Friday, December 31, 2010

Fructose Sets You Up for Weight Gain Without Warning

Fructose Sets Table For Weight Gain Without Warning
(Adapted from ScienceDaily)

"Eating too much fructose can induce leptin resistance, a condition that can easily lead to becoming overweight when combined with a high-fat, high-calorie diet, according to a study with rats.

"Although previous studies have shown that being leptin resistant can lead to rapid weight gain on a high-fat, high-calorie diet, this is the first study to show that leptin resistance can develop as a result of high fructose consumption. The study also showed for the first time that leptin resistance can develop silently, that is, with little indication that it is happening.
"The study, “Fructose-induced leptin resistance exacerbates weight gain in response to subsequent high-fat feeding,” was carried out by Alexandra Shapiro, Wei Mu, Carlos Roncal, Kit-Yan Cheng, Richard J. Johnson and Philip J. Scarpace, all at the University of Florida College of Medicine in Gainesville. The study appears in the American Journal of Physiology – Regulatory, Integrative and Comparative Physiology, published by The American Physiological Society.
Leptin as regulator
"Leptin is a hormone that plays a role in helping the body to balance food intake with energy expenditure. When leptin isn’t working -- that is, when the body no longer responds to the leptin it produces -- it’s called leptin resistance. Leptin resistance is associated with weight gain and obesity in the face of a high-fat, high-calorie diet.
Obesity has been a growing problem in the U.S. and in other parts of the world and fructose has been suspected of playing a role. Fructose is the sugar found in fruit, but it’s not the normal consumption of fruit that is the problem. Table sugar and high-fructose corn syrup are about 50% fructose and these ingredients have become increasingly common in many foods and beverages. With sugar and high-fructose corn syrup being added to many foods, people now eat much more fructose than ever before.
"The University of Florida researchers hypothesized that a high-fructose diet could lead to leptin resistance, which in turn could lead to exacerbated weight gain in the face of a high-fat, high-calorie diet, a typical diet in industrialized countries. To test their hypothesis, the research team performed a study with two groups of rats. They fed both groups the same diet, with one important exception: one group consumed a lot of fructose while the other received no fructose.
Two groups similar over six months
"During these six months, there were no differences in food intake, body weight, and body fat between rats on the high-fructose and the rats on the fructose-free diets. In addition, there was no difference between the two groups in the levels of leptin, glucose, cholesterol or insulin found in their blood. There was only one difference at the end of the six months: The rats on the high-fructose diet had higher levels of triglycerides in their blood.
"The researchers next tested the animals to see if they were leptin resistant. They injected all the animals with leptin, to see if they would respond by eating less. Animals whose leptin response is functioning normally will lower their food intake. The researchers discovered that the rats on the high-fructose diet were leptin resistant, that is, they did not lower their food intake when given leptin. The no-fructose animals responded normally to leptin by eating less.
"This first six months of the study showed that leptin resistance can develop silently. “Usually, leptin resistance is associated with obesity, but in this case, leptin resistance developed without obesity,” Shapiro said. “This was very surprising.”
Role of diet
"Having seen that leptin resistance could develop silently, the researchers next wanted to find out what would happen if they switched the rats to a high-fat, high-calorie diet -- the kind many Americans eat. They found that the animals exposed to the high-fructose diet, the leptin resistant rats, ate more and gained much more weight and fat than the leptin responsive animals on the fructose-free diet. All told, this study showed that leptin resistance can:
  • develop by eating a lot of fructose
  • develop silently, that is, with very little indication it is happening
  • result in weight gain when paired with a high fat, calorie dense diet
Scarpace said the study suggests it is the interaction between consumption of large amounts of fructose-containing foods and eating a high-fat, high-calorie diet that produces the weight gain. “This study may explain how the global increase in fructose consumption is related to the current obesity epidemic,” Shapiro said.
How it happens
"Other studies have shown that elevated triglycerides impair the transport of leptin across the blood brain barrier. The researchers hypothesize that the elevation in triglycerides produced by fructose prevented leptin from reaching the brain. If leptin does not reach the brain, the brain will not send out the signal to stop eating.
“'The presence of high fructose alters the way leptin works, fooling the brain so that it ignores leptin,'” Scarpace said. Consumers should be cautious about what they eat, checking labels to see how much sugar the items contain, Shapiro said.
"The researchers hope to perform future studies to find out if leptin resistance can be reversed by removing or reducing the fructose content of the diet.
What can I do to increase leptin?
Leptin is a "protein" hormone and is broken down by the stomach when ingested. Therefore, it is not possible to "take a pill" to increase leptin.
Other things that promote leptin resistance include lack of sleep, lack of omega 3 & 6 fatty acids, and lack of exercise. So, getting appropriate sleep, eating fish 2-3 times per week and regular exercise actually increase your ability to make and use leptin and help you loose weight. Intake of protein dense foods also improve leptin sensitivity.
Decreasing your intake of any product containing high fructose corn syrup, and decreasing intake of products containing simple table sugar (which is broken down into glucose and fructose in almost equal portions) will drastically help. This is why a low carbohydrate diet works so effectively in weight loss.

