Injection Drug Users Most in Need of Treatment, Study Says (HealthDay)

FRIDAY, July 15 (HealthDay News) -- Injection drug users have the greatest need for substance abuse treatment, regardless of what types of drugs they use, according to a new study.

Since injection drug users suffer higher rates of abuse, dependence and other physical and psychological problems, researchers argued their findings could help treatment programs specialize their care to target these high-risk individuals.

"Our findings indicate that injection drug use is associated with substantially more substance abuse-related problems than non-injection drug use, including a higher prevalence of dependence, unemployment, and co-occurring mental and physical disorders," said the study's lead author Scott Novak, senior behavioral health epidemiologist at RTI International in an RTI news release.

"These problems appear to characterize a treatment-resistant population in need of specialized treatments," he concluded.

The study was published in the July issue of the Journal of Addictive Diseases.

To investigate injection drug use, the researchers compiled data from the National Survey on Drug use and Health, an annual U.S. survey of about 70,000 children and adults.

Among the study's findings, researchers revealed those living in rural areas were more likely to inject drugs than those residing in either urban or suburban areas. Injection drug users were also more likely than those using drugs in other ways to be aged 35 and older, unemployed, and to not have a high school diploma.

"This study confirms a longstanding belief that injection drug users are a unique population with their own treatment needs, regardless of what drug they inject," concluded Novak. "By learning more about how routes of administration are related to user characteristics, we could improve our ability to tailor substance abuse treatment and prevention strategies to individual users."

The study's authors also noted that injection drug users are more commonly arrested or jailed than other types of drug abusers. As a result, individualized treatment for injection drug users should extend to those who are incarcerated.

More information

The National Institute on Drug Abuse provides more information on substance abuse treatment.

Health Tip: Controlling Your Diabetes (HealthDay)

(HealthDay News) -- Tight diabetes control means carefully managing your meals, exercise and medication to ensure that your blood glucose levels are stable.

The American Diabetes Association mentions these potential benefits of tight diabetes control:

Lower risk of diabetic eye disease, kidney disease and nerve disease.Reduced risk of any existing diabetes complications getting worse.Increased energy levels and simply feeling better.More flexibility with meal schedules.Reduced risk of birth defects in offspring if you become pregnant.

Medicaid Coverage 'Substantially' Improves Access to Care: Study (HealthDay)

THURSDAY, July 7 (HealthDay News) -- Expanding Medicaid coverage among low-income adults increases health care use, improves health and well-being and reduces the financial strain for people with the publicly funded health coverage, according to new research.

"This study shows that Medicaid substantially expands access to and use of care for low-income adults relative to being uninsured," co-principal investigator Katherine Baicker, professor of health economics at Harvard School of Public Health, said in a Harvard news release.

She and her colleagues looked at 10,000 low-income, uninsured adults in Oregon who were randomly selected in a 2008 state lottery to accept additional people into its Medicaid program. The health outcomes of these people were compared to the 80,000 applicants who weren't selected in the lottery.

The first year of the ongoing study showed that Medicaid coverage increases the likelihood of outpatient care by 35 percent, the use of prescription drugs by 15 percent, and of hospital admission by 30 percent. This leads to about a 25 percent increase in annual health care spending.

Medicaid coverage also increases the use of recommended preventive care such as mammograms by 60 percent and cholesterol monitoring by 20 percent. It also increases access to care. For example, people with Medicaid were 70 percent more likely than those without insurance to have a regular doctor's office or clinic for primary care, and were 55 percent more likely to have a particular doctor that they usually see.

Compared to uninsured people, those with Medicaid coverage were 40 percent less likely to have to borrow money or skip paying other bills to pay for health care, and 25 percent less likely to have an unpaid medical bill sent to a collection agency.

The researchers also found that the adults with Medicaid coverage were 25 percent more likely to report they were in good to excellent health, and 10 percent less likely to report being depressed.

The findings are published July 7 as a working paper (number 17190) on the website of the National Bureau of Economic Research. Support for the study was provided by the U.S. National Institute on Aging, the Centers for Medicare & Medicaid Services, the California Healthcare Foundation, and other foundations and government agencies.

"Some people wonder whether Medicaid coverage has any effect. The study findings make clear that it does. People reported that their physical and mental health were substantially better after a year of insurance coverage, and they were much less likely to have to borrow money or go into debt to pay for their care," co-principal investigator Amy Finkelstein, a professor of economics at MIT, said in the news release.

The researchers will follow the lottery participants for another year and directly measure health outcomes such as obesity, blood pressure, cholesterol and blood sugar control.

Under the Obama administration's Affordable Care Act, Medicaid coverage will be expanded to cover additional low-income adults in all states in 2014.

More information

The U.S. Centers for Medicare and Medicaid Services has more about Medicaid.

Behavioral Techniques a Better Value for Chronic Migraine Than Meds: Study (HealthDay)

FRIDAY, July 8 (HealthDay News) -- Behavioral treatments such as relaxation training, hypnosis and biofeedback to help prevent chronic migraine headaches are cost-effective alternatives to prescription drugs, a new study suggests.

Researchers compared the costs of several types of behavioral treatment with preventive prescription drugs. After six months, minimal-contact behavioral treatment was comparable with drug treatment using medicines that cost 50 cents or less per day.

In minimal-contact treatment, a patient sees a therapist a few times a year and for the most part practices the behavioral techniques at home, helped by literature or audio tapes.

After one year, minimal-contact therapy was nearly $500 cheaper than drug treatment.

The study is published in the June issue of the journal Headache.

Initially, the daily cost of prescription drugs taken as a preventive measure by many chronic migraine sufferers may not seem too high, said study co-author Dr. Donald Penzien, a professor of psychiatry at the University of Mississippi Medical Center.

"But those costs keep adding up with additional doctor visits and more prescriptions. The cost of behavioral treatment is front-loaded. You go to a number of treatment sessions but then that's it. And the benefits last for years," he said in a medical center news release.

More information

The U.S. National Institute of Neurological Disorders and Stroke has more about migraine.

