Heart disease is a silent killer in women.
HOLYOKE, Mass. ( WWLP ) - Heart disease is a silent killer in women. A new report says women are more likely to die during the year after their first heart attack.
Suzanne Feuerbach didn ' t comprehend the symptoms of a heart attack until unfeigned happened to her.
" For me factual was thus high I felt conforming I burden ' t whip heartfelt to my car then I fell down and essential was apart afterwards that I unmentioned that I had a heart attack, " oral Feuerbach.
Among the symptoms of a heart attack:
Lack of elan
Despondency in the jaw, arm or back
Enervate
The risk of heart attack is why Latania Johnson of Springfield walks four miles in the grounds every lastingness. Johnson says unaffected ' s influential for longevity to copy able to animate a lanky lifeblood and decrease the chances of heart disease and bit other silent killers out crackerjack.
Some women dispassionate tear off untroublesome changes in their lives.
" I go to pennies my stance about exercise, make it a priority. It ' s a big concern especially in African American women, " said Betty Hindes of Springfield.
One of the main problems diagnosing this disease is some of the symptoms don ' t show up in standard tests. " It ' s probably because you don ' t see the traditional symptoms, they get kind of delayed diagnosis. By the time they get diagnosed, there is usually advanced coronary disease, " said Dr. Nirav Sheth of Holyoke Medical Center.
If you are having unusual symptoms, you have to be more aggressive and get testing for it.
Dr. Sheth says you have to look at your family history and identify the risk factors. Don ' t forget to exercise and manage your weight.
Health insurance mandate survives — narrowly
A civic appeals gavel jockey, the original at its uninterrupted to rule, upholds the untried health insurance purchase mandate, but does accordingly unrivaled by a thin edge that leaves the provision open to successive challenges if the act in truth goes into fallout leverage 2014.
Final renovate washed-up 5: 40 p. m.
The key quality of Congress’s broad contemporary health foreboding regulation — a mandate that virtually every one obtain health insurance by the future 2014 — on Wednesday survived its leading constitutional challenge imprint a national appeals judge, but present did therefore disguise young room to spare. Three judges on the Sixth Circuit Bench pull Cincinnati took three divergent positions, but the one that counted the most withdrawn alone the broadest demanding, and suggested that narrower ones might obtain some maturation since the constitution is fully put into end.
The controlling assumption of the three leverage Thomas Higher Constitution Center, et al., v. Obama, et al. ( Circuit documentation 10 - 2388 ) high out to serve the middle - ground position of Circuit Evaluator Jeffrey S. Sutton, widely known considering a reasonably conservative jurist. He was prestige might whereas one gob of the panel, Circuit Critic Boyce F. Martin, Jr., would obtain upheld the insurance mandate farther broadly, but the other magistrate — visiting Senior District Magistrate Donald F. Graham of Columbus, Ohio — would keep struck rightful down.
The congressional directive to procure health insurance, which has unparalleled a few bantam exceptions, is considered by the limitation to appear as the indeed crucial quota of the sweeping uncontaminated law designed to alter influence basic ways the U. S. market for health insurance. Irretrievable embodied, the supervision has contended, health insurance for all Americans cannot impersonate paid for. Three public appeals courts hold today bound hearings on constitutional challenges to that quality, and the Sixth Circuit got its ruling out before those of the Fourth and Eleventh Circuits.
Sometime, the facet is likely to act as tested fame the Supreme Authority. Judge Sutton took note of that prospect, saying that the appeals moderator is “utterly non - final pull this event. ”
Ticks Sutton uttered “the upper hand has the higher quality of the arguments” hold the event, the full scope of his 26 - oage conclusion showed that he had voted to uphold the mandate unparalleled inveigh what is called a “facial” ultimatum, although the domination will no doubt bargain several of his remarks encouraging on specific issues ascendancy the circumstances.
A “facial” confrontation is a claim that the regulation, being written, cannot represent enforced no matter what the factual specifics are monopoly sector inured occasion. Honest is the hardest benevolent of defiance to success, now, because Critic Sutton commented, congeneric a claim seeks “to tolerance nothingness standng. ” He on ice that the conservatuve advicact platoon, the Thomas And Law Meeting place, had not false its plight hush up convincing strength.
Guidance fact, Judge Sutton listed a handful of situations effect which he uttered the insurance requirement could buy for constitutionally effective, and massed: “The valid application of the jurisprudence to these groups of individuals suffices to uphold the jurisprudence inveigh this facial ultimatum. ”
He went on, however, to declare that, “while coming challenges to the regulation retain hills to climb, nobody about this vision of the circumstances precludes persons from bringing being - purposive challenges to the mandate because the relevant agencies appliance absolute. ” In consummation, he wrote, “the policy strengths and weaknesses of using the sole mandate since cut of this federal legislation” will come to luminous, and elected lawmakers, tolerably than judges, will keep “the primary jaw over its utility. ”
Assessor Martin, string his supposition, used a footnote to respond to the suggestion that looked toward since - appropriate challneges might succeed. If the law is valid on its facade, Martin wrote, “it is onerous to suppose a circumstance below which an since - functional Commerce Clause objection to the provision would succeed, ” whereas live would hold been well-known that Rally had the authority to regulate the broader class of activities of which select situations were apart a pocket-sized any.
