Professor URLs April 16th

Autism may be associated with maternal obesity.

The AP (4/8, Tanner) reported, "Obesity during pregnancy may increase chances for having a child with autism," according to a study published online April 9 in the journal Pediatrics and supported by the National Institutes of Health. After examining data on some 1,000 California children and their mothers, researchers found that "women who were obese during pregnancy were about 67 percent more likely than normal-weight women to have autistic children. They also faced double the risk of having children with other developmental delays."
        The Wall Street Journal (4/9, A3, Wang, Subscription Publication) points out that the majority of the risk for autism depends on genetic factors. The remainder of the risk appears to be made up of various factors, including age of the parents, being born prematurely, or the mother's not taking vitamins during pregnancy. The Journal also underscores the public health implications of the new study, observing that about 33% of women of childbearing age in the US are obese.
        Despite the findings, experts who were not involved in the study "were quick to point out that the study merely reported an association; it did not prove that obesity or diabetes contributed to autism," the Los Angeles Times (4/9, Khan) reports. In response, senior study author and epidemiologist Irva Hertz-Picciotto, PhD, of the University of California-Davis, "agreed that it would be 'premature' to say that obesity in mothers caused autism in children. But if future work does back up the findings, she added, 'The good part is, it's modifiable. It can be controlled.'" Also covering the story are the Sacramento Bee (4/9, 1B, Rubenstein), and the CNN (4/9, Wadas-Willingham) "The Chart" blog.
        Pregnancy length associated with autism severity. HealthDay (4/7, Dallas) reported, "Children with autism who were born either prematurely or several weeks late may experience more severe symptoms than kids with autism who were born on time," according to a study published online April 3 in the Journal of Autism and Development Disorders. Researchers arrived at this conclusion examining "after an online database of 4,200 mothers with children with autism," then grouping "the children into one of four categories based on the timing of their birth: very preterm (fewer than 34 weeks' gestation), preterm (34 to 37 weeks), standard (37 to 42 weeks) and post-term (more than 42 weeks)." Obesity Accounts for 21 Percent of U.S. Health Care Costs, Study Finds

ScienceDaily (Apr. 9, 2012) — Obesity now accounts for almost 21 percent of U.S. health care costs -- more than twice the previous estimates, reports a new Cornell University study.

The research, which is the first to show the causal effect of obesity on medical care costs, uses new methods and makes a stronger case for government intervention to prevent obesity, the authors say in the January issue of the Journal of Health Economics.  The study reports that an obese person incurs medical costs that are $2,741 higher (in 2005 dollars) than if they were not obese. Nationwide, that translates into $190.2 billion per year, or 20.6 percent of national health expenditures. Previous estimates had pegged the cost of obesity at $85.7 billion, or 9.1 percent of national health expenditures.

Whether Higher Health Care Spending In The United States Versus Europe Is ‘Worth It’ In The Case Of Cancer.
The United States spends more on health care than other developed countries, but some argue that US patients do not derive sufficient benefit from this extra spending. We studied whether higher US cancer care costs, compared with those of ten European countries, were “worth it” by looking at the survival differences for cancer patients in these countries compared to the relative costs of cancer care. We found that US cancer patients experienced greater survival gains than their European counterparts; even after considering higher US costs, this investment generated $598 billion of additional value for US patients who were diagnosed with cancer between 1983 and 1999. The value of that additional survival gain was highest for prostate cancer patients ($627 billion) and breast cancer patients ($173 billion). These findings do not appear to have been driven solely by earlier diagnosis. Our study suggests that the higher-cost US system of cancer care delivery may be worth it, although further research is required to determine what specific tools or treatments are driving improved cancer survival in the United States.
Philipson T et al. Health Aff 2012;31:667-675


Web-Based Tool Produces Fast, Accurate Autism Diagnosis

Autism is diagnosed through a careful analysis of an individual's behavior. When children are evaluated for autism, they typically take the Autism Diagnostic Interview, Revised, known as the ADI-R, a 93-question questionnaire, and/or the Autism Diagnostic Observation Schedule, known as the ADOS exam, which measures several behaviors in children. Together these evaluations can take up to three hours to complete and must be administered by a trained clinician. Researchers found that only seven questions were sufficient to diagnose autism with nearly 100 percent accuracy, equivalent to the full 93-question exam, near perfect sensitivity and slightly less than 95 percent specificity. Comment: In other words, 5% false positives.

Eliminating Waste in US Health Care.

The need is urgent to bring US health care costs into a sustainable range for both public and private payers. Commonly, programs to contain costs use cuts, such as reductions in payment levels, benefit structures, and eligibility. A less harmful strategy would reduce waste, not value-added care. The opportunity is immense. In just 6 categories of waste—overtreatment, failures of care coordination, failures in execution of care processes, administrative complexity, pricing failures, and fraud and abuse—the sum of the lowest available estimates exceeds 20% of total health care expenditures. The actual total may be far greater. The savings potentially achievable from systematic, comprehensive, and cooperative pursuit of even a fractional reduction in waste are far higher than from more direct and blunter cuts in care and coverage. The potential economic dislocations, however, are severe and require mitigation through careful transition strategies. JAMA. 2012;307(14):1513-1516.

Phthalates Can Lead to Greater Risk for Type-2 Diabetes

An analysis of new information from the so-called PIVUS study, which covers more than 1,000 70-year-old women and men in Uppsala showed that diabetes was more common among participants who were overweight and had high blood lipids. But the researchers also found a connection between blood levels of some of the phthalates and increased prevalence of diabetes. Comment: Another Scandinavian study showing an association but not causation for an environmental chemical. 


Most laboratory cancer studies cannot be replicated, study shows

From an editorial in the BMJ today [BMJ 2012;3BMJ 2012;344] we learn that of 53 “landmark” publications in the literature that Glenn Begley and colleagues attempted to double check, only six could be successfully replicated. A team at Bayer Health Care in Germany last year reported that only about a quarter of the published preclinical studies that they had double checked could be validated. The recognition that not all is well has grown alongside a marked increase in the number of retracted papers. A committee of the US National Academy of Sciences was told last month that the number of retractions had increased 10-fold over the past decade, while scientific publications had risen by 44%.