We Can Reduce US Health Care Costs

The primary reason that the US needs health care reform is that we pay more for health care than any other country in the world; yet our health outcomes are below that of other western nations.(1) Our health outcomes are suboptimal because millions of Americans have limited access to ongoing primary and preventive care because they can't afford our health insurance.

Reducing Administrative Costs

We spend more than a third of our health care dollars on overhead and administration: billing, advertising, profits, and bonuses for health care executives.(2, 3) Administrative costs in countries such as Canada that have a single payer (non-profit national health insurance) are half as much as in the US.(2) If we had a single payer instead of hundreds of insurers with thousands of different plans, we would save 15% of our health care costs. Fifteen per cent of trillions adds up!

A Price Waterhouse Coopers study reported that our complex, fragmented health care delivery system wastes $210 billion per year on unnecessary billing and administrative costs.(4) The ultimate solution to our excessive health care costs is national health insurance: Medicare for all(5); but that won't happen–at least not in the very near future. What can we do to decrease health care costs now?

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-- James E. Dalen, MD, MPH

This article originally appeared in the March 2010 issue of The American Journal of Medicine.

Analgesic Use and the Risk of Hearing Loss in Men

Regular use of aspirin, acetaminophen and nonsteroidal anti-inflammatory drugs, the most commonly used drugs in the US, may increase risk of hearing loss in men.

Abstract
Background
Hearing loss is a common sensory disorder, yet prospective data on potentially modifiable risk factors are limited. Regularly used analgesics, the most commonly used drugs in the US, may be ototoxic and contribute to hearing loss.

Methods
We examined the independent association between self-reported professionally diagnosed hearing loss and regular use of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen in 26,917 men aged 40-74 years at baseline in 1986. Study participants completed detailed questionnaires at baseline and every 2 years thereafter. Incident cases of new-onset hearing loss were defined as those diagnosed after 1986. Cox proportional hazards multivariate regression was used to adjust for potential confounding factors.

Results
During 369,079 person-years of follow-up, 3488 incident cases of hearing loss were reported. Regular use of each analgesic was independently associated with an increased risk of hearing loss. Multivariate-adjusted hazard ratios of hearing loss in regular users (2+ times/week) compared with men who used the specified analgesic <2 times/week were 1.12 (95% confidence interval [CI], 1.04-1.20) for aspirin, 1.21 (95% CI, 1.11-1.33) for NSAIDs, and 1.22 (95% CI, 1.07-1.39) for acetaminophen. For NSAIDs and acetaminophen, the risk increased with longer duration of regular use. The magnitude of the association was substantially higher in younger men. For men younger than age 50 years, the hazard ratio for hearing loss was 1.33 for regular aspirin use, 1.61 for NSAIDs, and 1.99 for acetaminophen.

Conclusions
Regular use of aspirin, NSAIDs, or acetaminophen increases the risk of hearing loss in men, and the impact is larger on younger individuals.

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-- Sharon G. Curhan, MD, ScM, Roland Eavey, MD, Josef Shargorodsky, MD, Gary C. Curhan, MD, ScD

This article originally appeared in the March 2010 issue of The American Journal of Medicine.

A Post-cure Complication

Long-term drug therapy for hepatitis C virus (HCV) infection would prove to have persistent effects—both desirable and undesirable. A 29-year-old woman with chronic hepatitis C, genotype 4, was to embark on a treatment regimen of oral ribavirin, 1000 mg, once daily and subcutaneous injections of pegylated interferon alfa-2b, 80 μg, once a week. At her initial physical examination, she had a body mass index of 26 (25-29 indicates overweight). Laboratory results showed that her alanine transaminase level, at 88 IU/mL, was well above the normal reference value (<31 IU/mL). Her albumin level and prothrombin time were within the normal range. She had no other relevant medical or family history.



In the first month, the patient reported anorexia, asthenia, and a weight loss of 8.8 lb (4 kg). Therapy continued, and just before the 48-week treatment period ended, she developed signs of bilateral lipoatrophy at the interferon injection site on her abdomen (Figure).



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-- Joana Nunes, MD, Rui Tato Marinho, MD, PhD, José Velosa, MD, PhD



This article originally appeared in the March 2010 issue of The American Journal of Medicine.