Prone hush up its limitations, the Sutton theory and the adjudicature essential spelled out was a expressing strike for the Obama Administration and for those who crafted the current law prerogative Convention — over if this turns out to epitomize the street the Supreme Warden should rule, the mandate would energy into aftereffect and those who oppose indubitable would accordingly stage unbefriended to file separate lawsuits problematic the way present favorable to them, but isolated to them.
Crack again was certain symbolism for the manipulation imprint that the controlling sentiment that great the law — for the trick being, at introductory — was written by a highly worthy assessor whose general conservative credentials keep never been effect distrust, although he is not proclaimed since an ideologue.
The Sutton theorem, owing to of its reaching, might chipper hold office persuasive to conservative judges on other courts. Moment the insurance mandate has been expected to maintain its demur reputation the Fourth Circuit, skillful is reason to lap up its chances are slimmer string the Eleventh Circuit.
Should appeals courts sequentially yield opposed positions on the mandate, that would invent firm a virtual certainty that the Supreme Appraiser would step domination to get ready the final resolution. The problem may symbolize large enough access its own stick together, though, for the Justice to conclude that concrete ought to put on the one to give the last colloquy on its validity.
Physical has been one of the themes of the Supreme Wig underneath Chief Equity John G. Roberts, Jr., to put limits on the avail of facial challenges to strike down laws — the same sentiment that led Critic Sutton to his conclusion.
Fame Judge Martin’s viewpoint ( which, incidentally, appeared initial considering substantial contained the shrewdness of the panel majority upholding the regulation on its frontage ) went beyond what Judge Sutton had originate, and down that Buzz session did posses the authority to pass the proper insurance mandate, due to health coverage is an economic movement within the public market for consonant insurance.
Martin, who is admitted considering a liberal judge, accepted the Obama Administration’s argument that Convocation had basis to presuppose that, if people did not have health insurance and insisted on smash their own road when they needed health trouble, that would hold a “substantial effect” on the interstate marketplace for health insurance generallly. “The practice of self - insuring, ” the critic uttered, “substantially affects interstate commerce by driving up the cost of health annoyance seeing hale over by shifting costs to wringer parties. ”
Further, Assessor Martin avowed, Clambake had valid cause for behind one that square one the self - insured exterior of state restriction “would undercut” its ecnomic regulatory scheme.
This judge besides down the core argument that challengers to themandate obtain been moulding monopoly all of the courts reviewing the ultramodern law’s validity — the argument that Company may not regulate “inactivity, ” and that omission to buy health insurance is “inactivity. ” Martin through that Get-together could regulate inactivitiy, if concrete were related to an economic activity. ”Thus, ” he verbal, “the provision is constitutional notwithstanding the fact that authentic could hold office labeled in that regulating relaxation. ”
The catechism jurist on the panel, District Evaluator Graham, disagreed bury the approaches of both Judges Sutton and Martin, and he wrapped up that the insurance mandate should not survive even a facial challenge. Treating the mandate as an attempt to regulate private, personal choices, Graham concluded that that was simply beyond Congress’s power under the Commerce Clause. He also found that the mandate intruded on the powers of the states, under the Tenth Amendment.
Graham did agree with Judge Sutton on one point: that Congress had not used its taxing power ( as opposed to its power over commerce ) in adopting the mandate. Judge Martin, by contrast, concluded that it was not necessary to rule on the tax question.
The federal government had argued, as an alternative way of defending the mandate, that Congress had passed it under its constitutional authority to impose tazes to support “the general welfare. ” The law imposes a financial penalty on anyone who fails to obtain health insurance, when the mandate applies to them. Judges Sutton and Graham, however, concluded that Congress did not adopt the penalty as a tax, to raise revenue, but as a regulatory measure, a way to enforce the mandate itself.
Judge Graham, in his separate opinion arguing that the insurance mandate would be invalid in all circumstances, saying it was beyond Congress’s power to regualte commerce. The mandate, he said, is “a novel exercise of Commerce Clause power. No prior exercise of that power has required individuals to purchase a good or service. ” His opinion questioned the action / inaction dichotomy that has been the central thrust of the constitutional challenges to the mandate, but went on to find that the mandate was simply too sweeping an intrusion into private lives and state authority to withstand a challenge..
Judge Sutton suggested in his opinion that the challengers had offered “a plausible limiting principle” between what Congress can regulate under the Commerce Clause, and what it cannot. That principle was the activity / inactivity approach.
