Non-coding RNAs include a class of molecules called microRNAs (miRNAs or miRs). MicroRNAs are highly expressed in normal tissues and are being found to have critical roles in gene regulatory processes during cellular development and differentiation. MicroRNAs are small ncRNAs ~21-nucleotides long that regulate gene expression at the post-transcriptional level. MicroRNAs function by binding target mRNA molecules and either inhibiting translation into protein or targeting them for degradation. Abnormal microRNA expression has been linked to many human diseases, including schizophrenia, autism and cancer.

Click for a larger image

MicroRNAs (miRNAs) are transcribed from DNA to produce a stem-loop structure containing a primary transcript called a pri-miRNA that ranges in size from hundreds of nucleotides to tens of kilobases. In the nucleus, pri-miRNAs are processed to shorter ~70 nucleotide hairpin precursor miRNAs known as pre-miRNAs by a multiprotein complex called the Microprocessor complex, which consist of the core components Drosha, an RNase III enzyme, and Pasah, a double-stranded RNA binding protein. The pre-miRNA is transported to the cytoplasm and processed by another RNase III enzyme, Dicer, to produce mature ~22-nucleotide miRNA:miRNA duplexes. A ribonucleoprotein complex called miRSC is then assembled with one strand of the miRNA duplex called the guide strand (purple in figure). Depending upon partial or exact complementarity to messenger RNA, miRISC mediates inhibition of translation or messenger RNA degradation [3].

MicroRNAs represent exciting cutting-edge biomarkers for present and future clinical use that are actively being investigated. Currently, there are three commercially available molecular diagnostic tests for cancer based on microRNAs, all from Rosetta Genomics. In addition, microRNAs have potential application as prognostic indicators and therapeutic targets.

For more information on microRNAs, see:

• miRNA Blog
• You’d Prefer An Argonaute

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References

1. Identification and analysis of functional elements in 1% of the human genome by the ENCODE pilot project. ENCODE Project Consortium. Nature. 2007 Jun 14;447(7146):799-816.
   View abstract
2. Structured RNAs in the ENCODE selected regions of the human genome. Washietl et al. Genome Res. 2007 Jun;17(6):852-64.
   View abstract
3. Mechanisms of post-transcriptional regulation by microRNAs: are the answers in sight? Filipowicz et al. Nat Rev Genet. 2008 Feb;9(2):102-14.
   View abstract

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Heart disease is the leading killer in the U.S. and throughout most of Europe. People’s behaviour can protect and reduce risk of heart disease, and interventions to help people “self-manage” exist. But what is the best way to “self-manage”? A recent study shows that group programmes and self-directed programmes have remarkably different effects [1].

Self-management interventions exist for many health problems. They are notoriously difficult to define. One thorough definition is that it relates to activities undertaken by the person who has a “chronic” or “long-term” condition such as asthma, multiple sclerosis or arthritis. These activities include problem solving, decision making, resource utilization, the formation of a patient-provider partnership, action planning and self tailoring [2]. Interventions or programmes are designed around these activities to help support people to manage their own illness. The idea is that following attendance at a programme of some sort, the activities and skills learned will be continued to be used, thus improving health, maintaining fitness and/or quality of life and reducing the risk of future acute episodes of ill health. These interventions are popular for many reasons, including the relatively low cost to health service providers as interventions can be delivered by health-care professionals or by people with the relevant condition who have been trained, or a mixture of both. Self-management interventions also allow people with long-term conditions to be meet in a group with people with similar conditions. The experience of being in a group, knowing one is not alone and sharing stories is thought to play some part in the effectiveness of self-management interventions. But to what extent is this true?

Researchers at the University of Michigan explored the effect of the format of a self-management intervention for women with heart disease by comparing a “self-directed” programme to a “group” programme to a control group [1]. In the “self-directed” version, there was a single session with health educator followed by completing programme at home. The “group” programme consisted of 6 – 8 women meeting for around 2 hours once a week for six weeks. In the control condition, no intervention was presented. The aim was to investigate which intervention would most usefully effect symptom experience, health status and weight. To make the comparison of the “self-directed” and “group” interventions more equitable, the “self-directed” version included videos of group discussions to emulate the motivation and support that would be given in the “group” programme. Further, to ensure information was provided to all, the “self-directed” group also received telephone calls from a health educator.

