Workplace Wellness Barrage

On April 16, 2015, several federal agencies released a barrage of regulatory issuances and guidances that further clarify their position on wellness programs.  First, the EEOC released a proposed rule on the application of the Americans with Disabilities Act to Wellness programs.  With the proposed rule, the EEOC released a fact sheet for small businesses and a question and answer set for the general public.

Second, the HHS Office of Civil Rights, which enforces the HIPAA privacy rules, released FAQs on the wellness programs and HIPAA privacy and security.  Third, HHS and the Departments of Labor and Treasury released a set of frequently asked questions on wellness programs.  Fourth, HHS released a separate set of FAQs regarding the relationship between the ACA insurance reforms and wellness programs.

Finally, the Department of Labor released a research report on workplace wellness programs. (Workplace Wellness Programs: Federal Agencies Weigh In. By Timothy Jost. Health Affairs, Apr. 17, 2015.)

http://healthaffairs.org/blog/2015/04/17/workplace-wellness-programs-federal-agencies-weigh-in/

As usual, smokers’ rights concerns are poorly addressed, if not completely trampled, by all. An example is what the departments of HHS, Labor and the Treasury consider to be a “reasonably designed” wellness program. “A program that collects a substantial level of sensitive personal health information without assisting individuals to make behavioral changes such as stopping smoking, managing diabetes, or losing weight, may fail to meet the requirement that the wellness program must have a reasonable chance of improving the health of, or preventing disease in, participating individuals.” But what about the rights of people who don’t want to quit smoking? What about the inherent coercion of so-called “incentives?”

And what about the fact that Workplace Wellness is founded on scientific and economic fraud in the first place? At least the economic nonsense is addressed in the last two paragraphs, summarizing the Department of Labor research report:

The study found that lifestyle management programs did not result in reduced utilization of health care services or reduced cost.  No evidence was found of reduced costs from smoking cessation or pre-disease management programs.  Greater exposure to interventions through telephonic counseling programs increased rather than reduced costs.  Lower cardiovascular events attributable to wellness programs reduced costs, but did not come close to offsetting increased costs of participation.

Wellness programs, in sum, do not reduce health program cost, contrary to the assertions of program vendors and the beliefs of employers.

Padding the Death Toll From Stomach Cancer

Relationship between Tobacco, cagA and vacA i1 Virulence Factors and Bacterial Load in Patients Infected by Helicobacter pylori.
Santibáñez M, Aguirre E, Belda S, Aragones N, Saez J, Rodríguez JC, Galiana A, Sola-Vera J, Ruiz-García M, Paz-Zulueta M, Sarabia-Lavín R, Brotons A, López-Girona E, Pérez E, Sillero C, Royo G.
PLoS One 2015 Mar 20;10(3):e0120444.
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0120444

The academic editor of this paper evidently lacked expertise on the socioeconomics of H. pylori infection, because this group put one over on her. Continue reading

Epstein-Barr virus genetic variants are associated with MS

Neurology. 2015 Mar 4. pii: 10.1212/WNL.0000000000001420. [Epub ahead of print]

Epstein-Barr virus genetic variants are associated with multiple sclerosis.

Mechelli R, Manzari C, Policano C, Annese A, Picardi E, Umeton R, Fornasiero A, D’Erchia AM, Buscarinu MC, Agliardi C, Annibali V, Serafini B, Rosicarelli B, Romano S, Angelini DF, Ricigliano VA, Buttari F, Battistini L, Centonze D, Guerini FR, D’Alfonso S, Pesole G, Salvetti M, Ristori G.
Abstract
OBJECTIVE:
We analyzed the Epstein-Barr nuclear antigen 2 (EBNA2) gene, which contains the most variable region of the viral genome, in persons with multiple sclerosis (MS) and control subjects to verify whether virus genetic variants are involved in disease development.

METHODS:
A seminested PCR approach and Sanger sequencing were used to analyze EBNA2 in 53 patients and 38 matched healthy donors (HDs). High-throughput sequencing by Illumina MiSeq was also applied in a subgroup of donors (17 patients and 17 HDs). Patients underwent gadolinium-enhanced MRI and human leucocyte antigen typing.

RESULTS:
MS risk significantly correlated with an excess of 1.2 allele (odds ratio [OR] = 5.13; 95% confidence interval [CI] 1.84-14.32; p = 0.016) and underrepresentation of 1.3B allele (OR = 0.23; 95% CI 0.08-0.51; p = 0.0006). We identified new genetic variants, mostly 1.2 allele- and MS-associated (especially amino acid variation at position 245; OR = 9.4; 95% CI 1.19-78.72; p = 0.0123). In all cases, the consensus sequence from deep sequencing confirmed Sanger sequencing (including the cosegregation of newly identified variants with known EBNA2 alleles) and showed that the extent of genotype intraindividual variability was higher than expected: rare EBNA2 variants were detected in all HDs and patients with MS (range 1-17 and 3-19, respectively). EBNA2 variants did not seem to correlate with human leucocyte antigen typing or clinical/MRI features.

CONCLUSIONS:
Our study unveils a strong association between Epstein-Barr virus genomic variants and MS, reinforcing the idea that Epstein-Barr virus contributes to disease development.

