Burgers For 'Alzheimer's Epidemic'?/As Obesity Surgeries Soar, So Do Safety, Cost Concerns

[Guest guest]

Rense.com

 

----------

----

 

http://www.rense.com/general51/epi.htm

 

New Book Blames Burgers

For 'Alzheimer's Epidemic'

canada.com

4-11-4

 

 

EDMONTON -- A new book could add to the woes of the mad cow ravaged beef

industry.

 

The book is called Dying for a Hamburger: Modern Meat Processing and the

Epidemic of Alzheimer's Disease.

 

It was written by Toronto coroner Dr. Murray Waldman and Marjorie Lamb and

it blames hamburgers for an " epidemic of Alzheimer's disease. "

 

Waldman argues hamburger is the main source of prions, a type of malformed

protein which trigger the disease in the aged.

 

But Canada's leading expert on prions says Waldman doesn't know what he's

talking about.

 

Dr. David Westaway of the University of Toronto says Alzheimer's isn't a

prion disease, and adds that experiments have shown it isn't transmissible.

 

Waldman also quotes the studies of University of Indiana epidemiologist Dr.

Hugh Hendrie.

 

But Hendrie says his work has been misinterpreted.

 

Despite such denunciations, Waldman insists his science is strong.

 

The book, published by McClelland and Stewart, will hit stores in the next

two weeks.

 

© Copyright 2004 Canadian Press

http://www.canada.com/health/story.html?id=25207E11-E591-4DEC-83AC-26F05114C

54F

 

 

As Obesity Surgeries Soar, So Do Safety, Cost Concerns

http://www.washingtonpost.com/ac2/wp-dyn/A2681-2004Apr10?language=printer

By Rob Stein

Washington Post Staff Writer

Sunday, April 11, 2004; Page A01

 

 

The number of overweight Americans resorting to stomach-shrinking surgery is

rising so rapidly that health experts and insurance companies are

increasingly becoming alarmed about the safety, effectiveness and mounting

costs of the operations.

 

 

 

 

While the operations can produce dramatic benefits for very obese people,

some hospitals and surgeons may be rushing too quickly to satisfy the

surging demand, offering the lucrative procedures without adequate training,

experience and support, experts say.

 

At the same time, the operations, which force people to eat less by reducing

the size of their stomachs, are being performed too commonly on people who

might be able to lose weight through diet and exercise, particularly younger

adults and teenagers, they say.

 

Alarm has intensified because of scattered reports of severe complications

and deaths around the country. In Massachusetts, for example, a special

panel has begun assessing the procedure for state health authorities after

several patients died following surgeries.

 

Citing uncertainty about the safety of the procedures and lingering

questions about their long-term effectiveness, a growing number of insurance

companies have begun balking at paying for the operations, which cost the

nation close to $3 billion a year.

 

To try to resolve some of these issues, the National Institutes of Health

has launched a five-year, $15 million research project to gather data about

the operations, identify patients most likely to benefit and learn more

about how they work.

 

In the meantime, the American Society for Bariatric Surgery, which

represents surgeons who perform the procedures, has established an

independent nonprofit corporation that in June will begin identifying

" centers of excellence " deemed most qualified to do the complicated

operations. The group is also gathering scientists at Georgetown University

next month in the hopes of reaching a consensus on the risks and benefits of

the treatment.

 

The rising concerns about stomach surgery illustrate the uncertainties that

can occur with the emergence and proliferation of new surgical procedures,

which often do not undergo the same level of testing, scrutiny and

government oversight as new drugs or medical devices.

 

In addition, the debate over whether insurers should pay for the surgery

illustrates the tension that is mounting as the obesity epidemic adds

billions of dollars to the nation's medical bill. Millions of Americans

already meet the criteria for the operation, which costs about $25,000, and

millions more are expected to join those ranks as obesity rates soar.

 

" Insurance companies are feeling the first pressure of the increasing costs

of the rising obesity epidemic from this procedure, " said Roland Sturm, who

studies the economic impact of obesity for the Rand Corp., a private

research organization. " If we look into the future, the rising obesity

epidemic will continue to have tremendous effects on health care costs. It's

an astonishingly big factor. And it's only going to get bigger. "

 

As the number of obese Americans has soared and new, less invasive

laparoscopic versions of stomach surgery have been introduced, the number of

people undergoing the operations has skyrocketed, spurred by the lack of

effective alternatives and by celebrity patients such as NBC's " Today " show

weatherman Al Roker. The number of surgeries shot up from about 16,000 a

year in the early 1990s to an estimated 103,000 in 2003 -- and is expected

to approach 150,000 this year, making it one of the fastest-growing

procedures. Many centers report long waiting lists.

 

Surgeons perform several variations, but all involve sharply restricting the

size of the stomach, either by stapling most of it closed or sealing it off

with elastic bands and bypassing portions of the digestive system to reduce

the number of calories that can be absorbed. The procedures can enable

severely obese people to lose hundreds of pounds, alleviating disabilities

and preventing, even sometimes reversing, serious health problems, most

notably diabetes and high blood pressure.

