Study: Low-carb diet best for weight, cholesterol

By MIKE STOBBE, AP Medical WriterThu Jul 17, 7:23 AM ET

The Atkins diet may have proved itself after all: A low-carb diet and a Mediterranean-style regimen helped people lose more weight than a traditional low-fat diet in one of the longest and largest studies to compare the dueling weight-loss techniques.
A bigger surprise: The low-carb diet improved cholesterol more than the other two. Some critics had predicted the opposite.
"It is a vindication," said Abby Bloch of the Dr. Robert C. and Veronica Atkins Foundation, a philanthropy group that honors the Atkins' diet's creator and was the study's main funder.
However, all three approaches — the low-carb diet, a low-fat diet and a so-called Mediterranean diet — achieved weight loss and improved cholesterol.
The study is remarkable not only because it lasted two years, much longer than most, but also because of the huge proportion of people who stuck with the diets — 85 percent.
Researchers approached the Atkins Foundation with the idea for the study. But the foundation played no role in the study's design or reporting of the results, said the lead author, Iris Shai of Ben-Gurion University of the Negev.
Other experts said the study — being published Thursday in the New England Journal of Medicine — was highly credible.
"This is a very good group of researchers," said Kelly Brownell, director of Yale University's Rudd Center for Food Policy and Obesity.
The research was done in a controlled environment — an isolated nuclear research facility in Israel. The 322 participants got their main meal of the day, lunch, at a central cafeteria.
"The workers can't easily just go out to lunch at a nearby Subway or McDonald's," said Dr. Meir Stampfer, the study's senior author and a professor of epidemiology and nutrition at the Harvard School of Public Health.
In the cafeteria, the appropriate foods for each diet were identified with colored dots, using red for low-fat, green for Mediterranean and blue for low-carb.
As for breakfast and dinner, the dieters were counseled on how to stick to their eating plans and were asked to fill out questionnaires on what they ate, Stampfer said.
The low-fat diet — no more than 30 percent of calories from fat — restricted calories and cholesterol and focused on low-fat grains, vegetables and fruits as options. The Mediterranean diet had similar calorie, fat and cholesterol restrictions, emphasizing poultry, fish, olive oil and nuts.
The low-carb diet set limits for carbohydrates, but none for calories or fat. It urged dieters to choose vegetarian sources of fat and protein.
"So not a lot of butter and eggs and cream," said Madelyn Fernstrom, a University of Pittsburgh Medical Center weight management expert who reviewed the study but was not involved in it.
Most of the participants were men; all men and women in the study got roughly equal amounts of exercise, the study's authors said.
Average weight loss for those in the low-carb group was 10.3 pounds after two years. Those in the Mediterranean diet lost 10 pounds, and those on the low-fat regimen dropped 6.5.
More surprising were the measures of cholesterol. Critics have long acknowledged that an Atkins-style diet could help people lose weight but feared that over the long term, it may drive up cholesterol because it allows more fat.
But the low-carb approach seemed to trigger the most improvement in several cholesterol measures, including the ratio of total cholesterol to HDL, the "good" cholesterol. For example, someone with total cholesterol of 200 and an HDL of 50 would have a ratio of 4 to 1. The optimum ratio is 3.5 to 1, according to the American Heart Association.
Doctors see that ratio as a sign of a patient's risk for hardening of the arteries. "You want that low," Stampfer said.
The ratio declined by 20 percent in people on the low-carb diet, compared to 16 percent in those on the Mediterranean and 12 percent in low-fat dieters.
The study is not the first to offer a favorable comparison of an Atkins-like diet. Research published in the Journal of the American Medical Association last year found overweight women on the Atkins plan had slightly better blood pressure and cholesterol readings than those on the low-carb Zone diet, the low-fat Ornish diet and a low-fat diet that followed U.S. government guidelines.
The heart association has long recommended low-fat diets to reduce heart risks, but some of its leaders have noted the Mediterranean diet has also proven safe and effective.
The heart association recommends a low-fat diet even more restrictive than the one in the study, said Dr. Robert Eckel, the association's past president who is a professor of medicine at the University of Colorado-Denver.
It does not recommend the Atkins diet. However, a low-carb approach is consistent with heart association guidelines so long as there are limitations on the kinds of saturated fats often consumed by people on the Atkins diet, Eckel said.
The new study's results favored the Atkins-like approach less when subgroups such as diabetics and women were examined.
Among the 36 diabetics, only those on the Mediterranean diet lowered blood sugar levels. Among the 45 women, those on the Mediterranean diet lost the most weight.
"I think these data suggest that men may be much more responsive to a diet in which there are clear limits on what foods can be consumed," such as an Atkins-like diet, said Dr. William Dietz, of the Centers for Disease Control and Prevention.
"It suggests that because women have had more experience dieting or losing weight, they're more capable of implementing a more complicated diet," said Dietz, who heads CDC's nutrition unit.
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On the Net:
New England Journal: http://nejm.org

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Finally, some validation that a low carbohydrate diet is not only effective but safe longterm.

As many of you know, I have long been a proponent of low processed carbohydrate diets. I have seen many beneficial effects including weight loss- especially around the waistline, increased energy level, decrease in appetite, better sugar levels for diabetics, and much improved cholesterol levels. Almost all of these benefits have been linked to a lower risk of cardiovascular disease.

When I think of diet, I try to think of what makes sense by how our bodies react to what we put into them. Our ancestors ate more of a low processed carbohydrate diet, as it was before industrialization and food processing began. They seemed to have had lower rates of what I called DRD, or diet related disorders. Some DRD’s include obesity, heart disease, diabetes and arthritis.

We need to eat more like our ancestors and stop believing that our modern food processing systems know more about how we can stay healthy than our individual bodies! If you have any further questions on how your diet can affect your health, then I encourage you to come in for an evaluation. As Benjamin Franklin once said, "An ounce of prevention is worth a pound of cure."

Steven Horvitz, D.O.

Board Certified Family Medicine

Founder of The Institute for Medical Wellness

For past issues of the newsletter please click here.

Cholesterol drugs recommended for some 8-year-olds

By LINDSEY TANNER, AP Medical WriterMon Jul 7, 7:26 AM ET

For the first time, an influential doctors group is recommending that some children as young as 8 be given cholesterol-fighting drugs to ward off future heart problems.

It is the strongest guidance ever given on the issue by the American Academy of Pediatrics, which released its new guidelines Monday. The academy also recommends low-fat milk for 1-year-olds and wider cholesterol testing.

Dr. Stephen Daniels, of the academy's nutrition committee, says the new advice is based on mounting evidence showing that damage leading to heart disease, the nation's leading killer, begins early in life.

It also stems from recent research showing that cholesterol-fighting drugs are generally safe for children, Daniels said.

Several of these drugs are approved for use in children and data show that increasing numbers are using them.

"If we are more aggressive about this in childhood, I think we can have an impact on what happens later in life ... and avoid some of these heart attacks and strokes in adulthood," Daniels said. He has worked as a consultant to Abbott Laboratories and Merck & Co., but not on matters involving their cholesterol drugs.

Drug treatment would generally be targeted for kids at least 8 years old who have too much LDL, the "bad" cholesterol, along with other risky conditions, including obesity and high blood pressure.

For overweight children with too little HDL, the "good" cholesterol, the first course of action should be weight loss, more physical activity and nutritional counseling, the academy says.

Pediatricians should routinely check the cholesterol of children with a family history of inherited cholesterol disease or with parents or grandparents who developed heart disease at an early age, the recommendations say. Screening also is advised for kids whose family history isn't known and those who are overweight, obese or have other heart disease risk factors.