The results revealed a remarkable difference. Eighteen months after the intervention, data were collected. For the “self-directed” intervention, cardiac symptoms such as chest pain and dizziness were reduced in number, frequency and impact. For the “group” intervention, weight loss and exercise capacity (in terms of how far a person can walk within a set time) were improved. This is despite the fact that the information and instructions provided in both programmes were the same.

So does this mean we should all join groups if we want to lose weight and exercise more but stay at home if we want to feel fewer symptoms? Not necessarily. This study, like all studies, has several limitations. Obviously, the women in the “self-directed” group were not observed, so we do not know to what extent they followed the intervention they were given. A diary record of what the women did could have been included in this study, but even that may not be an accurate picture of how well the intervention was followed. Another issue is that the women in the “group” may have experience a higher “dose” of the intervention - that is to say the they attended a meeting for approximately 2 hours per week, receiving a two hour “dose”. We do not know how much time the women in the “self-directed” intervention spent on their activities. Further, this study included a sample only of women who were white and high school educated. Therefore, we cannot say whether the same effect would be observed outside of this group of people. It would be interesting to see this issue investigated with other demographics, including men (who may be less amenable to group processes), different ethnic groups and educational levels.

What the results do suggest however is that being in a group may facilitate exercise and weight loss improvement for women with heart disease. But we still do not know how this occurs. A common problem in behavioural interventions, including self-management interventions, is that we simply do not know which bit of the intervention is working. The study suggests that the “group” part of the intervention is affecting how the intervention works. However, we do not know why. Is peer pressure a factor? Would these results be the same if we looked at people in relation to personality type? Would a shy, introverted sample show the same results?

There are many self-management interventions available today, in terms of both health service packages, “self-help” books and DVDs, information from health care professionals, charity groups and community organisations. Our health and its care is now a collaborative endeavour in which we are involved actively and with responsibility. Self-management is increasingly included in health policies. Researching and understanding whether such interventions work, which components work, what “dose” is needed and who they work for, is vital to our future health.

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References

1. Clark et al. Heart disease management by women: does intervention format matter? Health Educ Behav. 2009 Apr;36(2):394-409. Epub 2007 Dec 15.
   DOI: 10.1177/1090198107309458
   View abstract
2. Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003 Aug;26(1):1-7.
   View abstract

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Faith is a PhD-trained research psychologist in health behaviors and is currently involved in studies at the Applied Research Centre for Health and Lifestyle Interventions at Coventry University. Her research interests include quality of life measurement, promotion of self-management, intervention development and cross-cultural psychology.

She brings to Highlight HEALTH a keen interest in quality of life measurement, general health self-management and HIV research.

You can follow Faith on Twitter @Fam6. You can also follow us via the Highlight HEALTH Twitter account @HighlightHEALTH.

Welcome Faith!

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By way of comparison, the Center for Scientific Review (CSR) reviewed 27,360 Research Project Grants (R01s) and 9,483 Exploratory/Developmental Research Grants (R21s) for the entire year of 2008 [2]. Over the next few months, the CSR will check the submitted Challenge Grant applications for compliance and then review them in a two-phase process. Reviewers with expertise in the specific Challenge Areas (listed below) will do the first phase reviews, followed by a study section comprised of researchers who will focus on each application’s overall significance and impact. The earliest anticipated start date for those grants funded is September 30th, 2009.

The new program will support research on a range of Challenge Areas that focus on specific knowledge gaps, scientific opportunities, new technologies, data generation or research methods that would benefit from a rush of funds to quickly advance the area in significant ways. The areas include:

• Behavior, Behavioral Change, and Prevention
• Bioethics
• Biomarker Discovery and Validation
• Clinical Research
• Comparative Effectiveness Research (CER)
• Enabling Technologies
• Enhancing Clinical Trials
• Genomics
• Health Disparities
• Information Technology for Processing Health Care Data
• Regenerative Medicine
• Science, Technology, Engineering and Mathematics Education (STEM)
• Smart Biomaterials - Theranostics
• Stem Cells
• Translational Science

Acting NIH Director Raynard S. Kington, M.D., Ph.D. said [1]:

These are exciting times for biomedical research and NIH. We issued the Challenge Grant Request for Applications and received the largest response in our history from the scientific community, both in terms of applications and assistance with the peer review process. Through the Challenge Grants, NIH will invest in targeted research of the highest quality that will impact both economic growth and human health.