Dental Care for Kids on Medicaid Varies by Fees Each State Sets (HealthDay)

By Steven Reinberg
HealthDay Reporter by Steven Reinberg
healthday Reporter – Tue?Jul?12, 11:52?pm?ET

TUESDAY, July 12 (HealthDay News) -- Low reimbursements to dentists from Medicaid make getting dental care difficult for children and adolescents covered by the government health plan, new research suggests.

Sandra L. Decker, senior service fellow in the division of health care statistics at the U.S. Centers for Disease Control and Prevention, found that in states with the highest Medicaid payments, children were more likely to get dental care, although they received care less often than children with private insurance.

"This may be partly because a lot of dentists don't participate in the Medicaid program, so they don't treat children with Medicaid," Decker said.

"In a lot of states, Medicaid dental fees are very low, so a dentist doesn't want to treat a Medicaid patient," she said. "So, low fees affect whether children on Medicaid get care."

The good news is that in states that raised their Medicaid reimbursements more children were able to find dental care, Decker said. "Some of those children were receiving dental care at the same rate as privately insured children," she noted.

But this progress may be in danger as states look for ways to cut costs. At a time when state budgets are being slashed, it is likely that reimbursements for dental care won't go up and may even be reduced, she added.

The report was published in the July 13 issue of the Journal of the American Medical Association.

Dr. Judy Schaechter, associate chair of pediatrics at the University of Miami Miller School of Medicine, said that "the relationship between type of insurance and visiting a dentist is well established."

But, "what this paper adds is that it reveals the direct relationship between Medicaid fee and provision of care," she said.

The reasons connecting fees to access are many, Schaechter said. "Among them are that fewer dentists will accept the lower fees, which hardly cover their costs for cleaning let alone their responsibility when they find severe dental disease," she said.

A recent study showed that some dentists agree to participate in Medicaid, and then make it difficult for Medicaid patients to see them for dental care, Schaechter added.

"From the patient perspective, if that happens enough, they think no one will see them. They give up trying to find a Medicaid dentist," she said. "Finally, with little to no financial incentives, neither dentists nor the Medicaid dental insurers are motivated to do sufficient outreach and educate families about coverage and the need to get preventive care at least every six months."

States are obligated to provide children with the same access and quality of health care through Medicaid as they would get with private insurance, Schaechter said. "We simply can't do that if we are not willing to pay for it."

For the latest study, Decker used data from the National Health Interview Survey from 2000-2001 on 33,657 children and adolescents, along with data on Medicaid dental fees in 2000 and 2008 in 42 states and the District of Columbia.

She found that in 23 states, the 2008 Medicaid dental fees were lower than they were in 2000 (after adjusting for inflation). In 19 states and the District of Columbia, Medicaid fees were higher in 2008 than in 2000.

In Connecticut, Indiana, Montana, New York, Texas and the District of Columbia, Medicaid payments to dentists increased by at least 50 percent between 2000 and 2008, Decker said.

Whether a child or adolescent had seen a dentist in the past six months was dependent on the type of insurance they had, Decker found.

In 2008 and 2009, children on Medicaid were less likely to see a dentist compared with children with private insurance (55 percent versus 68 percent, respectively) in the past six-month period. However, both groups were more likely to see a dentist than children without any coverage (27 percent), the study found.

As payments for dental care increased, children on Medicaid were more likely to see a dentist, Decker said. For example, a $10 increase in Medicaid payments for a check-up, from $20 to $30 between 2000 and 2008, increased the likelihood that a child would see a dentist by 3.92 percent.

More than one-third of children in the United States are covered by public health insurance, primarily Medicaid and the Children's Health Insurance Program. Covering dental care for children and adolescents is required by these programs.

However, states can set payment rates for dentists, so these rates vary by state. In addition, dentists are not required to see Medicaid patients.

More information

For more on Medicaid dental care, visit the U.S. Centers for Medicare and Medicaid Services.

Health Tip: Controlling Your Diabetes (HealthDay)

(HealthDay News) -- Tight diabetes control means carefully managing your meals, exercise and medication to ensure that your blood glucose levels are stable.

The American Diabetes Association mentions these potential benefits of tight diabetes control:

Lower risk of diabetic eye disease, kidney disease and nerve disease.Reduced risk of any existing diabetes complications getting worse.Increased energy levels and simply feeling better.More flexibility with meal schedules.Reduced risk of birth defects in offspring if you become pregnant.

Generic, Brand-Name Heart Drugs Seem to Have Same Effect on Thyroid (HealthDay)

WEDNESDAY, July 13 (HealthDay News) -- For patients taking the heart rhythm drug amiodarone (Cordarone), generic versions of the drug do not cause more incidents of thyroid dysfunction than the brand-name medication, researchers report.

When it comes to thyroid disease, there is no difference between the two drugs, according to the report released online July 11 in CMAJ (Canadian Medical Association Journal).

Amiodarone, a drug used to control arrhythmia -- a type of irregular heartbeat -- is known to cause hypothroidism and hyperthyroidism. These conditions affect the body's metabolism by altering the amount of hormone produced by the thyroid gland. Not enough thyroid hormone causes the body to slow down, resulting in weight gain, thinning hair and muscle pain. On the flip side, too much thyroid hormone results in nervousness, weight loss, rapid heart rate and diarrhea.

In conducting the study, researchers compared 2,804 atrial fibrillation patients aged 66 or older taking brand-name amiodarone (Cordarone) with 6,278 patients taking the generic form of the drug. The study revealed the two groups were equally affected by thyroid dysfunction.

"The incidence rate for thyroid dysfunction was estimated at 14.1 per 100 person-years, similar for both formulations," study author Dr. Louise Pilote, of the McGill University Health Center, and colleagues said in a journal news release. "The incidence rates for hypothyroidism and hyperthyroidism per 100 person-years were comparable between brand-name and generic formulations, with hypothyroidism occurring more commonly than hyperthyroidism."

The study authors pointed out that the findings should provide doctors and policy makers with critical information regarding the use of brand-name vs. generic drugs.

The researchers also noted that patients taking amidarone should be aware of the drug's possible side effects so they can recognize and report any symptoms.

More information

The U.S. National Library of Medicine provides more information on thyroid diseases.

Injection Drug Users Most in Need of Treatment, Study Says (HealthDay)

FRIDAY, July 15 (HealthDay News) -- Injection drug users have the greatest need for substance abuse treatment, regardless of what types of drugs they use, according to a new study.