Screening is recommended sometime after age 2 but no later than age 10, at routine checkups.

The academy's earlier advice said cholesterol drugs should only be considered in children older than 10 after they fail to lose weight. Its previous cholesterol screening recommendations also were less specific and did not include targeted ages for beginning testing.

Because obesity is a risk factor for heart disease and often is accompanied by cholesterol problems, the academy recommendations say low-fat milk is appropriate for 1-year-olds "for whom overweight or obesity is a concern."

Daniels, a pediatrician in the Denver area, agreed that could include virtually all children. But he said doctors may choose to offer the new milk advice only to 1-year-olds who are already overweight or have a family history of heart problems.

The academy has long recommended against reduced-fat milk for children up to age 2 because saturated fats are needed for brain development.

"But now we have the obesity epidemic and people are thinking maybe this isn't such a good idea," said Dr. Frank Greer of the University of Wisconsin, co-author of the guidelines report, which appears in the July edition of Pediatrics, the group's medical journal.

Very young children are increasingly getting fats from sources other than milk and Greer said the updated advice is based on recent research showing no harm from reduced-fat milk in these youngsters.

With one-third of U.S. children overweight and about 17 percent obese, the new recommendations are important, said Dr. Jennifer Li, a Duke University children's heart specialist.

"We need to do something to stem the tide of childhood obesity," Li said.

Li said that 15 years ago most of her patients with cholesterol problems had an inherited form of cholesterol disease not connected to obesity.

"But now they're really outnumbered" by overweight kids with cholesterol problems and high blood pressure, she said.

Dr. Elena Fuentes-Afflick, a pediatrics professor at the University of California at San Francisco, also praised the new advice but said some parents think their kids will outgrow obesity and cholesterol problems, and might not take it seriously.

"It's hard for people to really understand" that those problems in childhood can lead to serious health consequences in adulthood, Fuentes-Afflick said.

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On the Net:

American Academy of Pediatrics: http://www.aap.org/

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When I first heard of this recommendation I was stunned, then outraged. Then I came to my senses and realized this is just another step in the direction of medicalizing our society, however this time with our children.

The theory is that adults already have some coronary artery blockages, and cholesterol lowering will slow this down. I do not buy into that theory as I have not seen it to work.

For an excellent website that refutes the cholesterol hypothesis please visit www.spacedoc.net .

Lets look at some numbers. You need to treat 50 adults with a statin cholesterol lowering drug to prevent 1 heart attack or death over 5 years. To simplify that means that there is a 1 in 50, or 2% chance that taking the drug will help, and a 49 in 50, or 98% chance that it will not help.

Now lets extrapolate that out to children who rarely have any coronary blockages and that even if they did would take a minimum of 30-40 years to exert any effect. So how many children would need to be treated with statin medications to prevent heart disease or death over 5, 10 or even 20 years? How bout the potential side effects that these drugs cause?

This recommendation is extremely misguided and I hope the American Academy of Pediatrics will change these recommendations.

Steven Horvitz, D.O.

Board Certified Family Medicine

Founder of The Institute for Medical Wellness

For past issues of the newsletter please click here.

Treating Summertime Insect Bites:

First , I would like to wish everyone a Happy 4th of July!

As we are now fully into the summer season, the bugs are out and a biting! Most bug bites will resolve on their own within a few days , but if they get worse or show signs of infection, they should be more closely evaluated. There are some hometown recipes I have heard over the years to ease the sting of bug bites.

Some are included below:

• Lime Juice: Mix lime juice with some water and rub onto the insect bites as long as the skin is still intact.
• Raw Potato: Mash and mix some raw potato with baking soda and water. Apply to the bite to help reduce the redness and itch.
• Aspirin: As long as you are not allergic to aspirin, you can crush a few aspirin pills and mix with water into a paste. You can then put the paste onto a sting to help with the inflammation.
• Rubbing Alcohol: First make sure the skin is intact and not broken. Coat the itchy area with rubbing alcohol to help soothe it.
  

For anyone who has a bad allergy to bee stings, if you do not have an epi-pen, please use this newsletter as your reminder to renew your prescription.

.

If anyone has any other home remedies that have worked please send them back to me via email. I am always interested in safe methods of treatment.

.

Steven Horvitz, D.O.

Board Certified Family Medicine

Founder of The Institute for Medical Wellness

For past issues of the newsletter please click here.

How to Head off Summer Headaches:

For those of you who know me well, I do not like to just throw you a pill. I prefer to think and find the cause or the trigger to your medical problem. One such summer problem is headaches. There are quite a few triggers that occur each summer. Avoiding or preparing for these triggers may help you to prevent the dreaded headache:

• Dehydration: In the hotter, steamier summer weather, our bodies may lose more water than they take in. If you do not replenish this water with an increased fluid intake, dehydration may occur and not long after a headache. Try drinking more fluids in the warmer days, and water is still the best option. Caffeinated or alcoholic beverages are not helpful. Some like Gatorade or Vitamin water. These two beverages have a large sugar content. If you prefer these beverages, try diluting them half with water. They will still taste good, and the fluid to sugar ratio will be healthier.
• Deli or Cured Meats: Summertime is the time for picnics and outdoor activities. Many of the deli or cured meats as well as vegetable salads and potato or macaroni salads have preservatives made from sodium nitrite. There are many nitrite sensitive migraine patients who develop worsening headaches after a summer barbecue or picnic. If you are in charge of your summer food, try reading the labels carefully for preservatives. I like to read labels and if I have a hard time pronouncing an ingredient on the label, I usually put it back. I prefer to eat food with no more than 4 ingredients on the label.
• Travel- In the warmer weather we like to travel or vacation more. The motion involved in planes, trains or automobiles can be overstimulating to our brain, causing motion sickness. If driving, try to keep the windows open and the air circulating and keep your head as still as possible. Headaches can be triggered by excessive movement of the head or eyes. Also try to keep your eyes focused on a fixed point in the distance. Some people believe that ginger capsules can help to alleviate motion sickness.
• Icy treats: Probably everyone's favorite summertime treat. I have to admit a slight increase in my gelato consumption since the weather warmed up. The roof of your mouth has very active and sensitive nerves. When cold particles touch the roof of your mouth, it can cause the blood vessels around the brain to temporarily swell, leading to a vascular headache. So go ahead and treat yourself to something cool. Just keep it away from the roof of your mouth. If you develop a headache, a caffeinated beverage may help. For all my patients who I have told to avoid icy treats for their health, remember everything is a balance. If it is a special occasion go for it, just don't have a special occasion every day!!

Steven Horvitz, D.O.

Founder of The Institute for Medical Wellness

For past issues of our newsletter , please click here

An Open Letter from America's Physicians

Dr Steven Horvitz- Reading between the lines: Healthcare Information you can trust!

In the first half of 2008, I have been involved in a grass roots campaign with other doctor's across the nation whose goal is to reform the healthcare system and to restore the doctor-patient relationship to make healthcare once again affordable for all. Written below is a letter that I helped to create along with six other doctors. We are presently acquiring physician signatures so that we can present our thoughts on the problems that face our healthcare system and how we can best solve them.

We presently have over 3,200 physician signatures with more each and every day.

I ask for your opinions on healthcare today and on the letter as it is written. The physician community truly wants to partner with the American public to create and better system.

If you have any thoughts about this letter or any possible solutions please email me directly at DrHorvitz@DrHorvitz.com.

