By ANNE D'INNOCENZIO, RACHEL BECK
The Associated Press
updated 11/7/2010 2:40:00 PM ET 2010-11-07T19:40:00
NEW YORK — Layaway, once the province of the poor, has gone mainstream. At the Mall of America in Minnesota, shoppers dart in for just one or two things. In New York, socialites do the unthinkable: They wear the same ball gown twice.
During the Great Recession, people made drastic changes in how they spent their money. They stopped treating credit cards as cash. They learned to save and learned to wait.
After a long stretch of subpar job growth, businesses may finally be getting back in a hiring mood.
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..Now the recession is over, at least technically, and the economy is growing again, at least a little. But many changes in spending habits that most Americans first saw as temporary have taken hold, perhaps for good, some economists say.
This is the reality of the new American consumer — focused, cautious and tactical.
In Jacksonville, Fla., Bernie Decelles and his wife both have jobs and own their home. They recognize that the economy is still fragile, though, and that they work in industries still struggling. They scrutinize every purchase they make.
"It used to be if we saw something, and liked it, we bought it," says Decelles, a salesman for a company that makes storage equipment. "Nowadays, no way."
In dozens of interviews nationwide with shoppers, retailers, manufacturers, economists and analysts, The Associated Press identified key changes in consumer behavior that have endured after the recession. They include:
•Americans are buying brands and shopping at stores that they shunned before. They are trying more store-brand products for things like detergent and beer. Goodwill and consignment shops are attracting customers across the income spectrum. And people are putting big-ticket items on layaway rather than whipping out charge cards.
•Consumers are taking a surgical approach to shopping, buying only what they need, when they need it. Pantries are no longer filled with weeks' worth of food, nor closets with clothes bought seasons in advance. Shoppers are visiting fewer stores, both traditional and online, and getting only what's on their shopping list.
•The wealthy are spending again, but their behavior is much like everyone else. They are buying more timeless and classic goods: watches and handbags that won't go out of style quickly. They are even — gasp! — recycling some of their most expensive clothes and wearing them twice.
These behavioral shifts aren't at the extremes of the Great Depression, which produced changes so drastic that many who lived through it adopted frugality as a lifelong habit.
Still, some experts say the changes from the recession of 2007, 2008 and 2009 could last.
"This was a massive cultural event for our society," says John Gerzema, a branding executive at marketing and advertising firm Young & Rubicam and co-author of a new book about the changing ways we spend money. "Eighty percent of Americans were born after World War II, so essentially this is our Depression."
The impact is hard to overstate. Consumer spending represents 70 percent of economic activity. Every business feels the pullback in some way, and it's more pronounced for those that sell things directly to people.
The new patterns of spending represent a radical turn from the boom years of the last decade. Americans up and down the income ladder piled on credit-card debt and used their homes as ATMs by taking out home-equity loans to pay for third cars, clothes and far-flung vacations.
During that time, the savings rate plunged to nearly zero. Americans accumulated debts that far exceeded their incomes. Household debt, including obligations for mortgages and credit cards, rose to about 140 percent of disposable income, double what it was before the boom years.
Credit was easy, and money seemed readily available. Until it wasn't.
"We saw a period of consumption that was unusual and unstable," says Jarrett Paschel, vice president of strategy and innovation at The Hartman Group, a consumer research firm in Bellevue, Wash.
A plunge in housing prices set off the economy's slump. Most Americans were left financially stressed in some way. Millions of people abandoned all but the necessities; for some, the necessities became luxuries.
The worst recession since the Depression ended in June 2009, according to the National Bureau of Economic Research, a group of academic economists that officially declares the starts and ends of recessions.
Americans' psyche hasn't recovered. An index of consumer confidence from The Conference Board has been in a tight range from the high 40s to high 50s. A reading of 90 indicates a healthy economy, and that level has not been seen since December 2007, the month the recession began.
U.S. households lost 17 percent of their wealth over in the past three years, more than $10 trillion, according to the Federal Reserve. The labor market remains in shambles, with nearly one in 10 Americans unemployed. One in six Americans now receives some form of government assistance, including food stamps and extended jobless benefits.
You may not see soup lines, but only because "the soup lines are in the mail," says David Rosenberg, chief economist and investment strategist at the Toronto-based money management firm Gluskin Sheff.
This stressful economic climate isn't just affecting Americans who are struggling to get by. Those who are more fortunate also have a new approach to spending.
Before the financial meltdown, philanthropist and socialite Allison Weiss Brady didn't think twice about dropping $20,000 each season on posh accessories. One prized possession she bought at the height of the boom? A $4,950 Fendi lizard handbag.
Brady still springs for luxury labels like Chanel, but she's snubbing the "it" handbags in favor of clothes and accessories that have staying power beyond a season.
She won't buy a new dress for every occasion, and will be wearing a Lanvin gown bought for a charity event last year to a few parties this year. And for the first time, she bought a peach-colored Chanel bag at a second-hand store, saving $2,000.
"I do think my mentality is more need-based now," says Brady, who lives in Florida and is a vice president of marketing for Florida Dental Benefits, a dental insurance company. "Am I going to show up with a new pair of diamond earrings every times I go to a ball? That's not happening." Brady is also buying more items at charity auctions — not only to save but to give to others.
