Prestigious Healthcare Experts Join OpenNotes Movement

John is an amazing doctor. I had the pleasure of working with John during his tenure at Consumer Reports Health Ratings Center. He made a difference for consumers while at CR and he will definitely continue to make a huge difference in the OpenNotes movement. As the article states “He is a prestigious healthcare expert” but more importantly, he is a darn good man! 

Reprinted from Boston CityBizList / February 24, 2016


National health care leaders, John Santa, MD, MPH, Homer Chin, MD, MS, and Amy Fellows, MPH, have joined the OpenNotes team. The three bring decades of expertise in information technology and population health to the expanding OpenNotes movement.

OpenNotes is a national initiative that urges health care institutions and clinicians to offer patients ready access to notes written by providers after a medical visit. Evidence shows that this type of transparency in health care leads to more active patient engagement, with patients reporting far more control of their own health and healthcare.

In the three years since the results of an initial OpenNotes study were published, the number of patients with ready access to their notes has grown from 20,000 to more than five million. The goal now is to expand open access to notes so that this new practice becomes the national standard of care.

"These three, outstanding individuals bring to OpenNotes considerable healthcare industry and IT expertise, along with vital clinical and consumer perspectives," said Tom Delbanco, MD, co-founder of OpenNotes and Koplow–Tullis Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center.

John Santa, MD, MPH, Director of Dissemination for OpenNotes, will take a vital leadership role in bringing the OpenNotes movement to clinical sites throughout the country.

Santa has more than 40 years of experience in clinical medicine and administration, having worked in leadership positions for hospitals, physician groups, insurers, state government, and consumer organizations. Drawing on his expertise in national rollouts of healthcare initiatives, he initiated the Northwest OpenNotes Consortium, whose members now offer more than a million patients access to their notes.

Before joining OpenNotes, Santa was Medical Director for the Drug Effectiveness Review Project, one of the country's most robust comparative effectiveness programs, as well as the Director of the Health Ratings Center at Consumer Reports from 2008 to 2014. The Ratings Center focuses on explicit approaches for evaluating and comparing health services, products, institutions, and practitioners. He is a board member and Treasurer of the National Physicians Alliance and a resident of Oregon.

"Transparency was my top priority in clinical practice and at Consumer Reports. I am thrilled to be part of a movement that brings that to millions of individual patients," said Santa. "If you're healthy, clinician notes are interesting, educating, and help you set priorities. But, if you're sick and want to be a full-fledged member of your own health care team, easy access to clinician notes is a game changer."

Homer Chin, MD, MS, will lead efforts to integrate Health Information Technology further with OpenNotes. He has extensive knowledge of medical informatics and electronic health systems and will work closely with electronic health record vendors, helping them to develop sophisticated methods for supporting OpenNotes.

Chin is an Affiliate Professor in the Department of Medical Informatics and Outcomes Research at the Oregon Health and Science University and a member of the board of OCHIN, a not-for-profit organization that provides information and management services to safety-net clinics in support of the medically underserved.

Chin was previously the Associate Medical Director for Medical Informatics at Kaiser Permanente Northwest, where he pioneered efforts to implement an award-winning comprehensive computer-based outpatient record.

"With the advent of the electronic health record it becomes much easier to share notes among providers, and as a logical extension, with patients. In light of the many benefits of doing so, it is time that we engage and empower patients by providing them easy access to their own medical information," said Chin. "We also have opportunities to work with EHR developers to enhance the patient experience and make it easier for them to interact with notes."

Amy Fellows, MPH, joins OpenNotes to focus on Community Health Programs, with particular attention to individuals who are medically underserved. She brings considerable experience in working to introduce electronic health records to the increasing number of vulnerable populations served by the OpenNotes movement.

Fellows is the Executive Director of We Can Do Better, a non-profit organization dedicated to creating opportunities for education and engagement, bringing people together who share the values of better health care and health for all. Under Fellow's leadership, We Can Do Better convened the Northwest OpenNotes Consortium, which currently includes all nine major health systems in the Portland, Oregon metro area. The group continues to expand, adding practices of all sizes, but has already allowed more than one million patients access to their medical notes through patient portals.

"OpenNotes is proving invaluable for helping patients take charge of their health," said Fellows. "I'm proud to be part of this movement whose goal is to help all patients and families take a more active role in their personal health care."

About OpenNotes

OpenNotes is a national movement that invites patients, families and clinicians to come together and improve communication through shared clinicians' notes and fully transparent medical records. Based at Beth Israel Deaconess Medical Center in Boston, OpenNotes is supported by the Robert Wood Johnson Foundation, the Gordon and Betty Moore Foundation, Cambia Health Foundation and the Peterson Center on Healthcare. To learn more, visit www.opennotes.org.