Mechelli – Neurology 2015 abstract / PubMed


Smokers are more likely to have been infected by EBV, for socioeconomic reasons. But the latest Surgeon General report (2014, Ch. 10, p. 569), which blames smoking for multiple sclerosis, doesn’t even mention EBV! And this reveals how the anti-smokers commit scientific fraud, by cynically exploiting infection to lay false blame on smoking.

EBV Causes Multiple Sclerosis / smokershistory.com

Conflict of Interest Purge at TPSAC

The FDA finally obeyed the District Court ruling of July 21, 2014, to reconstitute the Tobacco Products Scientific Advisory Committee (TPSAC), due to conflicts of interest with pharmaceutical companies. Its chairman, the infamous Jonathan Samet, is gone, along with three others – Claudia Barone, Joanna Cohen, and Suchitra Krishnan-Sarin, all militant anti-smokers, needless to say. Samet is truly the rottenest of the rotten, but my joy at seeing him gone is tempered with regret that it was for the wrong reason. It should have been because his flagrant scientific fraud in the Surgeon General reports, etc., made him unsuitable to occupy any federal position other than a cell in a penitentiary. Continue reading

Rich People Drive Up Antibiotic Use

From “Competition For Wealthy Elites Drives Up Antibiotic Prescription Rates,” by News Staff, Science 2.0, Feb. 25, 2015.

Competition between doctors’ offices, urgent care centers and retail medical clinics that cater to wealthy elites often leads to an increase in the number of antibiotic prescriptions written per person, finds a new analysis.

The number of physicians per capita and the number of clinics are significant drivers of antibiotic prescription rate, they found, with the highest per capita rates of antibiotic prescriptions found in the southeastern U.S. and along the West and East coasts. The team’s comparative analysis of data for the years 2000 and 2010 were collected from the U.S. Census Bureau and the IMS Health Xponent database, which tracks prescriptions dispensed at the ZIP code level. Notably high rates were found in Manhattan, southern Miami and Encino.

The data showed that the presence of retail medical clinics, like those found in chain drug and “super” stores, and of urgent care centers increases the prescribing rate, but the effect was different in wealthy versus poor areas.

In wealthy areas, the presence of clinics correlated to an increase in the prescribing rate of physicians. However, while the presence of retail or urgent care clinics in poorer areas increased access to health care, it did not generate competition among providers that resulted in higher prescribing behavior by physicians’ offices.

The study: Influence of provider and urgent care density across different socioeconomic strata on outpatient antibiotic prescribing in the USA. Klein EY, Makowsky M, Orlando M, Hatna E, Braykov NP, Laxminarayan R. J Antimicrob Chemother 2015 Jan 20 [Epub ahead of print]

We found large geographical variation in prescribing, driven in part by the number of physician offices per capita. For an increase of one standard deviation in the number of physician offices per capita there was a 25.9% increase in prescriptions per capita. However, the determinants of the prescription rate were dependent on socioeconomic conditions. In poorer areas, clinics substitute for traditional physician offices, reducing the impact of physician density. In wealthier areas, clinics increase the effect of physician density on the prescribing rate.

http://www.ncbi.nlm.nih.gov/pubmed/25604743

It also means that the people who are the most likely to benefit from antibiotics, due to higher rates of exposure to pathogens, are also the least likely to receive them.

Global Burden of Helicobacter pylori

Global burden of gastric cancer attributable to Helicobacter pylori.

Int J Cancer 2015 Jan 15;136(2):487-490.

Plummer M1, Franceschi S, Vignat J, Forman D, de Martel C.
Author information
1International Agency for Research on Cancer, Lyon, France.

Abstract
We previously estimated that 660,000 cases of cancer in the year 2008 were attributable to the bacterium Helicobacter pylori (H. pylori), corresponding to 5.2% of the 12.7 million total cancer cases that occurred worldwide. In recent years, evidence has accumulated that immunoblot (western blot) is more sensitive for detection of anti-H. pylori antibodies than ELISA, the detection method used in our previous analysis. The purpose of this short report is to update the attributable fraction (AF) estimate for H. pylori after briefly reviewing new evidence, and to reassess the global burden of cancer attributable to H. pylori. We therefore reviewed the literature for studies comparing the risk of developing non-cardia gastric cancer (NCGC) in cases and controls, using both ELISA and multiple antigen immunoblot for detection of H. pylori. The results from prospective studies were combined, and the new pooled estimates were applied to the calculation of the AF for H. pylori in NCGC, then to the burden of infection-related cancers worldwide. Using the immunoblot-based data, the worldwide AF for H. pylori in NCGC increased from 74.7% to 89.0%. This implies approximately 120,000 additional cases of NCGC attributable to H. pylori infection for a total of around 780,000 cases (6.2% instead of 5.2% of all cancers). These updated estimates reinforce the role of H. pylori as a major cause of cancer.

KEYWORDS:
Helicobacter pylori; attributable fraction; gastric cancer; immunoblot

http://www.ncbi.nlm.nih.gov/pubmed/24889903


 

The Prevalence of Helicobacter pylori Remains High in African American and Hispanic Veterans.

