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Hunger in America, supplements quality, and subsidized foods

If you're interested in reading a current systematic evidence review on vitamin and mineral supplements, you may wish to check out the review of fair and good quality randomized trials and studies of vitamin and mineral supplements, since Americans spend an estimated $11.8 billion each year on vitamin and mineral supplements, according to the study, "Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: An updated systematic evidence review for the U.S. Preventive Services Task Force," published in the Annals of Internal Medicine, December 17, 2013.

 Hunger in America, supplements quality, and subsidized foods.
Anne Hart, photography. Backyard squash patch.

You may wish to check out this systematic review of fair and good quality randomized trials and observational studies of vitamin and mineral supplements either alone or in combination in adults without known nutritional deficiencies. You can download the PDF article here. Authors are Fortmann SP, Burda BU, Senger CA, Lin JS, and Whitlock EP.

The article basically informs readers that vitamin and mineral supplements have not been shown to reduce cardiovascular disease or mortality in older adults without known nutritional deficiencies. A multivitamin supplement was associated with a small reduction in the incidence of cancer, but without a mortality benefit, and in men only. B-carotene supplementation is associated with an increased risk of lung cancer and a possible small increase in all-cause mortality in people with substantial exposure to cigarette smoke or inhaled asbestos.

On the other hand, you have magazines that give the results of studies on vitamins, minerals, and other plant extracts as supplements that have had different results. These magazines also carry ads marketing various supplements that are related to the studies. For example, take a look at one of the Life Extension Magazine articles, "‎A Hidden Cause Of Brain Aging."

The Life Extension Magazine article provides a partial listing of some nutraceutical supplements that can be helpful in reducing risk factors, thereby potentially slowing the progression of leukoaraiosis. You also may wish to see, "Vitamin, Mineral, and Multivitamin Supplements for the Primary Prevention of Cardiovascular Disease and Cancer," from the U.S. Preventive Services Task Force.

You'll find on the topic page a summary of the U.S. Preventive Services Task Force (USPSTF) recommendations on vitamin, mineral, and multivitamin supplementation to prevent cardiovascular disease and cancer. You also may check out the PDF file format articles, "Recommendation Statement." Or see, "Evidence Report." At the website, there's also the Consumer Fact Sheet, Clinical Summary, and Evidence Synthesis.

Conclusions sometimes are different because some publications represent the medical profession where prescriptions are written for drugs, whereas the vitamin and mineral manufacturers are making supplements to replace deficiencies in the diet

Take affordable, neighborhood budget type food, for example. Junk food as defined by some as processed foods using lots of salt, sugar, bleached white wheat flour, GMO grains, or fats, may be subsidized by the government. You're not going to find expensive loaves of bread made with sprouted grains, figs, and flax, for example that are subsidized. So those types of foods cost more and are usually found in natural food markets or natural food aisles. The foods that are subsidized may be cheaper on the shelf to buy for a low-income hungry family than fresh produce. If you're going to feed your family on a tight budget, the cheap burger from the fast-food eatery can fill up more stomachs than one large vegetable at some markets.

So you'll find lots of cheap foods that uses GMO wheat, corn, soy, or other grains such as commercial cookies, chips, crisps, and soda. On the other hand, organic apples, grapes, and other fruit are more expensive because they're not subsidized and usually come from small organic farms. What is subsidized are the largest of the industrial food manufacturers featuring GMO wheat, corn, and soy, for example. Sometimes, the consumer is listened to and influences big food manufacturing, such as when certain unsweetened cereals remove GMO products from their processed foods, based on customer 'demand.'

Chips and soda are cheaper on the food market shelf compared to a head of broccoli or a pound of organic cherries, not contaminated with all types of pesticides. See, "A Place at the Table (2012) - IMDb." Millions in the USA are going hungry daily. Fifty million people in the U.S.—one in four children—don't know where their next meal is coming from, despite our having the means to provide food to be sent everywhere else, as needed, says a review of that film, sometimes shown as a documentary video on television. In Sacramento, the documentary aired the morning of July 1, 2014 on channel 197 (Pivot) Dish Network.

The 'smarter' the food, often the more expensive it turns out to be on the market shelf or produce counter. But you really can't publicly say any given food is bad for you, unless the particular food has been recalled with a specific date and lot number. Otherwise you run a chance of being sued by the manufacturers of that type of food. See, "Talk of the Town: Burgers v. Oprah - New York Times," and "Judge dismisses lingering beef lawsuit against Oprah Winfrey." You need to think before you ask whether there's free speech concerning any food you don't like.