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An Open Letter from America's Physicians

Dear Fellow Americans,

For decades the United States has led the world in healthcare. We have enjoyed the finest hospitals, medical schools, research, technology, and resources. Unfortunately, our healthcare system has lost focus to the point where patient well-being is placed after politics, profits, and special interests. Healthcare costs are on the rise and patients have lost their freedom of choice. These trends are hurting our economy and compromising the doctor-patient relationship. As a result, it has become difficult for physicians to deliver the best possible care.

Our heavily fragmented healthcare system has made it very difficult for you, the American public, to get the care you need. As your physicians, we want to partner with you to address the critical defects of the system as outlined below:

• You are paying a lot for healthcare and not receiving enough in return. Your insurance premiums continue to increase while your healthcare options are dwindling. Gatekeepers, insurance networks, and restrictive regulations limit your choice of doctors and your access to care.

• You have been made dependent on complicated and expensive health insurance plans. Employers are forced to take money out of your paycheck to purchase health coverage. If you lose your job, you are left with no safety net and the money you have paid for health coverage vanishes.

• The time you spend with your physician has become remarkably brief due to regulatory hurdles requiring doctors to spend more time on documentation than with you.

We believe the following factors have made our current healthcare system unsustainable:

• The insurance industry's undue authority and oppressive control over healthcare processes

• Excessive and misguided government regulation

• The practice of defensive medicine in response to a harmful and costly legal environment

We, the physicians of the United States, will no longer remain silent. We will not tolerate a healthcare system where those without medical expertise or genuine interest in our patients' health have absolute control. This letter is merely a summary of the most important problems in our current system. We believe that by partnering with the public we can start to demand real change and formulate practical solutions.

We invite you, our patients, friends, neighbors, and employers to unite with us at this important time in the history of healthcare in the United States. Together, we can guarantee our nation a healthier tomorrow.

Please talk to your doctor about this letter and visit http://www.sermo.com/doctor... for more information.

Respectfully,

The Undersigned U.S. Physicians

FDA: Time for asthma patients to switch inhalers

The following article from Yahoo News and The Associated Press.

FDA: Time for asthma patients to switch inhalers

Fri May 30, 8:16 PM ET

Old-fashioned asthma inhalers that contain environment-harming chemicals will no longer be sold at year's end — and the government is urging patients not to wait until the last minute to switch to newer alternatives.

Patients use inhalers to dispense airway-relaxing albuterol during asthma attacks.

Chemicals called chlorofluorocarbons, or CFCs, once were widely used to propel the drug into the lungs. But CFC-containing consumer products are being phased out because CFCs damage the Earth's protective ozone layer. As of Dec. 31, asthma inhalers with CFCs can no longer be made or sold in the U.S. Inhalers instead will be powered by ozone-friendly HFAs, or hydrofluoroalkanes.

The ozone layer shields the planet from harmful ultraviolet radiation.

Patients have been warned of the change for several years, but the Food and Drug Administration issued an advisory Friday saying anyone still using CFC inhalers should ask their doctor about switching now.

The FDA warns that patients will face a learning curve: HFA inhalers may taste and feel different. The spray may feel softer. Each must be primed and cleaned in a specific way to prevent clogs. And they tend to cost more.

CFC-free albuterol inhaler options include GlaxoSmithKline's Ventolin HFA, Schering Plough's Proventil HFA and Teva Specialty Pharmaceuticals' ProAir HFA. Sepracor's Xopenex HFA is also CFC-free, but it contains levalbuterol, a similar medication.
The FDA said Armstrong Pharmaceuticals is the sole remaining maker of CFC inhalers and is expected to stop production even before the deadline. A spokesman for Armstrong's parent company wouldn't say when production would stop, but sales of remaining inventory will continue until Dec. 31.
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Asthma is a disease that can go from mild to life threatening quickly. As in life and politics, there is good change and bad change. Nonetheless, this change is happening. For anyone using the old non-HFA albuterol preparations, you should watch your symptoms closely. Hopefully you will not notice any change in effectiveness, but if you do, you should contact your physician for instructions.

Steven Horvitz, D.O.
Founder of The Institute for Medical Wellness

For past issues of newsletters please click here.

Vitamin D may help curb breast cancer, study finds

A recent article in HealthDay News from Yahoo via the Associated Press.
By MARILYNN MARCHIONE, AP Medical Writer

Breast cancer patients with low levels of vitamin D were much more likely to die of the disease or have it spread than patients getting enough of the nutrient, a study found — adding to evidence the "sunshine vitamin" has anti-cancer benefits. The results are sure to renew arguments about whether a little more sunshine is a good thing.
The skin makes vitamin D from ultraviolet light. Too much sunlight can raise the risk of skin cancer, but small amounts — 15 minutes or so a few times a week without sunscreen — may be beneficial, many doctors believe.
While the vitamin is found in certain foods and supplements, most don't contain the best form, D-3, and have only a modest effect on blood levels of the nutrient. That's what matters, the Canadian study found.
Only 24 percent of women in the study had sufficient blood levels of D at the time they were first diagnosed with breast cancer. Those who were deficient were nearly twice as likely to have their cancer recur or spread over the next 10 years, and 73 percent more likely to die of the disease.
"These are pretty big differences," said study leader Dr. Pamela Goodwin of Mount Sinai Hospital in Toronto. "It's the first time that vitamin D has been linked to breast cancer progression."
But people shouldn't start downing supplements, she warned. Experts don't agree on how much vitamin D people need or the best way to get it, and too much can be harmful. They also don't know whether getting more vitamin D can help when someone already has cancer.
"We have no idea whether correcting a vitamin D deficiency will in any way alter these outcomes," said Dr. Julie Gralow, a cancer specialist at the University of Washington in Seattle.
The study was released Thursday by the American Society of Clinical Oncology and will be presented at the group's annual meeting later this month.
Lots of earlier research suggests vitamin D may help prevent prostate, breast and especially colon cancer. In lab and animal tests, vitamin D stifles abnormal cell growth, curbs formation of blood vessels that feed tumors and has many other anti-cancer effects.
Other evidence: People who live in northern regions of the world have higher cancer rates than those living closer to the equator, possibly because of less sunshine and vitamin D.
The Canadian researchers wanted to see whether it made a difference in survival. They took blood from 512 women at three University of Toronto hospitals between 1989 and 1995, when the women were first diagnosed with early-stage breast cancer.
A decade later, 83 percent of those who had had adequate vitamin D blood levels were alive without extensive spread of their cancer, versus 79 percent of those whose vitamin D levels were insufficient and 69 percent of those who were deficient, as defined by widely used medical standards for measuring intake.
One red flag: The few women with the very highest levels of vitamin D seemed to have worse survival.
Though the study was too small and those results were not conclusive, "there may be an optimal level of vitamin D in women with breast cancer and it may be possible to take too much," Goodwin said.
The federal government says up to 2,000 international units of vitamin D a day seems OK. Taking 800 units per day will, on average, raise blood levels to the middle of the range that seems best for bone and general health, Goodwin said.
Vitamin D is in salmon and other oily fish, and milk is routinely fortified with it, but dietary sources account for little of the amount of D circulating in the blood, experts say.
"It's very hard to make a recommendation" because how much difference a supplement makes depends on someone's baseline level, which also can be affected by sunlight, skin type and time of year, she explained.
Doctors do suggest breast cancer patients get their vitamin D levels checked to see whether they are deficient. The simple blood test is available in many hospitals and labs for about $25, Goodwin said.
Dr. Nancy Davidson, a Johns Hopkins University cancer specialist who is president of the oncology society, said those tests are growing in popularity, even in ordinary medical care.
"Rightly or wrongly, I'm increasingly seeing physicians who are measuring this," she said.
The Canadian study was paid for by the Breast Cancer Research Foundation in New York, established by cosmetics magnate Evelyn Lauder.
"It's a very provocative paper. It's confirmatory of a tremendous amount of evidence that vitamin D is an important component of health," said Dr. Larry Norton, chief of breast cancer programs at Memorial Sloan-Kettering Cancer Center in New York and a medical adviser to the foundation.
Breast cancer is the most common cancer in women. About 184,450 cases and 40,930 deaths from the disease are expected in the United States this year.
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On the Net:
Government vitamin information:
http://ods.od.nih.gov/factsheets/vitamind.asp
Cancer conference: http://www.asco.org