Tempered spending by Americans of most income levels means the economic recovery is having a harder time gaining steam. Rosenberg says that at this point of the economic cycle — two years and 11 months since the recession began — things should be much better.
Retail sales are off by 2.6 percent since the recession began in December 2007. That's a stark contrast to the last 60 years. At this stage in an economic recovery, retail sales on average were up 25 percent, according to Gluskin Sheff. Retail sales include food, autos, clothing, furniture and electronics.
Decelles, of Jacksonville, acknowledges his spending was more careless a few years back. Saving was barely on the radar. Now he eats out far less, doesn't entertain much and spends little time shopping.
"Things certainly feel a lot different now," he says, "than they did back then
Sunday, November 7, 2010
Wednesday, October 27, 2010
Lung cancer pill shrinks some tumors
Drug may be effective for up to 10,000 cancer patients in the United States
By Gene Emery
Reuters
updated 10/27/2010 5:30:44 PM ET 2010-10-27T21:30:44
BOSTON — A promising cancer pill that could help as many as 5 percent of people with the most common type of lung cancer helps most patients treated but may be vulnerable to resistant tumors, researchers reported Wednesday.
The Pfizer Inc drug, crizotinib, shrank the tumors of 57 percent of patients and stabilized another 33 percent, Dr. Eunice Kwak of the Massachusetts General Hospital and colleagues reported in the New England Journal of Medicine.
Kwak's team projected that 72 percent of the patients would have enjoyed six months without their disease worsening. Their findings update earlier reports given to various cancer meetings.
"While this is a Phase 1 study, the high response rates observed in patients with ALK-positive (lung cancer) who received crizotinib suggest that we may be one step closer to the development of 'precision' or 'personalized' cancer treatments that target specific genetic factors that drive certain tumors," said Pfizer's Dr. Mace Rothenberg.
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..But a team of doctors led by Young Lim Choi of the University of Tokyo reported on a patient who developed two independent mutations that made the tumor resistant to crizotinib.
The appearance of resistance is not surprising, Dr. Hiroyuki Mano of the University of Tokyo said in a telephone interview. Other so-called ALK inhibitors have the same problem to some degree.
"The news is both good and bad," said Mano. "It's bad in that there may be some refractory population. But it's good that we know the resistant mutations, so the next generation of ALK inhibitors will use that information to make a less refractory drug in the very near future."
Pfizer said it planned to start submitting data for approval of the drug to the U.S. Food and Drug Administration later this year.
The experimental drug works against cells that have turned cancerous when two genes fuse to form a new gene called EML4-ALK. Although only about 3 percent to 5 percent of people with non-small-cell lung cancer fall into this category, that translates into nearly 10,000 cancer patients in the United States.
Nearly all the volunteers in that study had already undergone one round of treatment with cancer drugs.
..Second-round chemotherapy typically only works in about 10 percent of such cases, Bengt Hallberg and Ruth Palmer of Umea University in Sweden said in a Journal commentary.
Side-effects such as nausea and diarrhea were reported to be mild to moderate and seen in 40 percent of patients.
The medical journal also reported that the drug, sometimes designated PF-02341066, helped a 44-year-old man with a rare inflammatory myofibroblastic tumor that had the ALK mutation.
A younger patient without the mutation did not benefit from the treatment, according to a team led by Dr. James Butrynski of the Dana-Farber Cancer Institute in Boston.
Existing cancer pills like AstraZeneca's Iressa and Roche's Tarceva are already known to be effective against cancer in patients with a mutation activating the epidermal growth factor receptor (EGFR).
Lung cancer is the most common cancer killer, with 1.61 million cases worldwide, according to the International Agency for Research on Cancer and it kills 1.2 million of them.
By Gene Emery
Reuters
updated 10/27/2010 5:30:44 PM ET 2010-10-27T21:30:44
BOSTON — A promising cancer pill that could help as many as 5 percent of people with the most common type of lung cancer helps most patients treated but may be vulnerable to resistant tumors, researchers reported Wednesday.
The Pfizer Inc drug, crizotinib, shrank the tumors of 57 percent of patients and stabilized another 33 percent, Dr. Eunice Kwak of the Massachusetts General Hospital and colleagues reported in the New England Journal of Medicine.
Kwak's team projected that 72 percent of the patients would have enjoyed six months without their disease worsening. Their findings update earlier reports given to various cancer meetings.
"While this is a Phase 1 study, the high response rates observed in patients with ALK-positive (lung cancer) who received crizotinib suggest that we may be one step closer to the development of 'precision' or 'personalized' cancer treatments that target specific genetic factors that drive certain tumors," said Pfizer's Dr. Mace Rothenberg.
Health highlights AP Could overhaul undermine employer health coverage?
The new health care law wasn't supposed to undercut employer plans that have provided most people in the U.S. with coverage for generations. But some employers are weighing the options.
..But a team of doctors led by Young Lim Choi of the University of Tokyo reported on a patient who developed two independent mutations that made the tumor resistant to crizotinib.
The appearance of resistance is not surprising, Dr. Hiroyuki Mano of the University of Tokyo said in a telephone interview. Other so-called ALK inhibitors have the same problem to some degree.
"The news is both good and bad," said Mano. "It's bad in that there may be some refractory population. But it's good that we know the resistant mutations, so the next generation of ALK inhibitors will use that information to make a less refractory drug in the very near future."