However, the unprecedented number of applications is putting a huge strain on the peer review process at the NIH. Some suggest that the influx of applications will “overwhelm the NIH’s capacity to conduct adequate, high-quality reviews” [3]. What’s more, with a paltry funding rate of ~1% compared to the ~20% for regular NIH grants, unfunded Challenge Grants are likely to be resubmitted as Research Project Grants (R01s) later this year. NIH peer-review advisory committee officials predict that the increased number of R01 grants will significantly reduce the percentage of fundable applications in the fall [4]. This “ripple effect” may negatively impact paylines - the percentage of fundable grant applications - for sometime.

What’s more, the recently announced U.S. FY2010 budget increases NIH funding by a meager 1.5% - about $442 million - over the 2009 budget, excluding the $10.4 billion received this year in stimulus spending [5]. This continues a trend of flat or below-inflation funding for the NIH since 2003. Health and Human Services Secretary Kathleen Sebelius claims that since the NIH received $10.4 billion from the Recovery Act this year, they won’t need “additional resources” in 2010 [6].

This story is far from over. Yesterday, Senator Arlen Specter chastised Sebelius at a Senate subcommittee hearing regarding the scant increase in NIH funding for next year, saying [7]:

I would urge you to take another look at that figure. [...] The 10 billion dollars, which was added in the stimulus package, has created an enormous wave of excitement of young people. We are in jeopardy of losing a generation of young research scientists and I think we have to maintain the growth rate. We talk about cutting down the costs of healthcare. What better way on the cost factor than to prevent illness. [...] The stimulus package and that $10 billion ought not to be looked at for the regular funding - that is extra. It was designed to create 70,000 new jobs for the two year period with a specific target that the President asked for and that the Congress responded in an affirmative way. [...] We were looking for that to stimulate the economy and for jobs. I couldn’t tell you line-by-line on all the other measured items but I believe that is was not a generalization that the stimulus would be used in place of future year’s funding. We’d like to maintain NIH funding on its own.

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References

1. NIH Receives 20,000 Applications for Challenge Grants Through the Recovery Act. U.S. Department of Health and Human Services, NIH News. 2009 Jun 8.
2. Challenges Continue to Mount at NIH. Medical Writing, Editing & Grantsmanship. 2009 May 5.
3. Breakthrough science can’t be rushed. Boston Globe. 2009 May 15.
4. Grant applications swamp agency. Nature News. 2009 June 9.
5. Science scores in 2010 US budget. The Scientist. 2009 May 7.
6. Flush with recovery money, NIH gets flat budget. ScienceInsider. 2009 May 7.
7. Senate Appropriations Subcmte. Hearing with HHS Sec. Sebelius. C-Span. 2009 Jun 9.

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The innovative campaign to bring attention to research is the brainchild of Meryl Comer, president of the Geoffrey Beene Gives Back Alzheimer’s Initiative, a philanthropic wing of the Geoffrey Beene menswear label, which donates all its net profits to support medical and educational research and outreach. Rock Stars of Science launched with a 6-page photo spread in the June issue of GQ Magazine, the popular men’s fashion magazine.

The print ad campaign is supported by the website www.rockstarsofscience.org, which will include behind-the-sciences videos and profile the scientists, their teams and research institutions. Readers will also be able to nominate their own Rock Stars of Science and sign a declaration calling for more funding in science research.

