Sharing Experiences

HD quality.. First videocast for diabeticradio! In this episode I talk about my experience having cataracts, and growing up without any diabetic diagnosis.

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Clinical trials showed a connection between Avandia and heart problems

A county in the U.S. state of California is suing GlaxoSmithKline, the maker of Avandia, a controversial diabetes drug. The lawsuit was spurred by a report on the drug released by the U.S. Senate last week (March 22). That report accused the drug company of withholding information about side effects of serious heart problems, including death. At issue now is whether Avandia should be taken off the market. A U.S. Senate report on the diabetes drug Avandia says both the manufacturer, GlaxoSmithKline, and the U.S. Food and Drug Administration should have warned patients about the dangers of the drug years before they did. The report recommends taking Avandia off the market. In 2007, Dr. Steven Nissen published a study showing that those taking Avandia had a 43 percent higher risk of having a heart attack and a 64 percent greater chance of dying from a heart attack than those not taking the drug. “We’ve been warning about this for two and a half years,” he said. “There really isn’t a good reason for physicians to continue to prescribe the drug. It’s time to get it off the market.” But doctors still prescribe Avandia to hundreds of thousands of patients worldwide.

Dr. Yasser Ousman at Washington Hospital Center prescribes it for some pre-diabetic patients or those in the early stages of diabetes. “There are a number of drugs that have been tested in these individuals and Avandia is one of them, and actually, it is quite effective in improving the blood sugar, in normalizing the blood sugar or delaying the occurrence of diabetes in these individuals,” Dr. Ousman said. “What bothers me the most is that every month that goes by, more people are harmed by a drug that people simply don’t need,” Dr. Nissen said. Dr. Nissen’s report was based on 42 clinical trials that showed a connection between Avandia and heart problems.

“I think when you look at the information and the statistics from the initial study, the initial paper by Dr. Nissen in 2007, the increase in the risks of heart attacks is actually small,” Dr. Ousman points out. He says that many over the counter drugs – aspirin, ibuprofen, acetaminophen or paracetamol – can be toxic if used improperly. “If you look at the large studies, that were published over the last several years, including a large number of patients comparing Avandia to a placebo or other drugs, there was actually no increase in that risk. That risk was based on smaller studies,” Dr. Ousman said.

A study on Avandia funded by GlaxoSmithKline published last year, found no increase in heart attacks. But it found a significant increase in the risk of heart failure where the heart cannot pump enough blood to the organs or muscles. A number of cases resulted in hospitalization or death. The Food and Drug Administration says it will review Avandia for heart risks and has scheduled a meeting of its advisory panel in July. The agency warns those taking Avandia not to discontinue use without consulting with a doctor.

Copyright© 2010 VOA

Joel Selanikio

Epidemiologist Joel Selanikio has used the explosion in mobile phone technology and the World Wide Web to deliver more effective public health services throughout the developing world.  Dr. Selanikio and his organization DataDyne.org are making a difference by improving the medical information available to public health programs in under-served areas of the world.  VOA’s Natalia Ardanza has a profile for this week’s “Making a Difference” series.

This year, Joel Selanikio received the prestigious Lemelson-MIT Award for Sustainability in recognition of these innovations.  EpiSurveyor is being used by more than 500 organizations in more than 100 countries, and it is being adopted for use in areas such as agriculture and public opinion polling.

© 2009 VOA

Genetic prediction of type 2 diabetes in the Botnia study

Type 2 diabetes has been loosely defined as “adult onset” diabetes, but as diabetes becomes more common, cases are being diagnosed in younger people and children. In determining the risk of developing diabetes, environmental factors, such as food intake and exercise, are known to have an important role; most people with type 2 diabetes are either overweight or obese. Inherited factors are also important, but the genes involved remain poorly defined. In rare forms of diabetes, mutations of one gene can result in disease, whereas in type 2 diabetes, many genes are thought to be involved. One difficulty in understanding the genetic role is that genes associated with diabetes might show only a subtle variation in their sequence, and these variations may be extremely common. Hence, it can be very hard to link such common gene variations, known as single nucleotide polymorphisms (SNPs), with increased risk of developing diabetes.