Pfizer said it planned to start submitting data for approval of the drug to the U.S. Food and Drug Administration later this year.
The experimental drug works against cells that have turned cancerous when two genes fuse to form a new gene called EML4-ALK. Although only about 3 percent to 5 percent of people with non-small-cell lung cancer fall into this category, that translates into nearly 10,000 cancer patients in the United States.
Nearly all the volunteers in that study had already undergone one round of treatment with cancer drugs.
..Second-round chemotherapy typically only works in about 10 percent of such cases, Bengt Hallberg and Ruth Palmer of Umea University in Sweden said in a Journal commentary.
Side-effects such as nausea and diarrhea were reported to be mild to moderate and seen in 40 percent of patients.
The medical journal also reported that the drug, sometimes designated PF-02341066, helped a 44-year-old man with a rare inflammatory myofibroblastic tumor that had the ALK mutation.
A younger patient without the mutation did not benefit from the treatment, according to a team led by Dr. James Butrynski of the Dana-Farber Cancer Institute in Boston.
Existing cancer pills like AstraZeneca's Iressa and Roche's Tarceva are already known to be effective against cancer in patients with a mutation activating the epidermal growth factor receptor (EGFR).
Lung cancer is the most common cancer killer, with 1.61 million cases worldwide, according to the International Agency for Research on Cancer and it kills 1.2 million of them.
Wednesday, October 13, 2010
Could Losing Weight Ease Your Arthritis Pain?
Osteoarthritis Health Center
By Gina Shaw
WebMD Feature Reviewed by Brunilda Nazario, MD
For 12 years, Robin Lutchansky spent most of her time in a wheelchair. The pain from her severe osteoarthritis, first diagnosed in her early 30s, made it difficult to walk more than short distances.
Then, a little over three years ago, Lutchansky found her way to a pain management clinic that taught her how to exercise -- first, teaching her how to walk again. Over the next three years, Lutchansky, now 51, gradually lost nearly 100 pounds with calorie reduction and exercise.
“I did it slowly. I started out just lifting 2-pound weights, and I walked in the pool every day,” she says.
Today, Lutchansky is out of the wheelchair and back at work as a public relations representative for a high-tech firm, and says that her daily pain levels have gone from an 8 or a 9 to a 1. “It’s amazing. It’s a new life. I had no idea it was possible.”
What Weight Does to Your Joints
If you are at all overweight, one of the best ways to reduce osteoarthritis pain is by taking off excess pounds. Being overweight increases the load that you put on your joints -- your knees, your hips, your ankle -- with every step you take.
“When we walk, when we go up and down stairs, or get into or out of a chair or car, we can put three to five times our body weight, and sometimes more, on the joints,” says Geoffrey Westrich, attending orthopedic surgeon and Director of Joint Replacement Research at the Hospital for Special Surgery in New York. “So if you’re 50 pounds overweight, you’re putting around 250 pounds of increased stress across your knees and hips.”
Over time, that extra weight makes you much more prone to developing arthritis and can cause arthritis to progress much more rapidly, leading to much more pain once it has developed.
Fortunately, the same principle works in reverse. “For every pound people lose, they lose 3 pounds of stress across their knee and 6 pounds of stress on their hip, on average,” says Westrich.
Small Steps, Big Changes
You don’t have to lose 100 pounds, like Lutchansky, to see a difference in your pain levels. C. Thomas Vangsness, Jr., MD, professor of orthopaedic surgery and chief of sports medicine at the Keck School of Medicine at the University of Southern California, says most of his arthritis patients who lose weight notice that their pain is diminishing after losing about 20 pounds.
Jane Angelich, a 58-year-old California businesswoman, has lost 33 pounds on Weight Watchers.
“What a difference!” she says. “It starts when I get out of bed in the morning. No more limping around and groaning for the first few minutes. Instead of finding excuses to sit on my couch instead of walking around, I now walk the equivalent of a 5k without any issues and can even function the next day!”
Losing weight cannot repair the damage that’s already been done to your joints by arthritis, but in addition to decreasing your pain, it can also help to slow down the further progression of the disease. One study found that knee osteoarthritis in obese men would decrease by 21.5% if they lost enough weight to be categorized as merely overweight; for women, arthritis would decrease by 31%.
“The damage is already done, and arthritis is a progressive process,” says Westrich. “But weight loss can be tremendously helpful in alleviating pain, allowing greater function, and prolonging the period of time before someone needs joint replacement surgery.”
And if you haven’t developed arthritis but you’re worried about it, losing excess weight can significantly lower your risk. If you’re significantly overweight, every 11 pounds you lose cuts your risk of developing arthritis by more than 50%.
Making It Happen
The best way to lose weight, any doctor will tell you, is to eat less, eat healthy foods, and exercise more. But while someone with arthritis can start to change their eating habits in pretty much the same way that someone without the disease can, having arthritis makes exercise a little more complicated.
High-impact exercise, like running, jogging, and aerobics, can put too much stress on the joints, so doctors recommend against these activities. “They can hasten the arthritis process and cause injury,” says Westrich.