Rock Stars of Science features some of the nation’s leading biomedical researchers in areas like cancer, HIV-AIDS, heart disease, alzheimer’s disease, genetics and personalized medicine. Scientists in the multi-page sponsored promotion include:

• Francis S. Collins, M.D., Ph.D., former Director of the National Human Genome Research Institute and likely the next head of the National Institutes of Health
• Anthony S. Fauci, M.D., Director of the National Institute of Allergies and Infectious Diseases
• Jeffrey Cummings, M.D., Neurologist at the University of California, Los Angeles
• Dale Schenk, Ph.D., Chief Scientific Officer at Elan Pharmaceuticals
• Eric J. Topol, M.D., Cardiologist at Scripps Translational Science Institution
• Harold Varmus, M.D., President of the Memorial Sloan-Kettering Cancer Center
• Ron Peterson, M.D., Ph.D., Professor at Mayo Clinic
• David B. Agus, M.D., Professor at Keck School of Medicine, University of Southern California
• Rudi Tanzi, Ph.D., Professor at Harvard Medical School
• Steven DeKosky, M.D., Dean of the University of Virginia School of Medicine
• Sam Gandy, M.D., Ph.D., Professor at Mount Sinai Alzheimer’s Disease Research Center

Geoffrey Beene sells strictly men’s clothing, so only male scientists were photographed for the campaign. Meryl Comer said that she hopes to photograph women for the “next round” of the campaign.

Rock Stars of Science was inspired by a public opinion survey conducted last year that found that nearly half of Americans couldn’t name Albert Einstein, Stephen Hawking or any other current scientist as a science role model for today’s youth [2]. Only 4% could name a living scientist such as Hawking or Bill Nye. The survey, done on behalf of Chicago’s Museum of Science and Industry and endorsed by the national organization, Research!America, found that the Public Loves Science But Ignores the Scientist. Indeed, 87% of U.S. adults agree they personally benefit from science every day. But when it comes to grasping science concepts, most admit they’re not sure they get it. Only one in four respondents feel they have a good understanding of science. Even worse, Americans are not impressed with how seriously America is taking science and the education children are receiving in science. In fact, 70% of Americans believe that America is not currently the world leader in science. Almost all U.S. adults agree that this is a detriment to our nation – 96% say it is important for the U.S. to be a leader in science education.

More about the survey “The State of Science in America”, including a fact sheet and methodology, can be found at www.stateofscience.org.

According to Dr. Francis S. Collins [1]:

Scientists like to tell ourselves that we are too busy to worry about image. But the reality is that our work only has a chance of making a difference if we build a much broader base of popular support for medical research than currently exists in this country. That has to include more public pressure for congressional funding of research and more commitment to developing scientific leadership for the next century.

Being a rock star is about the same amps, thunder, and art it’s always been, but these days a rock star can be anyone whose genius moves the crowd – whether they’re onstage or in the lab.

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References

1. will.i.am, Sheryl Crow, Seal, Joe Perry and Josh Grobin Shine a Spotlight on the Top Rock Stars of Science in GQ’s Campaign for Geoffrey Beene Gives Back. QQConnects.com press release. 2009 May 25
2. Einstein may outrank Britney Spears but survey shows science education needs help in United States. Museum of Science and Industry, 2008 Mar 20.

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High blood pressure or hypertension affects more than one in three people worldwide and is a major cause of strokes, heart attacks and heart failure [1]. The degree with which blood pressure traits can be inherited suggests a genetic component. However, limited consistent evidence of genes associated with blood pressure have been produced. A new study in the journal Nature Genetics reports for the first time a number of genes showing significant associations with blood pressure and hypertension across the genome [2].

Although large-scale genome-wide association studies (GWAS) have been used successfully to identify genes associated with common diseases and traits, studies on blood pressure or hypertension have failed to identify loci at a genome-wide significant threshold (p-value < 5 x 10^-8). The significance of GWAS data relies on several variables, including the accuracy of phenotypic measures, density of markers and size of the study population. Thus, if blood pressure variation in the general population is due to multiple genetic factors with small effects, a very large sample size is needed to identify them.

Researchers at the Johns Hopkins University School of Medicine, along with an international team of collaborators, established the Cohorts for Heart and Aging Research in Genome Epidemiology (CHARGE) Consortium to address the need for a very large sample size. The CHARGE Consortium was formed to “facilitate genome-wide association study meta-analyses and replication opportunities among multiple large and well-phenotyped longitudinal cohort studies.” In other words, they’re combining data from a number of large GWAS studies that collect data in a standardized fashion to perform a “study of studies”. The Consortium consists of almost 30,000 people of European descent whose average systolic blood pressure (meaning the blood pressure when the heart is contracting) ranged from 118 mm Hg to 143 mm Hg and average diastolic blood pressure (meaning the blood pressure when the heart relaxes between beats) ranged from 72 mm Hg to 83 mm Hg.