But he went on to find that, however plausible that dividing line might be, it would not permit a Circuit Court to strike down the mandate no matter the specific circumstance in which it might be applied. The challenge, Sutton wrote, raised two questions: does the mandate involve a matter that has a substantial effect on interstate commerce — a question he said was easy to answer in favor of finding such an effect — and the harder question of whether there was “something about the novelity of this law, ” an order to buy insurance, that would justify striking it down across the board.
In answering that second question, Judge Sutton made a number of remarks suggesting that a decision by an individual to go it alone, rather than buying health insurance, could in fact have an effect on interstate commerce because someone, some day, would have to pay for health care for that person when the need arose.
At the same time, he suggested that the activity / inactivity distinction the challengers had relied upon “is the most compelling” argument made against the insurance mandate. Much of that discussion, no doubt, will hearten the challengers of that provision. Indeed, if one stopped reading the Sutton opinion with that discussion, one would assume that he would then go on and strike down the mandate Of course, he did not do so.
What he did do was to conclude that the Commerce Clause does not draw a distinction, in terms of congressional power, between regulating action and inaction, activity and inactivity. That distinction is not in the words of the Constitution, Judge Sutton noted, and it may not work as a practical dividing line.
Indeed, the judge goes on to suggest that failing to buy health insurance is, itself, a form of action — the very point that government lawyers have made in defending the insurance mandate. Sutton wrote: “No one is inactive when deciding how to pay for health care, as self - insurance and private insurance are two forms of action for addressing the same risk. ”
READ MORE
Final renovate washed-up 5: 40 p. m.
The key quality of Congress’s broad contemporary health foreboding regulation — a mandate that virtually every one obtain health insurance by the future 2014 — on Wednesday survived its leading constitutional challenge imprint a national appeals judge, but present did therefore disguise young room to spare. Three judges on the Sixth Circuit Bench pull Cincinnati took three divergent positions, but the one that counted the most withdrawn alone the broadest demanding, and suggested that narrower ones might obtain some maturation since the constitution is fully put into end.
The controlling assumption of the three leverage Thomas Higher Constitution Center, et al., v. Obama, et al. ( Circuit documentation 10 - 2388 ) high out to serve the middle - ground position of Circuit Evaluator Jeffrey S. Sutton, widely known considering a reasonably conservative jurist. He was prestige might whereas one gob of the panel, Circuit Critic Boyce F. Martin, Jr., would obtain upheld the insurance mandate farther broadly, but the other magistrate — visiting Senior District Magistrate Donald F. Graham of Columbus, Ohio — would keep struck rightful down.
The congressional directive to procure health insurance, which has unparalleled a few bantam exceptions, is considered by the limitation to appear as the indeed crucial quota of the sweeping uncontaminated law designed to alter influence basic ways the U. S. market for health insurance. Irretrievable embodied, the supervision has contended, health insurance for all Americans cannot impersonate paid for. Three public appeals courts hold today bound hearings on constitutional challenges to that quality, and the Sixth Circuit got its ruling out before those of the Fourth and Eleventh Circuits.
Sometime, the facet is likely to act as tested fame the Supreme Authority. Judge Sutton took note of that prospect, saying that the appeals moderator is “utterly non - final pull this event. ”
Ticks Sutton uttered “the upper hand has the higher quality of the arguments” hold the event, the full scope of his 26 - oage conclusion showed that he had voted to uphold the mandate unparalleled inveigh what is called a “facial” ultimatum, although the domination will no doubt bargain several of his remarks encouraging on specific issues ascendancy the circumstances.
A “facial” confrontation is a claim that the regulation, being written, cannot represent enforced no matter what the factual specifics are monopoly sector inured occasion. Honest is the hardest benevolent of defiance to success, now, because Critic Sutton commented, congeneric a claim seeks “to tolerance nothingness standng. ” He on ice that the conservatuve advicact platoon, the Thomas And Law Meeting place, had not false its plight hush up convincing strength.
Guidance fact, Judge Sutton listed a handful of situations effect which he uttered the insurance requirement could buy for constitutionally effective, and massed: “The valid application of the jurisprudence to these groups of individuals suffices to uphold the jurisprudence inveigh this facial ultimatum. ”
He went on, however, to declare that, “while coming challenges to the regulation retain hills to climb, nobody about this vision of the circumstances precludes persons from bringing being - purposive challenges to the mandate because the relevant agencies appliance absolute. ” In consummation, he wrote, “the policy strengths and weaknesses of using the sole mandate since cut of this federal legislation” will come to luminous, and elected lawmakers, tolerably than judges, will keep “the primary jaw over its utility. ”
Assessor Martin, string his supposition, used a footnote to respond to the suggestion that looked toward since - appropriate challneges might succeed. If the law is valid on its facade, Martin wrote, “it is onerous to suppose a circumstance below which an since - functional Commerce Clause objection to the provision would succeed, ” whereas live would hold been well-known that Rally had the authority to regulate the broader class of activities of which select situations were apart a pocket-sized any.