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7 Smart Swaps for People on a Low-Sugar Diet

Consumer Reports / Trisha Calvo / February 24, 2016

Some packaged foods are surprisingly high in the sweet stuff, but you can find healthier options

There's more to following a low-sugar diet than cutting out soda and cookies. In every aisle of the supermarket, you’ll find added sugars in packaged foods and beverages—even in products that sound healthy—sometimes where you least suspect it and in shocking amounts. The most sugars you should have in a day is 6 to 11 teaspoons (24 to 44 grams), so even a few grams here and there can add up fast. Check labels. When you compare similar foods—sometimes even within the same brand—as we’ve done here, you may find that the sugars and calorie counts vary widely.

Cheerios Protein sounds healthy, but the Cinnamon Almond flavor has 13 times the sugars of Regular Cheerios. And comparing 1¼-cup servings, the protein difference is minor: 4 grams in Regular vs. 7 grams in the Protein version. There are four sources of sugars in the Protein ingredients list. In fact, Cheerios Protein has about as much sugars as Apple Cinnamon and more than any other variety, including Chocolate, Frosted, and Honey Nut.

Apples are sweet, but some types of applesauce—like many packaged fruit products—contain added sugars anyway. Always check the ingredients list on canned, dried, and frozen fruits for different types of sugars. Natural Mott’s has no sugars added, so all of its sweetness comes from the apples. Compare it with the original version and you can calculate that it contains about 11 grams of added sugars.

Yes, tomatoes do have natural sugars, as do veggies such as beets, butternut squash, carrots, corn, and sweet potatoes. That’s where the 4 grams of sugars in the Victoria sauce come from. But Bertolli’s contains added sugars—figure about 8 grams, or 2 teaspoons, when you compare the two.

Frozen meals with added sugars? If they have sauces, it pays to check the ingredients list. For example, Amy’s Asian Noodle Stir-Fry has three types of sugars, including organic evaporated cane syrup and organic cane sugar. Don’t be fooled though: “Organic” may make the sugar sound somehow better for you, but it’s not healthier than any type of nonorganic sugar. 

Nut milks and soy milks usually have added sugars, even in the plain versions. But there’s a big difference in sugar content between the two here, which shows you that it’s a good idea to compare the unsweetened to the sweetened version of a product. If you find the unsweetened version unpalatable, you can add a small amount of sugar on your own.

It’s called tonic water, but it’s really soda—ounce for ounce it has more calories and grams of sugars than regular Coke. If you’d rather skip the artificial sweetener in the diet version, try making your gin and tonic with club soda—which, despite the name, has zero calories and no sugar or other sweeteners—and a twist of lime.

Condiments can contain a surprising amount of added sweeteners. If you choose Sweet Baby Ray’s sauce, you’ll come close to your daily sugar allotment by having just a tiny 2-tablespoon serving. In addition to barbecue sauce, check ingredients lists on bottles of ketchup, mustard, salad dressings, teriyaki sauces, and the like for added sugars.

Editor's note: This article also appeared in the February 2016 issue of Consumer Reports on Health.

Why Where You Store Prescription Painkillers Is So Important

Consumer Reports / Lisa Gill/ December 2015

Deaths due to these powerful drugs are on the rise, 

but our poll finds most people don’t secure them

Americans have a lot of painkillers sitting around in their homes, and some of these unused drugs can pose dangers to children and others.

In fact, of those who take any kind of prescription medication, more than 80 percent of people in a recent Consumer Reports poll said that they don’t lock up their narcotic painkillers, such as Oxycontin, Percocet, and Vicodin—and nearly three-quarters said they had children living at home. That translates to more than 16 million households across the U.S. where powerful opioid painkillers sit unsecured in medicine cabinets, closets, and kitchen drawers. 

The Consumer Reports National Research Center conducted the telephone poll of a nationally representative sample of more than 2,000 U.S. adults in June 2015.

The results are concerning because too many of those potentially deadly drugs wind up in the wrong hands. Pain relievers are by far the most commonly abused prescription drugs, with more than half of people who abuse them reporting that they got the drugs for free from family and friends, according to the National Institute on Drug Abuse. 

The results can be tragic. More than 47,000 Americans died of a drug overdose in 2014—more than during any other year on record, according to a new report released last week from the Centers for Disease Control and Prevention.

The number one culprit? The same painkillers that some people don't keep locked up. In fact, the CDC report found that overdose deaths from prescription pain relievers, which have skyrocketed in the last decade, also reached record highs—up 9 percent in 2014 alone.

“Leaving narcotic drugs unsecured is like having a loaded gun lying around,” says Marvin M. Lipman, M.D., Consumer Reports' chief medical adviser, noting that when it comes to prescription pain relievers, there’s little margin for error. Using someone else’s medication, taking too much, or combining it with the alcohol or certain other medications can be a fatal mistake. 

Safer Strategies for Dealing With Prescription Painkillers

“You may not think anyone would get into your medication, but you’d be surprised,” says Lipman. “It could be anyone from an inquisitive youngster to someone seeking the drugs to sell or for recreational use.”

