin. You do not need to reapply these if they leave a visible white paste on your skin. Check the list of ingredients.
A comprehensive review of more than 1000 sunscreens was conducted by the Environmental Working Group in summer of 2009. Their findings, with brand name listings and recommendations, are available at http://www.ewg.org/cosmetics/report/sunscreen09/investigation/summary-of-findings www.DrMirkin.com
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NewScientist.com — Our universe appears to be unfathomably uniform. Look across space from one edge of the visible universe to the other, and you’ll see that the microwave background radiation filling the cosmos is at the same temperature everywhere. That may not seem surprising until you consider that the two edges are nearly 28 billion light years apart and our universe is only 14 billion years old.
Nothing can travel faster than the speed of light, so there is no way heat radiation could have travelled between the two horizons to even out the hot and cold spots created in the big bang and leave the thermal equilibrium we see now.
This “horizon problem” is a big headache for cosmologists, so big that they have come up with some pretty wild solutions. “Inflation”, for example.
You can solve the horizon problem by having the universe expand ultra-fast for a time, just after the big bang, blowing up by a factor of 1050 in 10-33 seconds. But is that just wishful thinking? “Inflation would be an explanation if it occurred,” says University of Cambridge astronomer Martin Rees. The trouble is that no one knows what could have made that happen – but see Inside inflation: after the big bang.
So, in effect, inflation solves one mystery only to invoke another. A variation in the speed of light could also solve the horizon problem – but this too is impotent in the face of the question “why?” In scientific terms, the uniform temperature of the background radiation remains an anomaly. Read more at: http://www.newscientist.com/article/mg18524911.600-13-things-that-do-not-make-sense.html?page=1