Since injection drug users suffer higher rates of abuse, dependence and other physical and psychological problems, researchers argued their findings could help treatment programs specialize their care to target these high-risk individuals.

"Our findings indicate that injection drug use is associated with substantially more substance abuse-related problems than non-injection drug use, including a higher prevalence of dependence, unemployment, and co-occurring mental and physical disorders," said the study's lead author Scott Novak, senior behavioral health epidemiologist at RTI International in an RTI news release.

"These problems appear to characterize a treatment-resistant population in need of specialized treatments," he concluded.

The study was published in the July issue of the Journal of Addictive Diseases.

To investigate injection drug use, the researchers compiled data from the National Survey on Drug use and Health, an annual U.S. survey of about 70,000 children and adults.

Among the study's findings, researchers revealed those living in rural areas were more likely to inject drugs than those residing in either urban or suburban areas. Injection drug users were also more likely than those using drugs in other ways to be aged 35 and older, unemployed, and to not have a high school diploma.

"This study confirms a longstanding belief that injection drug users are a unique population with their own treatment needs, regardless of what drug they inject," concluded Novak. "By learning more about how routes of administration are related to user characteristics, we could improve our ability to tailor substance abuse treatment and prevention strategies to individual users."

The study's authors also noted that injection drug users are more commonly arrested or jailed than other types of drug abusers. As a result, individualized treatment for injection drug users should extend to those who are incarcerated.

More information

The National Institute on Drug Abuse provides more information on substance abuse treatment.

Massage Beats Meds for Lower Back Pain, Study Says (HealthDay)

By Maureen Salamon
HealthDay Reporter by Maureen Salamon
healthday Reporter – Tue?Jul?5, 11:50?pm?ET

TUESDAY, July 5 (HealthDay News) -- Massage therapy may be better than medication or exercise for easing low back pain in the short term, a new government-funded study suggests.

Seattle researchers recruited 401 patients, mostly middle-aged, female and white, all of whom had chronic low back pain.

Those who received a series of either relaxation massage or structural massage were better able to work and be active for up to a year than those getting "usual medical care," which included painkillers, anti-inflammatory drugs, muscle relaxants or physical therapy, the researchers found.

Lead study author Daniel Cherkin, director of Group Health Research Institute, said he had expected structural massage, which manipulates specific pain-related back muscles and ligaments, would prove superior to relaxation or so-called Swedish massage, which aims to promote a feeling of body-wide relaxation.

Structural massage, which focuses on soft-tissue abnormalities, requires more training and may be more likely to be paid for by health insurance plans, which may equate it with physical therapy, said Cherkin.

"I thought structural massage would have been at least a little better, and that's not the case," Cherkin said. "If you're having continuing problems with back pain even after trying usual medical care, massage may be a good thing to do. I think the results are pretty strong."

The study, funded by the National Center for Complementary and Alternative Medicine, part of the U.S. National Institutes of Health, is published in the July 5 issue of Annals of Internal Medicine.

Participants were randomly assigned to one of the three groups: structural massage, relaxation massage or usual care. Those in the massage groups were given hour-long massage treatments weekly for 10 weeks.

At 10 weeks, more than one-third of those who received either type of massage said their back pain was much better or gone, compared to only one in 25 patients who received usual care, the study said. Those in the massage groups were also twice as likely in that period to have spent fewer days in bed, used less anti-inflammatory medication and engaged in more activity than the standard care group.

Six months out, both types of massage were still linked to improved function, Cherkin said, but after one year, pain and function was almost equal in all three groups.

Noting that most Americans will experience low back pain during their lifetime, Cherkin said another benefit of massage is its relative safety.

"Maybe one of 10 patients felt pain during or after massage, but most of those thought it was a 'good pain,'" he said. "A good massage therapist will be in tune with the patient and will ask what hurts."

One of the study's weaknesses was that those who were assigned to usual care knew that others were receiving massage therapy and may have been disappointed to be excluded, tainting their reported improvement, said Dr. Robert Duarte, director of the Pain and Headache Treatment Center at North Shore-LIJ Health System in Manhasset, N.Y.

"I think massage therapy can be useful for patients with back pain, but more as a . . . supplemental therapy," Duarte added.

More information

The U.S. National Institute of Neurological Disorders and Stroke has more on low back pain.

Addiction Starts Early in American Society, Report Finds (HealthDay)

WEDNESDAY, June 29 (HealthDay News) -- A new study reveals that 90 percent of Americans who are addicted to tobacco, alcohol or other substances started smoking, drinking or using drugs before they were 18 years old.

The study also found that one-quarter of Americans who began using any addictive substance before age 18 are addicted, compared with one in 25 Americans who started using an addictive substance when they were 21 or older.

And nearly half of American high school students now smoke, drink or use other drugs, according to the researchers at the National Center on Addiction and Substance Abuse (CASA) at Columbia University.

They said their findings show that adolescence is the most important period of life for the start of substance abuse and its consequences.

"Addiction is a disease that in most cases begins in adolescence, so preventing or delaying teens from using alcohol, tobacco or other drugs for as long as possible is crucial to their health and safety," Susan Foster, CASA's vice president and director of policy research and analysis, said in a CASA news release. "We rightfully worry about other teen health problems like obesity, depression or bullying, but we turn a blind eye to a more common and deadly epidemic that we can in fact prevent."

In teenagers, the brain is not fully developed, increasing the chances that they'll take risks, including using addictive substances that hamper brain development, impair judgment and increase the risk of addiction, the study authors explained.

The investigators found that 75 percent (10 million) of all U.S. high school students have used addictive substances such as tobacco, alcohol, marijuana or cocaine, and that 20 percent of these students meet the medical criteria for addiction. Currently, 46 percent (6.1 million) of all U.S. high school students use addictive substances and one-third of them meet the medical criteria for addiction.

Nearly three-quarters (72.5 percent) of U.S. high school students have consumed alcohol, 46.3 percent have smoked cigarettes, almost 37 percent have used marijuana, about 15 percent have misused prescription drugs, and over 65 percent have used more than one addictive substance, the study authors stated.

A number of social factors are linked to the high risk of addictive substance use by American teens, according to the researchers. These include: acceptance of substance use by parents, schools and communities; widespread advertising of products such as alcohol and cigarettes; and media depictions of substance use as harmless, glamorous, fun and relaxing.