Journal Reference:
  1. Shapiro et al. Fructose-Induced Leptin Resistance Exacerbates Weight Gain in Response to Subsequent High Fat Feeding. AJP Regulatory Integrative and Comparative Physiology, October, 2008; DOI:10.1152/ajpregu.00195.2008

Adapted from ScienceDaily (Oct. 19, 2008)

Tuesday, December 21, 2010

Lunar Eclipse In Time Lapse

Amazing and rare lunar eclipse occured last night and was seen around the world. Here are some of the spectacular shots and time lapse photography that was recorded. Unfortunately, I slept through it, but, thanks to the world wide web, we get to see it in full color.

Friday, December 17, 2010

Tuesday, December 14, 2010

8 Ways to Kill the Happiness in Your Christmas!


8 Ways to Take the Joy Out of the HolidaysIn case you haven’t noticed, the winter holidays are here. They sweep over us like a tsunami of lights, sights, sounds and smells. It can be a season of joy or a season of stress. Most of us would choose the joy, but it’s easy to get caught up in things that can bring out the bah-humbug in the best of us.
Here are eight surefire ways to make sure we are exhausted, resentful, and broke by December’s end. Perhaps being aware of them will help us all keep good holiday spirits right into the new year.
1. Neglect the basics.
Don’t get enough sleep. Eat nothing but sugar. Don’t move except from car to store to car to door. It’s easy to neglect health and wellbeing during a time of celebratory eating, rushing around to do in a week what should take a month, and staying up too late to make sure every tradition is honored. We can fill our days with excuses (“Oh just this once I’ll …”) or we can stick to our healthy routines some — or even most — of the time and still enjoy the season.
2. Decorate every inch of the house.
The covers on those women’s magazines at the checkout counter can make us all feel like slackers. Twenty-four holiday gifts you can make in a day! 50 easy cookie recipes! Simple crafts to make your house inviting, warm, wonderful, in the spirit! Yeah. But most of us already put in a full day every day. The very idea of actually making those gifts, cookies, and decorations is exhausting.
If you truly enjoy crafts and decking the halls, by all means do it — just do it in a way that makes you as well as the house feel great. If your job is demanding and you already feel stretched to the max, it’s really okay to use the same decorations you’ve always used (that’s what traditions are all about anyway) and to buy a couple of dozen cookies.
3. Dig up memories of past holidays where you were neglected, mistreated, or ignored by someone or maybe by several someones.
We can relive our disappointments over and over or we can focus on making this holiday season happier and more meaningful. Promise yourself to take charge of some part of the holiday season this year and make a happy memory to look back on next year. Do this enough years in a row and you will build a fund of good memories.
4. Focus on what you don’t have and can’t do.
‘Tis the season when we can feel sorry for ourselves for not being able to buy the gifts we’d like to buy, for not being able to go on a winter vacation, for not being as well off as some family member, friend, or neighbor. Or we can appreciate what we do have and be grateful for the moments when we can do something special with or for someone we love.
5. Over-commit your time by saying yes when you really need to say no.
The PTO needs cookies? You agree to bake 6 dozen. The church needs folks to staff the holiday fair? You take two shifts as a favor to your friend the committee chair. The Cub Scouts need a place to have a party? You volunteer your house.
All are worthy activities. But you don’t have to do them all or do them all in a big way to be a good enough person. Choosing carefully when to say an enthusiastic yes and when to say a graceful no can make the difference between joyful participation and high stress.
6. Overspend.
It’s so tempting, isn’t it? The holiday sales are on. Every catalogue promises deals and steals – and free shipping. While you’re out buying for others, it’s hard not to throw in things you wanted for yourself. Although you intend to stay within a budget, it’s hard not to get just one more little thing for each of the kids. Bad idea. The likely outcome of going over budget is that you’ll be financially stressed until March. Believe me. The kids would rather have a happy parent than another toy or a designer sweater.
7. Try to get to too many places in too short a time.
Most of us don’t get a week off during the holidays, but many of us act as if we do. Let’s see: Christmas Eve at your mother’s, Christmas morning at your house. Christmas dinner with your partner’s family. The next day you’re expected to show up for a party. You put 500 miles on the car in three days. The kids are cranky. You’re cranky. Everyone is exhausted. As much as others may be disappointed, you do have a choice about all that running around. Stay put. Invite relatives to come to you for a change. Or stretch the holiday visiting out over the month. Only Santa has to get around the world in 24 hours. You don’t.
8. Threaten the kids.
“If you don’t behave, Santa won’t come.” As tempting as it may be to use Santa as the heavy, it can make a child anxious now and resentful in the future. Although it may buy a moment’s peace, threatening kids with the promise of a stocking stuffed with coal or bribing them with the promise of a pony can only destroy the magic. Leave Santa out of your repertoire for child management. Instead, catch them being good whenever you can. Be firm and fair in your discipline. You’ll be more effective as a parent and you’ll get the bonus of being able to see the magic of Christmas through a child’s eyes.

