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Smoking Associated With More Rapid Progression Of Multiple Sclerosis
Patients with multiple sclerosis who smoke appear to experience a more rapid progression of their disease, according to a report in the July issue of Archives of Neurology, one of the JAMA/Archives journals.
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Recent Studies And Surveys
Health Affairs: Annual Medical Spending Attributable to Obesity: Payer- and Service-Specific Estimates -- Using data from 1998 and 2006 Medical Expenditure Panel Surveys (MEPS) - "a nationally representative survey of the civilian noninstitutionalized population that quantifies a person"s total annual medical spending by type of service and of payment" - the authors estimate the health cost of obesity in the U.S. is $147 billion. "Across all payers, per capita medical spending for the obese is $1,429 higher per year, or roughly 42 percent higher, than for someone of normal weight. In aggregate, the annual medical burden of obesity has increased from 6.5 percent to 9.1 percent of annual medical spending and could be as high as $147 billion per year (in 2008 dollars) based on the NHEA [National Health Expenditure Accounts] estimate," according to the study. In conclusion, the authors write, "The take-home message is that without a strong and sustained reduction in obesity prevalence, obesity will continue to impose major costs on the health system for the foreseeable future. And although health reform may be necessary to address health inequities and rein in rising health spending, real savings are more likely to be achieved through reforms that reduce the prevalence of obesity and related risk factors, including poor diet and inactivity" (7/27).
News of the day
NEJM Perspective Pieces Examine Physician Involvement In Health Reform, Congressional Progress On Reform
"Achieving Health Care Reform -- How Physicians Can Help," New England Journal of Medicine: In a perspective piece, Elliott Fisher, a professor of medicine and of community and family medicine at Dartmouth Medical School and associate director for Population Health and Policy at the Dartmouth Institute for Health Policy and Clinical Practice; Donald Berwick, a professor at the Harvard University School of Public Health Department of Health Policy and Management and president and CEO of the Institute for Healthcare Improvement; and Karen Davis, president of the Commonwealth Fund, call on physicians to "lead the change our country needs" on health reform. They suggest several areas for physicians to become involved, saying that physicians should "first help to create a shared vision that could overcome doctrinal divides" and that they also must "recognize that achieving savings sufficient to cover the cost of expanded coverage need not impose a hardship on patients or providers." Finally, physicians also must help with a health reform deal that "all stakeholders can support," the authors say (Fisher et al., NEJM, 5/21).
Cardiovascular

Maternal Immunity Not All Good For A Fetus

As a fetus does not mount an immune response to maternal proteins that cross the placenta, it has been assumed that a fetus would not reject non-genetically matched blood cells (specifically allogeneic blood cells) if they were transplanted while the fetus was in utero. The hope is that this procedure, which is known as IUHCT, could provide a viable approach for treating congenital blood disorders. However, studies using a mouse model of IUHCT indicate that most fetal recipients of allogeneic blood cells lose their transplanted cells 3-5 weeks after transplantation. Alan Flake and colleagues, at Children"s Hospital of Philadelphia, have now identified an immune mechanism responsible for graft failure in this model of IUHCT. Surprisingly, although fetal immune cells eliminated the transplanted allogeneic blood cells, they were triggered to do so by immune molecules known as alloantibodies that they obtained from their mother"s breast milk. The maternal alloantibodies were produced in response to IUHCT and so the authors conclude that in the absence of either a maternal immune response or transmission of the maternal alloantibodies to the fetus, transplanted blood cells should not be rejected, leaving open the door for IUHCT as a potential clinical strategy. TITLE: Maternal alloantibodies induce a postnatal immune response that limits engraftment following in utero hematopoietic cell transplantation in mice AUTHOR: Alan W. Flake Children"s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. PDF of this article. Karen Honey Journal of Clinical Investigation


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