One method of finding these diabetes genes is by whole-genome linkage studies in which associations between parts of the genome and risk of developing diabetes are looked for. Studies so far have identified several candidate genes associated with type 2 diabetes, although many results have been difficult to replicate. The list of genes for which there is good evidence from meta-analyses includes genes encoding for PPARG, calpain 10, Kir 6.2, and insulin receptor substrate-1 (IRS1).

These genes have a variety of effects; PPARG P12A polymorphism is associated with enhanced insulin sensitivity and protects against type 2 diabetes. Two SNPs in the gene encoding for cystein protease calpain 10 (CAPN10) confer increased susceptibility to insulin resistance and type 2 diabetes. Kir 6.2 is involved in glucose-stimulated insulin secretion in pancreatic cells. And carriers of a polymorphism in the IRS1 gene have been shown to have reduced islet insulin content in pancreatic islets.

In this issue of PLoS Medicine, Valeriya Lyssenko and colleagues from Lund University sought to consolidate previous work by studying the predictive value of these variants for type 2 diabetes side by side in the largest study of its kind to date. They investigated the effect of these gene variants in 2,293 nondiabetic people aged 18–70 years old in western Finland—the Botnia study—over a median of six, range 2–12, years. In addition, they also studied the uncoupling protein 2 gene (UCP2)—a polymorphism in the promoter of this gene (UCP2 −866G>A) (rs659366) has been associated in some, but not all, studies with increased risk of type 2 diabetes and impaired insulin secretion.

The study took place from 1990 to 2002, and enrolled patients from five health centers in western Finland who were asked to have health checks every two to three years. Six percent (132) of people developed type 2 diabetes. The key finding was that variants in the PPARG and CAPN10 genes increased future risk for type 2 diabetes, particularly in individuals with other risk factors. In individuals with a high risk of developing diabetes—with a fasting plasma glucose (FPG) of 5.6 millimoles per liter and body mass index (BMI) of 30 kilograms per square meter—the hazard ratio increased to 21.2 for the combination of the PPARG PP and CAPN10 SNP43/44 GG/TT genotypes compared with those with low-risk genotypes with normal FPG and BMI less than 30 kilograms per square meter.

The researchers found that replacing the family history with the PPARG and CAPN10 variants in a predictive model (particularly in combination) gave almost the same strong prediction of subsequent type 2 diabetes. These genotypes also influenced the relationship between BMI and FPG, that is, in carriers of risk genotypes, there was a steeper increase in FPG for any given BMI.

The authors argue that the comparison of all the key gene variants side by side in one large study adds substantially to previous papers that have examined the effect of single gene variants on the risk of conversion to type 2 diabetes in interventional trials.

However, it is important to understand the effect of these variants on the risk of disease in a large, prospective observational study before studying additive or synergistic effects with interactions such as lifestyle changes, they said. One of the problems of other studies has been that results have been different between different subgroups.

Although this study has limited power, as the largest of its kind it suggests that genetic variants in candidate genes can predict future type 2 diabetes, particularly in association with conventional risk factors such as obesity and abnormal glucose tolerance. With accumulating data from prospective studies, it should be possible to define whether there will be a future role for genetic prediction of type 2 diabetes or whether these variants will influence response to prevention or treatment.

Photo: White House US President Barack Obama delivers the weekly address

As U.S. lawmakers work toward a final agreement on overhauling health care, President Barack Obama says some of the reforms will take effect this year. The president admits, however, that other changes will not be in place for several years. President Obama is working with Democrats in both houses of Congress to merge their two versions of health reform. In the meantime, the president is using his weekly radio and Internet address to assure Americans that once he signs a health overhaul bill, they will see immediate benefits. “We are on the verge of passing health insurance reform that will finally offer Americans the security of knowing they will have quality, affordable health care whether they lose their jobs, change their jobs, move or get sick. The worst practices of the insurance industry will be forever banned,” he said.

Mr. Obama hopes to sign the bill into law by early February. Some consumers and advocates are disappointed that parts of the plan will not take effect until as late as 2014. The president acknowledges that some of the changes will take time to implement, but he says others will start working sooner. “Now, it will take a few years to fully implement these reforms in a responsible way. But what every American should know is that once I sign health insurance reform legislation into law, there are dozens of protections and benefits that will take effect this year,” he said.