Teens who have abused prescription medications, for example, cite friends and their parents' medicine cabinet as the most common sources for the drugs.

Lipman advises taking two steps for safer, more responsible handling of narcotic drugs at home.

Lock them up. Secure prescription pain relievers and all other medications up and out of sight of visitors and children in a locked cabinet or container. Don’t keep loose pills in bags or containers in your purse, luggage, or office drawer and, when you travel, keep medications in a locking case.

Discard unused pills properly. You can take unwanted medication to drop-off spots at pharmacies, hospitals, clinics, and long-term care centers any time of the year, with no appointment needed. Or you can mail it in to collection centers in special envelopes that are available from pharmacies and other designated locations. To find out where to drop off pills or pick up a mailer, call the DEA’s Registration Call Center at 800-882-9539 or go to deadiversion.usdoj.gov and search for “drug disposal.”

If there’s no drop-off spot in your area and you don’t want to use the mail-back option, the Food and Drug Administration recommends flushing them down the toilet. That’s usually a bad idea because of the possibility of contaminating the water supply and possibly harming aquatic life. But the danger of someone accidentally getting his or her hands on opioids make flushing an acceptable option if you have no other choice.

Taking leftover pills from an old prescription can be dangerous. Read more surprising facts about prescription pain relievers.

Editor's Note: These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Remembering Harper Lee

I think I will re-read To Kill a Mockingbird and follow it up with Go Set a Watchman (which I have not read), in Harper's honor. I know I still have a hard copy on the shelf and an electronic version on my Kindle.

Condolences to her family. 

RIP Harper Lee.

Taken from Barnes and Noble: 

Harper Lee, literary giant and author of the beloved classic To Kill a Mockingbird, has passed away in Monroeville, Alabama, at the age of 89. Her death comes just seven months after the publication of Go Set a Watchman, which was set two decades after her Pulitzer Prize-winning masterpiece.

The Great American Novel
It’s almost impossible to overstate the importance of To Kill a Mockingbird to readers and, indeed, to our nation. There was, of course, the initial impact of a book that tackled issues of race, prejudice, and justice at a time when the Civil Rights movement was just gearing up—and that dealt with those issues thoughtfully and emotionally, from a place of simple human decency. Then, over the years, To Kill a Mockingbird became a touchstone for people everywhere, a fixture in our classrooms and our culture. Every year, a new generation of young readers is introduced to the simple beauty of Lee’s book. To Kill a Mockingbird becomes a favorite for most, and a shared cultural experience that links all of us. No one walks away from the novel without being changed—or, at the very least, provoked into thinking a little harder about the world. This is a book that has inspired legions to become lifelong readers, impassioned lawyers, and, simply, better people.

The Woman Behind the Name
Lee was born Nelle Harper Lee in 1926. She didn’t use her first name (which was her grandmother Ellen’s name backwards) professionally because she didn’t want people to call her “Nellie,” although people apparently did that all the time in Monroeville, Alabama, where Lee returned to live permanently several years ago after she suffered a stroke. The people of Monroeville adored Lee, and despite her resistance to the public life, residents told The New Yorker last year that Lee was “allergic to press, not people.”

Those who’ve read To Kill a Mockingbird—that is, nearly all of us—may be justified in feeling they know Harper Lee a little. The story draws on Lee’s own family and experiences growing up in Monroeville, and Scout Finch shares something in common with her creator, who described herself as a tomboy. One of the most moving aspects of To Kill a Mockingbird is this emotional honesty. It doesn’t matter that we never met Harper Lee, and knew so little about her; thanks to her novels, we know the way her mind works, and when we need inspiration or comfort we hear, in our souls and hearts, the wry, warm, curious voice of Scout Finch.

Just One Kind of Folks
In the end, Harper Lee was a brilliant writer who created a masterpiece, and then stepped back, turning down press requests and keeping herself to herself. Her writing will ultimately guarantee her a place in history, and her writing is peerless—Lee accomplished more with two books than most writers manage with fifty.

As Scout Finch says, “You never really understand a person until you consider things from his point of view.” Every time we return to her work, Harper Lee helps us step outside ourselves and see the world from a new perspective. Although she is gone, her impact endures, her characters will keep inspiring us to do and be better, and her writing will live forever.

Harper Lee--A life in Pictures http://www.theguardian.com/us-news/gallery/2016/feb/19/harper-lee-a-life-in-pictures

Gregory Peck and Harper Lee on set of the film. They became friends and Peck’s grandson was named after her.

Photograph: Bettmann/Corbis

4 Ways to Get Insurance to Cover Your Prescription Drugs

Reprinted from Consumer Reports / Ginger Skinner / February 12, 2016

If your medication costs have shot up, ask your doctor for help

If your medication prices seem higher than last year, one culprit might be changes to your insurance company’s “formulary”—the list of drugs covered by your health plan.

During the year, insurance plans may change which prescription treatments they cover, and that’s true especially when it’s time to re-enroll.