Monday, December 13, 2010

How Do I Start My Weight Loss Journey?

Yes.  Weight loss is a journey.  It was a journey getting here and it will be a journey getting back to that smaller size.  So, how do you start?
Great question.  That's what I am frequently asked by those wanting to start loosing weight. The most important point is that you need to want to start. In the words of Napoleon Hill, "Desire is the starting point of all achievement, not a hope, not a wish, but a keen pulsating desire which transcends everything."
First, Know Where You Are Coming From.
Get a journal and weight yourself.  Write it down and then check your weight every 2-3 days.  Don't weigh yourself every day.  This can be discouraging and many people fluctuate 2-5lbs every day based on meals and water intake.  
What you should record every day is what you eat.  Record your meals.  If you are being followed by a weight loss specialist, they will want to see this.  Record every thing you eat.  And, record your water intake.  I am amazed at how many of my patient's are dehydrated and just putting water back into their systems help them loose weight. 
Second, Plan Your Day.
Planning is the key to weight loss on any program.   You should plan your exercise and plan your meals the night before.  Failing to plan is really just planning to fail. 
Third, What's the Underlying Cause?
Acanthosis Nigricans
You can't loose weight unless you understand why you are gaining weight.  Two thirds of my patients are insulin resistant to some degree.  This is usually the cause of their weight gain.  Your doctor will need to identify this through blood work.  However, as a rule of thumb,  if you walk toward the wall and the first thing that touches the wall is your belly, there is a significant chance you are insulin resistant.   If you have skin tags or thickened browning skin at areas of skin folds, you are probably insulin resistant.  
Skin Tag
Insulin resistance requires a different dietary approach than the low fat diets.  If you are insulin resistant a low fat diet will not be very effective and you may even gain weight on a low fat diet.  If you have any of these symptoms, you need to follow up with your doctor or weight management specialist.
Loosing weight is possible.  As a journey, it will probably have a number of components that will be necessary to make it effective for you.  
Either way, enjoy the journey!!

