Read Prather on health care costs

Robert Prather is a great blogger! There, I have typed it. Now read his rant on health care costs. I need not expand on his outstanding rant – Health Insurance Abuse

Tort reform dealt a blow

Tort reform, R.I.P. While this article refers to more general tort reform, the inability to pass this legislation seems chilling to those who champion malpractice reform.

Tort reform is a popular issue for Republicans on the stump. At a March speech to the American Medical Association, President Bush said, “Without fair and reasonable limits, the legal system looks more and more like a lottery. And with trial lawyers getting as much as 40 percent of the awards and settlements, it’s pretty clear who is holding the winning ticket.” Tort reform is a major plank of the president’s plan to reform health care. Unfortunately, Senate Republicans blew an opportunity to make progress on limiting excessive lawyers’ fees.

By a vote of 61-37, the Senate last Thursday rejected an amendment authored by Jon Kyl to the tax-cut bill that would have capped the amount lawyers could receive when working on major tort cases for the government, such as in the anti-tobacco litigation. Republicans voting against the amendment were George Voinovich, George Allen, Norm Coleman, Lindsey Graham, Lincoln Chafee, Saxby Chambliss, Thad Cochran, Mike Crapo, Mike DeWine, Richard Shelby, Gordon Smith and Arlen Specter. Trent Lott voted “present,” and Orrin Hatch voted against it twice ? once in the Finance Committee two days earlier, signaling to conservative colleagues that it was acceptable to vote against it on the floor. Every single Democrat voted nay, except for Daniel Inouye, who didn’t vote.

Despite the 14 Republican defections,Mr. Kyl’s legislation was not radical or restrictive to the suing profession. It merely would have confined the lawyers’ cut of awards of more than $100 million to 500 percent of “reasonable hourly rates.” Poor chaps, the law would have pared their pay down to $2,500 per hour, from the $100,000 an hour some currently are making on the tobacco settlement.

For once I think that I am speechless.

Worldwide AIDS funding approved

We have followed this story closely for several months. This link summarizes the final bill – $15 Billion AIDS Plan Wins Final Approval in Congress

The Atkins Diet – new studies

So the NEJM published two articles today on low carbohydrate diets. If you read the popular press you will see various spins on the results. The AP reports – Atkins Diet Bolstered by Two New Studies

The research, in Thursday’s New England Journal of Medicine, found that people on the high-protein, high-fat, low-carbohydrate Atkins diet lose twice as much weight over six months as those on the standard low-fat diet recommended by most major health organizations.

However, one of the studies found that the Atkins dieters regain much of the weight by the end of one year.

The Washington Post reports Atkins Similar to Low-Fat Diets Study: Long-Term Results Differ Little

“The findings say that no matter what diet you’re on, doing it alone is tough work,” said the study’s lead author, Gary Foster, clinical director of the University of Pennsylvania’s Weight and Eating Disorders Program.

Because the Atkins diet encourages consumption of foods high in saturated fat, including butter, cream and steak, there has been great concern that it may increase the risk of heart disease. But three months into the study, there were no differences in the two groups in either total cholesterol or low density lipoprotein (LDL), the “bad cholesterol.”

“The weight loss may override the effect of the high-fat, high-cholesterol” Atkins approach, said the University of Cincinnati’s Bonnie J. Brehm, who has been studying the Atkins diet in women. “These findings are similar to ours.”

And this report from Medscape – Benefits of Low-Carbohydrate Diet Still Uncertain

The controversy over the benefits of low-carbohydrate diet continues, according to two reports and an editorial in the May 22 issue of the New England Journal of Medicine. A randomized trial showed no difference in weight loss at 12 months for a low-carbohydrate diet compared with a conventional weight-loss diet. Another study in severely obese patients did show a benefit, but the duration of the trial was six months. The editorialist helps to clarify the message.

“Despite the popularity of the low-carbohydrate, high-protein, high-fat (Atkins) diet, no randomized, controlled trials have evaluated its efficacy,” write Gary D. Foster, PhD, from the University of Pennsylvania School of Medicine in Philadelphia, and colleagues.

…

“Severely obese subjects with a high prevalence of diabetes or the metabolic syndrome lost more weight during six months on a carbohydrate-restricted diet than on a calorie- and fat-restricted diet, with a relative improvement in insulin sensitivity and triglyceride levels, even after adjustment for the amount of weight lost. This finding should be interpreted with caution, given the small magnitude of overall and between-group differences in weight loss in these markedly obese subjects and the short duration of the study,” the authors write. “Future studies evaluating long-term cardiovascular outcomes are needed before a carbohydrate-restricted diet can be endorsed.”

So what does DB think? First, these studies do vindicate the concept that weight loss trumps fat intake. The most important factor in maintaining or decreasing lipid levels comes from weight. Second, one can lose weight on a low carbohydrate diet. But finally, weight loss remains difficult. Diets can start the ball rolling, but true sustained weight loss depends on lifestyle changes. No gimmicks need apply. We must all figure out how to control portion sizes indefinitely and increase our calorie expenditure (through both resistance and cardiovascular exercises).