Formularies are often developed to encourage people to use the least expensive medications whenever possible. But that list can change if an insurer negotiates a better deal with a drug company, if new research shows the medication isn’t as safe or effective as thought, or a less expensive generic version of the drug hits the market.

Even if your drug is covered on an insurance company’s formulary, the full cost of it may not be. Where an insurance company places a drug on its formulary, the list of drugs is further divided into what is called a ”tier”—and it’s essentially a way to determine how much you’ll pay out of pocket for it, through your co-pay. The higher the tier the higher your share of the costs.

"Consumers need to be on guard because drugs can be taken off a formulary at any time, or moved to a higher tier, which could make a big difference in your share of the costs," says Betsy Imholz, Consumers Union's director of special projects.

Most plans have about four levels, or tiers, of coverage, but in the last few years, more insurers have added a fifth tier by splitting the "generics" tier into two: "preferred" and "nonpreferred." Insurance companies do this to encourage people to choose less expensive medications.

Your copay for a drug in the non-preferred generic tier, for example, may be $15, compared to a preferred generic in the lowest tier, where your copay could be $5 or less. 

Diligently checking your plan's formulary (you can find it on your insurer’s website) can help you avoid getting stuck with paying the full costs of your prescriptions. But if it turns out a drug you're taking is dropped or moved to a higher tier, you have several options:

1. Switch Drugs. Ask your doctor to prescribe a drug on your formulary that may be just as effective and safe for your condition. Most plans will offer one or more alternatives to a medication they no longer cover.

2. Ask for an Exception. "Many people don't realize that just because a drug is not on your plan's formulary does not mean it's unavailable for coverage," says Imholz, "Work with your doctor."

If a drug alternative is not possible, your doctor can file an exception, or "prior authorization," through your health plan, requesting that the drug be covered because it’s medically necessary. If that happens, your plan should approve or deny your request within a few days.

3. Try Step Therapy. Depending on what medication it is, after your doctor files an exception, some plans may require that you agree to “step therapy” first, which is a type of prior authorization. It means trying other lower-cost medications that are appropriate for your condition first. If the lower-cost drug doesn’t work for you, your doctor can ask your insurer to cover the more expensive drug. 

4. File an Appeal. If your insurer still denies your request to cover a drug you need, you can file an appeal. You and your doctor can either complete and file an appeals form provided by your insurer, or write a letter that includes the name of the drug, why you need it covered, and any other supporting documents from your doctor. Your insurer's website will provide more details on the appeals process.

If your plan denies your appeal, you can file for an external, or independent, review with your state’s insurance regulator, which will make the final decision.

If your state doesn’t have an external review mechanism, the Department of Health and Human Services (HHS) or an independent review organization will oversee the process. A decision can take up to 60 days and is free if handled by the HHS, but may cost you to $25 if it’s handled by your state or an independent review organization.


When All Else Fails, Shop Around
Filing an appeal can be a lengthy process, and there’s still no guarantee that your insurer will agree to cover your medication. If you end up having to pay more for your medications out-of-pocket, shop around.

Our secret shoppers have found that prescription prices can vary widely from one pharmacy to the next, even in the same zip code. Costco often offers low prices (you don’t have to be a member) and independent pharmacies may be able to negotiate. And ask your pharmacist if you can save more by not using your insurance; many chains and big-box stores, such as Target, Walgreens, and Walmart, offer hundreds of generics for as low as $4 for a 30-day supply and $10 for a 90-day supply.

When it's time to re-enroll or change insurance plans, before choosing coverage, Imholz recommends checking the formulary to make sure the drugs you need are covered and under which tier.


Editor's Note: These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

A Brief History Of Antibiotic Resistance

The Grapevine

A Brief History Of Antibiotic Resistance: How A Medical Miracle Turned Into The Biggest Public Health Danger Of Our Time

Feb 17, 2016 09:30 AM By Lecia Bushak

The discovery of penicillin marked the advent of the age of antibiotics, 

an era where previously deadly infectious diseases could be cured in days. Wikimedia

Antibiotics, also known as antibacterials and antimicrobials, revolutionized medicine during the later half of the 20th century. But as time goes on, the success of antibiotics may be completely cancelled out by their combative counterparts: resistant bacteria.

Humans have overused antibiotics simply by harnessing them to treat all sorts of infections from pneumonia to strep throat — but also by sometimes taking too much of them, or infusing them into agricultural systems, animals, and food products, as the CDC illustrates . This overuse has opened the door for bacteria to evolve into resistant strains to beat out drugs. We’re now in a place where changes desperately need to be made in order to prevent millions of deaths from antibiotic resistance in the coming decades. These microscopic microbes seem to be smarter than us.

The authors of a 2010 report on the evolution of resistance note that microbes have “extraordinary genetic capabilities” that benefit “from man’s overuse of antibiotics to exploit every source of resistance genes... to develop [resistance] for each and every antibiotic introduced into practice clinically, agriculturally, or otherwise.” Here’s how antibiotics went from being a revolutionizing medical breakthrough to a massive public health concern.