In addition, tobacco, alcohol, marijuana and prescription drugs are widely available to teens.

Teen substance use is the largest preventable and most expensive public health problem in the United States, according to the study. The immediate costs per year of teen substance use include an estimated $68 billion associated with underage drinking and $14 billion in substance-related juvenile justice costs.

The total national cost of substance use by people of all ages is at least $468 billion per year, or nearly $1,500 for every person in the nation, the report indicates.

"The combination of adolescence, an American culture that glorifies and promotes substance use, and easy access to tobacco, alcohol and other drugs creates a perfect storm for our teens and for taxpayers," Jim Ramstad, a CASA board member who also chaired the report's National Advisory Commission, said in the news release.

"We no longer can justify writing off adolescent substance use as bad behavior, as a rite of passage or as kids just being kids. The science is too clear, the facts are too compelling, the health and social consequences are too devastating and the costs are simply too high," he added.

The study offers a number of recommendations including:

Educating the public that teen substance use is a public health problem and that addiction is a medical problem that in most cases begins in adolescence.Using effective public health strategies to prevent or delay the start of substance use.Routine screenings to identify teens most at risk.Early intervention to prevent further substance use and consequences.Giving teens with substance use disorders appropriate medical treatment.

The study findings are based on online surveys of 1,000 high school students, 1,000 parents of high school students and 500 school personnel; analyses of seven national data sets; interviews with 50 leading experts; five focus groups with students, parents and school personnel; and a review of 2,000 scientific articles and reports.

More information

The American Academy of Pediatrics offers resources about children and substance abuse.

FDA to Hear Appeal on Breast Cancer Drug (HealthDay)

By Amanda Gardner
HealthDay Reporter by Amanda Gardner
healthday Reporter – Tue?Jun?28, 11:48?pm?ET

TUESDAY, June 28 (HealthDay News) -- The controversial cancer drug Avastin becomes the focus of U.S. regulators' attention again Tuesday during a two-day hearing to determine if the medication can keep its FDA approval for the treatment of metastatic breast cancer.

Back on Dec. 16, the U.S. Food and Drug Administration recommended revoking approval of the drug to fight breast cancer, citing the medication's poor performance in follow-up studies and its potential for serious side effects.

The drug's maker, Genentech, now owned by the pharmaceutical giant Roche, was given the chance to appeal the FDA recommendation and present additional evidence. That appeal will be the focus of the hearing and, according to published reports, will involve Genentech urging one more clinical trial before any government action on the drug.

The FDA's unusual step of scheduling another hearing on the drug underscores the difficulty of withdrawing approval of a cancer medication, the Associated Press reported.

"It says to me that either they [the FDA] have gotten a great deal of negative feedback from various quarters, or there's some kind of internal disagreement within the agency," Dr. Gary Lyman, professor at the Duke Cancer Institute in North Carolina, told the news service. Lyman was part of the FDA advisory panel that voted 12-1 last July to revoke Avastin's approval as a breast cancer therapy.

The FDA's December recommendation did not immediately affect breast cancer patients' access to the drug or limit use of Avastin (bevacizumab) for advanced colon, lung, kidney and brain cancer.

"FDA has taken the first step to removing the breast cancer indication from the label of the cancer drug Avastin," Dr. Janet Woodcock, director of the FDA's Center for Drug Evaluation and Research, announced at the Dec. 16 news conference. "This is a first step in a process and will not have an immediate impact on use of Avastin or the drug's availability."

"Oncologists currently treating patients with Avastin should use medical judgment in deciding whether to continue treatment or explore other treatment options," she added.

Some doctors expressed concern at the FDA's decision last December.

"This is a tough issue. There are women who have clearly responded to the treatment, [and] this is going to be a very difficult pill to swallow for those women," said Dr. Neil Spector, professor of medicine at the Duke Cancer Institute.

"There's a very real possibility that there may be a subgroup of women that are likely to respond to this," Spector said. "I don't think this will be the end from the standpoint of investigation and people trying to understand who that subpopulation is. It's just unfortunate that this will put a huge crimp in trying to figure that out."

Another expert, Dr. Julie Gralow, director of breast medical oncology at the Seattle Cancer Care Alliance (SCCA), called the FDA decision "disappointing."

"It is clear that some breast cancer patients derive substantial benefit from Avastin," Gralow, who is also professor in the Medical Oncology Division of the University of Washington School of Medicine, said in a SCAA press statement. "We don't know how to select those tumors or patients yet. It is looking like patient factors, not tumor factors, might be the best way to select those who benefit. To withhold this drug from all patients because some don't benefit is incorrect."

Doctors can continue to prescribe Avastin to patients "off-label," as they do other drugs. But it's unlikely that insurance companies would cover off-label use of the drug given its high price tag, Spector said. Avastin costs more than $8,000 a month, according to published reports.

The FDA last December did not rule out the possibility that if Avastin is actually revoked, approval could be restored for certain subgroups of patients who may benefit.

"FDA is ready to work with Genentech on any proposals to conduct additional studies in metastatic breast cancer designed to identify responsive tumors," Woodcock added at the time.

Avastin was OK'd in 2008 for use in conjunction with chemotherapy under the FDA's accelerated approval program. Approval was based on one clinical trial of patients with metastatic HER2-negative breast cancer that found a benefit in terms of cancer recurrence -- but not overall survival -- and was contingent on further data to confirm the results.

Three subsequent studies failed to find an overall survival benefit and, in fact, showed less impressive improvements in survival involving no progression of cancer.

After reviewing all four studies, FDA concluded that "patients receiving Avastin did not live any longer than patients not treated with the drug and were at greater risk of severe side effects, some of which are unique to Avastin," Woodcock said.

"These include perforations of the nose, stomach and intestine, many of which can be life-threatening, as well as high blood pressure, heart attack or heart failure, wound-healing complications and organ damage or failure," she said.

More information

The U.S. National Cancer Institute has more on Avastin.

Medicaid Coverage 'Substantially' Improves Access to Care: Study (HealthDay)

THURSDAY, July 7 (HealthDay News) -- Expanding Medicaid coverage among low-income adults increases health care use, improves health and well-being and reduces the financial strain for people with the publicly funded health coverage, according to new research.