Instead, Vangsness recommends that his patients pursue one of three types of exercise that are particularly well suited for people with arthritis:
Swimming
Cycling (especially on a recumbent stationary bike, which is easier on knees and hips than a standard bike)
Elliptical trainers
“These all get your heart rate up without putting any stress on the knee,” he says. “The buoyancy of water helps to alleviate pain during water exercise. And working out using a stationary bike or an elliptical trainer can help strengthen key muscles like the quadriceps. If your quadriceps are strong, that can cushion the ‘heel strike’ moment when you step forward while walking, and decrease pain as well.”
He adds that some of his extremely obese patients have gotten their weight loss started through gastric bypass or gastric banding surgery. “They start peeling off the pounds, and this tremendous loss of weight really knocks down their pain,” he says. “It’s like a whole new knee. And after losing that weight, they can exercise where they couldn’t before, strengthen their muscles, and further reduce pain.”
By Gina Shaw
WebMD Feature Reviewed by Brunilda Nazario, MD
For 12 years, Robin Lutchansky spent most of her time in a wheelchair. The pain from her severe osteoarthritis, first diagnosed in her early 30s, made it difficult to walk more than short distances.
Then, a little over three years ago, Lutchansky found her way to a pain management clinic that taught her how to exercise -- first, teaching her how to walk again. Over the next three years, Lutchansky, now 51, gradually lost nearly 100 pounds with calorie reduction and exercise.
“I did it slowly. I started out just lifting 2-pound weights, and I walked in the pool every day,” she says.
Today, Lutchansky is out of the wheelchair and back at work as a public relations representative for a high-tech firm, and says that her daily pain levels have gone from an 8 or a 9 to a 1. “It’s amazing. It’s a new life. I had no idea it was possible.”
What Weight Does to Your Joints
If you are at all overweight, one of the best ways to reduce osteoarthritis pain is by taking off excess pounds. Being overweight increases the load that you put on your joints -- your knees, your hips, your ankle -- with every step you take.
“When we walk, when we go up and down stairs, or get into or out of a chair or car, we can put three to five times our body weight, and sometimes more, on the joints,” says Geoffrey Westrich, attending orthopedic surgeon and Director of Joint Replacement Research at the Hospital for Special Surgery in New York. “So if you’re 50 pounds overweight, you’re putting around 250 pounds of increased stress across your knees and hips.”
Over time, that extra weight makes you much more prone to developing arthritis and can cause arthritis to progress much more rapidly, leading to much more pain once it has developed.
Fortunately, the same principle works in reverse. “For every pound people lose, they lose 3 pounds of stress across their knee and 6 pounds of stress on their hip, on average,” says Westrich.
Small Steps, Big Changes
You don’t have to lose 100 pounds, like Lutchansky, to see a difference in your pain levels. C. Thomas Vangsness, Jr., MD, professor of orthopaedic surgery and chief of sports medicine at the Keck School of Medicine at the University of Southern California, says most of his arthritis patients who lose weight notice that their pain is diminishing after losing about 20 pounds.
Jane Angelich, a 58-year-old California businesswoman, has lost 33 pounds on Weight Watchers.
“What a difference!” she says. “It starts when I get out of bed in the morning. No more limping around and groaning for the first few minutes. Instead of finding excuses to sit on my couch instead of walking around, I now walk the equivalent of a 5k without any issues and can even function the next day!”
Losing weight cannot repair the damage that’s already been done to your joints by arthritis, but in addition to decreasing your pain, it can also help to slow down the further progression of the disease. One study found that knee osteoarthritis in obese men would decrease by 21.5% if they lost enough weight to be categorized as merely overweight; for women, arthritis would decrease by 31%.
“The damage is already done, and arthritis is a progressive process,” says Westrich. “But weight loss can be tremendously helpful in alleviating pain, allowing greater function, and prolonging the period of time before someone needs joint replacement surgery.”
And if you haven’t developed arthritis but you’re worried about it, losing excess weight can significantly lower your risk. If you’re significantly overweight, every 11 pounds you lose cuts your risk of developing arthritis by more than 50%.
Making It Happen
The best way to lose weight, any doctor will tell you, is to eat less, eat healthy foods, and exercise more. But while someone with arthritis can start to change their eating habits in pretty much the same way that someone without the disease can, having arthritis makes exercise a little more complicated.
High-impact exercise, like running, jogging, and aerobics, can put too much stress on the joints, so doctors recommend against these activities. “They can hasten the arthritis process and cause injury,” says Westrich.
Instead, Vangsness recommends that his patients pursue one of three types of exercise that are particularly well suited for people with arthritis:
Swimming
Cycling (especially on a recumbent stationary bike, which is easier on knees and hips than a standard bike)
Elliptical trainers
“These all get your heart rate up without putting any stress on the knee,” he says. “The buoyancy of water helps to alleviate pain during water exercise. And working out using a stationary bike or an elliptical trainer can help strengthen key muscles like the quadriceps. If your quadriceps are strong, that can cushion the ‘heel strike’ moment when you step forward while walking, and decrease pain as well.”
He adds that some of his extremely obese patients have gotten their weight loss started through gastric bypass or gastric banding surgery. “They start peeling off the pounds, and this tremendous loss of weight really knocks down their pain,” he says. “It’s like a whole new knee. And after losing that weight, they can exercise where they couldn’t before, strengthen their muscles, and further reduce pain.”