Sunday, December 12, 2010

Drinking from the Virtual Fire-Hose

It is late. I find myself waxing philosophical this evening.  Like you, I am busy.  I am always looking for a more efficient method of doing menial tasks. For example, I have an electronic medical record - it does the repetitive writing for me with each visit.  I also have computerized transcription software that increases my input speed from 120 wpm to over 600 words per minute (for some reason I am typing this though, hmm?)  I use one of my medical assistants in the exam room for me to take transcription as well.  All of these things help me do the things I want to do and was trained to do more effectively.
However, I'm still trying to find the most efficient method of sorting through the fire-hose flow of news, information and medical information at my fingertips every day.  What is the status on South Korea's attack? Are our congressmen doing anything about the budget deficit? Did the Medicare pay cut get fixed and will this affect my ability to see those patients? Is there more to the bureaucratic monstrosity I need to be aware of this week?  Does the newest medication just out change our treatment of atrial fibrillation?  Is there drug resistance to this strain of staph. aureus in my office this week? How do you efficiently sort through the fodder, read the important information, apply it, and still have time to see your patients and be home before the dinner is cold and the kids are in bed?
I'm a solo practitioner.  Between seeing the patient's, reviewing their labs & diagnostics, follow up messages, managing the staff, paying the bills and ensuring that payroll is covered, adding an additional ball to the juggling seems ominous.  
I have been impressed by Bryan Vartabedian, MD (, Dr. Rob (, Kevin Pho, MD (, and Wendy Sue Swanson, MD (Seattlemamadoc). These are the trailblazers and some how seem to be able to drink from the fire-hose and not get that flapping lip, water in your lungs, spewing out your nose sensation.  I have to give them credit.  As I have read their blogs and seen their tweeds, I have gleaned a few bits of insight.  Thanks. 
But, I got tired of trying to swallow it all one week and just ignored it all. I turned off Twitter, Facebook and ignored my e-mail . . . and it caught up with me. I missed some major events that were important to me that week. I was disappointed with myself.  Disappointed with the system. Just disappointed. 
I reviewed the previous few weeks.  What was wrong?  
I forgot about the basics.  I realized that any good sports team or athlete when confronted with poor performance goes back to the basics.  The fundamentals. The grounding principles. 
The problem I see with the information fire-hose is that in trying to drink, we often forget how to breath and swallow when our face is in the water. We are now involved in virtual interactions and global interrelations. They are no longer preplanned and thought out. They are no longer face-to-face.  Virtual stage fright occurs and we forget the basics. So, many just decide the fire-hose isn't for them. 
So, in the spirit of returning to the basics, I am reminded of Luke Skywalker's basic training under Master Yoda.  Small though he was, big on insight were the few lines he captivated me with as a young boy.
"Do or do not . . . there is no try!"
I realize that I need to take these one bite at a time.  Just the effort of getting of the couch, getting out of the chair, reading one article, finishing one book, writing a few of my thoughts has helped. Remember why you go to work.  Remember why you see each patient.  Remember why you enjoy these interactions so much.  Search for those one or two things each day that will make it easier to go to work, to see each patient, and to enhance your personal interactions with those you render care to.
"Named must your fear be before banish it you can."
What is to be gained from the information superhighway and what are the risks of driving on it?  The answer to both questions is "Time". Drinking from the fire-hose will can help you improve your efficiency, but, it can also suck up too much of your precious time. I have found that if I focus the time I am on the information superhighway and I set a specific reason or goal to accomplish by being there, I find it very rewarding. 
"Always in motion is the future."
The only thing constant in life is change.  That's what is so fascinating about our access to information in this age. That's why it is so anxiety provoking as well.  Many are unnerved by seeing the speed around us that the world moves.  Although, I don't think that the world really sped up, I think that we just see more of it and need to realize that our consistency will be like a ship on moving water. 
"Always two there are, no more no less: a master and an apprentice."
There will always be a teacher.  There will always be one who has mastered the art.  From them we can learn, apply and improve our own capacities. For those who have mastered the art, I am grateful. The master teaches and emphasizes mastery of the basics.  
So, if you have mastered drinking from the fire-hose, please pass it on.

Thursday, December 9, 2010

Is Social Media Making You Lonelier?

Why Social Media Might Be Making You Lonelier

 (Originally Posted on WEBMD)

woman behind computer
People heavily steeped in the new phenomenon of social media have many more ‘friends’ than anyone ever could have imagined in years past. The number of people you can communicate with feels almost infinite. Communication is constant. While this buzz of activity sounds great on the surface, that’s not always the case.
The fact that social media is less complex than face-to-face interactions is one of its great benefits, but is also a potential problem. Email, texting, and Facebook are all great ways to communicate quickly. However, each one — albeit in differing ways — limits the amount of information that is being exchanged. For example, with all of them, many people like that they can say what they want without having to engage in further conversation. They can tell someone something upsetting without having to directly experience that person’s reaction of anger or disappointment. But they also can’t read tone of voice or body language or the earnestness in someone’s eyes. In these and other ways, social media provides a more limited (and sometimes ’safer’) form of communication than face-to-face interactions.
Different kinds of people use social media in different ways. Some recent research has shown that those who are confident and outgoing tend not to be as taken with social media. Even when they actively use it, they prefer communicating in ways that are more complex, like the telephone or face-to-face conversations. For them, social media is a way to enhance relationships they’ve developed in person; or to expand from a solid base of developed friendships.
By contrast, insecure people tend to prefer social media to richer forms of communication. For them, email provides a sense of safety from the anxiety they feel in face-to-face interactions. Whether their difficulty is based in poor social skills or social anxiety (despite having good social skills), they avoid discomfort by using less direct forms of communication. And, the more they avoid social situations, the more likely they will be to continue to avoid them. Thus, they have fewer complex and deeply connected social interactions — experiences that cannot occur solely through social media. As a result, they tend to feel lonely.
The best way for them to cope with this loneliness is to gently face the problem. Those with poor social skills must work on the skills needed for direct interactions. They can get training from an individual therapist, a social skills therapy group, or a self-help book (though improvement, of course, still requires live practice). Those who have good social skills, but are still highly anxious, need to practice slowly increasing the richness of the ways they communicate. They might be able to do this on their own, but also might need the help of a professional. In both cases, as people become more adept and comfortable in social situations, they will also begin to feel more connected — less lonely.
Like so many other things, social media is not a problem by itself. It’s just a tool. By using social media as an adjunct to relationships developed through direct, personal interactions, it can be wonderfully helpful and engaging.
(from Clinician’s Research Digest; 2009; “Are Shy people more likely to use e-mail to communicate to others?”)Posted by: 
Leslie Becker-Phelps, PhD (Originally Posted on WEBMD)