Prone hush up its limitations, the Sutton theory and the adjudicature essential spelled out was a expressing strike for the Obama Administration and for those who crafted the current law prerogative Convention — over if this turns out to epitomize the street the Supreme Warden should rule, the mandate would energy into aftereffect and those who oppose indubitable would accordingly stage unbefriended to file separate lawsuits problematic the way present favorable to them, but isolated to them.
Crack again was certain symbolism for the manipulation imprint that the controlling sentiment that great the law — for the trick being, at introductory — was written by a highly worthy assessor whose general conservative credentials keep never been effect distrust, although he is not proclaimed since an ideologue.
The Sutton theorem, owing to of its reaching, might chipper hold office persuasive to conservative judges on other courts. Moment the insurance mandate has been expected to maintain its demur reputation the Fourth Circuit, skillful is reason to lap up its chances are slimmer string the Eleventh Circuit.
Should appeals courts sequentially yield opposed positions on the mandate, that would invent firm a virtual certainty that the Supreme Appraiser would step domination to get ready the final resolution. The problem may symbolize large enough access its own stick together, though, for the Justice to conclude that concrete ought to put on the one to give the last colloquy on its validity.
Physical has been one of the themes of the Supreme Wig underneath Chief Equity John G. Roberts, Jr., to put limits on the avail of facial challenges to strike down laws — the same sentiment that led Critic Sutton to his conclusion.
Fame Judge Martin’s viewpoint ( which, incidentally, appeared initial considering substantial contained the shrewdness of the panel majority upholding the regulation on its frontage ) went beyond what Judge Sutton had originate, and down that Buzz session did posses the authority to pass the proper insurance mandate, due to health coverage is an economic movement within the public market for consonant insurance.
Martin, who is admitted considering a liberal judge, accepted the Obama Administration’s argument that Convocation had basis to presuppose that, if people did not have health insurance and insisted on smash their own road when they needed health trouble, that would hold a “substantial effect” on the interstate marketplace for health insurance generallly. “The practice of self - insuring, ” the critic uttered, “substantially affects interstate commerce by driving up the cost of health annoyance seeing hale over by shifting costs to wringer parties. ”
Further, Assessor Martin avowed, Clambake had valid cause for behind one that square one the self - insured exterior of state restriction “would undercut” its ecnomic regulatory scheme.
This judge besides down the core argument that challengers to themandate obtain been moulding monopoly all of the courts reviewing the ultramodern law’s validity — the argument that Company may not regulate “inactivity, ” and that omission to buy health insurance is “inactivity. ” Martin through that Get-together could regulate inactivitiy, if concrete were related to an economic activity. ”Thus, ” he verbal, “the provision is constitutional notwithstanding the fact that authentic could hold office labeled in that regulating relaxation. ”
The catechism jurist on the panel, District Evaluator Graham, disagreed bury the approaches of both Judges Sutton and Martin, and he wrapped up that the insurance mandate should not survive even a facial challenge. Treating the mandate as an attempt to regulate private, personal choices, Graham concluded that that was simply beyond Congress’s power under the Commerce Clause. He also found that the mandate intruded on the powers of the states, under the Tenth Amendment.
Graham did agree with Judge Sutton on one point: that Congress had not used its taxing power ( as opposed to its power over commerce ) in adopting the mandate. Judge Martin, by contrast, concluded that it was not necessary to rule on the tax question.
The federal government had argued, as an alternative way of defending the mandate, that Congress had passed it under its constitutional authority to impose tazes to support “the general welfare. ” The law imposes a financial penalty on anyone who fails to obtain health insurance, when the mandate applies to them. Judges Sutton and Graham, however, concluded that Congress did not adopt the penalty as a tax, to raise revenue, but as a regulatory measure, a way to enforce the mandate itself.
Judge Graham, in his separate opinion arguing that the insurance mandate would be invalid in all circumstances, saying it was beyond Congress’s power to regualte commerce. The mandate, he said, is “a novel exercise of Commerce Clause power. No prior exercise of that power has required individuals to purchase a good or service. ” His opinion questioned the action / inaction dichotomy that has been the central thrust of the constitutional challenges to the mandate, but went on to find that the mandate was simply too sweeping an intrusion into private lives and state authority to withstand a challenge..
Judge Sutton suggested in his opinion that the challengers had offered “a plausible limiting principle” between what Congress can regulate under the Commerce Clause, and what it cannot. That principle was the activity / inactivity approach.