Using data from the CHARGE Consortium, scientists report that they have identified a number of single nucleotide polymorphisms (SNPs) for blood pressure and hypertension that just missed the significance threshold for GWAS.

The top ten CHARGE SNPs for systolic blood pressure, diastolic blood pressure and hypertension were then included in a joint meta-analysis with the Global Blood Pressure Genetics (Global BPgen) Consortium consisting of another 34,000 people of European ancestry published in the same issue of the journal Nature Genetics [4]. Eleven CHARGE genes showed significant associations across the genome, attaining genome-wide significance (p-value < 5 x 10^-8).

Four CHARGE loci attained genome-wide significance for systolic blood pressure:

• ATPase, Ca(2+)-transporting, Plasma membrane (ATP2B1)
• Cytochrome P450, Family 17, Subfamily A, Polypeptide 1 (CYP17A1)
• Pleckstrin homology domain-containing protein, Family A, Member 7 (PLEKHA7)
• SH2B adaptor protein 3 (SH2B3)

Six CHARGE loci attained genome-wide significance for diastolic blood pressure:

• ATPase, Ca(2+)-transporting, Plasma membrane (ATP2B1)
• Calcium channel, Voltage-dependent, Beta-2 subunit (CACNB2)
• Cytoplasmic tyrosine kinase (CSK) – Unc51-like kinase 3 (ULK3)
• SH2B adaptor protein 3 (SH2B3)
• T-Box 3 (TBX3) – T-Box 5 (TBX5)
• Unc51-like kinase 4 (ULK4)

One CHARGE loci attained genome-wide significance for hypertension:

• ATPase, Ca(2+)-transporting, Plasma membrane (ATP2B1)

According to Dr. Aravinda Chakravarti, Ph.D., head of the Center for Complex Disease Genomics in the McKusick-Nathans Institute of Genetic Medicine at Hopkins [3]:

Strikingly, none of the genes we identified as having common variation are part of the system we know about that regulates blood pressure – the genes identified are not the ones targeted by current prescription drugs to control hypertension. If we can increase the number of genes implicated in blood pressure maintenance from the current 12 to the expected 50 in the next year, our understanding of the biology will change completely.

One gene in particular, ATP2B1 was linked to all three traits: systolic blood pressure, diastolic blood pressure and hypertension. The gene ATP2B1 encodes a plasma membrane protein that pumps calcium out of cells that line the vascular endothelium – the thin layer of cells that line the inside of blood vessels. A high concentration of intracellular calcium causes endothelial cells to contract, constricting the blood vessel and reducing flow. This is why calcium channel blockers are frequently prescribed to lower blood pressure. Thus, it’s not surprising to find a calcium-specific protein pump in the list of genes associated with blood pressure and hypertension.

SH2B adaptor protein 3 (SH2B3) was associated with both systolic and diastolic blood pressure. The SH2B3 gene encodes a protein that mediates the interaction between extracellular receptors and intracellular signaling pathways. In addition, there is evidence that SH2B3 is involved in controlling adaptive immune responses. SH2B also regulates proliferation of several hematopoietic cell lineages (meaning blood cells).

Prevention

Consistently elevated blood pressure increases the risk of stroke, heart attack and kidney failure, among other conditions. Although genetics affects blood pressure, the environment – diet, physical activity, stress – also play a substantial role. You can take steps to prevent high blood pressure by adopting a healthy lifestyle. These steps include:

• Maintaining a healthy weight
• Being physically active
• Eating healthy (fruits, vegetables and lowfat dairy foods)
• Reducing salt and sodium in your diet
• If you drink alcohol, drink in moderation
• Quitting smoking

You can find more information on “high blood pressure” and “hypertension”, as well as advice and support, at iMedix.