Which Came First, The Antibiotic Or The Resistance?

The antibiotic era, as it’s called, may not have begun until the 21st century, but antibiotics were still in use in ancient folk medicine. The term “antibiotic” has an extremely broad definition, describing the activity of any compound or chemical that can be applied to kill or inhibit bacteria that cause infectious diseases.

350-550 CE. The earliest traces of antibiotic use date back thousands of years. Tetracycline — a common antibiotic still used today — has been found in skeletons from Sudanese Nubia, an area that included ancient Egypt. Researchers believe that ancient Nubians were actually brewing tetracycline into their beers or otherwise incorporating it into their diets over a long period of time because the compound was found embedded deep in their bones and the population’s documented infectious diseases seem to be quite low. This discovery overturned the commonly-held belief that antibiotics didn’t exist before 1928.

It’s tough to detect other ancient antibiotics aside from tetracyclines, however, as most didn’t settle into bones and tooth enamel in the same way. Only documentation and anecdotes remain to give us insights into the use of other ancient antibiotics. What is now known to be an antimalarial drug, artemisinin, was used in ancient Chinese medicine, and it’s possible that herbalists also used moldy bread to prevent wounds from getting infected. There’s also historical evidence that, in Jordan, red soils rich in antibiotic-producing bacteria were used to treat skin infections like rashes.

And for as long as antibiotics have existed, bacterial resistance has existed alongside them — but never on such a large scale. “The natural history of antibiotic resistance genes can be revealed through the phylogenetic reconstruction,” the authors of one study write, “and this kind of analysis suggests the long-term presence of genes conferring resistance to several classes of antibiotics in nature well before the antibiotic era.” In short, bacteria have always been doing what they’re good at: finding ways to survive.

Alexander Fleming, who discovered penicillin, was also one of the first scientists
to warn about the perils of antibiotic resistance. Wikimedia

1928. Alexander Fleming, a Scottish biologist, took the fight against infections to a new level when he identified penicillin, making this the year that the modern antibiotic era began.

The discovery had apparently been an accident. Fleming had left an uncovered Petri dish of Staphylococcus bacteria near an open window in his basement lab, and in the morning found that mold growth had inhibited the bacteria. Penicillin, which comes from a type of fungi known as Penicillin rubens , became the first compound to be used officially as an antibiotic.

Penicillin was popular in the public during the 1940's and 50's due to its ability to treat a variety
of infectious diseases quickly; this also led to an increased build-up of antimicrobial resistance. Wikimedia

1943. Penicillin was on its way to mass production and was used heavily to treat Allied troops fighting in Europe during World War II. Considered a miracle drug, it was soon available to the public, despite warnings from Alexander Fleming that overuse could lead to mutant bacteria. Because bacteria can transfer genes horizontally — from one bacteria to another immediately — its ability to share resistance was adding to a growing threat unheeded by many scientists and doctors of the day.

1948. Transferring antibiotic use from medicine to agriculture also happened in a rather accidental way. Robert Stokstad, an animal nutritionist, and Thomas Jukes, a biochemist, were working at the company Lederle to develop an “animal protein factor” that could enhance chicken growth and boost poultry profits. The researchers were initially experimenting with vitamin B12, which was believed to boost animal growth, but eventually found that the cellular remains of Streptomyces aureofaciens bacteria — from which tetracyclines are extracted — contained a lot of the vitamin. As the Lederle labs had also discovered the first tetracycline, the researchers had access to plenty of these bacterial remains. Chicks that received supplements including Streptomyces auerofaciens grew 24 percent more than those receiving liver extract, which also contained high levels of B12. The bacteria shells, which still contained traces of the antibiotics, were more effective in making them grow (and much cheaper than liver extract). This discovery jump started the process of routinely injecting antibiotics into animals.

Meanwhile, resistant staph bacteria were growing in hospitals. According to Harvard Magazine, resistant staph infections in hospitals had risen from 14 percent in 1946 to 59 percent in 1948.

1952. By this time, doctors were somewhat aware of the possibility of antibiotic resistance, but overall they remained hopeful and optimistic about the success of these new drugs, which could defeat diseases that had long plagued humanity, like cholera and syphilis. A study on antibiotic resistance published that year concluded that syphilis could be treated “without any indications of an increased incidence of [resistant] infections, and this work gives grounds for hoping that the widespread use of penicillin will equally not result in an increasing incidence of infections resistant to penicillin.”

1950s–1970s. The next couple decades were considered the golden era of antibiotics, due to the sheer number of new drugs that were being developed: streptomycin, to treat serious infections like endocarditis and the plague; ampicillin, which treats respiratory tract infections and meningitis; and dozens of others. In the excitement surrounding the success of these antibiotics, they were made readily available to the public, like penicillin, ultimately paving the way for resistance to develop more easily.