Mr. Obama says before year’s end, insurance companies will be prohibited from dropping coverage when a person becomes ill, people with medical conditions will be allowed to buy affordable health insurance, and some small businesses will get government help in covering their employees. “All told, these changes represent the most sweeping reforms and toughest restrictions on insurance companies that this country has ever known,” he said.

The president began his address by talking about the economy. The U.S. unemployment rate remained at 10 percent in December, and 85,000 more Americans lost their jobs last month. Mr. Obama said the road to recovery will be long and sometimes bumpy.

© 2009 VOA

By Dean Olsen
Enterprise News Service

SPRINGFIELD, Ill. —

Veteran central Illinois broadcaster Bob Murray lost 170 pounds on a liquid diet and got down to 210 – his “perfect weight” – in 2002.

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He maintained that weight for several months before beginning a slide into his old habits as a “volume eater” and food addict. He switched jobs and worked a new schedule that didn’t allow him to continue attending a weight-loss support group. After noticing he was gaining weight, he became self-conscious, and his daily workouts at the YMCA in his hometown of Decatur became less frequent. Then, after Murray found that his new wardrobe didn’t fit anymore, the floodgates to big portions and drive-through fast food swung wide open. And his motivation to exercise plunged. “You think that you’re doing OK, and suddenly the pants don’t fit like they used to,” he said. “Once you get the next-size pants, it’s goodbye.” Murray, 62, is far from alone in his journey. Gaining and losing weight are common in the United States, where two-thirds of adults are either overweight or obese, and it’s common knowledge that excess weight increases a person’s risk of heart disease, Type 2 diabetes, high blood pressure and several forms of cancer.

Some people maintain weight loss

Maintaining a weight loss is not as uncommon as once thought. Studies from the early 1990s indicated that almost everyone who lost weight gained it back within a few years. But those studies may have been skewed because they focused on people who were the heaviest and sickest, according to a 1999 study in the International Journal of Obesity. Authors of the study wrote that their nationwide survey of the general population found almost half of overweight adults who had intentionally lost 10 percent or more of their weight maintained the weight loss for at least a year. As many as 27 percent of them had kept the weight off for five years or more. That still means a majority of people regained weight, but the study’s authors wrote that they “reject the notion that weight loss maintenance is impossible.” Murray, who said he has gained back all the weight he lost – plus 30 pounds – said he would “love to lose weight, but like a lot of people who are overweight, I want to do it the easiest way possible.” David Steward doesn’t have to be told how hard it is to maintain a weight loss. The Springfield resident, a physician specializing in general internal medicine at Southern Illinois University School of Medicine, lost 60 pounds 4 1/2 years ago through healthier eating and regular exercise. Steward, 59, credited exercise – primarily bicycling – for helping him keep the weight off. But he won’t guarantee that he will continue to be successful, and he doesn’t look down on people who end up regaining weight. “I’m glad that it’s lasted this long,” he said “I’m always surprised that this is so hard.”

What has worked

The Rhode Island-based National Weight Control Registry has studied the habits of successful weight losers since 1994. More than 6,000 Americans who have sustained a weight loss of 30 pounds or more have volunteered to be in the registry. They lost weight with a variety of diets, and almost all increased their physical activity – mostly through walking. The ways they kept from regaining weight were strikingly similar, according to Graham Thomas, a clinical psychologist and co-investigator at the not-for-profit registry.

Most of them tend to eat a low-fat, low-calorie diet, and most said they consume fewer than 2,000 calories a day, although they really may be eating more than that and underestimating their consumption, he said. “They don’t tend to splurge on weekends or holidays, either,” he said. There’s not a lot of variety in their diets, which may help them keep track of calories through a limited number of “safe foods,” Thomas said. Most weigh themselves daily or, at minimum, once a week, and they exercise – a lot. The average was 60 minutes of moderate physical activity every day, which is what the Institute of Medicine recommends.

How do they find the time for all that huffing and puffing? They watch far less television – averaging 10 hours or less each week – compared with 28 hours for the average American adult, Thomas said. “The average American is sedentary,” said Anne Daly, a registered dietitian and director of a weight-management program operated through the office of Springfield endocrinologist Dr. Norman Soler. And most jobs don’t require heavy lifting, she said. The average farmer in 1900 burned 5,000 calories a day, she said. “Today, farmers sit on a machine and push buttons,” she said. To be successful at maintaining weight loss, Daly said most people need to both eat less and exercise more.