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References

1. High Blood Pressure. The American Heart Association. Accessed 2009 May 25.
2. Levy et al. Genome-wide association study of blood pressure and hypertension. Nat Genet. 2009 May 10. [Epub ahead of print] DOI: 10.1038/ng.384
   View abstract
3. New genes implicated in high blood pressure. Johns Hopkins Medicine press release. 2009 May 10.
4. Newton-Cheh et al. Genome-wide association study identifies eight loci associated with blood pressure. Nat Genet. 2009 May 10. [Epub ahead of print]
   View abstract

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The Institute of Medicine Roundtable on Evidence-Based Medicine brings together leaders from key healthcare sectors to accelerate the collaborative work necessary to drive improvements in the effectiveness and efficiency of medical care. According to a Roundtable issue brief published earlier this year [2]:

While the U.S. has the highest per capita spending on health care of any industrialized nation, health outcomes lag those achieved elsewhere. The increasing costs of care are reducing access to care and constitute an ever heavier burden on employers and consumers. To address both the costs and the performance of the health care system, greater consensus will be required on what constitutes value in health care, and how to measure and increase that value.

Indeed, value is a relative term – what’s valuable to me may not be valuable to you. With policymakers looking to overhaul the U.S. healthcare system, one way to quantify and compare the value of health programs, products and services is to ask consumers and taxpayers.

In the medical and healthcare industry, the U.S. government has assigned standard industry classification (SIC) codes to 27 programs, products and services for measuring economic activity in various sectors of the economy. The Spectrum Health Value Study, a national, online survey to ask Americans what they value when it comes to medical and healthcare products and services, is using those 27 SIC codes to identify the relative importance of each program, product or service. Additionally, the study aims to gain a better understanding of consumer use of each product and/or service, and to identify key segments of healthcare consumers.

Each quarter, beginning in January 2009, Spectrum, a Washington DC-based public relations and public affairs firm, will interview 1,000 repondents and ask them to identify from the 27 healthcare products, programs and services tested those ever used and how satisfied or not satisfied they were each. The results can be used to identify what Americans value in healthcare programs, products and services, and how the value changes over time.

Second quarter 2009 results

During the first two quarters of 2009, 2,025 respondents were interviewed. Half the respondents were men and half were women; half were married; 15% were African-American and 73% were White; 27% were aged 18 – 34, 41% were aged 35 – 54 and 33% were over the age of 55. The mean household income was $51,600. Sixty-one percent suffered from a health condition in the past year, and 78% of all respondents had insurance coverage.

The study found that four services: prescription drugs, over the counter drugs, dentist services and physician services have ‘ever been used’ by the vast majority of people; these are also the four services most commonly ‘used regularly’. Surgical services, over the counter drugs, dentist services, physician services, diagnostic laboratory services, prescription drugs and health/personal care goods were the highest rated services among the 27 tested. The lowest rated services included care for the elderly, health relief services, mental retardation services, mental health services, substance abuse services, preventive health services and individual social/health services.

Central to the Spectrum Health Value Study is the analysis of the relative value that respondents place on the 27 healthcare programs, products and services listed above. Each respondent was asked the following question several times, each time showing them a set of four different programs, products and services from the 27 being tested:

Recognizing that health care costs vary depending on your level of insurance coverage, and other health benefits that you either purchase or receive through an employer or other sources, and thinking about the actual dollars that are spent, listed below are four health care services with costs that you and other individuals ultimately pay for either directly or indirectly. Of these four, which is the most important and which is the least important for you and your family as you spend your health care dollars?

The following programs, products and services were picked as ‘most important’ more often than not:

• Physician services
• Medical services at a hospital
• Emergency care services
• Prescription drugs
• Dentist services
• Outpatient services
• Diagnostic laboratory services
• Surgical services
• Preventive health services
• Medical research
• Over the counter drugs
• Health/personal care goods
• Individual social/health services

Afterward, respondents were shown the following statement:

The cost of health care benefits and services for Americans is – one way or the other – ultimately paid for by individuals who contribute in various ways. These various types of payments include insurance policy premiums that people pay, income and sales taxes people pay, employer deductions from employees’ paychecks, an individual’s out-of-pocket expenses or co-pays, as well as payments or personal charitable contributions to health providers. In summary, whatever the combination or method of funding for health care, the ultimate payer is the individual.