Helicobacter. 2015 Feb 17. doi: 10.1111/hel.12199. [Epub ahead of print]

Nguyen T1, Ramsey D, Graham D, Shaib Y, Shiota S, Velez M, Cole R, Anand B, Vela M, El-Serag HB.
Author information
1Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA; Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Abstract
BACKGROUND:
Helicobacter pylori in the United States has been declining in the 1990s albeit less so among blacks and Hispanics. As the socioeconomic status of racial groups has evolved, it remains unclear whether the prevalence or the racial and ethnic disparities in the prevalence of H. pylori have changed.

METHODS:
This is a cross-sectional study from a Veteran Affairs center among patients aged 40-80 years old who underwent a study esophagogastroduodenoscopy with gastric biopsies, which were cultured for H. pylori irrespective of findings on histopathology. Positive H. pylori was defined as positive culture or histopathology (stained organism combined with active gastritis). We calculated age-, race-, and birth cohort-specific H. pylori prevalence rates and examined predictors of H. pylori infection in logistic regression models.

RESULTS:
We analyzed data on 1200 patients; most (92.8%) were men and non-Hispanic white (59.9%) or black (28.9%). H. pylori was positive in 347 (28.9%) and was highest among black males aged 50-59 (53.3%; 44.0-62.4%), followed by Hispanic males aged 60-69 (48.1%; 34.2-62.2%), and lowest in non-Hispanic white males aged 40-49 (8.2%; 2.7-20.5%). In multivariate analysis, age group 50-59 was significantly associated with H. pylori (adjusted odds ratio (OR), 2.32; 95% confidence interval (CI), 1.21-4.45) compared with those aged 40-49, and with black race (adjusted OR, 2.57; 95% CI, 1.83-3.60) and Hispanic ethnicity (adjusted OR, 3.01; 95% CI, 1.70-5.34) compared with non-Hispanic white. Irrespective of age group, patients born during 1960-1969 had a lower risk of H. pylori (adjusted OR, 0.45; 95% CI, 0.22-0.96) compared to those born in 1930-1939. Those with some college education were less likely to have H. pylori compared to those with no college education (adjusted OR 0.51; 95% CI, 0.37-0.69).

CONCLUSION:
Among veterans, the prevalence of active H. pylori remains high (28.9%) with even higher rates in blacks and Hispanics with lower education levels.

KEYWORDS:
Helicobacter pylori ; age group; birth cohort; race; socioeconomic status

http://www.ncbi.nlm.nih.gov/pubmed/25689684


Anti-smokers exploit the fact that smokers are more likely, for socioeconomic reasons, to have been infected by H. pylori to falsely blame smoking for stomach cancer.

Helicobacter pylori causes ulcers and stomach cancer

Other gastric carcinomas are caused by Epstein-Barr virus, which comprises the largest number of EBV-related cancers. Like H. pylori, EBV infection is more common among less-wealthy people.

Epstein-Barr Virus Causes Gastric Carcinoma

CMV, Influenza and B Cells

Cytomegalovirus (CMV) seropositivity decreases B cell responses to the influenza vaccine.

Vaccine. 2015 Feb 7. pii: S0264-410X(15)00128-0. doi: 10.1016/j.vaccine.2015.01.071. [Epub ahead of print]

Frasca D1, Diaz A2, Romero M2, Landin AM2, Blomberg BB2
Author information
1Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL 33101, USA. Electronic address: dfrasca@med.miami.edu.
2Department of Microbiology and Immunology, University of Miami Miller School of  Medicine, Miami, FL 33101, USA.
Abstract
Cytomegalovirus (CMV)-seropositivity has been shown to have a negative effect on influenza vaccine-specific antibody responses. In this paper, we confirm and extend these results showing for the first time, a negative association between CMV-seropositivity and B cell predictive biomarkers of optimal vaccine responses. These biomarkers are switched memory B cells and AID in CpG-stimulated B cell cultures measured before vaccination which positively correlate with the serum response to the influenza vaccine. We also found that CMV-seropositivity is associated with increased levels of B cell-intrinsic inflammation and these both correlate with lower B cell function. Finally, CMV-seropositivity is associated with decreased percentages of individuals responding to the vaccine in both young and elderly individuals.

KEYWORDS:
Aging; B cell biomarkers; CMV; Influenza vaccine
PMID: 25659271 [PubMed – as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/25659271

Highlights
• Influenza vaccination is less effective in CMV-seropositive individuals.
• B cell biomarkers of optimal vaccine responses are reduced by CMV-seropositivity.
• CMV-seropositivity is associated with increased intrinsic inflammation in B cells.


This study is important because anti-smokers claim that smokers are more likely to get flu. But their studies always ignore the role of infection, so they’re exploiting the circumstance that smokers are more likely to have been exposed to CMV, for socioeconomic reasons. In studies that don’t find a difference between smokers and non-smokers, this is presumably because smokers and non-smokers had similar rates of CMV infection. Many studies have shown that cytomegalovirus impairs immunity to influenza.

http://www.smokershistory.com/influenza.html#CMV