Then again you can say what food you do prefer and why. You may wish to see the article, "10 Food Service Lawsuits That Have Played Out in the Public Eye." You also may wish to take a look at "Provider and Patient Expectations for Dietary Supplement Discussions."

Unnecessary blood testing study

Efforts to cut unnecessary blood testing bring major decreases in health care spending, say researchers at Johns Hopkins Bayview Medical Center, according to a new study, "Reducing Excess Cardiac Biomarker Testing at an Academic Medical Center," published online June 28, 2014 in the Journal of General Internal Medicine.

The scientists used two relatively simple tactics to significantly reduce the number of unnecessary blood tests to assess symptoms of heart attack and chest pain and to achieve a large decrease in patient charges. The team provided information and education to physicians about proven testing guidelines and made changes to the computerized provider order entry system at the medical center, part of the Johns Hopkins Health System.

The guidelines call for more limited use of blood tests for so-called cardiac biomarkers. A year after implementation, the guidelines saved the medical center an estimated $1.25 million in laboratory charges.

In this case, part of the focus was on tests to assess levels of troponin, a protein whose components increase in the blood when heart muscle is damaged

Frequently, troponin tests are repeated four or more times in a 24-hour period, which studies have suggested is excessive, and they are often done along with tests for other biomarkers that are redundant. In the report published June 28, 2014 in the Journal of General Internal Medicine, the research team describes how these interventions reduced overuse of troponin and other biomarker testing without compromising patient care. If adopted widely, the team says, cost savings could be substantial.

"This study has broader implications for the health care system, as most hospitals continue to redundantly test people for chest pain and other symptoms," says report author Jeffrey C. Trost, M.D., according to the July 1, 2014 news release, "Efforts to cut unnecessary blood testing bring major decreases in health care spending." Trost is an assistant professor of medicine, director of the cardiac catheterization laboratory and co-director of interventional cardiology at Johns Hopkins Bayview Medical Center. "Implementing our interventions could save patients and society a significant amount of money, potentially several billion dollars."

For the study, the Johns Hopkins team set out to lower the rate at which doctors order cardiac biomarker testing for the diagnosis of acute coronary syndrome by basing the desired rate on scientific evidence

In 2010, the researchers report, more than 17 million patients with chest pain visiting an emergency department in the United States received cardiac biomarker testing.

Between August and October 2011 at Johns Hopkins Bayview Medical Center, the team introduced written institutional guideline and changes to the computerized provider order entry system designed to reduce redundant testing.

The new guidelines suggest ordering troponin alone, without creatine kinase or creatine kinase-MB, for patients suspected to have acute coronary syndrome

It specifies that troponin should be assessed no more than three times over 18 to 24 hours. Internists and emergency department doctors attended informational sessions to learn the guidelines, and all received quick reference cards summarizing them.

In the computerized provider order entry system, orders for creatine kinase and creatine kinase-MB were removed from all standardized order sets. Troponin orders were removed from all order sets, except two that are used for evaluating new acute coronary syndrome symptoms. A pop-up warning alerted providers when a troponin test was ordered sooner than six hours after a previous one, or when a provider attempted to order creatine kinase or creatine kinase-MB at the same time.

Twelve months after the interventions, doctors' use of the new guidelines increased from 57.1 percent to 95.5 percent and led to a 66 percent decrease in the absolute number of tests ordered. Also, there was a small but statistically significant increase in the primary or secondary diagnosis of acute coronary syndrome after the intervention period.

Lead author Marc R. Larochelle, M.D., an internal medicine resident at Johns Hopkins Bayview Medical Center during the study and now a fellow in general medicine at Harvard Medical School, says, according to the news release that, "Through review of available evidence and reflection on our own practice, I believe we can proactively identify many practices that may be unnecessary and wasteful. We have demonstrated proof of concept that doctors can be leaders in delivering improved value for our patients and health care systems."

Larochelle and Trost believe that provider education and changes to the ordering system were effective in aligning physician ordering behavior with evidence-based guidelines and reducing wasteful health care spending.

Other authors of the report are Amy M. Knight, M.D., Hardin Pantle, M.D., and Stefan Riedel, M.D., Ph.D., from Johns Hopkins Bayview Medical Center. This work was supported by a Putting the Charter Into Practice Grant from the American Board of Internal Medicine Foundation. Larochelle's work was supported by the Health Resources and Services Administration (T32 HP10251, T32 HP12706), the Ryoichi Sasakawa Young Leaders Fellowship Fund and the Harvard Pilgrim Health Care Institute.

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