More information on the health benefits of Vitamin D. I have previously commented on the benefits of Vitamin D in previous newsletters, and a link to an excellent website on Vitamin D can be found at the Vitamin D Council website . There is ample information on this website about the cancer preventing benefits of Vitamin D. I highly recommend you look through the information.
Many physicians are hesitant to go against the grain and make nutritional or vitamin recommendations that are not echoed by either the majority of physicians or by large medical studies. But they usually join the crowd when it becomes mainstream.
I have been advocating Vitamin D supplementation to normal physiologic levels for the past few years. As Vitamin D is produced by our bodies in response to sunlight, it seems a very natural and safe alternative to good health! If a treatment, whether it be traditional or alternative, can help while doing no harm, then it is reasonable to try under monitoring and supervision.
At my office, “First Do No Harm”is side be side with “How can we keep you well with as little medication as possible”.

If you have questions on how to get the proper amount of Vitamin D, please contact my office.

Steven Horvitz, D.O.
Founder of The Institute for Medical Wellness

For past issues of the Newsletter please click here.

More information on Dr. Horvitz can be found at his website at www.DrHorvitz.com

Nasal Irrigation Can Help Fight Spring Allergies

Sun May 11, 7:01 PM ET

SUNDAY, May 11 (HealthDay News) -- When you're doing your spring cleaning, don't forget your nose.

Nasal irrigation is a cheap and easy way for people with spring allergies, nasal congestion, stuffy noses and post-nasal drip to get relief, says Dr. Melissa Pynnonen, co-director of the Michigan Sinus Center and an assistant professor in the University of Michigan's department of otolaryngology.

Nasal irrigation involves rinsing the nose and nasal passages with a solution made with a quarter-teaspoon of kosher salt, eight ounces of warm tap water and a quarter-teaspoon of baking soda.

There are a number of ways to administer the solution. For people who've never done nasal irrigation, Pynnonen recommended using an eight-ounce squeeze bottle and squirting four ounces of the solution into each nostril. The solutions exits through the opposite nostril. Opening your mouth and making a "K" sound will prevent the solution from coming out of your mouth.

Some people use a neti-pot, which looks like a miniature teapot. When using a neti-pot, the solution is poured, rather than squeezed, into the nose. Turkey basters or syringes like those used to suction a baby's nose also work.

"For most patients, the benefit of nasal irrigation is that it does a great job of treating symptoms that otherwise aren't well treated with medicine," Pynnonen said in a prepared statement. "Nasal irrigation can be considered a first-line treatment for common nasal and sinus symptoms. It's often more effective than medications," she concluded.

Nasal irrigation alone may be sufficient to control mild allergy symptoms in some people, but others may need to used medications in addition to nasal irrigation.

So long as children are old enough to cooperate, it's safe to give them nasal irrigation, using a smaller amount of solution, Pynnonen said.

More information

Queen's University in Kingston, Ontario, Canada, has more about nasal irrigation.

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One of the more common causes for visits to my office every May is allergies. When allergies get bad, people complain of sinus infections, asthma, losing their voices, headaches, and the overall misery of runny nose and itching. The best treatment for allergies is avoidance. A good handout on allergen avoidance can be found on my website at:

http://www.drhorvitz.com/listing/Allergen_Avoidance.pdf

Neti pots have become more mainstream of recent. I have never used one, but many of my patient’s have. For a demonstration of a neti-pot in use please click on the following link for a you-tube demonstration.

http://www.youtube.com/watch?v=xCjVigOnyc4

Steven Horvitz, D.O.
Founder of The Institute for Medical Wellness

Stressed out? Turmoil takes a toll on diet, exercise routine

Thu Apr 24, 6:30 PM ET
Stressed workers often reach for calorie-rich foods, skip the gym after a taxing day or forego meals because of heavy workloads. Or they indulge in other bad-for-you behavior like smoking, drinking or staying out late.
As the credit and housing crises rattle Wall Street, pressures over bigger workloads, job security and shrinking nest eggs are upending diets and fueling unhealthy habits across the country.
Breakfast is diet Pepsi and two packets of M&M's. For lunch, macaroons and white chocolates filled with marzipan from the farmer's market near Wall Street.
After learning her job would be cut this summer, Kelly Daly started reaching more frequently for the soothing effects of sugar.
"It's a stress reliever. Especially now that a bunch of us are going to be laid off," said the 49-year-old Daly, whose job reviewing medical insurance records in Manhattan's financial district is being cut after 11 years.
But it is in times of duress, experts say, that minding your health is perhaps more critical than ever.
Eating right and getting exercise may seem burdensome and even frivolous under such circumstances, but it actually gives people a greater sense of control and calm, said registered dietitian Heather Bauer, author of "The Wall Street Diet."
"It's one less thing to stress you out," Bauer said. "If you're out of a job or in a financial slump, it can give you a sense of inspiration as well."
For Aleksandra Cogura, heftier workloads in recent months means skipping lunch. If she's lucky, she'll manage to grab breakfast on the go. Once a gym regular, she hasn't been in four months.
"I just feel like I need to complete my work," said Cogura, a 44-year-old sales analyst in publishing in Manhattan.
Stress can take more serious, physical tolls. People under great stress release hormones and nerve chemicals that weaken the immune system, rendering them more susceptible to illness, said Dr. Esther Sternberg, who studies the effects of stress at the National Institute of Mental Health. Stress can also slow the body's ability to heal wounds, she said.
That could all translate into higher worker absenteeism, and those who do show up are likely not as productive when under great stress, said David Ballard, who specializes in work stress issues at the American Psychological Association.
Some ingredients for happy, productive workers include a flexible work-life balance, employee recognition programs and an atmosphere that lets employees take part in decisions, he said.
"It's about looking at the big system, creating a work place that puts a variety of components in place," Ballard said.
For individuals, reducing stress means "controlling the things you can control" when works seems to get too chaotic, said Marlene Clark, a dietitian with Cedar Sinai Medical Center in Los Angeles.
Taking a brisk, 10-minute walk can do wonders for clearing the head, Clark said. She suggests penciling the breaks in and giving them as much priority as other meetings.
Laying off the caffeine — coffee, tea, soda or even chocolate — could also help calm nerves, she said. Getting enough sleep is critical, too, especially when faced with more demanding work and hours, Clark said.
Taking such measures to reduce stress will only become more critical as the economic forecast darkens.
The nation's unemployment rate, now at 5.1 percent, is expected to move higher in coming months. Gasoline and food prices are at record levels, too, with ground beef, milk, apples, coffee and orange juice costing more these days.
"The first thing people want to do when they get stressed is eat stuff that's bad for them," said Bauer, who counsels Wall Street executives. "But the end result is that they're more stressed out because they're eating something they shouldn't have."
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On the Net:
Information on stress: http://www.nlm.nih.gov/medlineplus/stress.html

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Andy Dick, an affiliate of The Institute for Medical Wellness has some helpful tips:

I think it is important that everyone acts selfishly to an extent. Take care of yourself first. By this, I mean to put your health, wellness, and happiness with your life before deadlines and perceived stresses by outside influences. If you take care of yourself, and feel better overall, every aspect of your life should be the better for it. If you are well rested, properly nourished, and enjoying your choices, then your personal life should be better, your family life should see benefits, and you should be a better, more efficient worker. I think it is important that I note I am not specifically talking about exercise. Although I feel that exercise is important to most, this should be a personal decision. If it does not make you feel better short, or long term, than you need to change what you do.