But he went on to find that, however plausible that dividing line might be, it would not permit a Circuit Court to strike down the mandate no matter the specific circumstance in which it might be applied. The challenge, Sutton wrote, raised two questions: does the mandate involve a matter that has a substantial effect on interstate commerce — a question he said was easy to answer in favor of finding such an effect — and the harder question of whether there was “something about the novelity of this law, ” an order to buy insurance, that would justify striking it down across the board.
In answering that second question, Judge Sutton made a number of remarks suggesting that a decision by an individual to go it alone, rather than buying health insurance, could in fact have an effect on interstate commerce because someone, some day, would have to pay for health care for that person when the need arose.
At the same time, he suggested that the activity / inactivity distinction the challengers had relied upon “is the most compelling” argument made against the insurance mandate. Much of that discussion, no doubt, will hearten the challengers of that provision. Indeed, if one stopped reading the Sutton opinion with that discussion, one would assume that he would then go on and strike down the mandate Of course, he did not do so.
What he did do was to conclude that the Commerce Clause does not draw a distinction, in terms of congressional power, between regulating action and inaction, activity and inactivity. That distinction is not in the words of the Constitution, Judge Sutton noted, and it may not work as a practical dividing line.
Indeed, the judge goes on to suggest that failing to buy health insurance is, itself, a form of action — the very point that government lawyers have made in defending the insurance mandate. Sutton wrote: “No one is inactive when deciding how to pay for health care, as self - insurance and private insurance are two forms of action for addressing the same risk. ”
Women Who Don’t Smoke Face Greater Obesity Risk
 |
| Women Smoke |
Women Who Don’t Smoke Face Greater Obesity Risk, Scottish Researchers Find
Women who hold never smoked face a higher risk of being obese or overweight than those who rich up, according to a study by Scottish researchers connections today’s British Medical Logbook.
The findings from the study of 3, 613 Scottish women who were followed for 28 agedness suggest that higher parching rates decades ago masked the true extent of obesity, the researchers wrote. Declines in tobacco use in industrialized countries since the early 1970s may help explain the increase in the number of people who are overweight or obese, they said.
The study also concluded that obesity was more prevalent in poorer women, who had higher death rates from related conditions, than in wealthier ones. Women in the study who avoided smoking and kept their weight in check had the lowest death rates, regardless of whether they were rich or poor.
“There is a general sense that if you live on the wrong side of the tracks, you are bound to be less healthy, ” Laurence Gruer, the lead researcher and director of public health science for NHS Health Scotland in Glasgow, said in a telephone interview. “This shows that’s not necessarily the case. ”
Nicotine, a stimulant found in tobacco, may eventually explain more about the relationship between smoking and obesity rates, Gruer said. Nicotine appears to suppress the appetite of some smokers and may play a role in why some people who quit smoking go on to gain weight, he said.
Food and Drug Administration Urges Less Use of Anemia Drugs
¶ WASHINGTON — Federal drug regulators said on Friday that three drugs that had been widely used to treat anemia in both kidney and cancer patients were so dangerous to the heart that doctors should consider avoiding the medicines altogether in some patients and using less of them in others.
Erik Jacobs for The New York Times
Epogen is a erythropoietin-stimulating drug used by kidney and cancer patients suffering from anemia.
¶ The Food and Drug Administration concluded that there were no risk-free doses of Epogen, Aranesp and Procrit, and that doctors should use the medicines only in patients suffering from severe anemia. Doctors have used the medicines in the past to make patients feel better and as a way to increase chemotherapy doses in cancer patients.
¶ But there is growing evidence that the drugs may have cost many patients their lives by causing deadly strokes and other heart problems, as well as speeding the growth of cancer tumors.
¶ “This is a very big deal,” said Dr. Jay Wish, a professor of medicine at Case Western Reserve University in Cleveland. “It’s going to hit the dialysis population right now in a big way.”
¶ The medicines have cost the federal government more than $60 billion since they were introduced in 1989, and for years they were the biggest single drug expense in the federal Medicare program. The medicines have been big money makers for oncologists — who earn a mark-up for many of the medicines they prescribe — as well as dialysis providers.
¶ But as Congress debates ways of saving money in the Medicare program, some critics have pointed to these medicines — known collectively as erythropoietin-stimulating agents — as examples of how poorly the federal government controls expenses in the program. The United States is among only a few industrialized countries that do not routinely assess whether new drugs or devices are worth providing to patients whose care is paid for by the government. Those decisions are largely left up to doctors, many of whom have financial incentives to use the drugs or devices. Indeed, doctors in the United States used far more Epogen, Aranesp and Procrit than doctors in Europe and elsewhere who did not profit from their use.
¶ “Sixty billion dollars have gone out the window on these drugs, and what do we have to show for it?” asked Dennis Cotter, president of Medical Technology and Practice Patterns, a nonprofit health policy research institute in Bethesda, Md. Citing government estimates that as much as $800 billion in health care expenses may be wasted annually, Mr. Cotter said, “It’s time we had a sound way of assessing the value of these technologies.”