 

But the operations are complicated, and patients are prone to

life-threatening complications, including bleeding, blood clots, leakages

and infections. Even if they have no serious complications, patients often

experience unpleasant side effects, including a phenomenon known as

" dumping " -- nausea, vomiting and diarrhea -- when they overeat. As a

result, patients have to undergo intensive counseling and monitoring to make

sure they eat appropriately and do not suffer nutritional deficiencies.

 

" It's extremely difficult surgery, " said Paul Ernsberger, an associate

professor of nutrition at Case Western Reserve University. " Even when it's

done perfectly, there can be a lot of problems. "

 

According to federal guidelines issued in 1991, the procedure is supposed to

be performed only on people who are at least 100 pounds overweight -- and

primarily on those who are also suffering severe health problems because of

their weight. While most people getting the procedure probably meet those

criteria, there is concern that increasing numbers of people who weigh less

are also undergoing the procedure.

 

" Many people who are not morbidly obese are trying to get this procedure.

It's rapidly viewed as the answer to obesity, and more and more say, 'I can

get surgery done as an answer to my problem,' " said Barry Schwartz of Blue

Cross and Blue Shield of Florida. " We've actually seen a couple of patients

who decided with their doctor that they would eat more so they could

qualify. It's perverse. "

 

Schwartz and other critics say the surge in popularity is enticing some

hospitals and surgeons to try to capitalize on the interest.

 

" Many hospitals and physicians see this as a cash cow, " Schwartz said.

" We've seen surgeons who did a weekend course and then started doing this

high-risk surgery. Make no mistake about this: This is high-risk surgery.

The quality of service is going down, and the risk to patients is going up. "

 

Some researchers also question the reliability of the data on the safety and

effectiveness of the procedures.

 

" We don't have quality longer-term studies that give us good data on

long-term safety and effectiveness, " said Frank Lefevre, an associate

professor of medicine at Northwestern University who evaluated the

procedures for the Blue Cross and Blue Shield Association.

 

Already alarmed by skyrocketing health costs overall, a number of insurers,

including Blue Cross and Blue Shield of Florida and Nebraska and Humana

Inc., are discontinuing coverage for the operations.

 

" We've had an explosion in obesity and an explosion in the demand for quick

fixes, if you will, to the problem of obesity, " said Helen Darling,

president of the National Business Group of Health, which represents major

corporations on health issues. " It's beginning to dawn on insurance

companies and employers that even after the surgery, there are a lot of big

expenses and a lifetime of care. Many employers and insurance companies feel

this is just not affordable today. "

 

Some experts liken the situation to what happened with bone marrow

transplants for breast cancer in the 1990s, when terminally ill breast

cancer patients clamored for the procedure until carefully designed studies

finally showed it did not save lives.

 

" Whenever a new technique seems to be providing benefit, it tends to

proliferate, " said Jonathan Moreno, a University of Virginia bioethicist who

studies surgical procedures. " Oftentimes, these things gradually become the

standard of care without going through any studies. "

 

Proponents of the surgery say the procedures have undergone extensive study

and have been clearly shown to help patients, enabling many to shed

one-third to one-half of their excess body weight or more and keep it off

for many years.

 

" I think these insurance companies may be using this as an excuse to avoid

their responsibility. They think they can get away with this because of the

prejudice that's out there for people who are obese, " said Harvey Sugerman,

president of the American Society for Bariatric Surgery. " I think it's a

travesty. "

 

For patients who have been suffering for years and been unable to lose

weight despite repeated diets and exercise regimens, the operations are

life-altering, he said. " It's an amazing operation. It's hard to describe

how helpful it is to these patients. You have a patient who comes in who can

hardly breathe, their legs are all swollen up, they have diabetes and high

blood pressure, and they come back to you in three months, and they're all

gone. They feel wonderful. "

 

While the procedures can be dangerous, Sugerman and others said that for

appropriate patients, the benefits clearly offset the risks, which are on a

par with the dangers of operations for other life-threatening conditions

involving seriously ill patients.

 

" It's actually surprising how good the results are, " said David R. Flum, a

University of Washington surgeon. " If you look at all the options available

for the treatment of obesity, we know one thing for sure: Nonsurgical

approaches, even the most radical approaches, even the most aggressive

nonsurgical approaches, are horribly ineffective. "

 

But Flum and some other experts acknowledge the complication rates are

unclear. Most published studies have involved highly experienced surgeons

operating on ideal candidates. Some research indicates the complication and

mortality risks may be much higher than reported, especially as less

experienced surgeons begin performing the procedures on a wider spectrum of

patients.

 

" We really don't know what's happening in the real world, and there's a lot

of reason to be really worried about that, " said Flum, who is helping

evaluate the procedures for the NIH consortium. " In the real world, surgeons

may do many fewer patients per year. They are learning the procedure. Or

picking patients who may not do as well. A lot of things have got us

worried. "