Rest, healthy living, nutrition, personal enjoyment, and anything else that you value should never be put on the back burner.

Andy Dick
Owner, Optimum Results
(609) 304-7598
www.optimumresults.net

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One of my favorite movies growing up was “The Karate Kid”. Mr. Miyagi (The karate instructor) taught Daniel (the Karate Kid) the meaning of the word Balance and how it relates to ones own life. There are many things that are important in life, and we need to balance out the good with the not so good, the stressful with the calming. We always look for things that make us happy, but sometimes the quick burst of happiness can cause further problems down the line. I try to tell my daughter, when she needs to make a decision, think of safety, health and happiness in that order.

First what you want must be safe, then it must be healthy for you, and then it should make you happy. Choosing happiness over safety or health will just make you end up in my office sooner rather than later!

Steven Horvitz, D.O.

Founder of The Institute for Medical Wellness

For past issues of the Newsletter please click here.

More information on Dr. Horvitz can be found at his website at www.DrHorvitz.com

Heart exam, EKG recommended before children get ADHD drugs

By STEPHANIE NANO, Associated Press Writer

Children should be screened for heart problems with an electrocardiogram before getting drugs like Ritalin to treat hyperactivity and attention-deficit disorder, the American Heart Association recommended Monday.

Stimulant drugs can increase blood pressure and heart rate. For most children, that isn't a problem. But in those with heart conditions, it could make them more vulnerable to sudden cardiac arrest — an erratic heartbeat that causes the heart to stop pumping blood through the body — and other heart problems.

About 2.5 million American children and 1.5 million adults take medication for attention-deficit hyperactivity disorder, or ADHD, according to government estimates. Stimulant drugs, like Ritalin, Adderall and Concerta, help children with ADHD stay focused and control their behavior.

The medications already carry warnings of possible heart risks in those with heart defects or other heart problems, which some critics said were driven more by concerns of overuse of the drugs than their safety.

The heart group is now recommending a thorough exam, including a family history and an EKG, before children are put on the drugs to make sure that they don't have any undiagnosed heart issues.

"We don't want to keep children who have this from being treated. We want to do it as safely as possible," said Dr. Victoria Vetter, a pediatric cardiologist at the University of Pennsylvania School of Medicine and head of the committee making the recommendation.

The label warnings were added after a review by the Food and Drug Administration of its databases found reports of 19 sudden deaths in children treated with ADHD drugs and 26 reports of other problems including strokes and fast heart rates between 1999 and 2003. There were also reports of heart problems in adults; the committee didn't look at adults.

An EKG can detect abnormal heart rhythms that can lead to sudden cardiac arrest. Children who are already on ADHD drugs should also be tested, Vetter said. If problems are found, the child should be sent to a pediatric cardiologist. With careful monitoring, Vetter said, children with heart problems can take the medicines if needed.

The cost of an EKG varies depending on who does it and the location. For example, the amount that Aetna Inc. pays for an EKG in a doctor's office ranges from $24 to $50; Medicare's payment rate is about $23. Vetter said Children's Hospital of Philadelphia, where she works, has been doing EKG screening for three years and it has been covered by insurance.

She said a screening of about 1,100 healthy children found that about 2 percent of them had some kind of heart problem.

"We thought it was reasonable to include the electrocardiogram as a tool for the pediatrician, the psychiatrist so that this would help identify additional children who have heart disease," Vetter said.

But Dr. Steven Pliszka, a child psychiatrist at the University of Texas in San Antonio, said he was baffled by the EKG recommendation. He said there's no evidence that sudden death is a bigger problem for children taking stimulants than for children who aren't taking the drugs.

Pliszka said an EKG might deter people from seeking treatment because it's an added expense and hassle. Psychiatrists aren't likely to have an EKG machine, and pediatricians might not either, making patients go elsewhere to get the test, he said.

The American Academy of Child and Adolescent Psychiatry recently updated its treatment guidelines for ADHD, and did not recommend routine EKGs, said Pliszka, who was the lead author. He has received research support or served as a consultant for makers of ADHD drugs.

"We definitely did not feel we needed to screen everyone," Pliszka said.

He noted that the heart association doesn't recommended EKG screening for young athletes to prevent sudden death. The group has said it wasn't feasible or cost-effective to screen all student athletes.

Representatives for Shire PLC, which makes Adderall and two other ADHD treatments, and Norvartis Pharmaceuticals Corp., which makes Ritalin, said the labeling already suggests patients be evaluated for heart problems and an EKG done if needed.

"There's no new information here. And frankly, we're a little perplexed as to the purpose of the American Heart Assocation coming out with this statement at this time," said Shire spokesman Matt Cabrey.

An ADHD advocacy group called CHADD said parents should monitor their child's reaction to all medications. EKG screening "will bring an even further measure of safety to what is already a safe clinical treatment approach," the group said.

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On the Net:

ADHD drugs: http://www.parentsmedguide.org/

American Heart Association: http://www.heart.org/

National Resource Center on ADHD: http://www.help4adhd.org/

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This article shows another case of putting the fear into parents of "Should I get this test or not???"

Heart abnormalities in children, thankfully are extremely low. I do not understand the reasons for recommending EKG's for children before potential treatment with ADHD stimulant medication. A thorough history and physical should tell most doctors whether the child is at risk for side effects.

Could the American Heart Association be recommending this to drum up more business??

My job is to help my patients stay healthy, through good preventive care and guidance, hopefully with as little medication and unnecessary testing as possible.

How do I know whether to recommend testing? By spending extra time talking with my patients and really honing in on the problems that need to be dealt with. The more specific we get, the less testing and treatment necessary!!

Steven Horvitz, D.O.

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For past issues of my newsletter please click here.
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August 10, 2008

Addendum: Copied below is the AAP (American Academy of Pediatrics) opinion on the above topic which agrees with my opinion.

AAP and AHA Differ on ECG/ADHD Advice

Sue Hughes

Heartwire 2008. © 2008 Medscape

August 1, 2008 — The American Academy of Pediatrics (AAP) has issued a new policy statement emphasizing that routine ECGs for children receiving medications for attention-deficit/hyperactivity disorder (ADHD) are not warranted [1]. The statement comes after advice given by American Heart Association (AHA) earlier this year [2], that physicians consider ordering an ECG to aid them in deciding whether or not underlying heart disease is present before prescribing ADHD drugs.

A spokesperson for the AHA told heartwire that in May/June it "clarified" its original advice, issued in April, in a joint advisory from the AHA and the AAP [3], saying that an ECG should be at the physician's discretion and it is not mandatory to obtain one. The AHA also updated its original statement [4]. "Our recommendations have not changed since we issued them this spring. Rather, we issued a clarification as a result of confusion and concern among the public and healthcare professionals. Routine use of ECGs to assess these children has not ever been part of our recommendations," the spokesperson said.

The current statement from the AAP, published in the August 2008 issue of Pediatrics, formalizes its position on the issue, an AAP spokesperson told heartwire. However, the two organizations still seem somewhat out of kilter on the strength of the advice they are issuing, with the AHA still more strongly recommending the use of an ECG than the AAP.