The Tide Turns, The Superbugs Arrive

1955. As Fleming had predicted, resistance to penicillin gradually built up due to the accessibility of the drug. By 1955, many countries had attempted to slow this resistance by limiting penicillin use to prescription only, but it was too little too late: many bacterial strains had already defeated the antibiotic, including staphylococci.

1960. In an attempt to defeat penicillin-resistant strains, scientists developed methicillin, a different antibiotic in the penicillin class that could work against resistance. But within a year, bacterial strains developed resistance to methicillin too — eventually called MRSA , methicillin-resistant Staphylococcus aureus , or S. aureus . Now, MRSA can resist most antibiotics, and infections are common in hospitals — making it one of the biggest forerunners of multiple-drug resistant (MDR) bacteria.

For decades, poultry and other animal farms utilized antibiotics
freely in feed to promote growth. Reuters

1976. At Tufts University, a physician and researcher named Stuart Levy became one of the first to identify antibiotic resistance due to their use in animals, and to clamor for greater awareness of the problem. He worked on a study that year that examined how small amounts of antibiotics in animal feed could cause resistance in humans. On a farm in Massachusetts, Levy fed tetracycline to chickens, and found that tetracycline-resistant bacteria began to populate the chickens’ gut flora within a week. Despite this, rampant use of antibiotics like vancomycin (which had previously been considered a “last resort” drug) throughout the 1980’s led to an epidemic of resistant strains on farms and among humans.

1990s. A stronger resistant strain of MRSA began sickening normal, healthy people in the 1990s. This perhaps created a greater public awareness of the danger of antimicrobial resistance.

In the midst of emerging superbugs and MDR bacteria, the CDC and other
public health organizations began issuing public service announcements
to curb the liberal use of antibiotics. CDC / Wikimedia

By 2002 , up to 60 percent of S. aureus cases in hospitals were resistant to methicillin. In 2005, over 100,000 Americans were stricken with MRSA infections and some 20,000 died, more than the amount of people who were dying from HIV and tuberculosis combined, according to Harvard Magazine.

2012. As more researchers began working on the impending antibiotic-resistant epidemic, they had to tackle the classification of multidrug-resistant bacteria, which were multiplying by the minute. In a 2012 study, a team of scientists proposed adding the terms extensively drug-resistant (XDR) and pandrug-resistant (PDR) to multidrug-resistant (MDR) bacteria to better help them classify and potentially defeat these superbugs. It was the first time that researchers had a unified set of definitions for MDR bacteria to better understand them.

2013. After decades of certain researchers calling for action, the FDA finally implemented aplan to phase out certain antibiotic use in animals. But the extent to which this plan is effective at reducing the massive damage already done is difficult to identify.

2014. In response to major superbug outbreaks like Klebsiella pneumoniae (which causes pneumonia and bloodstream infections in the hospital) and gonorrhea strains all over the world, the World Health Organization (WHO) released a statement noting that “this serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country.”

2015. McDonald's announced that it would phase out all meat sources that contained antibiotics, marking the first step of a major fast food company to heed the public health warnings and take action.

Since the 70s, very few new antimicrobial agents have been discovered, and the only way for researchers to combat resistant bacteria has been to modify already existing antibiotics. This has led to a standstill of sorts between current antibiotics and the rapidly adjusting “superbugs.”

Today, from farms to hospitals to everyday workplaces, animals and humans are likely teeming with different forms of resistant bacteria. In 2013, a Consumer Reports investigation showed that over half of ground turkey meat sold in the U.S. contained strains of drug-resistant bacteria. According to the CDC , some 2 million people in the U.S. are infected with drug-resistant bugs every year, and 23,000 of them die from these infections. Those numbers are likely to get worse in the coming decades, according to recent reports.

The danger of the situation is mainly in its complexity, Rustav Aminov writes in a 2010 report on antibiotic resistance: “It is not a single grand challenge; it is rather a complex problem requiring concerted efforts of microbiologists, ecologists, health care specialists, educationalists, policy makers, legislative bodies, agricultural and pharmaceutical industry workers, and the public to deal with. In fact, this should be of everyone's concern, because, in the end, there is always a probability for any of us at some stage to get infected with a pathogen that is resistant to antibiotic treatment.”

New Packaging Law Aims to Protect Kids From E-Cig Liquid Nicotine Exposure

Poison-control centers last year received more than 3,000 

reports of exposure  to these dangerous liquids

Consumer Reports / Lauren Cooper/ January 28, 2016

President Obama today signed into law a bill that requires child-resistant packaging for liquid nicotine containers used for e-cigarettes and other vaping devices.

Liquid nicotine, used in battery-operated vaping devices such as e-cigarettes and vape pens, is extremely dangerous. One teaspoon is potentially lethal to a child, according to the American Association of Poison Control Centers.