Bob Murray’s struggles

Murray, the voice behind the “Morning Newswatch” at Springfield radio station WTAX (1240 AM/107.5 FM), said he was successful at both sides of the weight-loss equation four times in his life, losing between 90 and 100 pounds in the 1980s before his biggest loss seven years ago. That was when a 4,000-calories-a-week liquid diet, supervised through Soler’s Health Management Resources weight-loss program, calmed his appetite and provided support and coaching, Murray said. Though never very athletic, Murray felt more energetic as he lost weight – an average of two pounds a week – and walked a treadmill for 45 minutes most days. Murray, who stands 6-foot-2, bought a whole new wardrobe and fielded questions from people who asked whether his shrinking body was the result of cancer.

But after he returned to solid food, he said he fell into a familiar pattern of feeling “cured” and relaxing his eating and exercise regimen. His switch from a daytime work schedule at WMAY-AM to a shift at WTAX that started at 1:30 a.m. coincided with his backsliding. But he didn’t put the blame on his new job. “It’s not the shift; it’s me,” he said. “In my case, I have to concentrate on losing weight. I have to change my complete lifestyle.” Since gaining back the weight, Murray said he and his wife, Sandy, who has never had a weight problem, don’t go to restaurants much anymore because he doesn’t want to draw attention to himself. For the same reason, he said he doesn’t eat when he makes personal appearances for his job.

“It gets you down,” he said.

Murray doesn’t go to the Y anymore and has a hard time mustering the motivation to exercise. “I have a great Schwinn Airdyne stationary bike at home that is a great clothes rack now,” he said. Daly said successful weight control usually is connected with accountability. For Steward, it’s his scale at home. “I weigh myself every day,” he said.

Dr. Steward’s success

Steward grew up in a small town in Iowa and was “always a little overweight,” he said. He played basketball and baseball for his high school teams and ran the 440-yard dash “slowly” for the small school’s track team, he said. His weight rose from 190 in high school to about 220 in college and fluctuated a bit during medical school at the University of Iowa, said Steward, who stands 5-foot-9. His maximum weight, in the mid-1980s, was between 240 and 250, he said. His big weight loss began after he fell on slick pavement while riding his bicycle in Washington Park. His knees, which had been giving him trouble for years, were badly twisted. The pain he felt while recovering from the fall made him realize that the excess weight he was carrying might make his knees wear out to the point that he would need orthopedic surgery within a few years.

Steward began exercising every day, something that his wife, Dr. Gina Kovach, had been doing already as part of her own strategy to stay fit. Steward, who is chairman of SIU’s internal medicine department, stopped snacking on candies, cookies and other junk food at work. And when the weather is bad, he works out hard – 40 minutes to an hour most mornings, getting his heart rate to about 140 beats a minute – on a stationary recumbent bicycle in his basement. He has set up a television in front of the cycle to help pass the time. “I keep telling myself I have to do this,” he said. “There’s no variety in it, but it’s easy on my knees.” Steward said he is fortunate to have the income to afford exercise equipment, and the time and a stable schedule that allows for regular workouts. He is quick to say that he doesn’t always eat healthy foods, but when he snacks, he tries to make low-fat selections. “I feel better in a lot of ways,” he said. “And my joints feel better.”

Dean Olsen can be reached at (217) 788-1543 or dean.olsen@sj-r.com.

Maintaining weight loss

People in the National Weight Control Registry who are successful in maintaining weight loss do these things:

_Most say they maintain a low-calorie, low-fat diet.

_78 percent eat breakfast every day.

_75 percent weigh themselves at least once a week.

_62 percent watch fewer than 10 hours of TV a week.

_90 percent exercise, on average, about one hour a day.

–Source: National Weight Control Registry, part of Brown University Medical School

While scientists have known for decades that vitamin D deficiency leads to bone diseases like rickets, more recently they have found connections between low vitamin D levels and a wide range of other illnesses, including cancer, autoimmune disorders and caradiovascular disorders.  The human body creates vitamin D through exposure to sunlight, and yet some of the sunniest parts of the world have the highest rates of vitamin D deficiency. Several factors have contributed to dangerously low vitamin D blood levels among people in the Middle East, Africa and Asia.

