Medicine Man

America's Medicaid system could spend nearly $10 billion less within five years if all Medicaid beneficiaries who smoke, quit. A new study released today by the American Legacy Foundation found that effective smoking prevention and cessation programs could cut Medicaid costs by 5.6 percent.

The report, Saving Lives, Saving Money II, was conducted by RTI International and funded by the foundation. This report updates Legacy's 2002 report Saving Lives, Saving Money: Why States Should Invest in a Tobacco-Free Future, that presented estimated savings to state Medicaid programs associated with reductions in adult smoking rates. The 2007 report presents a powerful new analysis of the costs of smoking to state Medicaid programs over the course of the lives of a cohort of young smokers. The methodologies used in the two reports differ and estimates are therefore not comparable.

According to the report, Medicaid spending attributable to current smoking ranges from $15 million in Wyoming to $1.5 billion in New York. Across all of the states, Medicaid expenditures would be $9.7 billion lower if all smokers in the system successfully quit.

"This report is a wake up call to the nation's health policy makers," said Janet Napolitano, Governor of Arizona and a board member of the American Legacy Foundation. "All of us who are struggling with the ever-rising costs of Medicaid should take these dramatic findings to heart. With more than 8.6 million Americans suffering from tobacco-related disease, and tobacco remaining the number one preventable cause of death in our nation, we must help smokers quit. These data make clear that investing in proven tobacco cessation programs is sound fiscal and public health policy. We can - and must - take the necessary steps to save both lives and taxpayer dollars."

The study went on to examine how much Medicaid programs would save over the course of young smokers' lives if they never smoked. If states could prevent all smoking among current 24-year-olds, Medicaid savings over their lifetimes would be between $1.4 million (in Alaska and Vermont) and $125 million (in Texas).

Another of the report's findings highlights a significant difference in the net cost of smoking for men versus women. Over the lifetime of a male smoker, the net cost of smoking to Medicaid is $6, but for women -- who make up 69 percent of Medicaid recipients - the cost is $1,372.

"This study underscores the need for strong and effective smoking prevention and cessation campaigns," said Cheryl G. Healton, Dr. PH, president and CEO of the American Legacy Foundation. "We hope that this report will serve as a tool for states to use when setting both long and short-term goals for reducing Medicaid expenditures associated with tobacco use."

"Reducing the number of smokers in the United States could save taxpayers billions of dollars in Medicaid costs," said Justin Trogdon, Ph.D., a health economist at RTI International and author of the report. "Policymakers looking for ways to reduce health care costs in America would be wise to look at areas of health behaviors that both improve health and reduce health care costs."

Smoking remains the country's leading preventable cause of death. New data released earlier this month by the U.S. Centers for Disease Control and Prevention (CDC) showed that smoking rates are no longer on the decline with 45.3 million adults reporting smoking in 2006. Adult smoking rates in the U.S. have stalled for a second year in a row, after a 7-year smoking decline.

The CDC reported that 20.8 percent of adults in the U.S. (45.3 million) were current cigarette smokers in 2006 and of these adults, 80.1 percent (36.3 million) smoked every day. Most smokers in America - 70 percent - say they want to quit, but in 2000, only about five percent were successful in quitting long-term.

The American Legacy Foundation(R) is dedicated to building a world where young people reject tobacco and anyone can quit. Located in Washington, D.C., the foundation develops programs that address the health effects of tobacco use, especially among vulnerable populations disproportionately affected by the toll of tobacco, through grants, technical assistance and training, partnerships, youth activism, and counter-marketing and grassroots marketing campaigns. The foundation's programs include truth(R), a national youth smoking prevention campaign that has been cited as contributing to significant declines in youth smoking; EX(R), an innovative public health program designed to speak to smokers in their own language and change the way they approach quitting; research initiatives exploring the causes, consequences and approaches to reducing tobacco use; and a nationally-renowned program of outreach to priority populations. The American Legacy Foundation was created as a result of the November 1998 Master Settlement Agreement (MSA) reached between attorneys general from 46 states, five U.S. territories and the tobacco industry. Visit http://www.americanlegacy.org/.

http://www.americanlegacy.org/

On World AIDS Day 2007, hundreds, perhaps thousands, of men who have sex with men (MSM) will become infected with HIV in cities across the Asia Pacific, becoming the latest statistics in an almost unrecognized but ever-growing crisis that many governments in the region are only just beginning to grapple with.

As these efforts take shape, the Asia Pacific Coalition on Male Sexual Health (APCOM) is offering its partnership to develop and support new strategies aimed at tackling this regional challenge.

Paradoxically, it may be more challenging for APCOM to draw attention to the MSM HIV issue. The recent adjustment downwards of global HIV and AIDS figures has been construed in some quarters as an indication that the AIDS crisis has been ''exaggerated'' all along. However, APCOM and the stakeholders it represents are urging the Asia Pacific region, and indeed the world, not to confuse the true picture.