Poison-control centers last year received 3,067 exposure reports across all age groups. In 2014, poison-control centers responded to 3,783 e-cigarette and liquid nicotine exposure cases. More than half of those involved children under age 6 who might have ingested or inhaled liquid nicotine or gotten it on their skin or in their eyes. In December 2014, a 1-year-old boy from Fort Plain, N.Y., died after ingesting liquid nicotine.

Consumers Union, the policy and advocacy arm of Consumer Reports, supported the Child Nicotine Poisoning Prevention Act since its introduction in January 2015 by Senator Bill Nelson (D-Florida), Senator Kelly Ayotte (R-New Hampshire), and 20 other senators.

E-cigs and related devices have been on the market for only about a decade, and experts are still evaluating many aspects of their safety. But “the danger that liquid nicotine poses to young children is undeniable,” says William Wallace, a policy analyst for Consumers Union, which partnered with the American Academy of Pediatrics, the Consumer Federation of America, and Kids In Danger to help educate lawmakers about the threat of young children being poisoned by liquid nicotine.

“Coming in a variety of bright colors and in flavors like cotton candy and gummy bear, liquid nicotine refills used in e-cigarettes have found their way into the hands of children across the country, causing serious and even deadly health consequences.” says Kyran Quinlan, M.D., chair of the American Academy of Pediatrics' Council on Injury, Violence, and Poison Prevention.

Under the new law, liquid nicotine can only be sold in child-resistant bottles and containers packaged in accordance with the Consumer Product Safety Commission's standards. That means that they must meet the same standards as other potentially poisonous household substances as set forth in the Poison Prevention Packaging Act of 1970. Among other stipulations, the law requires that the packaging must be difficult for children under 5 years old to open. Manufacturers have six months to comply.

The American Vaping Association agrees that requiring child-resistant packaging makes sense.

“Parents are recognizing that these products should be kept away from children,” says Gregory Conley, president of the organization. “Requiring child-resistant caps on e-liquid products is a reasonable regulation and is already the law in fifteen states,” he says, adding that, “The Child Nicotine Poisoning Prevention Act [brings] uniformity across all 50 states on this issue."

Next up: preserving the FDA’s ability to regulate e-cigarettes, which is under threat by some members of Congress.

“The new law helps address a known safety risk to children, but e-cigarettes have not been around long enough for us to know the long term effects of using them. It’s critical that the FDA retains the ability to address additional health risks that may emerge with these untested products,” Wallace says.

How to Cancel Travel Plans Due to the Zika Virus

Consumer Reports / By Jeff Blyskal / Feb 5 2016

Travel insurance helps, but be prepared to haggle as well

If you plan to cancel the tropical vacation you've booked to avoid coming down with the Zika virus, you're probably in good company. Worries over travel have picked up in recent days with the news that at least 31 people in the U.S. have been diagnosed with the virus including a pregnant woman in New York City, according to the Centers for Disease Control and Prevention.

But canceling raises more questions. Will you be hit with cancellation penalties? Will you be able to get a refund?

The good news is that some major airlines and cruise lines are bending their usually strict rules on cancellation for passengers with tickets to the affected areas. But at the same time, you may also need to negotiate for a refund to cancel travel plans.

Airlines

JetBlue, which was rated the most highly among airlines in our 2015 airline Ratings, has the most forgiving policy among the five largest U.S. carriers we contacted. Customers concerned about Zika and holding tickets to affected areas can cancel travel for a refund even if they purchased non-refundable tickets. Re-bookings can be made without penalty.

United and American provide similar options, but only to women who are pregnant or attempting to become pregnant, and their travel companions, and their policies doesn't apply to non-refundable tickets. American requires a note from a doctor and refunds are limited for travel to only 11 countries, including Brazil, Mexico, Panama, and Puerto Rico.

Southwest Airlines, also highly rated by our subscribers, has no specific Zika policy, but it never charges penalties for changing flight plans. So any traveler concerned about Zika is free to avoid problem destinations. If you have non-refundable tickets, their full value can be applied to travel elsewhere on Southwest.

Delta did not respond to our request for comment, but the airline's website says customers may be able to change their destinations and travel dates without being charged a fee. They may also qualify for a refund if they cancel travel plans. Changes need to be made by February 29.

What you should do. If you're not pregnant or trying to become pregnant and still prefer to cancel, getting a refund may be more difficult. If you bought travel insurance that has a rider that permits cancellation for any reason, that should protect you. If you don't have the insurance, we recommend that you negotiate for a refund from the airlines. That may require that you argue that canceling your trip helps prevent the spread of the virus to the U.S. It is especially advisable if you expect to be in contact with anyone who is pregnant (there are still questions as to how easily this disease gets transmitted).


Cruises
Consumers who buy tickets for a cruise are typically subject to stiff penalties if they change or cancel travel plans. Payment in full is usually required 90 or more days before departure. If you later want to cancel, you can lose up to 100 percent of your payment depending on when you make that decision.