"This study shows that Medicaid substantially expands access to and use of care for low-income adults relative to being uninsured," co-principal investigator Katherine Baicker, professor of health economics at Harvard School of Public Health, said in a Harvard news release.

She and her colleagues looked at 10,000 low-income, uninsured adults in Oregon who were randomly selected in a 2008 state lottery to accept additional people into its Medicaid program. The health outcomes of these people were compared to the 80,000 applicants who weren't selected in the lottery.

The first year of the ongoing study showed that Medicaid coverage increases the likelihood of outpatient care by 35 percent, the use of prescription drugs by 15 percent, and of hospital admission by 30 percent. This leads to about a 25 percent increase in annual health care spending.

Medicaid coverage also increases the use of recommended preventive care such as mammograms by 60 percent and cholesterol monitoring by 20 percent. It also increases access to care. For example, people with Medicaid were 70 percent more likely than those without insurance to have a regular doctor's office or clinic for primary care, and were 55 percent more likely to have a particular doctor that they usually see.

Compared to uninsured people, those with Medicaid coverage were 40 percent less likely to have to borrow money or skip paying other bills to pay for health care, and 25 percent less likely to have an unpaid medical bill sent to a collection agency.

The researchers also found that the adults with Medicaid coverage were 25 percent more likely to report they were in good to excellent health, and 10 percent less likely to report being depressed.

The findings are published July 7 as a working paper (number 17190) on the website of the National Bureau of Economic Research. Support for the study was provided by the U.S. National Institute on Aging, the Centers for Medicare & Medicaid Services, the California Healthcare Foundation, and other foundations and government agencies.

"Some people wonder whether Medicaid coverage has any effect. The study findings make clear that it does. People reported that their physical and mental health were substantially better after a year of insurance coverage, and they were much less likely to have to borrow money or go into debt to pay for their care," co-principal investigator Amy Finkelstein, a professor of economics at MIT, said in the news release.

The researchers will follow the lottery participants for another year and directly measure health outcomes such as obesity, blood pressure, cholesterol and blood sugar control.

Under the Obama administration's Affordable Care Act, Medicaid coverage will be expanded to cover additional low-income adults in all states in 2014.

More information

The U.S. Centers for Medicare and Medicaid Services has more about Medicaid.

Massage Beats Meds for Lower Back Pain, Study Says (HealthDay)

TUESDAY, July 5 (HealthDay News) -- Massage therapy may be better than medication or exercise for easing low back pain in the short term, a new government-funded study suggests.

Seattle researchers recruited 401 patients, mostly middle-aged, female and white, all of whom had chronic low back pain.

Those who received a series of either relaxation massage or structural massage were better able to work and be active for up to a year than those getting "usual medical care," which included painkillers, anti-inflammatory drugs, muscle relaxants or physical therapy, the researchers found.

Lead study author Daniel Cherkin, director of Group Health Research Institute, said he had expected structural massage, which manipulates specific pain-related back muscles and ligaments, would prove superior to relaxation or so-called Swedish massage, which aims to promote a feeling of body-wide relaxation.

Structural massage, which focuses on soft-tissue abnormalities, requires more training and may be more likely to be paid for by health insurance plans, which may equate it with physical therapy, said Cherkin.

"I thought structural massage would have been at least a little better, and that's not the case," Cherkin said. "If you're having continuing problems with back pain even after trying usual medical care, massage may be a good thing to do. I think the results are pretty strong."

The study, funded by the National Center for Complementary and Alternative Medicine, part of the U.S. National Institutes of Health, is published in the July 5 issue of Annals of Internal Medicine.

Participants were randomly assigned to one of the three groups: structural massage, relaxation massage or usual care. Those in the massage groups were given hour-long massage treatments weekly for 10 weeks.

At 10 weeks, more than one-third of those who received either type of massage said their back pain was much better or gone, compared to only one in 25 patients who received usual care, the study said. Those in the massage groups were also twice as likely in that period to have spent fewer days in bed, used less anti-inflammatory medication and engaged in more activity than the standard care group.

Six months out, both types of massage were still linked to improved function, Cherkin said, but after one year, pain and function was almost equal in all three groups.

Noting that most Americans will experience low back pain during their lifetime, Cherkin said another benefit of massage is its relative safety.

"Maybe one of 10 patients felt pain during or after massage, but most of those thought it was a 'good pain,'" he said. "A good massage therapist will be in tune with the patient and will ask what hurts."

One of the study's weaknesses was that those who were assigned to usual care knew that others were receiving massage therapy and may have been disappointed to be excluded, tainting their reported improvement, said Dr. Robert Duarte, director of the Pain and Headache Treatment Center at North Shore-LIJ Health System in Manhasset, N.Y.

"I think massage therapy can be useful for patients with back pain, but more as a . . . supplemental therapy," Duarte added.

More information

The U.S. National Institute of Neurological Disorders and Stroke has more on low back pain.

FDA Panel Rejects Avastin for Breast Cancer (HealthDay)

WEDNESDAY, June 29 (HealthDay News) -- The blockbuster cancer drug Avastin got soundly rejected late Wednesday as a treatment for metastatic breast cancer by a U.S. health advisory panel that found the medication was not effective and causes dangerous side effects.

By unanimous vote, the panelists rejected the drug maker's appeal of a U.S. Food and Drug Administration recommendation last December to revoke Avastin's approval for breast cancer. The FDA recommendation cited the medication's poor performance in follow-up studies and its potential for serious side effects.

The drug maker, Genentech, now owned by pharmaceutical giant Roche, was given an unusual two-day hearing this week before the six-member advisory group.

Tuesday's opening-day hearing was dominated by patients and physicians who argued, often emotionally, against the drug's revocation.

"For the patients and their supporters, it was the reality that many of them were alive and well with few symptoms, which they and their physicians attributed to the fact that Avastin had a significant treatment benefit for their breast cancer," blogged Dr. Len Lichtenfeld, Deputy Chief Medical Officer for the American Cancer Society, who attended the hearing.