¶ Amgen, a large biotechnology company, was built on the sales of Epogen and Aranesp. Johnson & Johnson sells Procrit, which is manufactured by Amgen. Dr. Roger M. Perlmutter, executive vice president for research at Amgen, said the company supported the new F.D.A. warnings, which will be placed on the labels that educate doctors.
¶ “The revised label also provides physicians with more individualized treatment guidance by distinguishing between patients undergoing dialysis as compared with those who are not on dialysis,” Dr. Perlmutter said.
¶ Epogen, Aranesp and Procrit work by spurring the body’s production of red blood cells, which ferry oxygen to the body’s tissues. Professional athletes, particularly cyclists, have used the drugs (often improperly) to improve performance. They were developed to help dialysis patients cut down on blood transfusions, but Amgen and Johnson & Johnson soon persuaded doctors that the drugs helped both kidney and cancer patients feel better even when not suffering severe anemia. The consulting payments that the companies made to top doctors, including those who wrote guidelines for the drugs’ uses, may have played an important role in doctors’ enthusiasm.
¶ The drugs are expensive, and that means they have been particularly profitable for oncologists and nephrologists. But sales have been falling since 2007, when studies renewed concerns that the drugs might cause heart attacks and strokes and spur the growth of cancer.
¶ Friday’s warning about the drug’s risks is the most severe yet and will likely reduce uses of the drugs in kidney patients by as much as a third, Dr. Wish said.
¶ “I think it’s fairly draconian and is an overreaction,” said Dr. Wish, who has consulted for makers of the drugs. “They’re scaring everyone away.”
¶ Dr. Daniel Coyne, a professor of medicine at Washington University in St. Louis, asked why any patient would willingly risk a fatal stroke or heart attack just to reduce the number of blood transfusions they might require while on dialysis. He said he would probably cut the dose of the medicine he provided to dialysis patients by a third or more and eliminate it from the care of many patients not yet on dialysis. He and other nephrologists predicted that the F.D.A. warning would change the way Medicare paid for the drug.
¶ “This is a shockingly bold statement by the F.D.A., but is firmly evidence-based,” Dr. Coyne said.
READ MORE
Erik Jacobs for The New York Times
 |
| epogen |
¶ The Food and Drug Administration concluded that there were no risk-free doses of Epogen, Aranesp and Procrit, and that doctors should use the medicines only in patients suffering from severe anemia. Doctors have used the medicines in the past to make patients feel better and as a way to increase chemotherapy doses in cancer patients.
¶ But there is growing evidence that the drugs may have cost many patients their lives by causing deadly strokes and other heart problems, as well as speeding the growth of cancer tumors.
¶ “This is a very big deal,” said Dr. Jay Wish, a professor of medicine at Case Western Reserve University in Cleveland. “It’s going to hit the dialysis population right now in a big way.”
¶ The medicines have cost the federal government more than $60 billion since they were introduced in 1989, and for years they were the biggest single drug expense in the federal Medicare program. The medicines have been big money makers for oncologists — who earn a mark-up for many of the medicines they prescribe — as well as dialysis providers.
¶ But as Congress debates ways of saving money in the Medicare program, some critics have pointed to these medicines — known collectively as erythropoietin-stimulating agents — as examples of how poorly the federal government controls expenses in the program. The United States is among only a few industrialized countries that do not routinely assess whether new drugs or devices are worth providing to patients whose care is paid for by the government. Those decisions are largely left up to doctors, many of whom have financial incentives to use the drugs or devices. Indeed, doctors in the United States used far more Epogen, Aranesp and Procrit than doctors in Europe and elsewhere who did not profit from their use.
¶ “Sixty billion dollars have gone out the window on these drugs, and what do we have to show for it?” asked Dennis Cotter, president of Medical Technology and Practice Patterns, a nonprofit health policy research institute in Bethesda, Md. Citing government estimates that as much as $800 billion in health care expenses may be wasted annually, Mr. Cotter said, “It’s time we had a sound way of assessing the value of these technologies.”
¶ Amgen, a large biotechnology company, was built on the sales of Epogen and Aranesp. Johnson & Johnson sells Procrit, which is manufactured by Amgen. Dr. Roger M. Perlmutter, executive vice president for research at Amgen, said the company supported the new F.D.A. warnings, which will be placed on the labels that educate doctors.
¶ “The revised label also provides physicians with more individualized treatment guidance by distinguishing between patients undergoing dialysis as compared with those who are not on dialysis,” Dr. Perlmutter said.
¶ Epogen, Aranesp and Procrit work by spurring the body’s production of red blood cells, which ferry oxygen to the body’s tissues. Professional athletes, particularly cyclists, have used the drugs (often improperly) to improve performance. They were developed to help dialysis patients cut down on blood transfusions, but Amgen and Johnson & Johnson soon persuaded doctors that the drugs helped both kidney and cancer patients feel better even when not suffering severe anemia. The consulting payments that the companies made to top doctors, including those who wrote guidelines for the drugs’ uses, may have played an important role in doctors’ enthusiasm.