Tuesday, December 7, 2010

Do What You Can Do . . .Today

I'm exhausted.  Up at 4am this morning to teach an early morning class at 5:45am.  Patients begin at 7am.  Finished seeing my last patient at 4:30pm, and spent three hours finishing my charting, participating in a training lecture and completing the piles of paperwork on my desk.  
These 14 hour days are killing me.  
Home at 7:45pm for dinner with the family.  Spent a few precious minutes talking with my wife and children.
Spent 2 hours preparing for tomorrows lesson and information for another class.
Here I sit, now, at 11pm composing a blog entry.  Am I nuts?   I think I must be.  
So, in looking for solace I read the words of Albert Schweitzer, "A man can do only what he can do. But if he does that each day he can sleep at night and do it again the next day."  Really?!!  You didn't mention anything about the sleeping only three hours part!
So, I read a little further and Dr. Schweitzer goes on to say, "Anyone who proposes to do good must not expect people to roll stones out of his way, but must accept his lot calmly, even if they roll a few stones upon it."
OK.  I've accepted my lot. I'm calm. . . I think.  But its hard. 
"But that's why you earn the big bucks, right, Doc?" I hear the recent voice of a patient echo in my mind.  "Apparently, you didn't read about the 'Doc Fix' that hasn't been fixed, I echo to myself." 
Great!  Now I'm talking to myself. 
But, I am reassured . . . I think back over the day.  
Two of today's patients seen in the office were in their late nineties, almost centenarians.  Both were smiling and both were happy.  Both sweet spirits in aging bodies, but both were a lift to my spirit.  
Somehow, both were energizing to talk to, even though both were curved and whithered and slightly rumpled by the years.  Is happiness nothing more than good health and a bad memory?  Not in the lives of these two.
The one is legally blind, but that has only made her more of a philosopher and a thinker.  Her words are simple, but profound. 
The other has severe arthritis and cannot walk, yet just shaking her hand brought hope and energy back into my limbs.
So, maybe Schweitzer is right: "Life becomes harder for us when we live for others, but it also becomes richer and happier." I know I am happier and emotionally richer for the experiences of the day. 

Monday, December 6, 2010

How Many Calories Do You Burn Walking?

Any parent that takes their kid out for a walk knows that children tire more quickly than adults, but why is that? Do kids and small adults walk differently from taller people or do they tire faster for some other reason? Peter Weyand from Southern Methodist University, USA, is fascinated by the effect that body size has on physiological function. 'This goes back to Max Kleiber's work on resting metabolic rates for different sized animals. He found that the bigger you are the slower each gram of tissue uses energy,' explains Weyand, who adds, 'It's interesting to know how and why metabolism is regulated that way.' Intrigued by the question of why smaller people use more energy per kilogram body mass than larger individuals when walking, Weyand teamed up with Maurice Puyau and Nancy Butte, from the USDA/ARS Children's Nutrition Research Center at Baylor College of Medicine, and undergraduate Bethany Smith. Together they decided to measure the metabolic rates of children and adults, ranging from 5 to 32 years old, weighing between 15.9kg and 88.7kg and ranging in height from 1.07m to 1.83m, to try to find out why larger people are more economical walkers than smaller people. Weyand and his colleagues publish their discovery that walkers of all heights use the same amount of energy per stride, making short people less economical because they take more steps. They also derive a fundamental equation to calculate exactly how much energy walkers use with direct applications in all walks of life. The team published its discovery on 12 November 2010 in The Journal of Experimental Biology. 

First Weyand and colleagues filmed male and female volunteers as they walked on a treadmill at speeds ranging from a slow 0.4m/s up to 1.9m/s. Meanwhile, they simultaneously measured the walkers' oxygen consumption and carbon dioxide production rates to obtain their total metabolic rate. Next the team calculated the amount of energy that each person used for walking by subtracting the basal metabolic rate (energy required to maintain the body's basic metabolic functions) from the total metabolic rate measured while walking. Finally, the team compared the way each person walked, measuring the walkers' stride lengths, stride durations and the proportion of each stride they spent in contact with the ground (duty factor) to find out if large and small people walk differently. 