Most MSM who contract HIV in city after city in the Asia Pacific region will never know they harbour the virus until they become ill with advanced symptoms. Without that knowledge, they probably will not change the very behaviours that put them, as well as their partners and loved ones, at risk. A recent survey in a major Asian capital suggested as many as 32% of MSM there are HIV positive. In other cities across the region, HIV infection rates for MSM range from estimates anywhere from 5% to 15% or 20% and higher.

''Despite MSM having higher infection rates than the general adult population, the financial investment for HIV prevention, care and support services for this marginalized group across the Asia Pacific is abysmally low in national HIV and AIDS programme planning, usually between zero and four percent,'' says Shivananda Khan, APCOM Chairperson and CEO of Naz Foundation International. ''Less than one in ten MSM in the region have access to any sort of HIV services, woefully short of the eight in ten that UNAIDS describes as optimal coverage necessary for high-risk groups. Is it any surprise then that we really don't have a clear picture of the true extent of the HIV crisis affecting men who have sex with men?''

Edmund Settle, HIV/AIDS Programme Manager for UNDP China, concurs. ''You've got these really alarming statistics of ten, 20, 30 percent HIV infection rates among MSM in some major cities, but when you ask whether this picture holds true across other urban centres, or even in suburban or rural areas, the answer's not at all simple. It ranges from 'Yes, it's somewhat likely' to 'Well, we're not really certain.' Still, we do know more today than just a couple of years ago.''

That growing clarity comes from a recent review of available data, soon to be released by UNAIDS, that describes the epidemiology of HIV and sexually transmitted infections (STI), and behaviours of MSM in the Asia Pacific region that put them at considerable risk of HIV and STI. As the paper states: ''Severe and established HIV epidemics are found among MSM in some countries while imminent or beginning HIV epidemics were observed in others.'' The review also recommends ways to change policy and programming that would confront this challenge and help improve the situation.

''This collection of data in the upcoming review allows us to highlight more accurately than before the extent of the HIV scenario vis-a-vis MSM in our region,'' according to Geoff Manthey, Regional Advisor on MSM for Asia Pacific UNAIDS Regional Support Team (RST-AP). "It also comes at a most opportune time, with the recent creation of the Asia Pacific Coalition on Male Sexual Health. We hope that the work of APCOM, and its strength in bringing together representatives from governments, the UN system, donors and NGOs side by side with affected communities will finally make the difference in creating a truly regional strategy to address the MSM HIV crisis -- and yes, even though it's an overused word or sounds like a clich??, this is a crisis, make no mistake about that.''

In 2006, a year before APCOM's creation, JVR Prasada Rao, director of UNAIDS RST-AP, had warned that "data in Asia show that without interventions, male to male sex will become one of the main sources of new HIV infections in the region.'' He added, ''We are facing a public health crisis, but you would never know it from the region's almost invisible response so far'' -- a fact supported by a UNAIDS report published this past August, Men who have sex with men -- the missing piece in national responses to AIDS in Asia and the Pacific.

The China Center for Disease Control and Prevention (CCDC) recently stated that HIV prevention for MSM was the latest hurdle for the government's drive to curb a fast-rising AIDS epidemic. In fact, China -- the world's most populous nation -- was the first country in the region to issue a specific national framework on MSM and HIV, which calls for urgent efforts to engage civil society in a concerted effort to reach out to men who have sex with men. China recently reported that male to male sexual transmission now accounts for 12.5 percent of new HIV cases in 2007, up from 2.5 percent in 2005.

Reflecting the growing regional awareness for enhanced surveillance that incorporates epidemiology as well as sociocultural awareness, the Center for HIV/AIDS/STI (CHAS) in Laos PDR has conducted the first survey of HIV among MSM in Laos and will soon be releasing the results. As governments and health partners across the Asia Pacific wake up to the realization that national HIV prevention strategies must include a significant MSM component, APCOM and its partners stand ready to support and strengthen such approaches.

''All of these surveys, these papers, these data and statistics represent hope that our region is making a breakthrough,'' says Dede Oetomo, who sits on APCOM's interim governing board and is a noted long-time gay activist in Indonesia, a country with limited but successful and well-documented results in HIV and STI prevention among MSM. ''However, the good work that's emerged in recent times also serves as a warning that the hard work now really begins. With the multisectoral strength that APCOM provides, we are poised to finally reach out to MSM groups in a way that hasn't been possible before. It's an important, exciting time -- full of challenges, yet full of promise. Let's go forward now and get the work done.''

http://www.msmasia.org/

The Therapeutic Goods Administration (TGA) in Australia has updated warnings on a popular sleeping drug.

The sleeping drug Stilnox, also called Stildem or Zolpidem, will in future be sold in packs of no greater than 14 tablets - down from 21.

The updated warning comes as a result of numerous reports of strange and potentially dangerous side-effects which include changes in behaviour and mental state, sleep walking, and undertaking strange and potentially dangerous behaviours while apparently asleep.