Vitamin D necessary for bone strength

Healthy bones depend on vitamin D, says Ambrish Mithal of the Indian Society for Bone and Mineral Research.  “Vitamin D is what absorbs calcium into our body and helps it reach the bone. Vitamin D deficiency, therefore, results in weak bones and bones that are soft, that will bend and break.”  Getting enough vitamin D should be relatively simple. “The major source of vitamin D is sunshine,” Mithal says. “We make vitamin D under the influence of UV rays that we get in the sunlight. We make it in our skin.”

Vitamin D deficiency common, even in sunny places

But some of the world’s sunniest regions have the highest rates of vitamin D deficiency. That’s the finding of a recent report from the International Osteoporosis Foundation, which reviewed research done over the past three decades. Mithal is a coauthor of that report. “Vitamin D deficiency is a global phenomenon. But certain parts of the world, they’re prone to severe vitamin D deficiency – for example, South Asia, like India, or Middle East, like Lebanon. There have been studies from these areas which have shown that almost 80 percent, or maybe even more, of the urban population is significantly vitamin D deficient.”

He points to several factors to explain why people who live in sunny areas still may not get sufficient vitamin D. “Those who live closer to the equator are actually less prone to vitamin D deficiency, but at times this, can be overshadowed by other factors like skin pigmentation, less outdoor activity and more skin cover with clothes,” Mithal says.

Vitamin D expert Michael Holick, of the Boston University Medical Center, explains why people with darker skin generally have lower levels of the nutrient than lighter-skinned people, even in the same country. “The major reason is that their melanin, which protects their skin from excessive exposure to sunlight, also prevents them from making vitamin D,” he says. “We showed that African-Americans need to be exposed three to five times longer to sunlight to be able to make the same amount as a white person.”

Another coauthor of the vitamin D review, Ghada El-Hajj Fuleihan, describes how people in the Middle East can spend time outdoors without absorbing enough vitamin D. “In these, the Middle Eastern countries, people tend to follow a very much more conservative clothing style, in a large proportion of subjects. And the other thing is that with modernization, women who do not follow the conservative clothing style use sunblock. Sunblock with sun protection factor as low as six and eight can completely block the ability of the skin to make vitamin D.” El-Hajj Fuleihan, of the American University of Beirut Medical Center, says this may explain why women in general have lower vitamin D levels.

Deficiency could be dangerous

There is new concern about vitamin D deficiency because, as Michael Holick explains, recent medical discoveries show it may be much more dangerous than previously thought. “What we haven’t appreciated until about the past decade is that vitamin D seems to be important for reducing risk of many chronic illnesses that span anywhere from autoimmune diseases like type 1 diabetes, multiple sclerosis, rheumatoid arthritis, to infectious diseases like tuberculosis and influenza, reduces risk of heart attack, stroke and most importantly, reduces risk of deadly cancers.”

Ways to get more vitamin D

People can get more of the nutrient in their diet. In the United States and other countries, some foods are fortified with vitamin D. But Holick says that’s generally not enough. “Children probably need a thousand units of vitamin D a day. Teenagers and adults need two thousand units of vitamin D a day to satisfy their requirement… You cannot get an adequate amount of vitamin D to satisfy your body’s requirement from your diet.”

So, he and other experts like Ghada El-Hajj Fuleihan, now recommend spending a little more time in the sun. “We are fully aware of the risk of skin cancer with sun exposure but suggest that there may be a happy compromise and that maybe the first 10 minutes or so three times a week… let the skin get some ability to make vitamin D, and then put the sunblock on.” In addition, she says, those who spend their days indoors should take a vitamin D supplement.

Although the World Health Organization has said that most people get enough vitamin D through sun exposure and diet, in light of the new research, it has commissioned its own report and may issue new recommendations.

© 2009 VOA

Podcast: Download (Duration: 4:45 — 1.1MB)

The World Health Organization estimates there are more than 180 million people with diabetes. The WHO says that number could double in 20 years. Many diabetics must interrupt their activities to monitor their blood sugar levels several times a day and inject insulin when those levels become abnormal, but most diabetics will tell you they would like to find relief from that chore. Fourteen-year-old Sarah Carlow is a diabetic. It is a fact never far from her mind. “I check my blood sugar on average maybe 10 or more times a day. I check it before breakfast, lunch and dinner. You have to check your blood sugars while you’re playing sports. I also have to count carbohydrates,” says Sarah.