Sixty-nine percent of respondents agreed that the cost of healthcare benefits and services are ultimately paid for by individuals who contribute in various ways. People who suffer from a health condition were statistically more likely to answer that they strongly agreed with the statement than were people who do not have a health condition.

Several notable points:

• Although respondents were not asked how much they value access to healthcare, those products and services associated with access were highest ranked in the analysis: physician services, medical services at a hospital, and emergency care services.
• Although Americans strongly value preventive health services, they do not use them on a regular basis. When preventive health services are used, Americans are not very satisfied with the quality service.
• Despite the attention being raised around the obesity epidemic, Americans neither value nor use nutrition services. When nutrition services are used, they are not considered very satisfactory.

Spectrum plans to update the study findings each quarter. Additional details as well as access to the full report can be read at http://www.healthvaluestudy.com/. Several summary reports are available (for each page below, click on ‘Download Full Report’):

• The Spectrum Health Value Study: An Overview
• Access: the Health Care Product that Americans Value Most
• The Value and Use of Preventive and Wellness Health Services
• Those Who Suffer: The Effect of Chronic Illness on Health Care Value
• Examining the Concerns of the “Anxious Insured”: Lessons for Health Reform

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References

1. The Spectrum Health Value Study. Spectrum. Accessed 2009 May 18.
2. Institute of Medicine of the National Academies. Roundtable on Evidence Based Medicine. Value in Health Care; accounting for cost, quality, safety, outcomes and innovations. 2009 March.

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The savings — an estimated $2 trillion over the next decade — would come from changes in the public-private partnership and include:

• Administrative standardization, simplification and transparency.
• Aligning quality and efficiency incentives among providers to reduce over- and under-use of healthcare.
• Encouraging coordinated care and adherence to evidence-based best practices and therapies.
• Reducing the cost of doing business by developing technology and regulatory reform.

Although the proposed health expenditure savings is small, experts say it’s significant [2]. The very fact that health industry leaders have stepped forward to voluntarily restrain costs is itself encouraging; these are the same groups that opposed the healthcare reforms proposed by President Clinton in the 1990s.

The growing burden of the American healthcare system

Indeed, with growing costs reform must come to the American healthcare system. A recent report by the Centers for Medicare and Medicaid Services (CMS) forecasts that growth in U.S. healthcare spending is expected to significantly outpace gross domestic product (GDP) growth in 2008 and 2009 due to the recession [3]. Between 2008 and 2018, the average annual spending growth by public payers (7.2%) is projected to outpace that of private payers (5.3%); as such, national healthcare spending is expected to reach $4.4 trillion and comprise 20.3% of GDP by 2018 [4].

To put those numbers in perspective, in 2008, national health spending was $2.4 trillion and comprised 16.6% of GDP.

What’s not being reported by the major media and perhaps the most frightening is that just two years ago, the Organization for Economic Cooperation and Development (OECD) projected that U.S. healthcare costs would consume approximately 20% of GDP by 2050 with dire consequences. We’re now looking at that occuring within the next decade.

Who’s job is healthcare anyway?

In 2007, U.S. households contributed $660.3 billion to healthcare spending, more than private business, state and local government, or the federal government [4]. Nevertheless, private business still contributed almost 60% more to private health insurance than households. An commentary on American Public Media’s Marketplace entitled Health care should be government’s job recently addressed the problem of U.S. corporations paying more for healthcare benefits than they’re earning in profits. In an age when U.S. companies can no longer afford to pay for health benefits, Matt Miller, senior fellow at the Center for American Progress and author of the book, “The Tyranny of Dead Ideas“, suggests that the larger truth is that “while having health insurance is crucial, it’s time we stopped looking to our companies instead of our country to help us obtain it” [5].

Miller continues, saying that:

America is the only advanced nation that operates much of its welfare state through corporations. This may have made sense 50 years ago, when medicine was cheap, a single breadwinner worked at a big company for 35 years, and American business dominated the world economy so that companies could pass on, through higher prices, the cost of much of the country’s safety net. But those days are gone. Today people switch jobs 10 times by the age of 40, and sky-high health costs make U.S. firms uncompetitive. Meanwhile, our archaic link between jobs and health care helps explain why 50 million people are uninsured, with millions more just a pink slip away from medical bankruptcy.