The TGA says Stilnox packs will include significantly changed Consumer Medicine Information (CMI) information about the side effects of Zolpidem which now include the less common adverse effects of rage reactions, worsened insomnia, confusion, agitation, hallucinations and other forms of unwanted behaviour.

Sleep walking, driving motor vehicles and other unusual and on some occasions dangerous behaviours whilst apparently asleep have been reported along with preparing and eating food, making phone calls and having sexual intercourse.

The TGA says people experiencing these effects have had no memory of the events and significantly such side effects can occur at therapeutic doses, without any intake of alcohol.

The TGA says alcohol intake heightens the risk of such side effects and warns the reactions could occur among both first-time and regular users, at prescribed doses and without the consumption of alcohol.

Australians wanting to report adverse reactions to the drug should phone 1300 134 237.

Zolpidem is sold in Australia under the brand-names Dormizol, Zolpibell, Zolpixdem, Somidem and Stildem.

It is also sold in the United States and in March this year the Food and Drug Administration (FDA) requested that all manufacturers of sedative-hypnotic drug products, such as Stilnox update their product labeling to include stronger language concerning potential risks.

These risks listed by the FDA include severe allergic reactions and complex sleep-related behaviours, including sleep-driving.

Also included were warnings about anaphylaxis (severe allergic reaction) and angioedema (severe facial swelling), which can occur as early as the first time the product is taken and complex sleep-related behaviours which may include making phone calls, and preparing and eating food (while asleep).

Experts say patients being treated with sleep medications should read the information before taking the product and talk to their doctors if they have questions or concerns.

The FDA has recommended that the drug manufacturers conduct clinical studies to investigate the frequency with which sleep-driving and other complex behaviours occur in association with individual drug products.

According to a new study from the U.S., the violence depicted on television, in films and video games threatens the safety of the public because it increases the aggressive behavior of the viewers.

The researchers from the University of Michigan, reached this conclusion after reviewing more than 50 years of research on the impact of violence in the media.

Researchers L. Rowell Huesmann and Brad Bushman say exposure to violent electronic media has a larger effect than all but one other well known threat to public health and that is the effect of cigarette smoking on lung cancer.

Smoking is one of the leading causes of preventable death and is linked to lung cancer and other serious illnesses.

Huesmann says many children spend an average of three hours watching television each day and more than 60 percent of TV programs contain some violence, 40 percent show extreme violence.

Video game units are now present in 83 percent of homes with children and who are also spending large amounts of time playing video games, most of which contain violence.

The findings support earlier research which also showed that children who watch violent television shows and who identify with the characters are more likely to be aggressive as adults and this is true for both men and women.

Huesmann says the research shows quite clearly that exposure to virtual violence increases the risk that both children and adults will behave aggressively and could have a particularly detrimental effect on the well-being of youngsters.

The researchers say though not every child exposed to violence in the media will become aggressive, parents and society need to exercise greater control on what children are exposed to in films, video games and television programs.

They say media violence significantly increases the risk that both children and adults will behave aggressively.

The research is published in a special issue of the Journal of Adolescent Health.

According to new research from the U.S. women who are suffering from depression may have an increased risk of osteoporosis.

The new research by scientists at the National Institute of Mental Health (NIMH) suggests that even mild depression is enough to cause harm to the bones.

There is already evidence that smoking and doing little or no exercise can cause osteoporosis, a disease of bone that leads to an increased risk of fracture.

But the new research has revealed that depression too can cause a level of bone density loss similar to that caused by smoking cigarettes and a lack of exercise.

The study which was conducted by Giovanni Cizza and colleagues at the NIMH looked at 89 women with mostly mild depression between the ages of 21-45 and an other 44 similarly-aged women without depression.

Tests for bone mineral density revealed that 17 percent of the depressed women showed evidence of bone thinning at a particularly vulnerable area of the thigh bone, compared to 2 percent of women who were not depressed.

In 20 percent of the depressed women lower bone density at the lumbar spine, the five bones in the lower-back portion of the spine, was also seen, compared to 9 percent of women without depression.

Cizza says that depression was associated with a 2 percent reduction in bone mass at the hip, roughly seven times the expected loss for a healthy premenopausal woman.

He says the study shows that even mild depression can have very real consequences for bones and needs to be recognized as a risk factor for bone loss in premenopausal women.

The researchers say doctors should consider testing women with depression for osteoporosis and treating them if necessary.

Another study by researchers from the San Francisco Coordinating Center has found that osteoporosis may be responsible for more fractures than previously thought.

The research team say while it has been assumed that fractures occurred in high-impact automobile crashes or severe falls were simply because of the trauma involved, the bones may have first been weakened by osteoporosis.

A review of studies involving more than 14,000 U.S. men and women aged 65 and up found bone mineral density was "strongly associated with high-trauma nonspine fractures in older women and men."

It also found such breaks "predicted subsequent fractures to the same extent as low-trauma nonspine fractures in women."

As a result, those injuries have not been included among the estimated 1.5 million low-impact osteoporosis-related fractures that occur every year in the U.S.

The research is published in the Journal of the American Medical Association.