AHA Recommendations

The AHA makes the following recommendations for children starting ADHD medications:

• A thorough patient and family history should be obtained for assessment of these children. This is a class I recommendation (using the ACC/AHA classes of recommendations and levels of evidence).
• Acquiring an ECG is a class IIa recommendation. This means it is reasonable for a physician to consider obtaining an ECG as part of the evaluation. It is not mandatory, but rather is left to the physician's discretion. Treatment of a patient with ADHD should not be withheld because an ECG is not done. The child's physician is the best person to assess whether there is a need for an ECG.
• It is reasonable to use ADHD medications with caution in patients with known congenital heart disease and/or arrhythmias if these patients are stable and under the care of a pediatric cardiologist.

Latest AAP Statement

The latest AAP statement says that the AHA's recommendation to obtain an ECG before starting medications to treat ADHD "contradicts the carefully considered and evidence-based recommendations of the American Academy of Child and Adolescent Psychiatry and the American Academy of Pediatrics." It notes that these organizations have concluded that sudden cardiac death in people taking medications for ADHD is a very rare event, occurring at rates no higher than those in the general population of children and adolescents. It also notes that it has not been shown that screening ECGs before starting stimulants have an appropriate balance of benefit, risk, and cost-effectiveness for general use in identifying risk factors for sudden death. "Until these questions can be answered, a recommendation to obtain routine ECGs for children receiving ADHD medications is not warranted," the statement concludes.

The AAP statement adds that the authors of the AHA statement acknowledge the lack of evidence showing a benefit of routine ECG screening for these children, but still assigned their recommendation for screening a IIa classification (weight of evidence/opinion is in favor of usefulness/efficacy) and a category C level of evidence (only consensus opinion of experts, case studies, or standard of care). The AAP disagrees with both of these classifications. "Using AHA criteria, the AAP would, at most, classify this recommendation as IIb ('the level of evidence is less well established by evidence/opinion . . . . Additional studies with broad objectives needed'). In addition, using the AAP classification of recommendations, the AAP would assign the recommendation a category D level of evidence (on the basis of expert opinion without even observational studies)," the statement says, adding that the AAP avoids making guideline recommendations with a category D level of evidence.

It further claims that expert opinion suggests that the harm outweighs the benefit of recommending routine ECGs for healthy children who are starting stimulant medication for ADHD. "Accordingly, the AAP would recommend against such routine ECG screening," the statement concludes.

AAP Recommendations

The AAP makes the following recommendations:

• Careful assessment of all children, including those starting stimulants, using a targeted cardiac history (eg, patient history of previously detected cardiac disease, palpitations, syncope, or seizures; a family history of sudden death in children or young adults; hypertrophic cardiomyopathy; long QT syndrome) and a physical examination, which includes a careful cardiac examination (evidence quality: C; strength: recommendation). If patient history, family history, or physical exam is suggestive of cardiac disease, further evaluation is advised, with input from a pediatric cardiologist.
• Given current evidence, the AAP encourages primary care and subspecialty physicians to continue currently recommended treatment for ADHD, including stimulant medications, without obtaining routine ECGs or routine subspecialty cardiology evaluations for most children before starting therapy with these medications (evidence quality: D; strength: option).
• More research is needed on risk factors for sudden cardiac death among all children and adolescents, including those with ADHD who are treated with stimulant medications. Better methods of detecting hidden cardiac disease in children should be another focus of such research efforts.

Nissen Disagrees with AAP

But cardiologist Dr Steven Nissen (Cleveland Clinic, OH) says the AAP statement is misguided. He commented to heartwire: "It suggests that as many as 8% of children should be treated with amphetamines or related stimulant drugs. These drugs increase blood pressure and have not been studied in long-term trials. The statement asserts that sudden death is not more common in children receiving these drugs. However, the FDA has issued a warning for all of the ADHD drugs that states that they can cause sudden death at usual doses. It is irresponsible for a professional medical society to recommend to its members that they ignore an FDA-mandated warning. This is the second time in a few weeks where the AAP has issued poorly thought out guidelines that promote inappropriate drug use in children. The previous statement promoted statin use in children as young as 8 years of age."

Ghostwriters for medical research criticized, reforms urged

By LINDSEY TANNER, AP Medical Writer 27 minutes ago

Two new reports involving the painkiller Vioxx raise fresh concerns about how drug companies influence the interpretation and publication of medical research.

The reports claim Merck & Co. frequently paid academic scientists to take credit for research articles prepared by company-hired medical writers, a practice called ghostwriting. They also contend Merck tried to minimize deaths in two studies that showed that the now withdrawn Vioxx didn't work at treating or preventing Alzheimer's disease.

Merck called the reports in Wednesday's Journal of the American Medical Association false and misleading. Five writers of the articles were paid consultants for people who sued Merck over Vioxx's heart and stroke risks; the sixth testified about Merck and Vioxx's heart risks before a Senate panel. Merck says those connections makes the reports themselves biased.

While Merck is singled out, the practices are not uncommon, according to JAMA's editors. In an editorial, they urge strict reforms, including a ghostwriting crackdown and requiring all authors to spell out their specific roles.

Dr. Catherine DeAngelis, JAMA's editor-in-chief, said those are already policies at JAMA but not at many other journals.

"The manipulation is disgusting. I just didn't realize the extent," she said.

The practices outlined in JAMA can lead editors to publish biased research that can result in doctors giving patients improper and even harmful treatment, she said.

DeAngelis said doctors, medical researchers and journal editors bear some responsibility for those harms.

"We're the ones who have allowed this to happen. Now we've got to make it stop," she said.

Drug studies involve several steps, including designing and performing the research, analyzing the results and writing them up for submission to a medical journal. Pharmaceutical companies sometimes pay for a study but have independent scientists perform all those steps. Sometimes companies and their own scientists are involved in some or all the steps, and those were the studies scrutinized in the JAMA reports.

The articles are based on reviews of company documents from court cases over Vioxx, which was pulled in 2004 because of its heart and stroke risks. Merck agreed to pay $4.85 billion last November to settle thousands of lawsuits.

One JAMA report says internal company data showed in 2001 that Vioxx patients in two Alzheimer's studies had a higher death rate than patients on dummy pills. Merck didn't publicize that "in a timely fashion" and provided information to federal regulators that downplayed the deaths, the report said.

But Jim Fitzpatrick, a Merck attorney, said "it's completely not true" that Merck tried to minimize those deaths. He said a Merck analysis found the excess deaths were not related to Vioxx.

The other JAMA article says one Alzheimer study was designed and conducted mainly by Merck scientists. But when published, the lead authors listed were academic scientists not named in a study draft.

Peter Kim, head of Merck Research Laboratories, said those authors "were intimately involved in the studies." One was New York University Alzheimer's specialist Steven Ferris. He also disputed the implication that he had little to do with the study, and said Merck paid him for his work.

Fitzpatrick acknowledged that Merck has hired outside firms to write drafts of other studies that later list scientists as first authors. In those cases, the scientists are expected to review the manuscript and can suggest changes, he said.

The Alzheimer study was published in 2005 in the journal Neuropsychopharmacology. Its new editor, Dr. James Meador-Woodruff, said the journal's policies have been strengthened to ban ghostwriting.

___

On the Net:

JAMA: http://jama.ama-assn.org

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If we did not trust the pharmaceutical industry before, how can we now?

Can we believe the hype and advertising that comes from this industry?

For those of you who know me well, I am not a big fan of medication. I prefer to use the least amount possible, and only after exhausting other options. I always prefer to find the cause of the problems and treat the cause with lifestyle adjustments first.

