Concierge Medicine

Columnist questions ethics of "concierge doctoring."
In the New York Times (8/27) Doctor and Patient column, Pauline W. Chen, MD, discusses concierge medical practices in which patients pay a monthly or yearly retainer to guarantee "around-the-clock access to [a] doctor, appointments within 24 hours of calling, longer office visits, and...personalized attention and care coordination." Over time, "the debate about the ethics of concierge doctoring has grown more heated, with more and more physicians unabashedly lining up to take sides." For example, "an editorial in the Annals of Internal Medicine this spring...questioned not only the ethics, but also the quality of care delivered in such practices." Chen wonders "whether it is possible to practice in a way that reconciles concierge medicine with all the ethical concerns."
Tufts Medical Center uses concierge retainer fees to provide free care to impoverished patients. The New York Times (8/26, Tara Parker-Pope) "Well" blog pointed out, "Although patients often sing the praises of concierge medicine, the medical community is grappling with the ethical concerns of creating two different levels of medical care for the haves and the have-nots." But, physicians at Tufts Medical Center in Boston have come up with a practice model that benefits both wealthy and poor patients alike. Since 2004, primary-care physicians there "have offered patients the option of being part of either a traditional general medical practice or a retainer practice." The $1,800 yearly retainer fee paid by the concierge patients "is used to support the traditional general medical practice, the teaching of medical students and trainees, and free care to impoverished patients."

Healthy Alternative with Antioxidants

Asian black "forbidden rice" may offer more health benefits than others.
A handful of stories focus on the health benefits of black rice, which is the subject of a new study presented at the American Chemical Society in Boston, by Zhimin Xu, associate professor at Louisiana State University Agricultural Center in Baton Rouge, and colleagues.
CNN /Health.com (8/26, Storrs) pointed out that black rice "is still relatively rare," although "researchers are trying to bring its distinctive flavor and mix of antioxidants to the masses," because the rice "is full of antioxidant-rich bran, which is found in the outer layer that gets removed during the milling process to make white rice." The bran of black rice also "contains the antioxidants known as anthocyanins, purple and reddish pigments -- also found in blueberries, grapes, and acai -- that have been linked to a decreased risk of heart disease and cancer, improvements in memory, and other health benefits."

Depressed Mothers and Impoverished Children

More than half of babies in poverty are being raised by mothers showing symptoms of depression.
The Washington Post (8/26, St. George) reported that, according to a study conducted by researchers at the District of Columbia-based Urban Institute and based on government data on more than 14,000 children born in 2001, "more than half of babies in poverty are being raised by mothers who show symptoms of mild to severe depression, potentially creating problems in parenting and in child development." What's more, investigators found that "one in nine infants in poverty had a mother with severe depression." Unfortunately, the study also found that "even severe depression goes largely untreated among low-income mothers of infants, with just 30 percent speaking to a professional about a mental health problem."

Depression in Children

Some research suggests depression may begin in preschool children.
The New York Times (8/29, MM48, Paul) examines a range of opinions on the topic of depression in preschoolers. After an anecdotal opening about the symptoms exhibited by a preschool child from St. Louis, the Times reports, "Preschool depression may be a legitimate ailment, one that could gain traction with parents in the way that attention-deficit/hyperactivity disorder (AD/HD) and oppositional defiant disorder (ODD)...have entered the what-to-worry-about lexicon." This is partly because, "according to recent research," the onset of depression "seems to be earlier than expected. Today a number of child psychiatrists and developmental psychologists say depression can surface in children as young as two or three."

Overeating and Body Changes

Overeating for just four weeks may cause lasting changes in body fat composition.
The Los Angeles Times (8/24, Roan) "Booster Shots" blog reported that, according to a study published in the journal Nutrition & Metabolism, "overeating for just four weeks can cause changes in body fat composition that last for years." In a two-year study of 18 young and healthy adults of normal body weight who were told to be sedentary and to raise their intake of calories by 70% for one month and a control group who changed neither their diet nor their exercise habits, researchers found that "at the one-year mark, the gluttony group was an average of 3.3 pounds heavier than before their four-week binge while there was no change in the body weight of the control group."
BBC News (8/24) reported, "The study suggests that even a short period of excessive eating and a lack of exercise can potentially change a person's physiology -- making it harder to lose and keep off weight." The UK's Telegraph (8/25, Alleyne) also covers the story.

Flu Shot Update

CDC officials urging public to get flu shot sooner this year.
The Wall Street Journal (8/25, Mckay) reports that this year, CDC and other health officials are urging Americans to get the flu shot, which contains protection against three strains, most notably, H1N1, early. CDC Director Thomas Frieden stated, "I think last year will be a plus rather than a minus in terms of vaccine coverage," and added that the agency is working on new technology that will allow vaccines to be produced faster. Nevertheless, CDC officials are aware that some people are still hesitant to get the vaccine because of concerns that it was not adequately tested, or because they believe H1N1 is not a major health threat.

Cymbalta and Chronic Pain

FDA panel recommends allowing duloxetine to treat some chronic pain conditions.
The New York Times (8/20, B3, Wilson) reports that an FDA advisory panel "on Thursday voted narrowly to recommend allowing Eli Lilly to market its blockbuster antidepressant Cymbalta [duloxetine] for some chronic pain conditions like lower back ailments that affect millions of Americans." The panel "voted 8-6 in favor of expanding approved uses" but "voted against the drug's use for osteoarthritis." FDA officials at the meeting also "assured the panel they would draft warnings against the overuse of Cymbalta for pain, if they did finally approve a label change."
The Wall Street Journal (8/20, Dooren) notes that Cymbalta is currently approved to treat depression, diabetic nerve pain, fibromyalgia and anxiety. Bob Rappaport, director of FDA's anesthesia and analgesia products division, also said the agency is considering the approval of Cymbalta to treat musculoskeletal pain, including lower-back pain, but not for all types of chronic pain.
The AP (8/20, Perrone) adds that the "panelists picked apart five clinical studies submitted by the company, which showed conflicting results for the drug's effectiveness in different pain disorders and patient groups." Many panelists also "complained that Lilly's studies were primarily composed of older, Caucasian patients, raising questions about the drug's effectiveness in different age groups and ethnicities."