But later in the day, he added, "the FDA told a different story. The data from clinical trials, after looking at thousands of patients treated with Avastin in addition to more standard chemotherapy, showed no meaningful clinical benefit. At one point, an FDA representative said that they were looking for only one trial that had some sort of benefit .. No such trial emerged, while the side effect risk was considerable."

On Wednesday, according to CNN, Dr. Sandra Horning, one of Genentech's top scientists, cited a February 2008 memo in which the head of the FDA's cancer drugs division made positive comments about the study that he had criticized on Tuesday. Genentech officials also defended E2100, the original study that formed the basis for the FDA's accelerated approval, and said there were no better treatments available for many women, CNN reported.

Lichtenfeld, at the end of the first day of hearings, outlined the dilemma. "Clearly, we are in a place where emotion meets science and the FDA's decision will prove to be a difficult one," he said in his blog.

The advisory panel's vote is non-binding, and FDA commissioner Margaret Hamburg will make a final ruling, the Associated Press reported.

The FDA's unusual step of scheduling another hearing on the drug underscored the difficulty of withdrawing approval of a cancer medication, the AP reported.

"It says to me that either they [the FDA] have gotten a great deal of negative feedback from various quarters, or there's some kind of internal disagreement within the agency," Dr. Gary Lyman, professor at the Duke Cancer Institute in North Carolina, told the news service. Lyman was part of the FDA advisory panel that voted 12-1 last year to revoke Avastin's approval as a breast cancer therapy.

The FDA's December recommendation did not immediately affect breast cancer patients' access to the drug or limit use of Avastin (bevacizumab) for advanced colon, lung, kidney and brain cancer.

Doctors can continue to prescribe Avastin to patients "off-label," as they do other drugs. But it's unlikely that insurance companies would cover off-label use of the drug given its high price tag. Avastin costs more than $8,000 a month, according to published reports.

Avastin was OK'd in 2008 for use in metastatic breast cancer in conjunction with chemotherapy under the FDA's accelerated approval program. Approval was based on a clinical trial of patients with metastatic HER2-negative breast cancer that found a benefit in terms of cancer recurrence -- but not overall survival -- and was contingent on further data to confirm the results.

Three subsequent studies failed to find an overall survival benefit and showed less impressive improvements in survival involving no progression of cancer.

More information

The U.S. National Cancer Institute has more on Avastin.

FDA to Hear Appeal on Breast Cancer Drug (HealthDay)

TUESDAY, June 28 (HealthDay News) -- The controversial cancer drug Avastin becomes the focus of U.S. regulators' attention again Tuesday during a two-day hearing to determine if the medication can keep its FDA approval for the treatment of metastatic breast cancer.

Back on Dec. 16, the U.S. Food and Drug Administration recommended revoking approval of the drug to fight breast cancer, citing the medication's poor performance in follow-up studies and its potential for serious side effects.

The drug's maker, Genentech, now owned by the pharmaceutical giant Roche, was given the chance to appeal the FDA recommendation and present additional evidence. That appeal will be the focus of the hearing and, according to published reports, will involve Genentech urging one more clinical trial before any government action on the drug.

The FDA's unusual step of scheduling another hearing on the drug underscores the difficulty of withdrawing approval of a cancer medication, the Associated Press reported.

"It says to me that either they [the FDA] have gotten a great deal of negative feedback from various quarters, or there's some kind of internal disagreement within the agency," Dr. Gary Lyman, professor at the Duke Cancer Institute in North Carolina, told the news service. Lyman was part of the FDA advisory panel that voted 12-1 last July to revoke Avastin's approval as a breast cancer therapy.

The FDA's December recommendation did not immediately affect breast cancer patients' access to the drug or limit use of Avastin (bevacizumab) for advanced colon, lung, kidney and brain cancer.

"FDA has taken the first step to removing the breast cancer indication from the label of the cancer drug Avastin," Dr. Janet Woodcock, director of the FDA's Center for Drug Evaluation and Research, announced at the Dec. 16 news conference. "This is a first step in a process and will not have an immediate impact on use of Avastin or the drug's availability."

"Oncologists currently treating patients with Avastin should use medical judgment in deciding whether to continue treatment or explore other treatment options," she added.

Some doctors expressed concern at the FDA's decision last December.

"This is a tough issue. There are women who have clearly responded to the treatment, [and] this is going to be a very difficult pill to swallow for those women," said Dr. Neil Spector, professor of medicine at the Duke Cancer Institute.

"There's a very real possibility that there may be a subgroup of women that are likely to respond to this," Spector said. "I don't think this will be the end from the standpoint of investigation and people trying to understand who that subpopulation is. It's just unfortunate that this will put a huge crimp in trying to figure that out."

Another expert, Dr. Julie Gralow, director of breast medical oncology at the Seattle Cancer Care Alliance (SCCA), called the FDA decision "disappointing."

"It is clear that some breast cancer patients derive substantial benefit from Avastin," Gralow, who is also professor in the Medical Oncology Division of the University of Washington School of Medicine, said in a SCAA press statement. "We don't know how to select those tumors or patients yet. It is looking like patient factors, not tumor factors, might be the best way to select those who benefit. To withhold this drug from all patients because some don't benefit is incorrect."

Doctors can continue to prescribe Avastin to patients "off-label," as they do other drugs. But it's unlikely that insurance companies would cover off-label use of the drug given its high price tag, Spector said. Avastin costs more than $8,000 a month, according to published reports.

The FDA last December did not rule out the possibility that if Avastin is actually revoked, approval could be restored for certain subgroups of patients who may benefit.

"FDA is ready to work with Genentech on any proposals to conduct additional studies in metastatic breast cancer designed to identify responsive tumors," Woodcock added at the time.

Avastin was OK'd in 2008 for use in conjunction with chemotherapy under the FDA's accelerated approval program. Approval was based on one clinical trial of patients with metastatic HER2-negative breast cancer that found a benefit in terms of cancer recurrence -- but not overall survival -- and was contingent on further data to confirm the results.

Three subsequent studies failed to find an overall survival benefit and, in fact, showed less impressive improvements in survival involving no progression of cancer.

After reviewing all four studies, FDA concluded that "patients receiving Avastin did not live any longer than patients not treated with the drug and were at greater risk of severe side effects, some of which are unique to Avastin," Woodcock said.