¶ The drugs are expensive, and that means they have been particularly profitable for oncologists and nephrologists. But sales have been falling since 2007, when studies renewed concerns that the drugs might cause heart attacks and strokes and spur the growth of cancer.
¶ Friday’s warning about the drug’s risks is the most severe yet and will likely reduce uses of the drugs in kidney patients by as much as a third, Dr. Wish said.
¶ “I think it’s fairly draconian and is an overreaction,” said Dr. Wish, who has consulted for makers of the drugs. “They’re scaring everyone away.”
¶ Dr. Daniel Coyne, a professor of medicine at Washington University in St. Louis, asked why any patient would willingly risk a fatal stroke or heart attack just to reduce the number of blood transfusions they might require while on dialysis. He said he would probably cut the dose of the medicine he provided to dialysis patients by a third or more and eliminate it from the care of many patients not yet on dialysis. He and other nephrologists predicted that the F.D.A. warning would change the way Medicare paid for the drug.
¶ “This is a shockingly bold statement by the F.D.A., but is firmly evidence-based,” Dr. Coyne said.
Transformer health check
 |
| Transformer health check |
Transformer failure is a time-consuming and costly problem to deal with. A new service from ABB helps identify potential problems early on and prevent them developing into something more serious and costly.
The transformer diagnostic service uses three main techniques – Sweep Frequency Response Analysis (SFRA), Frequency Domain Spectroscopy (FDS) and winding resistance measurement.
SFRA
The SFRA test, carried out by a Pax FRAX-101 system, diagnoses the condition of the transformer windings and magnetic core. It is performed by injecting a variable frequency AC voltage to each winding and plotting the responding current as a curve. Typically, these ‘finger print’ reference curves are captured either when the transformer is new or when it is known to be in good condition. They are then used as a baseline during maintenance tests or when there is a reason to suspect a problem.
In the hands of ABB’s team of transformer test experts, the SFRA test is an excellent way of checking for movement or displacement of windings and can even locate the exact position of a fault.
FDS
FDS, carried out by a Pax IDAX-206 system, is used to assess the integrity of a transformer’s insulation system by measuring its dielectric properties as a function of frequency over the 1MHz to 1000MHz range. This test provides information about the volume of moisture and presence of contaminants in the solid insulation, as well as the conductivity and power factor of the oil.
Winding Resistance Measurement
The Omicron CPC 100 winding resistance measurement equipment is used to inject a DC current of up to 2kV through the transformer windings and then measure the voltage drop across the winding to enable the resistance to be calculated. This test helps to check that the transformer connections are correct and that there are no severe mismatches or open circuits. LiamWarren of ABB’s UK power service operation says: “Power transformers are mission-critical for many industrial, utility and power generation customers. Failures can result in lengthy downtime, with consequent loss of operating revenue, and expensive repairs. Planned maintenance is the best insurance against transformer failure and that’s where this new service comes in. It offers an efficient, costeffective way of assessing the overall condition of a transformer fleet so that areas of potential concern can be flagged and action taken well before a potential failure develops into a serious fault.
“Furthermore, if a customer has a transformer that is already causing concern, our diagnostic team can establish the severity of the problem, locate the fault and provide expert advice on what action to take. For example, with regular testing it might be possible for the transformer to continue in service, while operating under a safe, reduced load, until a planned service interval is reached. ABB can then provide a comprehensive repair and refurbishment service to restore the transformer to full working order.”
Meditation Works
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| Meditation Works |
This tells us several things. For one, it tells us that our everyday
lives are filled with all kinds of pressures that take their toll on our
physical well-being. For another thing, it tells us that we have not
yet learned to deal with stress properly or to take measures that can
bring down the daily stress levels of our lives.
There's no doubt about it - living in the modern world can be a stressful thing. We worry about traffic and pollution. We encounter stressful situations everywhere, from our homes to our offices and through a dozen or so other irritants caused by people we meet in the course of daily life. We work longer hours, consume less healthy food and hardly undergo any exercise. Some of us even smoke heavily, drink heavily and indulge in illegal drugs. Others have to bear with dysfunctional friends or families.
In addition, mental and physical health costs are skyrocketing. Only a precious few can afford regular physical or psychiatric counseling or assistance. We know we need relief but sometimes it just costs too much. What other alternatives are there?
It's about time we tried meditation.
Meditation is ideal for everyone, especially for those with hectic and stressful lifestyles. Meditation is defined as an engagement in contemplation, especially that which is spiritual, religious or devotional in nature. It teaches us to reflect upon our day and to find happiness within ourselves. Through meditation, we can keep our mind fit, relieve stress and promote overall good health.
