Better coverage for women’s preventive health starts today

Beginning today, insurance companies must begin paying for eight vital women’s preventive health services without charging deductibles or co-payments. The new regulations, part of the Affordable Care Act, are expected to improve the health of an estimated 47 million women by the end of 2012, according to the Department of Health and Human Services.

Paula Johnson, MD, a member of the Institute of Medicine Panel that recommended these services for inclusion in the health law, said that providing coverage for these services is a major advance for women’s health. “Politics has turned attention away from preventive care. If we continue to ignore it, it will bankrupt the country.”

The regulations apply immediately to all new insurance plans. As existing plans get renewed or changed, benefits will be incorporated. All women with private health insurance will receive these services over time, according to Judy Waxman, of the National Women’s Law Center.

Members of Hervotes, a coalition of more than 50 women’s organizations, plan a massive nationwide awareness campaign to inform women about these covered services and encourage them to vote for political candidates that strongly support women’s health and women’s rights. For my report on what several key women’s groups have to say about these new benefits, check out the HealthCetera blog at the Center for Health, Media & Policy.

Visit Healthcare.gov for detailed information about the new covered services.

Important Shift in Women’s Health Benefits This Week

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Major changes in women’s health benefits under the Affordable Care Act  kick in on Wednesday, August 1 – many without cost sharing.

As of Wednesday, Covered Preventive Services for Women, including pregnant women include: 

Note: Services marked with an asterisk ( * ) must be covered with no cost-sharing in plan years starting on or after August 1, 2012. See Affordable Care Act Rules on Expanding Access to Preventive Services for Women

You can also check the Health Resources and Services Administration (HRSA) for a breakout of the specific coverage guidelines.

Many women’s organizations, including  Raising Women’s Voices, the National Women’s Health Network, the National Women’s Law CenterHERvotes were instrumental in making sure these services were included in the new law.

Health and Human Services Secretary Kathleen Sebelius and other key contributors to the legislation plan a press conference on Tuesday to speak on these important changes. The Human Factor will bring you the latest details then!

Calcium Supplements May be Bad for Your Heart. Or not.

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I feel caught between the proverbial rock and hard place. A new study just released in the journal Heart shows that calcium supplements — the type that many women take for to improve bone health — may be linked to higher incidence of heart attacks. Researchers also found that increasing calcium in the diet had no significant advantage in terms of preventing heart disease and stroke.

This was a fairly large scale, long-term European study of 24,000 people, who were tracked for 11 years — so the results are hard to brush off. It’s true that those with moderate dietary calcium intake had lower risk of heart attack by almost a third compared with those in the bottom 25 percent of intake levels; however people whose diet included above-average calcium levels did not have significantly lower risk.

Those who took both vitamin supplements and calcium supplements regularly were 86% more likely to have a heart attack than those who didn’t use any supplements. And this risk increased further among those who used only calcium supplements. They were more than twice as likely to have a heart attack as those who didn’t take any supplements.

The authors conclude: “This study suggests that increasing calcium intake from diet might not confer significant cardiovascular benefits, while calcium supplements, which might raise [heart attack] risk, should be taken with caution.”

So what do you do? Calcium supplements have been pretty much de rigueur to combat osteoporosis, especially in menopausal age women.

Now researchers tell me it can possibly lead to a heart attack? Apparently supplements have also been linked to kidney stones, and don’t have that much of an effect on bone health – yielding only about a 10% reduction in fractures. These investigators are pushing for a return to a more balanced diet that includes plenty of calcium naturally found in products like milk, cheese, broccoli and almonds.

Ok, but let’s get real. The diets of most Americans are anything but balanced.

The study also has its critics. In a report by HealthDay News. Robert Recker, M.D., president of the National Osteoporosis Foundation said he believed the study’s findings were flawed, or at the very least, biased. It’s not surprising that NOF takes this position, since their overall goal is bone health. That, of course, requires a certain level of calcium intake. As a lay person, I can’t begin to guess whether or not there were problems with the study. However, I can express concern and frustration.

It’s another example of “now what?” Calcium is good for you. No, it’s bad. Red wine is good for your heart. No, it’s not. Chocolate has protective ingredients – but don’t eat too much. Here’s the latest wonder drug. Wait, the FDA is pulling it off the market.

Is it any surprise that people are confused?

What are the trade offs? All most of us want to know is whether or not we need to boost something in our diets for better health – or cut something out because it will cause harm. We’re getting a lot of mixed messages depending on who is doing the research — and where the funding is coming from. Maybe we need a study about studies.

In the meantime, it seems as if the best thing to do is to check with your doctor and see whether osteoporosis or heart attacks are more of a risk if you take calcium supplements. Researchers have no definitive answer. At least this week.