It sometimes take a little longer to come up with the solution, but it may save you both medication side effects and the cost of expensive medications.

If you think you are taking too much medication, please schedule an appointment so we can truly the assess their need, their benefits and their possible risks.

Always remember, that I work for you! Not for your insurance, not for the government!

You will get individualized and personal care and advice. That is what Family Practice is all about!!

Dr Steven Horvitz

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For past issues of my newsletter please click here.

For more information on my office please visit my website at www.DrHorvitz.com

MED MIX-UPS HURT 1 IN 15 KIDS

Medicine mix-ups, accidental overdoses and bad drug reactions harm roughly one out of 15 hospitalized children, according to the first scientific test of a new detection method, according to a new study published in the medical journal Pediatrics.

Other findings:

• Researchers found a rate of 11 drug-related harmful events for every 100 hospitalized children.
• That compares with an earlier estimate of two per 100 hospitalized children, based on traditional detection methods.
• The rate reflects the fact that some children experienced more than one drug treatment mistake.
• The new estimate translates to 7.3 percent of hospitalized children, or about 540,000 kids each year, a calculation based on government data.
• Simply relying on hospital staffers to report such problems had found less than 4 percent of the problems detected in the new study.

The new monitoring method developed for the study is a list of 15 "triggers" on young patients' charts that suggest possible drug-related harm. It includes use of specific antidotes for drug overdoses, suspicious side effects and certain lab tests. By contrast, traditional methods include non-specific patient chart reviews and voluntary error reporting.

The researchers said their findings highlight the need for "aggressive, evidence-based prevention strategies to decrease the substantial risk for medication-related harm to our pediatric inpatient population."

Patient safety experts said the problem is likely even bigger than the study suggests because it involved only a review of selected charts. Also, the study didn't include general community hospitals, where most U.S. children requiring hospitalization are treated.

Source: "Med Mix-Ups Hurt 1 In 15 Kids," USA Today, April 7, 2008.

For text:

http://www.usatoday.com/news/health/2008-04-07-chidlren-medicine_N.htm

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Hospitals are dangerous places for children as well as adults.

The best way to prevent hospital errors is by avoiding hospitals. But to avoid hospitals you need to stay healthy.

Getting yearly wellness exams , learning about how your body works, learning about lifestyle modifications you can make to stay healthier will all help to achieve that goal.

How many of you are at an ideal body weight? If not do you know a healthy way to achieve it?

How many of you smoke and can't find a way to quit?

How many of you have had recent physical exams with proper laboratory testing to gauge your risks?

How many of you have sat with your doctor and talked about your families medical history and how it relates to you?

There are many things you can do to stay healthy. Truly knowing the status of your health and promoting continued well being is the foundation that gets you there.

If you have not done so already, set up a wellness physical. The time you spend will be well worth the good health you will enjoy!!

Steven Horvitz, D.O.

Founder Institute for Medical Wellness

For past newsletter editions please click here.

Change for our Healthcare system, but what kind?

I read an interesting article today written by a senator from Oklahoma who also happens to be a physician. From his position he can see the two disparaging ends of our present healthcare debate, government versus private control. You can read his article at http://www.nysun.com/article/72610.

I am a strong proponent of an individuals rights, especially when it comes to choices in healthcare. This is one of the driving forces behind my practice transition.

Many of my patients have asked why I took this "risk" of change.

Let me state a few of the reasons:

Health insurers intrusion into patient care- The past few years has seen more and more power given to the health insurers to delay or deny needed medical care. Health insurers are for profit companies. They make profits by NOT spending on your healthcare. That puts the doctor at a disadvantage when trying to help you access the care you need.

Increased Overhead- Insurance rules and regulations add enormously to business overhead driving up the cost of providing you healthcare. All of these regulations would take my office staff hours each day, and take them away from helping you. Let me list a few of these onerous burdens which I consider nonsensical to your care:

• Insurance Referrals


• pre-certifications


• pre-authorizations


• Medication formularies


• Pay for performance

All of these regulations are added by insurers to make it difficult to obtain necessary care and more importantly to increase the profits for insurers. By removing these regulations, my office has more time to spend with you and for you! I want and need to spend more time with you and less with paperwork. This enables a more open discussion of your problems and helps with better treatment plans. Would you rather spend 8 minutes with your physician or 20 minutes?

That brings me to costs. Healthcare does not have to cost a lot. My fees are listed for all to see, so there will be no sticker shock. Ask a doctor who participates with an insurance company to tell you their true fees. They probably do not even know! And almost all my present patients still have health insurance to cover their big ticket costs such as hospitalization and emergency care.

So far this year, there has been no health insurer intrusion into my patients care, my practice overhead has dropped considerably, we spend more time with patients, we have many available and affordable payment options, and fees are known upfront. We are also able to stress wellness and preventive care and advise of lifestyle modifications to prevent further illness. All the positives in a medical practice that gives choice and price transparency to patients.

I agree that change is needed in our healthcare system. The change I forsee is to a system that provides affordable access, high quality and innovative care, and rewards prevention. This can be best accomplished with freedom and choice, transparency of costs, and where patients are once again put back in charge of their healthcare dollar.

Steven Horvitz, D.O.
Founder Institute for Medical Wellness

Who should make the decisions? Your health insurer or your doctor?

March 2, 2008: This article from Yahoo news brought to you as a service from Dr. Steven Horvitz and the Institute for Medical Wellness.

Aetna postpones sedation policy change

By STEPHEN SINGER, AP Business WriterWed Feb 27, 6:00 PM ET
Aetna Inc. said Wednesday it will delay a proposed policy that would stop covering the cost of using anesthesiologists during colonoscopies. The policy had been opposed by a group of New Jersey doctors who said denying coverage of anesthesiologists to anxious patients would lead to fewer cancer screenings.
The Hartford-based insurer's policy was to take effect Apri1 1. Aetna said it will now be implemented after the U.S. Food and Drug Administration approves other forms of sedation.
"Implementation of our policy on April 1 would inconvenience our members ... and potentially depress cancer screening rates in the short term," said Dr. Troyen Brennan, Aetna's chief medical officer.
Aetna initially announced its policy in December in an attempt to address questions about the medical necessity of an anesthesiologist's services during routine upper and lower endoscopic procedures, such as colonoscopies. Aetna would still cover anesthesiologists for high-risk patients.
The change was opposed by the Medical Society of New Jersey, which said patients should be assured that their insurance coverage includes the cost of anesthesiologists who administer propofol, an anesthesia the doctors say is effective and comfortable.
A call was placed to the group seeking comment.
Aetna has said moderate sedation works just as well and does not require an anesthesiologist, which can drive up the cost of the procedure by between $200 and $1,000. Gastroenterologists generally decide whether to use propofol or moderate sedation.
Aetna said it hopes delaying the policy will allow adequate time for new "attractive, patient-friendly alternatives to anesthesiologist-monitored sedation services" to be approved by the FDA.
New medical devices, as well as new sedatives, are expected on the market during the late summer and are in review with the FDA now, Aetna said.
Once that occurs, Aetna will implement its policy, Brennan said.
Colorectal cancer is the second leading cause of cancer death in the United States and regular screening could eliminate as many as 60 percent of deaths each year, according to the U.S. Centers for Disease Control and Prevention.

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This is another example of health insurance companies dictating treatments for patients, against their doctors wishes. Aetna's motives were solely to cut costs and increase already soaring profits. For more on Aetna's 2007 earnings, totaling over 1.8 Billion dollars please click here.

Can you imagine how many of the uninsured could be helped with 1.8 billion dollars?