"These include perforations of the nose, stomach and intestine, many of which can be life-threatening, as well as high blood pressure, heart attack or heart failure, wound-healing complications and organ damage or failure," she said.

More information

The U.S. National Cancer Institute has more on Avastin.

New Blood Thinner Beats Plavix When Paired With Low-Dose Aspirin (HealthDay)

MONDAY, June 27 (HealthDay News) -- Brilinta, an experimental anti-clotting medication currently awaiting U.S. Food and Drug Administration approval, performed better than the industry standard, Plavix, when used in tandem with low-dose aspirin, a new study finds.

Heart patients who took Brilinta (ticagrelor) with low-dose aspirin (less than 300 milligrams) had fewer cardiovascular complications than those taking Plavix (clopidogrel) plus low-dose aspirin, researchers found.

However, patients who took Brilinta with higher doses of aspirin (more than 300 milligrams) had worse outcomes than those who took Plavix plus high-dose aspirin, the investigators reported.

Antiplatelet drugs are used to prevent potentially dangerous blood clots from forming in patients with acute coronary syndrome, including those who have had a heart attack.

Brilinta has already been approved for use in many other countries. In July 2010, an FDA panel voted 7-to-1 to approve the use of Brilinta for U.S. patients undergoing angioplasty or stenting to open blocked arteries, but the approval process is still ongoing.

The panel's recommendation was based in part on prior findings from this study, called the Platelet Inhibition and Patient Outcomes (PLATO) trial.

In this latest analysis of PLATO findings, researchers found that patients who took Brilinta with low-dose aspirin were 16 percent less likely than those who took Plavix with low-dose aspirin to have a heart attack or stroke, or to die within a year.

The findings were reported Monday in an American Heart Association online conference.

One expert said the new information is valuable.

"The study highlights that if one chooses to use ticagrelor in subjects with acute coronary syndromes, it would be logical to use aspirin 81 milligrams per day (and not 325 mg daily)," said Dr. Jeffrey S. Berger, assistant professor of medicine and director of cardiovascular thrombosis at NYU Langone Medical Center in New York City. "Of note, there is little reason to ever use aspirin 325 mg except in the acute setting of a heart attack or stroke," he added. "A higher aspirin dose (325 mg versus 81 mg) increases the risk of bleeding without increasing the efficacy of the drug."

A study author agreed that for most patients, using the drug with a lower dose of aspirin is usually warranted.

"Patients with acute coronary syndrome have options to prevent recurrent events," study lead author Dr. Kenneth W. Mahaffey, co-director of cardiovascular research at the Duke Clinical Research Institute, and associate professor of medicine at Duke University Medical Center, said in an AHA news release. "Physicians choosing to use ticagrelor in countries where it is approved and available should consider using a low-dose of maintenance aspirin with the drug."

The data and conclusions of the research should be viewed as preliminary until published in a peer-reviewed journal.

More information

The American Academy of Family Physicians outlines medicines used to treat patients with acute coronary syndrome.

New Blood Thinner Beats Plavix When Paired With Low-Dose Aspirin (HealthDay)

MONDAY, June 27 (HealthDay News) -- Brilinta, an experimental anti-clotting medication currently awaiting U.S. Food and Drug Administration approval, performed better than the industry standard, Plavix, when used in tandem with low-dose aspirin, a new study finds.

Heart patients who took Brilinta (ticagrelor) with low-dose aspirin (less than 300 milligrams) had fewer cardiovascular complications than those taking Plavix (clopidogrel) plus low-dose aspirin, researchers found.

However, patients who took Brilinta with higher doses of aspirin (more than 300 milligrams) had worse outcomes than those who took Plavix plus high-dose aspirin, the investigators reported.

Antiplatelet drugs are used to prevent potentially dangerous blood clots from forming in patients with acute coronary syndrome, including those who have had a heart attack.

Brilinta has already been approved for use in many other countries. In July 2010, an FDA panel voted 7-to-1 to approve the use of Brilinta for U.S. patients undergoing angioplasty or stenting to open blocked arteries, but the approval process is still ongoing.

The panel's recommendation was based in part on prior findings from this study, called the Platelet Inhibition and Patient Outcomes (PLATO) trial.

In this latest analysis of PLATO findings, researchers found that patients who took Brilinta with low-dose aspirin were 16 percent less likely than those who took Plavix with low-dose aspirin to have a heart attack or stroke, or to die within a year.

The findings were reported Monday in an American Heart Association online conference.

One expert said the new information is valuable.

"The study highlights that if one chooses to use ticagrelor in subjects with acute coronary syndromes, it would be logical to use aspirin 81 milligrams per day (and not 325 mg daily)," said Dr. Jeffrey S. Berger, assistant professor of medicine and director of cardiovascular thrombosis at NYU Langone Medical Center in New York City. "Of note, there is little reason to ever use aspirin 325 mg except in the acute setting of a heart attack or stroke," he added. "A higher aspirin dose (325 mg versus 81 mg) increases the risk of bleeding without increasing the efficacy of the drug."

A study author agreed that for most patients, using the drug with a lower dose of aspirin is usually warranted.

"Patients with acute coronary syndrome have options to prevent recurrent events," study lead author Dr. Kenneth W. Mahaffey, co-director of cardiovascular research at the Duke Clinical Research Institute, and associate professor of medicine at Duke University Medical Center, said in an AHA news release. "Physicians choosing to use ticagrelor in countries where it is approved and available should consider using a low-dose of maintenance aspirin with the drug."

The data and conclusions of the research should be viewed as preliminary until published in a peer-reviewed journal.

More information

The American Academy of Family Physicians outlines medicines used to treat patients with acute coronary syndrome.

Single Reading Can't Gauge Blood Pressure Control: Study (HealthDay)

By Kathleen Doheny
HealthDay Reporter by Kathleen Doheny
healthday Reporter – Mon?Jun?20, 11:48?pm?ET

MONDAY, June 20 (HealthDay News) -- Evaluating how well a person responds to medication meant to lower blood pressure requires multiple readings, new research suggests.

Blood pressure often spikes at doctor appointments, a condition known as "white coat" hypertension, so readings should also be taken by patients at home, said the study's lead author, Dr. Benjamin Powers, assistant professor of medicine at Duke University Medical Center.