Gene Predicts Breast Cancer Treatment Success
Breast Cancer Health
Tamoxifen Works Poorly in Women With Active BCAR4 Gene, Study Shows
By Nicky Broyd
WebMD Health NewsReviewed by Keith Barnard, MDOct. 12, 2010 -- Scientists have identified a gene that could help predict whether a breast cancer patient will respond to the drug tamoxifen.
A study published today in the British Journal of Cancer showed a potential link between the activity of a gene called BCAR4 and the likelihood that a breast cancer tumor will not respond to tamoxifen hormone therapy.
The study also found that the level of BCAR4 in a tumour was linked to a poor prognosis regardless of whether the patient received tamoxifen.
A Visual Guide to Breast Cancer
Breast Cancer and Hormone Therapy
Tamoxifen is a hormone treatment given after surgery. It was developed more than 30 years ago and is widely used to treat women with breast cancer.
Tamoxifen comes in tablet form and is given for about five years after surgery to help prevent the disease from returning.
Tamoxifen prevents estrogen from stimulating the growth of breast cancer cells, but some tumors can eventually develop resistance to the treatment, making the drug ineffective.
BCAR4 in Breast Cancer
The research looked into why this might happen by examining whether the BCAR4 gene is involved in tamoxifen resistance. Using samples from 280 breast cancer patients, the researchers found that tamoxifen had a weak, or limited effect, on tumors with a highly active BCAR4 gene.
Study researcher Ton van Agthoven, says in a news release: “We know that breast cancer cells have different ways to escape tamoxifen therapy. Now BCAR4 may be a promising target for development of new treatments.
“Preliminary results show that BCAR4 is only active in the cancer cells and not in normal adult tissues. Therefore, treatments which fight against BCAR4 may have limited side effects for the patient.”
Research into the genes that control how breast cancer responds to treatment will help doctors provide patients with the most effective treatment for their tumor as early as possible, increasing their chance of survival.
It could also lead to the development of new breast cancer drugs to target tumors with a specific genetic makeup.
Further Research
Julie Sharp, senior science information manager at Cancer Research UK, says in a news release, “These early results tell us more about why tamoxifen can stop working for some women. We need further research into the BCAR4 gene to decide if it could lead to better ways to treat patients.
“Understanding the makeup of a tumor can enable drugs to be tailored to individual patients, and this could potentially improve cancer survival in the long term. In the future, doctors may be able to use this type of information to match the best treatment to the patients most likely to benefit and avoid giving treatment that is less likely to be effective.”
Tamoxifen Works Poorly in Women With Active BCAR4 Gene, Study Shows
By Nicky Broyd
WebMD Health NewsReviewed by Keith Barnard, MDOct. 12, 2010 -- Scientists have identified a gene that could help predict whether a breast cancer patient will respond to the drug tamoxifen.
A study published today in the British Journal of Cancer showed a potential link between the activity of a gene called BCAR4 and the likelihood that a breast cancer tumor will not respond to tamoxifen hormone therapy.
The study also found that the level of BCAR4 in a tumour was linked to a poor prognosis regardless of whether the patient received tamoxifen.
A Visual Guide to Breast Cancer
Breast Cancer and Hormone Therapy
Tamoxifen is a hormone treatment given after surgery. It was developed more than 30 years ago and is widely used to treat women with breast cancer.
Tamoxifen comes in tablet form and is given for about five years after surgery to help prevent the disease from returning.
Tamoxifen prevents estrogen from stimulating the growth of breast cancer cells, but some tumors can eventually develop resistance to the treatment, making the drug ineffective.
BCAR4 in Breast Cancer
The research looked into why this might happen by examining whether the BCAR4 gene is involved in tamoxifen resistance. Using samples from 280 breast cancer patients, the researchers found that tamoxifen had a weak, or limited effect, on tumors with a highly active BCAR4 gene.
Study researcher Ton van Agthoven, says in a news release: “We know that breast cancer cells have different ways to escape tamoxifen therapy. Now BCAR4 may be a promising target for development of new treatments.
“Preliminary results show that BCAR4 is only active in the cancer cells and not in normal adult tissues. Therefore, treatments which fight against BCAR4 may have limited side effects for the patient.”
Research into the genes that control how breast cancer responds to treatment will help doctors provide patients with the most effective treatment for their tumor as early as possible, increasing their chance of survival.
It could also lead to the development of new breast cancer drugs to target tumors with a specific genetic makeup.
Further Research
Julie Sharp, senior science information manager at Cancer Research UK, says in a news release, “These early results tell us more about why tamoxifen can stop working for some women. We need further research into the BCAR4 gene to decide if it could lead to better ways to treat patients.
“Understanding the makeup of a tumor can enable drugs to be tailored to individual patients, and this could potentially improve cancer survival in the long term. In the future, doctors may be able to use this type of information to match the best treatment to the patients most likely to benefit and avoid giving treatment that is less likely to be effective.”
Monday, October 11, 2010
Diabetic information
- Diabetes is a chronic condition for which there IS no cure.
- Every year more than one million Americans learn they have diabetes.
- Nearly one in five Americans over the age of 60 have diabetes.
- Diabetes is the fourth leading cause of death in the USA. Most of these deaths are due to heart disease and high blood pressure.
