a EIGHTEEN percent decrease in infant mortality??

A recent large, double blind trial published in the Lancet shows that multiple micronutrient supplements may decrease infant mortality by 18% over iron/folate vitamin supplements. This would be huge for public health if it turns out to be accurate.

clipped from www.modernmedicine.com Anuraj Shankar, M.D., of the University of Mataram in Indonesia, and colleagues from the Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT) Study Group randomly assigned 262 Indonesian midwives to distribute either iron and folic acid supplements or multiple micronutrient supplements to 31,290 pregnant women through government prenatal care services with instructions that the supplements be taken daily through 90 days post partum. Compared to iron and folic acid supplementation, the researchers found that multiple micronutrient supplementation was associated with an overall reduction of 18 percent in early infant mortality, and even higher reductions among women who were either undernourished or anemic at baseline (25 percent and 38 percent, respectively). "The data from our study suggest that maternal multiple micronutrient supplementation could reduce infant death and potentially be an important complement to overall strengthening of prenatal-care programs."

Older adults can hold their liquer just as well as their kids.

Despite US recommendations that elderly people curb their drinking more than young people, an article in the Journal of the American Geriatric Society from January of this year reports that elderly people actually have no more difficulty managing activities of daily living or on cognitive tests when drinking than their younger counterparts.

clipped from www.aafp.org Older age is associated with increased sensitivity to alcohol. Because of this, some nations (e.g., the United States) have lower recommendations for safe alcohol limits in persons 65 years or older. A pooled analysis using data from HRS and ELSA included 5,759 men and 7,574 women; a longitudinal analysis using HRS data included 2,338 men and 3,698 women; and a longitudinal analysis using ELSA data included 1,152 men and 1,471 women. Over a four-year period, there were no statistically significant differences in any outcome measures related to a rise in drinking level There did not appear to be any statistically significant health or mortality risk increase in older persons consuming greater than one to two drinks of alcohol per day. The benefits of moderate alcohol consumption on disability and mortality probably occur through cardiovascular risk reduction. guidelines for older adults need not be overly restrictive relative to recommendations for younger adults.

Child safety seats more effective than shoulder belts.

Although common practice, and for many of us common sense, the use of child safety seats had been recently called into question for children 2 to 6 years of age. A recent article in the Archives of Pediatric Adolescent Medicine reviewed this topic. They found (big surprise) that safety seats do indeed save lives.

clipped from www.aafp.org Studies have shown that safety seats are more effective than lap-shoulder seat belts in reducing the risk of injuries and death in children. However, one study by researchers at the National Bureau of Economic Research found that lap-shoulder seat belts were as protective as child safety seats in children two to six years of age, and that they were significantly less expensive. Data were collected from the Crashworthiness Data System of the National Highway Traffic Safety Administration from January 1, 1998, to December 31, 2004. A total of 463 children were included in the analysis, with 409 children being restrained by child safety seat and 54 by lap-shoulder seat belts. Unadjusted injury probability for children in severe crashes was 46 percent lower in the safety seat group compared with the lap-shoulder seat belt group. Child safety seats appear to be more effective than lap-shoulder seat belts in reducing the risk of nonfatal injuries in chil-dren two to three years of age.

Invasive treatment not better than medical management for non-ST MI.

A randomized controlled trial published in the Lancet showed no benefit from early invasive treatment for non-ST elevation MI. Although it's true that they experienced fewer symptoms of angina, they did experience more MI's than their piers. This study seems to indicate that early invasive treatment in these cases is not indicated.

clipped from www.aafp.org Initial data indicated that routine invasive therapy was more effective than selective invasive treatment in reducing subsequent major cardiovascular events. More recently, large trials with up to five years' follow-up have had contrasting results. The researchers enrolled 1,200 patients 18 to 80 years of age between 2001 and 2003. Patients were randomly assigned to receive early invasive therapy or initial medical management with intervention only if clinically indicated...cumulative three-year results for the primary composite end point (death, recurrent myocardial infarction, or hospitalization) were 30 percent in the early invasive group and 26 percent in the selective intervention group (P = .09). The authors conclude that early invasive treatment did not provide better outcomes over four years than the selective strategy in patients with non-ST-elevation acute coronary syndrome and elevated cardiac troponin.

Hi

Free clinics may help fill the gap

While the medical system has come under fire recently, thousands of free clinics around the country have been working to fill the holes. Seen as an acute stop-gap for something that is essentially a chronic problem, the cost of these clinics to their providers is generally a tiny fraction of the true value of care received by patients.

No potential medical system can successfully deliver universal coverage while at the same time controlling costs if it does not stimulate the delivery of low cost and free basic services to those most in need.

clipped from www.tcsdaily.com The Free Clinic movement is living embodiment of many conservative principles: the principles of subsidiarity and voluntarism, the spirit of enterprise and of community self-reliance. As health care becomes more and more of a national concern, if people are truly concerned about the less fortunate, there should be a population explosion in the number of free clinics around the country. All the good intentions in the world would not make a free clinic possible in our litigious society. But that problem has been solved in Virginia, whose example could easily be followed. With the help of the Virginia Association of Free Clinics, the state recently established the "VaRISK2" liability risk management program. Operating under the Division of Risk Management of the Department of the Treasury, of the Commonwealth of Virginia, the program indemnifies Directors, Officers, employees, and volunteers in a Free Clinic.

The wrong direction for healthcare?

With the presidential campaigns pushing universal health care back into the forefront of our collective consciousness, the industry itself has gotten into the debate. Unfortunately, it seems to have come in on the wrong side. An article from the New York Post, which appeared on the Cato Institute web page, reports that The American Cancer Society is devoting it's entire advertising budget to the promotion of government-run health care.

Unfortunately for their patients, getting their way will undoubtedly mean worse outcomes. Although free markets often create greater variation in outcomes than bureaucratically managed systems, they are also the only way to guarantee consistent quality care to the majority of customers.

The article, quoted below, elaborates.

clipped from www.cato.org The American Cancer Society announced recently that it will spend its entire advertising budget next year on campaigning for a government takeover of the U.S. health-care system. This is perverse: It's hard to imagine anything worse for cancer patients than government-run health care. Cancer patients understand this. The overall five-year survival rate for all types of cancer for men in America is 66.3 percent, and 62.9 percent for women, the best outcome in the world. free-market U.S. medicine provides the incentives that lead to innovative breakthroughs in new drugs and other medical technologies. U.S. companies have developed half of all the major new medicines introduced worldwide over the last 20 years. Take prostate cancer, for example. we are less likely to die from the disease. Fewer than 20 percent of American men with prostate cancer will die from it, against 57 percent of British men and nearly half of French and German men.