More about this proposal can be found in a Fortune editorial written by Miller in 2007 entitled Opening the Capitalist Mind. His commentary offers an interesting perspective on the linking of healthcare to jobs.

What’s your opinion? If you could reform one aspect of the U.S. healthcare system, what would it be?

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References

1. AMA to President Obama: All Americans should have access to affordable, high quality health care services. American Medical Association, Letters to the Editor. 2009 May 11.
2. Health care cutting for stake in reform. Marketplace, American Public Media. 2009 May 11.
3. National Health Expenditure Data. Centers for Medicare & Medicaid Services. Accessed 2009 May 11.
4. Health Care Costs 101, 2009 Edition. California Health Care Foundation. 2009 April.
5. Health care should be government’s job. Marketplace, American Public Media. 2009 May 11.

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Kids learn early on in preschool that to truly prevent the spread of germs, you’ve got to wash your hands. Nevertheless, a dab of soap and a quick rinse isn’t effective. The key is to wash your hands for at least 20 seconds to ensure that you’ve removed the microbes. By rubbing your hands with soapy water, you pull dirt and oil from your skin. The soap lather suspends any germs trapped inside and are then washed away when rinsing.

The Right Way to Wash Your Hands

When washing you hands with soap and water, follow these steps:

1. Wet your hands and wrists with warm running water and apply soap.
2. Rub your hands, including the fingers, palm to palm in a circular fashion.
3. With palms still together, intertwine the fingers and rub in between them.
4. In a circular fashion, rub the back of each hand with the opposite palm, making sure not to ignore the knuckles and fingers.
5. Rub each thumb by gripping it with the opposite hand.
6. Continue washing hands for 20 seconds. Here’s a trick: sing the ABC’s to yourself.
7. Rinse your hands and wrists thoroughly under warm running water. Keep your hands lower than your elbows to avoid water flowing up the arms and then back down onto the hands, contaminating them.
8. Don’t turn off the water! Dry your hands completely using a clean or disposable towel.
9. Using the towel, turn off the faucet. If in a public restroom, use the towel to grasp the door handle and open the door, then discard the towel.

If soap and water aren’t available, use an alcohol-based hand sanitizer.

While alcohol-based hand sanitizers reduce the number of germs on skin, they aren’t necessarily more effective at reducing influenza A H1N1 virus on human hands. A recent study evaluated the effectiveness of routine hand hygiene against live human influenza A virus H1N1 using soap and water hand washing or one of three different types of alcohol-based hand rubs (61.5% ethanol gel, 70% ethanol plus 0.5% chlorhexidine solution, or 70% isopropanol plus 0.5% chlorhexidine solution) [3]. Hand washing with soap and water was found to be statistically superior to all three alcohol-based treatments.

For a visual demonstration on the effectiveness of hand washing, check out the publication linked below from the University of Georgia College of Agriculture and Environmental Sciences. An experiment was performed to show the difference in the amount of bacteria on an unwashed hand, a rinsed hand, a washed hand and a sanitized hand. The experiment involved touching agar plates (special food used to grow bacteria in a laboratory) with or without hand hygiene and then incubating them for 24 hours. Food, Hands and Bacteria illustrates the importance not only of hand washing but washing for more than 20 seconds [4].

To promote the importance of proper handwashing, CDC-TV released a video late last year, “Put Your Hands Together,” in its “Health Matters” series, presented below.

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References

1. Swine flu could come back in more virulent form after summer, European experts say. BMJ 338:b1792. 2009 Apr 29.
2. Put Your Hands Together. National Center for Preparedness, Detection, and Control of Infectious Diseases (NCPDCID) and National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED). 2008 Oct 13.
3. Grayson et al. Efficacy of soap and water and alcohol-based hand-rub preparations against live H1N1 influenza virus on the hands of human volunteers. Clin Infect Dis. 2009 Feb 1;48(3):285-91.
   View abstract
4. Food, Hands and Bacteria. Prepared by Estes Reynolds. Accessed 2009 May 6th

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