- The risk of stroke and heart disease is 2 to 4 times higher in people with diabetes.
- Up to 65% of people with diabetes have high blood pressure and 70% have some nerve damage.
- Over 20,000 people lose their eyesight every year due to complications from diabetes.
- Every year more people die of diabetes than all the deaths from AIDS, breast cancer, and car accidents.
- One in three American kids will develop diabetes in their lifetime. Many American kids do not exercise enough and overeat.
Elvis Presely, Earnest Hemingway, Arthur Ashe, Sugar Ray Robinson, Mary Tyler Moore, Halle Berry, Thomas Edison, and Elizabeth Taylor were ALL diabetics.
- $592 billion is spent every year taking care of diabetic patients.
- Over 6% of Americans have diabetes, more than 18 million. Unfortunately 1/3 of them have not been diagnosed.
- The average American eats about 150 pounds of sugar every year.
- Simple sugars- candy, cake, jam, white flour- are absorbed and digested quickly and causes a sudden surge of sugar into the blood stream.
- Complex sugars- whole wheat bread, pasta, brown rice, dried beans, and vegetables- are absorbed and digested much more slowly and results in a steady level of blood sugars.
- Every year more than one million Americans learn they have diabetes.
- Nearly one in five Americans over the age of 60 have diabetes.
- Diabetes is the fourth leading cause of death in the USA. Most of these deaths are due to heart disease and high blood pressure.
- The risk of stroke and heart disease is 2 to 4 times higher in people with diabetes.
- Up to 65% of people with diabetes have high blood pressure and 70% have some nerve damage.
- Over 20,000 people lose their eyesight every year due to complications from diabetes.
- Every year more people die of diabetes than all the deaths from AIDS, breast cancer, and car accidents.
- One in three American kids will develop diabetes in their lifetime. Many American kids do not exercise enough and overeat.
Elvis Presely, Earnest Hemingway, Arthur Ashe, Sugar Ray Robinson, Mary Tyler Moore, Halle Berry, Thomas Edison, and Elizabeth Taylor were ALL diabetics.
- $592 billion is spent every year taking care of diabetic patients.
- Over 6% of Americans have diabetes, more than 18 million. Unfortunately 1/3 of them have not been diagnosed.
- The average American eats about 150 pounds of sugar every year.
- Simple sugars- candy, cake, jam, white flour- are absorbed and digested quickly and causes a sudden surge of sugar into the blood stream.
- Complex sugars- whole wheat bread, pasta, brown rice, dried beans, and vegetables- are absorbed and digested much more slowly and results in a steady level of blood sugars.
Tuesday, October 5, 2010
Health Care’s Lost Weekend
Contributing Columnist
By PETER ORSZAG
Published: October 3, 2010
Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or a television network that didn’t measure its ratings. Improving the quality of health care and reducing its cost will require that doctors make many changes — but working weekends and consenting to quality management are two clear ones.
Related
A Health Care Plan for Colleges (September 19, 2010)
One Nation, Two Deficits (September 7, 2010)
Peter Orszag's Columns for the Opinionator
That’s why an effort at New York University Langone Medical Center to institute both of these changes is so important. If it succeeds, it will help point the way to the health care system of the future.
First, weekends. It’s never good to be hospitalized, but you really don’t want to be hospitalized on a weekend. There are fewer doctors around, and people admitted on Saturdays and Sundays fare relatively poorly.
One study in 2007 found, for example, that for every 1,000 patients suffering heart attacks who were admitted to a hospital on a weekend, there were 9 to 10 more deaths than in a comparable group of patients admitted on a weekday. The weekend patients were less likely to quickly receive the invasive procedures they needed — like coronary artery bypass grafts or cardiac catheterization.
It’s not just a safety issue but, for less life-threatening medical problems, also a matter of convenience. Wouldn’t it be nice to be able to schedule your elective surgery on a Saturday if you wanted? Most hospitals don’t offer that option.
And then there are the economics of a $750 billion-a-year industry letting its capacity sit idle a quarter or more of the time. If hospitals were in constant use, costs would fall as expensive assets like operating rooms and imaging equipment were used more fully. And if the workflow at existing hospitals was spread more evenly over the entire week, patients could more often enjoy the privacy of single-bed rooms.
N.Y.U.’s first step toward seven-day service has been to keep certain functions going all weekend, like radiology study interpretation, magnetic resonance imaging and elective cardiac surgery. The cancer center also now provides some treatments on weekends. And some procedures, like elective Caesarean sections, are offered on Saturdays. So far, the doctors involved are on board.
A second innovation is quality assessment and management. As the saying goes, if you can’t measure it, you can’t manage it — or improve it. That’s why the federal government is now making key investments to encourage hospitals, clinics and doctors to adopt health information technology and report statistics on quality of care.
Robert Grossman, the dean and chief executive of N.Y.U. Langone, has gathered data from around the medical center into a “management dashboard.” This allows him to monitor not only financial information like operating margins and cash balances but also detailed quality data on individual doctors like 30-day hospital readmission rates and the number of infections associated with invasive procedures.
The patterns he has been able to discern this way have been eye-opening. The dashboard data revealed, for instance, that on any given day a disproportionately small number of eligible patients were discharged before noon, so that many people were kept in the hospital longer than necessary. Further analysis revealed a key reason: several routine procedures that some patients need before leaving, like the insertion of central catheters, were not performed in the morning. The medical center has since begun to offer the procedures earlier, and the percentage of discharges before noon has increased significantly.