Analysing the walkers' styles, the team found that all of them moved in exactly the same way regardless of their height. Essentially, if you scaled a 5 year old up to 2m, the giant child would walk in exactly the same way as a 2m tall adult. So large people are not more economical because they walk differently from smaller people. 

Next the team calculated the metabolic cost of a stride as each walker moved at their most economical pace and they discovered that walkers use the same amount of energy per stride regardless of their height. So, big people do not become more economical because they walk in a more economical style. Something else must account for their increased economy. 

Finally, the four scientists plotted the walkers' heights against their minimum energy expenditure and they were amazed when they got a straight line with a gradient of almost -1. The walkers' energy costs were inversely proportional to their heights, with tall people walking more economically than short/smaller people because they have longer strides and have to take fewer steps to cover the same distance. So smaller people tire faster because each step costs the same and they have to take more steps to cover the same distance or travel at the same speed. 

Based on this discovery the group derived an equation that can be used to calculate the energetic cost of walking. 'The equation allows you to use your height, weight and distance walked to determine how many calories you burn,' says Weyand. The equation could also be built into popular pedometers to provide users with a more realistic idea of how many calories they expend walking throughout the day. Finally, the team is keen to extend the equation to calculate metabolic costs at any speed. 'This has clinical applications, weight balance applications and the military is interested too because metabolic rates influence the physiological status of soldiers in the field,' explains Weyand. 

Kathryn Knight 
The Company of Biologists

Medical News Today

Sunday, December 5, 2010

The Perfect Saturday

We spent the afternoon as a family taking some pictures.  Lori Calhoun of Calhoun Ink came out and spent a little time with us.  She has done wonderful work in the past, and this is another example of the beautiful work she does.  I can't wait to see the rest of the pictures.  There's nothing like spending some time with your children and your horses in the sunset.  This captured the moment wonderfully.  I have been so greatly  blessed.  I find that spending time with my family and the horses calms my soul and when you do so under a sky like the one above, you come to know that there is a God in the heavens and He is mindful of us.

Friday, December 3, 2010


Healthy citizens are the greatest asset any country can have.

Criticism Is Essential

Criticism may not be agreeable, but it is necessary. It fulfils the same function as pain in the human body. It calls attention to an unhealthy state of things.

                                                                                                                            Winston Churchill.

Thursday, December 2, 2010


All the great things are simple, and many can be expressed in a single word: freedom, justice, honor, duty, mercy, hope.

To build may have to be the slow and laborious task of years. To destroy can be the thoughtless act of a single day.
Winston Churchill

Thursday, November 18, 2010

Senate & House Unveil Possible Temporary Fix for Medicare

by Robert Lowes
November 18, 2010 — House Democrats introduced legislation today that would postpone a 23% cut in Medicare reimbursement for physicians set for December 1 until January 1, 2012, and instead boost rates by 1% in the meantime.
Meanwhile, Sen. Max Baucus (D-MT), the chair of the Senate Finance Committee, and Sen. Chuck Grassley (R-IA), the committee’s ranking Republican member, unveiled a 2-part plan that also would spare physicians the massive pay cut for 13 months.
Under the senators’ bipartisan agreement, the Senate would delay the December 1 pay cut until January 1, and in the meantime craft another extension for the rest of 2011. The 1-month delay would be paid for with savings achieved elsewhere in the Medicare program. The financing for the longer extension has yet to be worked out.
The House was scheduled to adjourn this afternoon for the Thanksgiving holiday and return on November 29. The Senate’s timetable for adjournment this week is still up in the air. If the 2 chambers of Congress fail to pass and reconcile their respective Medicare “doc fix” plans this week, they still have November 29 and November 30 to finish up.
Brendan Daly, a spokesperson for House Speaker Nancy Pelosi (D-CA), told Medscape Medical News that the House would consider the 1-month Senate extension on November 29. The timing on the 13-month House bill has yet to be determined, Daly said.
Organized medicine has warned that if the 23% pay cut takes effect, many physicians will close their doors to new Medicare patients and even drop out of the federal program. To make matters worse, another Medicare cut of roughly 2% is scheduled for January 1.
Bipartisan Lip Service for Permanent Fix, Clash Over Financing
Organized medicine, along with the Obama administration, supports delaying the Medicare pay cut until 2012 — the so-called 13-month fix — as a way to buy Congress more time to devise a permanent solution to the Medicare reimbursement crisis. At its heart is the sustainable growth rate (SGR) formula that Congress created in 1997 to help control Medicare spending. The formula sets a target for annual Medicare expenditures on physician services based partly on growth in the gross domestic product. If actual spending in 1 year tops the target, Medicare is supposed to reduce physician reimbursement the following year to recoup the difference.
The American Medical Association and other medical societies argue that the formula is defective because physician practice expenses grow at a faster pace than the gross domestic product. They support replacing the SGR formula with one more squarely based on the Medicare Economic Index, which measures inflation in physician practice costs.
The SGR formula has triggered pay cuts every year going back to 2003, but Congress has postponed each one. However, the difference between targeted and actual spending accumulates from year to year, meaning the cuts keep getting bigger.
The notion of a permanent doc fix attracts lip service from Democrats and Republicans alike. Where the 2 parties part ways is over how to foot the bill.
The Congressional Budget Office estimates that merely freezing current Medicare rates through 2020 as opposed to decreasing them would cost taxpayers $276 billion. Giving physicians raises based on the Medicare Economic Index ups the ante to $330 billion.
In the past, Congressional Democrats have been willing to pay for such ambitious payment reforms through deficit spending. Republicans, in contrast, have insisted on cutting the budget elsewhere to finance even the smallest of doc fixes. With Republicans now in charge of the House, the debate over financing will go up several notches, especially because lawmakers will be challenged to find hundreds of billions of dollars in the federal budget that they can excise to offset a permanent fix.