How about lowering your health insurance premiums with some of the 1.8 billion dollars?

So to believe that Aetna's decision not to pay for colonoscopy anaesthesia was good for patient care is disingenuous. After reading the above article, the questions you must ask are who you want to help you in making medical decisions, your doctor or your health insurance carrier? I vote for doctors making the decisions!

One of the main reasons I dropped out of insurance networks was to be able to offer all my patient's unbiased yet affordable family medical care without any third party interference. By not contracting with these billion dollar profit making health insurers, I can truly be your best advocate to get you through this healthcare system.

As we are now two months into our new insurance-free system, I ask all of my patients for comments on how I can make my practice work better for you both today and in the future. Any and all comments are appreciated.

I also ask for suggestions on future newsletter topics. I try to get recent newsworthy items of interest and read between the lines to put it into proper unbiased perspective. Please send any suggestions to me by email at DrHorvitz@DrHorvitz.com.

Steven Horvitz, D.O.
Founder of the Institute for Medical Wellness
Your Partner in health!

Just 1 in 4 know heart attack signs

February 23, 2008 - This article from Yahoo news is brought to you as a service from Dr Steven Horvitz and The Institute for Medical Wellness.

Just 1 in 4 know heart attack signs

By MIKE STOBBE, AP Medical WriterThu Feb 21, 9:02 PM ET

Only about 1 in 4 Americans know the warning signs of a heart attack and what to do first, according to a new government report. That's a decline in knowledge since the last survey in 2001, which showed nearly 1 in 3 to be well informed.

The study's lead author, Dr. Jing Fang, called public awareness in the new survey "alarmingly low." Fang is with the Centers for Disease Control and Prevention, which surveyed residents of 13 states and the District of Columbia.

Heart attack warning signs can include one or more of the following five symptoms: shortness of breath; pain or discomfort in the chest; discomfort in the arms or shoulder; a feeling of weakness or lightheadedness; and discomfort in the jaw, neck or back.

Chest pain is the most common symptom. Women are more likely than men to experience some of the other symptoms, particularly shortness of breath and back or jaw pain, according to the American Heart Association.

Anyone experiencing these symptoms should call 911, the heart association advises.

The groups best informed of heart attack warning signs and what to do about them tended to be white, highly educated, and women. Also scoring well were residents of West Virginia, which has some of the nation's highest heart attack death rates.

Each year more than 900,000 Americans suffer a heart attack, and about 157,000 of them are fatal. About half the deaths occur within an hour of symptoms occurring, experts say.

Because different people experience different symptoms, it's important to be aware of all of them, doctors say.

"It's not always massive chest pain," said Wayne Rosamond, a University of North Carolina epidemiology professor and expert on heart disease statistics.

Of course, knowing is not the same as doing: Although most of those who got the heart attack symptoms right said they would call 911, other studies show that only about half of heart attack victims go to a hospital by ambulance, Rosamond noted.

Patients' concerns about lack of health insurance status or other matters may explain why so few go to a hospital, said Rosamond, who was not involved in the new study.

The CDC's findings were based on a random-digit-dial telephone survey of about 72,000 people in 2005.

In West Virginia, more than 35 percent of respondents from that state knew all five warning signs and that they should call 911, compared with 27 percent in the overall study population.

Iowa and Minnesota also were at the top of the list. The gap between West Virginia and the two other states was not statistically significant.
West Virginia consistently ranks among the states with the highest heart attack deaths rates, and also is a leader in smoking, obesity, high cholesterol and other heart disease risk factors. But it's not clear whether personal experience was the reason the state's residents were so well informed. Public health education campaigns or other factors may also explain the result, experts said.


It is very important to know the warning signs of a heart attack. But heart attacks are only one cause of medical illness. My first job as your physician is not to treat you for your heart attack but to teach you how to prevent it and many other medical illnesses. This is different from alot of the medical community today, the majority of which are geared towards treating your lab values, and then giving you more and more medications to make your numbers look just right. They do not always take into account that treating numbers is not the same as treating disease.

Case in point. People with total cholesterol levels above 200 are responsible for 50% of the heart attacks yearly. What does that mean? It means people with total cholesterol levels below 200 are responsible for the other 50% of heart attacks. So where do you want your total cholesterol to be?

One of my goals for 2008 is to help my patients with prevention and wellness. Patients enrolled in my wellness or retainer programs will be shown many different ways to prevent illness. I will use lab numbers as an indicator of risks, but I prefer to help my patients with lifestyle adjustments as opposed to just using medications. For example, if we lower our risks through proper diet and exercise, and be proactive on other personal risk factors revealed through a comprehensive wellness program, then I feel I am doing my job correctly.

Steven Horvitz, D.O.
Founder of the Institute for Medical Wellness

Open Letter to my patients

February 20, 2008

We near the end of February, nearly two months into the transition of my practice. Many of my patients, peers, friends and family have asked how the transition is going.

So far, so good.

The goals I have set for my practice are being met.

Please allow me to list a few of these:

1. Same day appointments- If you are not feeling well and need an appointment, the last thing you need to hear from your doctor’s office is that they can schedule you in three days. That just does not work! We have always offered same or next day appointments, and now if you call our office before noon on a workday, you will be offered a same day appointment. My father was also a family physician in a solo practice. He would always tell me, “Make sure you get patients into your office when they are sick, because if you wait a few days they may not be sick anymore.” I have followed my father’s advice.

2. Longer appointment times- When my office participated with health insurance companies, the large overhead expense forced us to try to see more patients per day. This would often cut into the length of time available per patient. Average appointment time prior to my transition was 12-15 minutes. Now we are scheduling for at least 20-minute appointment times, and longer for Wellness exams and physicals. My goal is that each patient gets the time they need for a full and comprehensive evaluation.

3. Less waiting time- With longer appointment times, I have finally been able to run on schedule. No one is perfect, but I have been doing a much better job of seeing patients at their scheduled appointment times. Another side benefit is less crowded waiting rooms and less time in the waiting room. In fact I am considering canceling some of my magazine subscriptions as no one is finding time to read them.

4. Creating a medical home for my patients- When contracted with health insurance companies my office staff and I would usually spend 4-6 hours per day on bureaucratic paperwork, referrals, precertifications and other health insurance nonsense that should have no place in our healthcare system. Well, no longer!! We now have time to serve as your sounding board to medical advice and treatment rendered by other caregivers and specialists. My office staff also has the time to help with the facilitation and coordination of your healthcare. This includes scheduling diagnostic tests and also referring and scheduling appointments with specialists.


I would like to restate my practice mission statement, as the words below are the standard of care that my office pursues.

To provide outstanding family medical care to our patients with a focus on comprehensive wellness and prevention.

To inform you of healthcare options that your health insurance carrier may not want you to obtain or know about.

To be an advocate for your medical care without regards to the health insurance bureaucracy.

Where patients go to be treated as a person and not as a commodity.

Where patients go to have a Physician who listens carefully and respects what the patient has to say and encourages the patient to say what is on their mind.

To give patients the ability to see their own Doctor and to make appointments without unreasonable waits.

To provide this care with an open mind, and to make your healthcare a team effort between Dr. Horvitz, his office staff, and you, the individual.


I appreciate the trust and confidence that my patients have shown in me. I take my job and my profession very seriously and I strive to treat every patient as I would want to be treated myself, and as I would treat my own family. I will always do my best to make every office visit or phone conversation worthy of your time.

If you have any suggestions or comments on how I can make my practice work better for you, please call or email. I will be happy to hear from you!

Steven Horvitz, D.O.
Founder Institute for Medical Wellness