So far, so good. But will these initiatives become a permanent part of the culture? And if the strategies do survive, how much difference can they make in the cost and quality of care?
N.Y.U. has historically not stacked up that well in cost comparisons with other hospitals. The Dartmouth Atlas of Health Care, which tracks data on regional variations in Medicare costs, suggested that from 2001 to 2005 a Medicare beneficiary’s care at N.Y.U. during the final two years of his life cost taxpayers more than $100,000 — roughly twice the cost at America’s most efficient hospitals.
The Dartmouth data also indicate that the N.Y.U. patients received no clear benefit for the higher cost. They saw, on average, more than 14 different doctors, compared with fewer than 10 for patients at the most efficient hospitals. But the extra visits did not seem to produce better outcomes. In fact, seeing more doctors may have caused harm, as patients ran the risk of side effects and complications from additional tests, treatments and medicines.
N.Y.U. will know that its innovations in weekend operations and doctor assessment are working if, in time, they help improve the cost-effectiveness of care. If they do, it’s important that any practices found effective be adopted widely. Better ways of spreading such innovations will be the focus of my next column. In health care, experimentation is the mother of improvement.
Peter Orszag, the director of the White House Office of Management and Budget from 2009 to 2010 and a distinguished visiting fellow at the Council on Foreign Relations, is a contributing columnist for The Times.
By PETER ORSZAG
Published: October 3, 2010
Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or a television network that didn’t measure its ratings. Improving the quality of health care and reducing its cost will require that doctors make many changes — but working weekends and consenting to quality management are two clear ones.
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That’s why an effort at New York University Langone Medical Center to institute both of these changes is so important. If it succeeds, it will help point the way to the health care system of the future.
First, weekends. It’s never good to be hospitalized, but you really don’t want to be hospitalized on a weekend. There are fewer doctors around, and people admitted on Saturdays and Sundays fare relatively poorly.
One study in 2007 found, for example, that for every 1,000 patients suffering heart attacks who were admitted to a hospital on a weekend, there were 9 to 10 more deaths than in a comparable group of patients admitted on a weekday. The weekend patients were less likely to quickly receive the invasive procedures they needed — like coronary artery bypass grafts or cardiac catheterization.
It’s not just a safety issue but, for less life-threatening medical problems, also a matter of convenience. Wouldn’t it be nice to be able to schedule your elective surgery on a Saturday if you wanted? Most hospitals don’t offer that option.
And then there are the economics of a $750 billion-a-year industry letting its capacity sit idle a quarter or more of the time. If hospitals were in constant use, costs would fall as expensive assets like operating rooms and imaging equipment were used more fully. And if the workflow at existing hospitals was spread more evenly over the entire week, patients could more often enjoy the privacy of single-bed rooms.
N.Y.U.’s first step toward seven-day service has been to keep certain functions going all weekend, like radiology study interpretation, magnetic resonance imaging and elective cardiac surgery. The cancer center also now provides some treatments on weekends. And some procedures, like elective Caesarean sections, are offered on Saturdays. So far, the doctors involved are on board.
A second innovation is quality assessment and management. As the saying goes, if you can’t measure it, you can’t manage it — or improve it. That’s why the federal government is now making key investments to encourage hospitals, clinics and doctors to adopt health information technology and report statistics on quality of care.
Robert Grossman, the dean and chief executive of N.Y.U. Langone, has gathered data from around the medical center into a “management dashboard.” This allows him to monitor not only financial information like operating margins and cash balances but also detailed quality data on individual doctors like 30-day hospital readmission rates and the number of infections associated with invasive procedures.
The patterns he has been able to discern this way have been eye-opening. The dashboard data revealed, for instance, that on any given day a disproportionately small number of eligible patients were discharged before noon, so that many people were kept in the hospital longer than necessary. Further analysis revealed a key reason: several routine procedures that some patients need before leaving, like the insertion of central catheters, were not performed in the morning. The medical center has since begun to offer the procedures earlier, and the percentage of discharges before noon has increased significantly.
So far, so good. But will these initiatives become a permanent part of the culture? And if the strategies do survive, how much difference can they make in the cost and quality of care?
N.Y.U. has historically not stacked up that well in cost comparisons with other hospitals. The Dartmouth Atlas of Health Care, which tracks data on regional variations in Medicare costs, suggested that from 2001 to 2005 a Medicare beneficiary’s care at N.Y.U. during the final two years of his life cost taxpayers more than $100,000 — roughly twice the cost at America’s most efficient hospitals.
The Dartmouth data also indicate that the N.Y.U. patients received no clear benefit for the higher cost. They saw, on average, more than 14 different doctors, compared with fewer than 10 for patients at the most efficient hospitals. But the extra visits did not seem to produce better outcomes. In fact, seeing more doctors may have caused harm, as patients ran the risk of side effects and complications from additional tests, treatments and medicines.
N.Y.U. will know that its innovations in weekend operations and doctor assessment are working if, in time, they help improve the cost-effectiveness of care. If they do, it’s important that any practices found effective be adopted widely. Better ways of spreading such innovations will be the focus of my next column. In health care, experimentation is the mother of improvement.
