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By John Schieszer
Medical Minutes 

Financial toxicity from medical expenses is getting worse

Medical Minutes

 

June 1, 2019



A new study is suggesting that more than half of Americans report problems with affordability, stress or delaying care because of medical costs. The study, which was published in the Journal of General Internal Medicine, estimates more than 100 million people in the U.S. experience medical financial hardship.

High out-of-pocket spending for medical care is an increasingly critical issue. It can lead to a depletion of assets and medical debt, as well as distress and worry about household finances. Patients may delay or forego needed medical care because of cost, jeopardizing benefits of treatment. In this latest study, researchers looked at data from the 2015-2017 National Health Interview Survey and found 56% of adults reported at least one domain of medical financial hardship, representing 137.1 million adults in the United States. Among adults 18 to 64, those with less educational attainment and more health conditions were more likely to report great intensity of hardship.

Women were more likely to report multiple domains of hardship than men and the uninsured were more likely to report multiple domains of hardship (52.8%) compared to those with some public insurance (26.5%) and private insurance (23.2%). The authors write that unless action is taken, the problem is likely to get worse.

While many studies have looked at the financial toll of a cancer diagnosis, less is known about financial hardship in the general population, outside of oncology. A study published March 25, 2019 online in CANCER found that many older adults with cancer are being prescribed preventive medications at the end of their lives that may be a waste of money and even harming their quality of life.

Walnuts may help lower blood pressure

When combined with a diet low in saturated fats, eating walnuts may help lower blood pressure in

people at risk for cardiovascular disease, according to a new study by researchers at Penn State University. In a randomized, controlled trial, they examined the effects of replacing some of the saturated fats in participants’ diets with walnuts. The team found that when participants ate whole walnuts daily in combination with lower overall amounts of saturated fat, they had better blood pressure levels.

“When participants ate whole walnuts, they saw greater benefits than when they consumed a diet with a similar fatty acid profile as walnuts without eating the nut itself,” said study investigator Penny Kris-Etherton, who is a Distinguished Professor of Nutrition at Penn State, Philadelphia, Pennsylvannia. “So, it seems like there’s a little something extra in walnuts that are beneficial, maybe their bioactive compounds, maybe the fiber, maybe something else that you don’t get in the fatty acids alone.”

Researchers theorize that walnuts contain alpha-linolenic acid (ALA), which is a plant-based omega-3 that may positively affect blood pressure. For this current study, the researchers recruited 45 participants who were overweight or obese and were between the ages of 30 and 65. Before the study began, participants were placed on a “run-in” diet for two weeks. The run-in diet included 12% of their calories from saturated fat, which mimics an average American diet.

After the run-in diet, the participants were randomly assigned to one of three study diets, all of which included less saturated fat than the run-in diet. The diets included one that incorporated whole walnuts, one that included the same amount of ALA and polyunsaturated fatty acids without walnuts, and one that partially substituted oleic acid (another fatty acid) for the same amount of ALA found in walnuts, without any walnuts.

Following each diet period, the researchers assessed the participants for several cardiovascular risk factors including central systolic and diastolic blood pressure, brachial pressure, cholesterol and arterial stiffness. The researchers found that while all treatment diets had a positive effect on cardiovascular outcomes, the diet with whole walnuts provided the greatest benefits.

For those who really want to quit

Combo therapy may be the way to go, if you really want to quit smoking. New evidence published in the Cochrane Library has found that using a combination of nicotine replacement therapies, such as a patch plus a short acting form (gum or lozenge), may lead to better success rates than the use of a single form nicotine.

Nicotine replacement therapy (NRT) is a medicine that is available as skin patches, chewing gum, nasal and oral sprays, inhalers, lozenges and tablets. The Cochrane Review looked at the different ways to use NRT to quit smoking, and which of these worked best to help individuals quit smoking for six months or longer. The review included 63 trials with 41,509 participants. Individuals enrolled in the studies typically smoked at least 15 cigarettes a day at the start of the studies.

Just over 17% of people who combined a patch with another type of NRT were able to quit compared with about 14% people who used a single type of NRT. Smokers were also more likely to successfully quit if they used higher dose nicotine gum (containing 4mg of nicotine) in comparison to lower dose nicotine gum (containing 2mg of nicotine). Higher dose nicotine patches (containing 25mg or 21mg of nicotine) probably make it more likely that a person will quit smoking than lower dose nicotine patches (15mg or 14mg of nicotine), however more evidence is needed to strengthen this conclusion, according to the authors.

When people quit smoking, they often set a quit day, which is the day when they plan to stop smoking entirely. There is evidence that starting to use NRT before a quit day may help more people to quit than starting using NRT on the quit day itself, but further investigation is required.

“This high-quality evidence clearly signposts that the most effective way to use NRT is to use a combination of two products at once, a patch and a fast acting form such as gum, nasal spray or lozenge. Quitting this way increases the chances of you stopping smoking altogether. Some people are concerned about using two forms at the same time, but the evidence does not indicate an increased risk of harms,” said lead author Dr Nicola Lindson from the Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.

John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute. He can be reached at medicalminutes@gmail.com.

 
 

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