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Anchor lead:  Now that the ACA hasn’t been repealed, how can we change healthcare to be less expensive? Elizabeth Tracey reports

What is the impact of the ACA on various states? The Commonwealth Fund recently examined the issue and found wide variation in healthcare coverage. Given that the ACA remains standing, at least for now, how can we change our healthcare system to become more equitable? Mike Klag, dean of the Johns Hopkins Bloomberg School of Public Health, has an indea.

Klag: There’s a lot of waste and inefficiency in the system. People talk about fraud, but my concern is not fraud it’s inefficiency.  If you look at the number of payers we have the work that a provider has to go through to submit bills for the number of payers using different forms, different methods, then at how those different payers process those bills its incredible.  We can argue about what the overhead is but its very clear that the overhead for private insurers is at least twice as much as it is for Medicare.  :29

Klag says Switzerland has a system of a number of private insurers but a single mechanism for submitting bills, which he believes would result in huge savings domestically. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Do supplements really help your health or is it your belief they will? Elizabeth Tracey reports

Ginseng supplements, which have been shown to help fatigue in people with cancer, really didn’t show any benefit relative to placebo in folks with HIV, a recent Johns Hopkins study led by Adriana Andrade shows. Andrade interprets some of the placebo effect to magical thinking.

Andrade: In the complementary and alternative medicine world I think sometimes there is a lot of this magical perception that something that is natural will have an effect on your symptom and your life.  :11

Andrade says that such studies as this are helpful in informing people making decisions about supplement use.

Andrade: I think it is important to show when something doesn’t work. Number one because people should not be spending money and some of these dietary supplements are very expensive, if it’s not going to generate the effect they’re looking for.   :12

Andrade notes that another potential danger of supplements is their interaction with other medications, so both a need and a benefit for taking them must be clearly established, and she also advocates for their FDA regulation. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Does the supplement ginseng help fatigue? Elizabeth Tracey reports

People with HIV, even when the virus is under control, often experience fatigue. Now a new study by Adriana Andrade at Johns Hopkins and colleagues has examined whether ginseng supplements, shown in previous trials in those with cancer to help alleviate fatigue, helps.

Andrade: What we found was that looking at the primary outcome of this study which was the fatigue severity scale, there was not a significant difference between ginseng and placebo, however, when we looked further then we saw impressive and significant improvement on the symptom of fatigue. However there was also a very powerful placebo effect, in other words the subjects who received a placebo had the perception that their fatigue improved significantly as well.   :29

Andrade says that the results relative to the placebo were not surprising and have been observed in many other studies, but do call into question the role of ginseng. She says perhaps additional study with higher doses and/or longer duration may show benefit. At Johns Hopkins, I’m Elizabeth Tracey.

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Two ski patrol and two paramedics transporting injured skier to sled.

This week’s topics include a single novel prosthesis report, the benefits of knee replacement, resorbable stents, and health policy on opioid prescription and treatment for addiction.

Program notes:

0:32 Stents that are bioresorbable
1:32 Typical metallic stent versus bioabsorbable
2:29 Not good for smaller arteries
2:45 Total knee replacement benefits
3:45 Underwent a knee replacement
4:41 Still have pain
4:50 Mind controlled limbs
5:50 Training of brain via electrodes
6:50 Just one limb
7:05 Guidelines relative to our drug issue
8:05 When opioids are needed time limited
9:03 Training for overcoming addiction
10:15 End

Related blog: https://podblog.blogs.hopkinsmedicine.org/2017/03/31/mind-control/

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This month's topic is medical apps

Program notes:

0:20 If not the most popular app certainly close

1:20 Help allow patients to become empowered

2:20 Just working with an EKG app

3:20 They’ll be a range of them at different price points

4:20 All important information for the health record

5:52 End

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Anchor lead: Is low glucose the only way to Alzheimer’s disease? Elizabeth Tracey reports

P38 is the unglamorous name of a protein now known to be involved in Alzheimer’s disease development, a new study concludes, showing it to be involved in glucose levels and insulin in the brain.  Constantine Lyketsos, an Alzheimer’s expert at Johns Hopkins, says there are a host of other ways to develop this common type of dementia.

Lyketsos: Alzheimer’s is not one disease. Another final common pathway seems to be a genetically determined overproduction of beta-amyloid, which causes Alzheimer’s disease, and those people whether or not they have glucose deprivation probably doesn’t matter too much, they’re going to get Alzheimer’s disease. So then shift gears and start thinking what are the other final common pathways that in some people will be entirely the underlying cause or might add with other final common pathways this might well be one of them. :29

Lyketsos says involvement of p38 is a great target for drug development and may help stave off or delay Alzheimer’s disease development for some. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How does glucose in the brain affect the development of Alzheimer’s disease? Elizabeth Tracey reports

People with Alzheimer’s disease have lower levels of glucose in their brain, researchers have known for some time. Now it appears that’s mediated through a protein called p38 that’s involved with insulin and glucose metabolism. Constantine Lyketsos, an Alzheimer’s expert at Johns Hopkins, comments.

Lyketsos: It further supports the idea that there may well be this tricking of the brain insulin system that in some people can contribute to the development of Alzheimer’s disease. It gives us a treatment target. If the glucose pathway goes through this single protein then perhaps inhibiting the activation of that protein could have therapeutic benefits. It’s a whole new line of thinking about some cases of Alzheimer’s disease and we’re in bad need to new lines of thinking about how to treat it. So in that sense it’s very good.   :30

Lyketsos notes that this is just one of the ways that Alzheimer’s disease can develop, since other pathways, particularly in those with a familial inheritance pattern, are also well known. At Johns Hopkins, I’m Elizabeth Tracey.

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