Peter Orszag, the director of the White House Office of Management and Budget from 2009 to 2010 and a distinguished visiting fellow at the Council on Foreign Relations, is a contributing columnist for The Times.
Thursday, September 30, 2010
New Genetic Clues for ADHD
Rare DNA Errors in ADHD Kids Linked to Brain-Development Genes
By Daniel J. DeNoon
WebMD Health News Reviewed by Laura J. Martin, MD Sept. 29, 2010
-- Attention deficit hyperactivity disorder (ADHD) is a brain disorder and not purely a behavioral problem, say the first researchers to identify rare genetic errors in ADHD kids.
People with ADHD have an unusually large number of "copy number variants" or CNVs -- chunks of DNA that are either missing or duplicated, says study researcher Anita Thapar, MD, professor of child and adolescent psychiatry at Cardiff University in Wales.
"These missing or duplicated chunks of DNA are in the areas of the chromosome that overlap with those implicated in autism and schizophrenia, [which are] established brain disorders," Thapar said at a news conference. "And we found that the most significant excess of these copy number variants was in a specific region ... that includes genes for brain development."
Thapar and colleagues analyzed genetic data from 366 children with ADHD ranging in age from 5 to 17 and from 1,047 matched children in the general population. They found that the kids with ADHD carried twice as many large CNVs.
This difference was even more pronounced in ADHD kids with intellectual disability. These children, with IQs of less than 70, had nearly six times more large CNVs than normal children. But regardless of intellectual disability, ADHD kids had significantly more large chunks of DNA that were missing and duplicated.
Slideshow: ADHD in Children
Complexity of ADHD
Because the findings don't identify a specific "ADHD gene," the kind of genetic analysis used in the study cannot be used as a test for ADHD.
"ADHD is a very complex disorder, which will have a number of different genetic factors involved, and also non-genetic, environmental factors. It is this combination that is the likely cause of ADHD," study researcher Kate Langley, PhD, a psychologist at Cardiff University, said at the news conference.
However, Thapar said the findings should be a great relief to parents and to people with ADHD who have been stigmatized by the disorder.
"There is a lot of misunderstanding about ADHD. Some say it is not a real disorder or that it is just the result of bad parenting," she said. "Our results show it should be considered a neurodevelopmental disorder like autism."
Indeed, kids with ADHD and kids with autism have some symptoms in common. This leads the researchers to suggest that there might be a biological link between the two disorders.
Thapar said that the study findings will spur more intensive research likely to uncover more specific information on the genetic factors that predispose a person to ADHD.
The study is reported in the Sept. 30 online issue of The Lancet.
Top Picks
Health Check: Is ADHD Affecting Your Life?
Adult ADHD Symptoms: Do You Know Them?
Slideshow: Top Concentration Killers
Anxiety, Stress and ADHD
By Daniel J. DeNoon
WebMD Health News Reviewed by Laura J. Martin, MD Sept. 29, 2010
-- Attention deficit hyperactivity disorder (ADHD) is a brain disorder and not purely a behavioral problem, say the first researchers to identify rare genetic errors in ADHD kids.
People with ADHD have an unusually large number of "copy number variants" or CNVs -- chunks of DNA that are either missing or duplicated, says study researcher Anita Thapar, MD, professor of child and adolescent psychiatry at Cardiff University in Wales.
"These missing or duplicated chunks of DNA are in the areas of the chromosome that overlap with those implicated in autism and schizophrenia, [which are] established brain disorders," Thapar said at a news conference. "And we found that the most significant excess of these copy number variants was in a specific region ... that includes genes for brain development."
Thapar and colleagues analyzed genetic data from 366 children with ADHD ranging in age from 5 to 17 and from 1,047 matched children in the general population. They found that the kids with ADHD carried twice as many large CNVs.
This difference was even more pronounced in ADHD kids with intellectual disability. These children, with IQs of less than 70, had nearly six times more large CNVs than normal children. But regardless of intellectual disability, ADHD kids had significantly more large chunks of DNA that were missing and duplicated.
Slideshow: ADHD in Children
Complexity of ADHD
Because the findings don't identify a specific "ADHD gene," the kind of genetic analysis used in the study cannot be used as a test for ADHD.
"ADHD is a very complex disorder, which will have a number of different genetic factors involved, and also non-genetic, environmental factors. It is this combination that is the likely cause of ADHD," study researcher Kate Langley, PhD, a psychologist at Cardiff University, said at the news conference.
However, Thapar said the findings should be a great relief to parents and to people with ADHD who have been stigmatized by the disorder.
"There is a lot of misunderstanding about ADHD. Some say it is not a real disorder or that it is just the result of bad parenting," she said. "Our results show it should be considered a neurodevelopmental disorder like autism."
Indeed, kids with ADHD and kids with autism have some symptoms in common. This leads the researchers to suggest that there might be a biological link between the two disorders.
Thapar said that the study findings will spur more intensive research likely to uncover more specific information on the genetic factors that predispose a person to ADHD.
The study is reported in the Sept. 30 online issue of The Lancet.
Top Picks
Health Check: Is ADHD Affecting Your Life?
Adult ADHD Symptoms: Do You Know Them?
Slideshow: Top Concentration Killers
Anxiety, Stress and ADHD
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