But if the reason for canceling has to do with the Zika virus, the cruise lines are being unusually lenient. Carnival, the largest cruise line, Disney Cruise Lines, Norwegian Cruise Lines and Princess Cruises are letting pregnant women cancel travel or change their itineraries to exclude Zika-prone destinations. They can also request credit for a future voyage.*

The new policies do not apply to those planning to become pregnant.

What you should do. If your cruise line isn't willing to help you avoid cancellation or change fees, remind them of the policies set by the other cruise lines and ask for similar treatment.

As with the airlines, if you purchased travel insurance that has a rider that permits cancellation for any reason, that should protect you. We suggest that you don't automatically take the limited insurance policy offeringsthat the cruise line sells. You're likely to get better coverage and lower fees if you shop the market more broadly by using an online broker such as InsureMyTrip.

Lodging
Hotel chains have more consumer-friendly cancellation policies and routinely require 48 to 72 hours’ notice to avoid a charge equal to one night’s stay.

However, if you cancel a prepaid stay during a peak period, you could forfeit the entire amount. Some resorts may bill you for three nights if you cancel your trip.

If you've booked a private vacation home rental through online marketplaces such as Airbnb, HomeAway, or VRBO, the homeowner sets the cancellation policy.

What you should do. Given the severity of the warning from the CDC, negotiate for a full refund or a reduced penalty waiver. It can help to contact the hotel or travel agent and explain that your doctor has warned against travel to the area.

For private vacation home rentals, check your contract for the owner's cancellation policy to see if you can get out of the deal within the rules. If you are unable to break the agreement, appeal to the owner on a personal level and try to negotiate a fair refund, given the new health threat.

Happy Valentine's Day

Cholesterol-Lowering Drugs May Be Linked to Diabetes

Consumer Reports Health / February 2016

You may have concerns about taking a cholesterol-lowering statin drug, such as atorvastatin (Lipitor and generic), rosuvastatin (Crestor), and simvastatin (Zocor and generic), after a recent study linked those drugs to an increased risk of type 2 diabetes. But Consumer Reports Best Buy Drugs experts say the heart-protective benefit of statins usually outweighs the risk of diabetes, so don’t skip a statin if you need one to lower your cholesterol.

Diabetes isn’t a new side effect of statins. The Food and Drug Administration added it to the label of all statins in 2012 based on a review of studies that found a slightly elevated risk. For example, one study that reviewed 13 randomized, controlled clinical trials of statins found that 4.9 percent of people who took one of the drugs for 4 years developed diabetes compared with 4.5 percent of those who didn’t take a statin.

Lower Cholesterol vs. Higher Blood Glucose

The new study, published in the Journal of General Internal Medicine, raises questions about whether the diabetes risk is higher than previously thought. Researchers looked at medical data of nearly 7,000 men and women with an average age of 53. About 31 percent of those who took a statin for an average of 5.5 years developed diabetes compared with 19 percent of those who didn’t.

But since the study was not a randomized, controlled study—the gold standard for determining whether a drug causes a particular side effect—it’s not known for sure that the increase in diabetes was entirely due to statins. The study participants might have had other factors that contributed to the development of diabetes.

"All we can say," says Ishak Mansi, M.D., an internist at the Veteran's Hospital in North Texas and co-author of the study, "[is] that in the healthy population selected ... the risk of diabetes after prolonged followup was higher than expected."

The risk of diabetes with statins is relatively low and is likely outweighed by the potential benefit of the medications to reduce LDL or “bad” cholesterol levels and prevent a heart attack or stroke, says Paul Thompson, M.D., chief of cardiology at Hartford Hospital in Connecticut. Previous research found that for every case of diabetes statins triggered, they prevented at least three heart attacks or other serious heart problems, Thompson adds.

“The bottom line is that the remote risk of developing type 2 diabetes should not deter you or influence your decision to use a statin if one is indicated,” says Marvin M. Lipman, M.D.,Consumer Reports’ chief medical adviser.

To figure out if a statin makes sense for you, our Best Buy Drug report on statins recommends using this calculator. It estimates your overall risk of a heart attack or stroke in the next 10 years based on your total cholesterol level, HDL “good” cholesterol, your age, blood pressure, and whether you smoke, or have diabetes.

Our medical advisers say that for some people with a low risk of heart attack or stroke—less than 10 percent over the next 10 years—diet and lifestyle changes should be the first step to lowering cholesterol. That includes adopting a healthy diet that is low in saturated fats, trans fats, and cholesterol, and making lifestyle changes such as exercising and losing weight if you need to or quitting smoking if you are a smoker.

Those changes could reduce your LDL and your heart attack and stroke risk low enough that you won’t need to take a statin. Or, if you already take a statin, these changes might allow you to discontinue your medication or lower your dose, which can in turn reduce your risk of side effects.

Our medical advisers also recommend that you use the calculator to look at how much taking a statin would reduce your risk. And talk with your doctor. You might find that reducing your cholesterol levels with a statin will not make much difference in your 10-year risk of heart attack or stroke. If that's the case, then skip it.

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