Thursday, November 11, 2010

A Fat Attack Can Kill You

What is a "Fat Attack?"  A "Fat Attack" is defined as a gain of more than 5% of your total body weight.  A gain of this much weight can be notably detrimental to your health.  Gaining just 5% of your total body weight increases your risk for diabetes, heart disease, hypertension, stroke, osteoarthritis, polycysitic ovarian disease, allergies, and the list goes on . . .  Most importantly, your weight gain significantly affects your life and increases your risk of death by 20-40% according to recent study in the New England Journal of Medicine.
Between 300,000-400,000 deaths occur every year due to obesity.  435,000 deaths occurred due to smoking in 2008 according to the CDC.  Obesity is just as dangerous as smoking
"Overweight and obesity are now so common that they are replacing the more traditional public health concerns such as under-nutrition and infectious disease as some of the most significant contributors to ill health." (World Health Organization 1997 statement on obesity.)
So what should you do if you're having a "Fat Attack?" You should follow up with a your physician or a weight management specialist, a physician that is specialty trained in the treatment of obesity and its related disorders.
You can find a physician that has this special training through the American Society of Bariatric Physicians. These physicians have significant specialty training in identifying and successfully treating overweight and obesity conditions.
You can be successful in loosing weight and your "Fat Attack" shouldn't lead you to a heart attack. Look up your nearby bariatrician and start your treatment today.

Saturday, November 6, 2010

EHR Incentive Money is Taxable

CMS' EHR Meaningful Use Bonus Money Subject to Federal Taxes
(Taken from AAPF News)
By Sheri Porter
Are CMS incentive payments, which are available to physicians who invest in electronic health records, or EHRs, and use them in a meaningful way, taxable by the IRS? That question was asked during the recent AAFP Town Hall meeting in Denver.
Stock photo of 1040 tax form with stethoscope
The simple answer is "yes." According to Steven Waldren, M.D., director of the AAFP's Center for Health IT, all health IT incentive payments received as a part of the American Recovery and Reinvestment Act of 2009 and the accompanying Health Information Technology for Economic and Clinical Health, or HITECH, Act are viewed by the IRS as taxable income.

Physicians who meet the incentive payment criteria are eligible to earn as much as $44,000 from Medicare, or they can choose to earn Medicaid incentives of as much as $63,750.

Waldren, who consulted with the Office of the National Coordinator for Health IT, noted that family physicians should consult their tax accountants for recommendations on how to manage the tax burden.


Mark Estroff, C.P.A., a principal at Gates Moore and Co., an Atlanta-based health care consulting and accounting firm, explained how the government is viewing the incentive program.

"The way I look at it, this is just enhanced reimbursement from the federal program," he told AAFP News Now. "They're just going to give you a little more money because you're utilizing the proper technology in your practice, and it is taxable just like any other practice gross receipts that you're going to receive."

Estroff added that there are some tax advantages for medical practices. For example, when physicians buy equipment -- whether it's hardware or most software -- the IRS allows them to write off as much as 100 percent of the cost of that equipment. However, that write-off is subject to the limitations of the optional expensing rules of Internal Revenue Code Section 179, Estroff added.

"Depending on how you go about it -- the tax law limitations, the size of your practice and a lot of other factors -- you may be able to write it all off in the year that you acquire it," he said, although in other situations, it may take five years to recover the investment through tax benefits.