By monitoring the carbohydrates in all of the food and drink she consumes, Sarah knows how much insulin to give herself, but recently the teenager was fitted with an artificial pancreas that did the work for her. Sarah explains, “Not having the every day, every minute, every hour hassle of worrying about my blood sugars, if this comes into play, I can live a life like I did before, which is awesome [wonderful].” Sarah was one of 17 teenagers with type one diabetes who were fitted with the artificial pancreas at Yale-New Haven Children’s Hospital.

The device uses a sensor to monitor the glucose and a pump which distributes the correct amount of insulin needed. Dr. Stuart Weinzimer of Yale-New Haven Children’s Hospital says the artificial pancreas has wide potential for other diabetics. Dr. Weinzimer explains, “It would potentially benefit anyone with diabetes, type one or type two, anybody who requires insulin.” Researchers say as a precaution the insulin was dispensed only with a doctor’s approval.

But the artificial pancreas was found to maintain appropriate blood glucose levels for up to 16 hours. It kept on pumping throughout exercise, meal time, even long after it was time to turn off the light. Scientists plan less controlled studies on patients outside the hospital setting.

© 2009 VOA

By Melissa Westphal
Norwich Bulletin

ROCKFORD, Ill. — Shopping for health insurance plans has become increasingly stressful for small-business leaders and their employees.

Choosing the right insurer — for the right price — is a time-stealer, tearing them from their focus on customers and profits.

“It takes a lot of time to dig through the different plans and meet with people. It’s a part-time job” in itself, says Lucas Derry, executive vice president of Header Die & Tool Inc. in Rockford. “That’s time I (can’t) dedicate to strategic planning, to growth, to face-time with customers.”

For workers, it’s an ever-increasing financial burden.

Family premiums for Illinois workers rose 5.6 times faster than their paychecks from 2000 to 2007. On average, premiums rose by 73.1 percent, although median earnings rose by 13.1 percent, according to the nonpartisan Families USA, a research and advocacy group based in Washington.

Increasingly expensive medical technology and rising prescription-drug costs are the culprits behind the steadily rising costs, says Kim Bailey, a senior health policy analyst for Families USA. Those increased costs force employers into the agonizing annual process of finding affordable health insurance plans, even if it means reducing coverage or increasing premiums for employees. For some of them, dropping health insurance is the only option — which creates different problems as trained and trusted workers find work with employers who offer it. The number of Americans covered by employment-based insurance fell more than 5 percent between 2000 and 2007, Families USA reported this year. Many Rock River Valley employers provide coverage, but more are asking employees to help foot the bill.

Mike McKinnon, president of Rogers Brothers Galvanizing, says the company covered 100 percent of the premiums for its 75 employees about five years ago. But it fell to about 85 percent in 2007 because of increased costs. Rogers Brothers absorbed the increases for 2008 but asked employees to cover a larger part of their deductibles. “There is a considerable amount of administrative time involved in the insurance process,” McKinnon says. “It’s more of a retention tool because it’s something you want to offer to keep people.” Gary Dietz, a Rogers Brothers employee of 15 years, wasn’t surprised to learn that his health insurance costs through work would increase. But the company did a good job of explaining why, Dietz says. “They had a meeting before they ever raised the premiums. They explained where their money goes as a company and how much insurance costs have shot up.” Dietz, his wife and their four sons — ages 14 to 22 — are covered by his employer insurance plan, and he most notices the increase when it comes to filling prescriptions.

Still, he’s grateful the company offers it: “They shopped around and got their money’s worth.” Gloria Stuhr Pernacciaro, CEO of metal stamping company Reliable Machine, says the company shopped 11 other insurance carriers this year but stayed with Blue Cross/Blue Shield. That meant better coverage but increased costs. The company had not increased employee contributions since 2005, but Reliable couldn’t weather a 24 percent cost increase this year without passing it on. “We will have to find ways to save money in other areas to make up for the increase in health-care costs,” she says.