''Collecting just a few, five or six, blood pressure readings from home will help your doctor make much better decisions about whether your blood pressure is in or out of control," Powers said.

For the study, Powers and his colleagues evaluated 444 U.S. veterans with high blood pressure, about 90 percent of them men with an average age of 64. All had been diagnosed about 10 years earlier. Their blood pressure was considered uncontrolled, even though most took multiple blood pressure-lowering medications. Untreated, high blood pressure can lead to stroke.

The study compared blood pressure readings taken in three settings -- at home, in a doctor's office, and at a clinical research setting -- at the study start and again at 6, 12 and 18 months. The findings are published in the June 21 issue of the Annals of Internal Medicine.

The measurements varied widely, Powers found. "Only a third of them were consistently categorized as in or out of control by all three measures," he said.

That points to the importance of getting multiple measures from different settings, said Powers, who is also with the Durham Veterans Affairs Medical Center. Using just one reading as the basis for prescribing or adjusting blood pressure medication could endanger patients who suffer from "white coat" hypertension, the study authors said.

As many as six readings were needed to obtain the best estimate of true blood pressure, the authors said, adding that doctors should average the results.

Home monitoring of blood pressure has gained respect in recent years, Powers said. About 43 percent of people with high blood pressure use home monitors, according to background information in the study. Powers and his colleagues said their results support recent calls for reimbursement of home blood pressure monitoring.

"I think patients should expect their doctors to make decisions based on home blood pressure [in addition to other measures]," he said.

Those who buy a home blood pressure monitor should get it validated for accuracy at their doctor's office, Powers added.

Patients should be advised to measure their blood pressure at different times of the day, and to sit and relax for five minutes before taking it, Powers explained. Variations are to be expected, he noted.

According to Dr. Joseph Diamond, director of nuclear cardiology at Long Island Jewish Medical Center in Hyde Park, N.Y., blood pressure readings are perhaps "the most frequent assessment that results in a change of medical therapy."

Even so, the procedure is frequently flawed because of poor measurement technique or insufficient measurements, he said.

"This study confirms the need to improve both measurement technique and the number of measurements obtained so that a therapeutic decision to start or change medication is based on more accurate information," said Diamond.

Writing in an accompanying editorial of the journal, Dr. Lawrence J. Appel and colleagues from Johns Hopkins University said the findings point to a need for regulation of blood pressure screening. "It is time to get serious about BP measurement," they wrote.

More information

To learn more about home blood pressure monitoring, visit the British Hypertension Society.

Health Tip: Regain Weight the Healthy Way (HealthDay)

(HealthDay News) -- If an illness, surgery or medication has left you needing to regain some weight, experts suggest there's a healthy way to do so.

The American Dietetic Association offers this advice:

Avoid too much junk food. The empty calories may help you add pounds, but won't benefit you nutritionally.If your appetite is lacking, eat five or six small meals a day. Drink fluids before or after meals, rather than during.Add healthier calorie-laden condiments and spreads, such as peanut butter or cheese.Use milk instead of water to cook oatmeal, and add higher-calorie foods such as honey, nuts, dried fruit, margarine or powdered milk after the oatmeal is cooked.Top salads with healthy fats, such as nuts and seeds, olive oil, olives or avocados.Add dry milk powder to dishes such as mashed potatoes or casseroles.Work with a dietitian to create a healthy eating plan to boost weight.

Millions Don't Get Meds for Serious Artery Disease: Study (HealthDay)

MONDAY, June 20 (HealthDay News) -- Millions of Americans suffer from a condition known as peripheral artery disease but aren't receiving medical treatment, putting them at risk of potentially fatal heart problems, a new study finds.

Those who had the condition but didn't take medications were more likely to die of all causes during the period studied, although it's not clear how the disease specifically affected their health, the researchers noted.

The findings, released online June 20 in advance of publication in an upcoming print issue of the journal Circulation, reinforce the belief that peripheral artery disease, or PAD, is an early warning sign of possible clogged vessels elsewhere in the body, said study lead author Dr. Reena L. Pande, a cardiologist and associate professor at Harvard Medical School.

"We think of it as a manifestation of a whole-body problem," she said. "What happens in the legs can happen in other parts of the body, like the heart and the brain even."

Atherosclerosis -- or blockages in the arteries in the legs caused by plaque -- is the source of PAD. Physicians have long known about the condition, but it's only begun to receive much attention in the last couple of decades, Pande said.

People with the condition may experience cramping in the hips, thighs or calves, pain and burning sensations in the legs, ulcers and even amputation. But in many cases, no symptoms occur.

A simple test of the blood pressure in the arm and the ankle can detect the condition, and there's debate about whether the test should be routine, said Pande, who is also an associate physician at Brigham and Women's Hospital in Boston.

In the new study, funded in part by federal grants, Pande and colleagues analyzed statistics from a national survey of 7,458 people aged 40 and older. The participants were tracked from 1999 through 2004.

The researchers found that about 6 percent of the participants suffered from peripheral artery disease, translating to about 7 million adults in the United States. Of those, 25, 36 and 31 percent, respectively, took high blood pressure medication, aspirin or cholesterol drugs.

Those who took two or more of the drugs were 65 percent less likely to die of all causes during the seven years of the study, Pande said. However, she said the percentages of people who died in each group -- those who took two or more drugs and those who didn't -- weren't available.

The research "raises the question of whether we should be looking for these people to get them on the appropriate treatments," Pande said. "We don't have any studies that tell us that if we find them and treat them, they'll have a lowered risk of dying. But it makes us wonder if we should try to find these individuals with a simple screening test."

The screening test is inexpensive and can be conducted by health care professionals other than doctors, she said. As for cost, at least one of the medications in question -- aspirin -- is very inexpensive.

Dr. Jeffrey W. Olin, a vascular medicine specialist at Mount Sinai School of Medicine in New York City, said the study provides more evidence that doctors should take peripheral artery disease seriously and treat it. In many cases, he said, doctors don't prescribe medications even when they know a patient has the condition.

"We've been working on this for 15 years, trying to get health care providers to be aware of the fact that people with peripheral artery disease don't die because of their legs," he said. "They die because they have heart attacks and strokes."

More information

For more about peripheral artery disease, visit the U.S. National Library of Medicine.