Estroff also advised physicians to comb their state tax laws to see if there are additional tax incentives -- as is the case in Georgia -- for upgrading their practice technology or for training staff to use a health IT system.

Putting himself in the role of a qualifying physician, "it's another cash infusion into my practice to help me pay for the cost of the EHR," said Estroff.


Estroff makes sure that his physician and health care professional clients are aware that the HITECH incentive offer is a once-in-a-lifetime chance to boost their income.

"If they do not implement (an EHR) and take advantage of this extra money that's being offered, eventually they're going to be penalized," said Estroff. The federal program offers several years of bonus payments, but in 2015, CMS will begin penalizing physicians who aren't using EHRs by reducing their Medicare payments.

"Right now, physicians are getting the carrot before the stick," said Estroff. "They're going to get the stick in a few years, so they might as well eat the carrot while they can."

Estroff concluded with this tip: "The tax question is a basic question. The real issue goes back to selecting the right (EHR) product," and that means physicians have to take a hard look at their practices' needs and capabilities. "There's a whole selection process that takes place, and you don't often let the tax implications drive your decision," said Estroff.

It's the Coffee, Not the Caffeine . . .

Coffee Boosts Stroke Risk, Study Finds

by Allison Gandey
November 5, 2010 — A cup of coffee can heighten the risk for ischemic stroke, particularly among infrequent drinkers, report researchers. Their study provides new information that may be useful in stroke prevention and is in line with what is already known about the physiologic effects of coffee.
Investigators led by Elizabeth Mostofsky, MPH, from Harvard Medical School in Boston, Massachusetts, found a 2-fold increased stroke risk in the hour after drinking a cup of coffee. The increased risk returned to baseline within a 2-hour window, which investigators say strengthens the possibility of a causal relationship.
The work appears in the November 2 issue ofNeurology.
The risk was highest in the hour after drinking coffee.
Previous studies evaluating the effect of coffee on cardiovascular diseases have provided conflicting results. Case-control studies have shown an increase in risk, but prospective cohort studies have suggested no harmful effects. Coffee has been shown to have a negative effect on cardiovascular biomarkers increasing serum cholesterol, insulin resistance, and plasma homocysteine. However, several studies have shown that coffee intake decreases the risk for type 2 diabetes.
In this new multicenter crossover study, researchers interviewed 390 people with ischemic stroke. They compared each person's coffee intake the hour before stroke symptoms to his or her usual consumption.
Most people, 78%, said they drank coffee the prior year. More than half of these had a cup of coffee within 24 hours of stroke. Close to 9% of patients had coffee within 1 hour of stroke onset.
Although an increase in stroke risk was seen with coffee, there was no apparent increase in risk in the hour after a cup of caffeinated tea or cola.
The association between ischemic stroke in the hour after coffee consumption was only apparent among those consuming 1 cup or less per day and not for those who drank coffee more regularly (for trend = .002). Relative risks remained similar when researchers restricted the sample to those who were not simultaneously exposed to other potential triggers, and the results remained significant after stratifying by time of day.
"Elegant Study Design"
In an accompanying editorial, Giancarlo Logroscino, MD, from University of Bari in Italy, and Tobias Kurth, MD, from the Institut National de la Santé et de la Recherche Médicale in Paris, France, say "the authors used an elegant study design" and they call this "an important addition to the 'coffee paradox'."
But they add clinicians will need further evidence to properly advise people about coffee intake, especially when other risk factors for stroke are present.
"Even if coffee contains other substances that may be responsible for the observed effect, caffeine is the most likely candidate for pulling the trigger," they note.
The peak plasma concentration of caffeine is usually less than 2 hours and has several systemic effects, including rapidly increasing epinephrine release, blood pressure, and insulin sensitivity, they explain. "Caffeine has both systemic and cerebral vasoconstrictive effects."
Lead study author Elizabeth Mostofsky reports receiving research funds from the National Institutes of Health and the National Institute of Allergy and Infectious Diseases. Editorialist Giancarlo Logroscino has received research support from the Amyotrophic Lateral Sclerosis Association, the Italian Ministry of Health, the University of Bari, the Apulia Region, and the Italian Ministry of University. Dr. Logroscino has also received compensation for services from Pfizer, Novartis, GlaxoSmithKline, and Eli Lilly. Dr. Tobias Kurth has received support from the National Institutes of Health, the French National Research Agency, the Migraine Research Foundation, and the Parkinson's Disease Foundation. He serves as a consultant for i3 Drug Safety and World Health Information Science Consultants. He has also received funding from Genzyme, Merck Serono, and Pfizer.
Neurology. 2010;75:1583-1588.