For instance, Reliable changed its production schedule in February 2006 so crews work four 10-hour days each week, saving the company money and giving employees three-day weekends. Pernacciaro also says employees were involved in investigating alternatives for insurance coverage so they better understood the costs.

Health insurance is the third-largest cost for Header Die & Tool, behind labor and raw materials, Derry says. Derry doesn’t see a point when the company would have to drop health insurance for employees, but deductibles and employees’ out-of-pocket expenses will increase. “We’re doing everything we can internally with employees to work on wellness initiatives and sharing what the costs are and how that affects the company. This does affect the overall bottom line of the company. When you absorb more costs, there is less left at the end of the day.”

About 50.7 million American families will spend more than 10 percent of their pre-tax income on health-care costs in 2008, and more than one-fourth of insured Americans report problems with medical bills or are paying off medical debt. Ella Hushagen, a health policy analyst and state policy coordinator for Families USA, says Illinois lacks protection in the individual insurance market to protect consumers, and some of the same issues can be applied to the small-group market.

The state needs to limit how much insurers can charge people based on their health status, she says, and needs to implement a minimum medical loss ratio to make sure insurers are using premium dollars efficiently. Hushagen also recommends requiring insurers to seek prior approval before increasing premiums. “Those are especially helpful for smaller firms because they see more impact from just one person’s health. In this case, there would be better risk-sharing capacity.”

Melissa Westphal can be reached at (815) 987-1341 or mwestpha@rrstar.com.

The bottom line
A report last month from the Kaiser Family Foundation, a nonpartisan health policy and communications research group, shed some light on why health care is so costly:

Expanding wealth. As nations become wealthier, they spend more money on health care. New treatment options and the development of new technology affect cost, too.

Obesity. People are getting fatter, and the chronic diseases related to obesity, such as hypertension and diabetes, tax the system because more people are seeking medical care and buying prescription drugs. About 45 percent of Americans suffer from one or more chronic illnesses, which account for 70 percent of deaths and 75 percent of all health-care spending.

Comprehensive health benefits. In a predictable irony, when insurance pays a higher percentage of the cost, people use more health care.

Inefficiencies in medical care delivery, such as lack of systems for electronically storing and transmitting health data, is another factor.

Prescription drug spending. It stood at $216.7 billion in 2006, more than five times higher than the $40.3 billion spent in 1990. Three factors driving those increases are increased use, price increases and changes in the types of drugs used.

Reforming the system
The National Federation of Independent Business (fixedforamerica.com) has published its small-business principles for health-care reform.

Included in those efforts is a list of 10 points:

1. Universal. All Americans should have access to quality care and protection against catastrophic costs. A government safety net should enable the neediest to obtain coverage.

2. Private. To the greatest extent possible, Americans should receive their health insurance and health care through the private sector. Care must be taken to minimize the extent to which governmental safety nets crowd out private insurance and care.

3. Affordable. Health-care costs to individuals, providers, governments and businesses must be reasonable, predictable and controllable.

4. Unbiased. Health care and tax laws should not push Americans into employer-provided or government-provided insurance programs and hobble the market for individually purchased policies. Small employers should be treated the same as large employers, who already can pool across state lines. A health-care system built on employer mandates is unacceptable.

5. Competitive. Consumers should have many choices among insurers and providers. Policymakers must alleviate the limitations that state boundaries and treatment mandates place on competitiveness.

6. Portable. Americans should be able to move throughout the United States and change jobs without losing their health insurance.

7. Transparent. Information technology should enable all parties to access accurate, user-friendly information on costs, quality and outcomes. Providers must be able to obtain relatively complete medical histories of patients. At the same time, patients’ privacy must be guarded zealously. The private sector must play a vital role in developing the new technologies.

8. Efficient. Health-care policy should encourage an appropriate level of spending on health care. Laws, regulations and insurance arrangements should direct health-care spending to those goods and services that will maximize health. Adequate risk pools throughout the health-care system are vital to accomplishing these goals.

9. Evidence-based. The health-care system must encourage consumers and providers to accumulate evidence and to use that evidence to improve health. Appropriate treatment choices and better wellness and preventive care should be key outcomes.

10. Realistic. Health-care reform should proceed as rapidly as possible, but not so quickly that firms and individuals cannot adjust prudently. It is important to assure that no one’s quality of care suffers as we move to provide coverage for all Americans.