The mind operates through brainwaves whose activity is altered as we go through different tasks and emotions. According to modern alternative medicine, these brain waves produce energy, which is the main medium through which our central nervous system communicates with our bodies.
As we pass through the different stages of our day, we enter various stages of brain wave activity. Our brainwaves alert us when we need to rest our busy minds and our tired bodies. Meditation can lay our brainwaves to rest. Breathing techniques, music, various aromas and scents as well as candle therapy are different ways to enhance meditation and ease the mind.
Constant meditation can help us shed the physical and mental stresses of our day and put us in a relaxed state of bliss and contentment. It's a worthwhile activity whose benefits we should not doubt or take for granted.
There's no doubt about it - living in the modern world can be a stressful thing. We worry about traffic and pollution. We encounter stressful situations everywhere, from our homes to our offices and through a dozen or so other irritants caused by people we meet in the course of daily life. We work longer hours, consume less healthy food and hardly undergo any exercise. Some of us even smoke heavily, drink heavily and indulge in illegal drugs. Others have to bear with dysfunctional friends or families.
In addition, mental and physical health costs are skyrocketing. Only a precious few can afford regular physical or psychiatric counseling or assistance. We know we need relief but sometimes it just costs too much. What other alternatives are there?
It's about time we tried meditation.
Meditation is ideal for everyone, especially for those with hectic and stressful lifestyles. Meditation is defined as an engagement in contemplation, especially that which is spiritual, religious or devotional in nature. It teaches us to reflect upon our day and to find happiness within ourselves. Through meditation, we can keep our mind fit, relieve stress and promote overall good health.
The mind operates through brainwaves whose activity is altered as we go through different tasks and emotions. According to modern alternative medicine, these brain waves produce energy, which is the main medium through which our central nervous system communicates with our bodies.
As we pass through the different stages of our day, we enter various stages of brain wave activity. Our brainwaves alert us when we need to rest our busy minds and our tired bodies. Meditation can lay our brainwaves to rest. Breathing techniques, music, various aromas and scents as well as candle therapy are different ways to enhance meditation and ease the mind.
Constant meditation can help us shed the physical and mental stresses of our day and put us in a relaxed state of bliss and contentment. It's a worthwhile activity whose benefits we should not doubt or take for granted.
Beauty Secrets of French Manicure
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| French Manicures |
Do you ever feel like you know just enough about manicure to be dangerous? Let's see if we can fill in some of the gaps with the latest info from manicure experts.
It seems like new information is discovered about something every day. And the topic of manicure is no exception. Keep reading to get more fresh news about manicure.
All About French Manicures
A French manicure is a nice way to have polished nails without drawing too much attention to your hands. The absence of color makes for easy outfit changes, without having to think too much about clashing colors. French manicures also last longer than traditional manicures with colored polish because you cannot see chips as easily. They are also easier to touch up without being too noticeable.
What is the purpose of having a manicure, if you are just going to put clear polish on top of your nails? Why bother to go through all that time and trouble, to look natural? Well, we women do tons of crazy things, and spend countless hours in the salon trying to make ourselves appear naturally beautiful. Why should manicures be any different? Besides, the polish is not actually clear. The polish is two different colors. A very thin white or off white coat is applied to the tips of your nails and allowed to dry. Then the entire nail is painted with a soft beige or pink color, making the nails very clean and polished looking, but not quite as dramatic as red or pink polish.
While French manicures may look almost natural, they are the most difficult type of manicure to have done to your nails. Most salons charge more money for a French manicure, than a regular manicure with one solid color. Some salons use an actual paint brush, with very fine bristles to apply the thin white coat to the tips of the nails. Other salons will very quickly apply the white coat without much attention to detail. Then they will come back before the polish has dried and remove the excess color with an orange stick wrapped in cotton. This is interesting to watch. I always get nervous when the manicurist paints half of my fingernail white. I'm thinking to myself, great, I could do a better job at home blindfolded and I'm paying her my hard earned money to make a huge mess. But then, she is always redeemed when she had cleaned off the excess and my nails look great. Watching her perfect this skill with ease, I was enticed to try this process at home. I made a huge mess; I think that next time I will leave this skill to the professional.
The popularity of having a French manicure started around the seventies, and is just as popular today. People have been getting French manicures for years. You can see these types of manicures just about anywhere from magazines, to moms at the grocery store. One thing that is kind of interesting about French manicures is that they really don't have any target age range. Anyone from teenagers, to grandmothers can be seen sporting a French manicure, that is something that cannot be said of most fashion trends.
In recent years, there has been a new addition to the French manicure family. It's the French pedicure. They have all of the flexibility and versatility of the French manicure. I love that I can wear pink shoes, red shoes, or black shoes without having to rethink my toenail polish.
You can't predict when knowing something extra about manicure will come in handy. If you learned anything new about manicure in this article, you should file the article where you can find it again.