New Study Adds to Screening Mammography Controversy

This post is based on my recent news report in Digital Journal

Results of a new study from Norway show that 15 to 25 percent – or about one in four – cases of breast cancer found through routine screening mammography is over diagnosed and would never have posed a health risk for the women had they never been found. Results of a long term study published in the April 3 issue of Annals of Internal Medicine, found that number of cases of invasive breast cancer in women aged 50 to 69 was the same in Norwegian counties that introduced screening programs and those that had not. This study adds more fuel to to ongoing debate about the benefits of screening mammography versus the risk of false positives – including additional exposure to radiation, unneeded surgery, and chemotherapy, as well as the mental trauma experienced.

Nearly 40,000 women were tracked for a decade, starting in 1996. About a quarter of the women were diagnosed with benign tumors or very slow-growing tumors that  would never cause symptoms, spread, or cause death. That worked out to 6 in 10 women being over diagnosed for every 2,500 screened. Without surgery, it is currently impossible to tell which tumors are benign and which pose a risk.

However, many of these women chose to undergo mastectomies, which ultimately proved to be unnecessary. This directly contradicts messages from government and non profit organizations that screening reduces mastectomy rates This study is in line with several earlier European studies that also reached similar conclusions about over-diagnosis of cancer with mammography screening. Women diagnosed with ductal carcinoma in situ, a different form of cancer, were excluded from this study.

So what’s a woman to do? For decades, we have been getting messages about getting annual mammograms.  But with each new study, more doubts are raised about risk vs. reward. The American College of Radiologists, a group that certainly has a strong interest in promoting screenings, said that women at elevated risk should also add ultrasound to their annual exams. For some women, this makes sense — for example, women with very dense breast tissue or those with at least one other risk factor such as family history. But what about the majority of the 40+ population?

Even breast cancer advocacy groups are divided. Perhaps Breast Cancer Action, which accepts no funding from pharmaceutical or other corporations that might profit from cancer diagnoses, had the best advice: there is no one “right” answer — women need to weight the risks, consider their own medical history, and look at other options, such as clinical breast exams. There are many ways to manipulate the numbers, and to spin the clinical results.

If your life, or your sister’s or mother’s, is the one saved by a screening mammography, there’s no question that it was the right option. However, the majority of women are not in a high risk category – so risks, benefits, chance of false positives or negatives, as well as other detection options, need to be part of a conversation with their physicians — and ultimately has to be a woman’s personal decision.

Check Your “D”

My doctor and I were recently surprised by the results of routine blood test – my vitamin D levels were well below the “normal” range. Of the various health issues to be concerned about, Vitamin D was nowhere near the top of my list. Recent studies in the journal Nutrition Research and The Southern Medical Journal confirm why it should be on yours.

Vitamin D is vital in maintaining calcium and phosphorus levels. It helps the body absorb calcium, which is vital to strong, healthy bones. Studies also show it protects the body from osteoporosis, rickets, high blood pressure, cancer, and other disorders. Vitamin D also has a role in your nerve, muscle, and immune systems. [Mayo Clinic]. This is one “D” you want to have!

Your body naturally forms Vitamin D after exposure to sunlight. However, be cautious, since too much sun exposure can lead to skin aging and skin cancer. Just 10 to 15 minutes of sunshine three times weekly is enough to produce the body’s requirement of vitamin D, according to the CDC. The sun needs to shine on the skin of your face, arms, back, or legs (without sunscreen). Because of the risk for skin cancer, you should use sunscreen after a few minutes in the sun.

You can get also get Vitamin D through your diet – it is found in in egg yolks, saltwater fish, and liver. Some other foods high in Vitamin D include dairy products – cheese, butter, cream, and fortified milk (all milk in the U.S. is fortified with vitamin D); fatty fish (such as tuna, salmon, and mackerel); oysters; fortified breakfast cereals, margarine, and soy milk (check the Nutrition Fact Panel on the food label) [NIH 2012].

Vitamin D sources

Many people do not get enough vitamin D through diet.  So a vitamin D supplement may be necessary. Always check with your health care provider to see whether or not you need one and if so, how much to take. The Institute of Medicine has revised the intake guidelines, and has concluded that more isn’t necessarily better — as too much Vitamin D can lead to other health problems.

Seniors, breastfed infants, people with dark skin, those with certain conditions such as liver diseases, cystic fibrosis and Crohn’s disease, and people who are obese or have had gastric bypass surgery are at greater risk for inadequate or deficient levels of Vitamin D.

I don’t fall into any of these categories. So what’s up test results? A CDC analysis shows that from 2001-2006, about one-quarter of the population was at risk of vitamin D inadequacy (serum 25OHD 30–49 nmol/L), and 8 percent were at risk of vitamin D deficiency (serum 25OHD less than 30 nmol/L). Additionally, many people over 50, particularly women, no longer produce enough Vitamin D naturally. That is my niche.

We know that bone density decreases significantly after menopause. Women who are peri-menopausal also have bone-related deficiencies, including low vitamin D levels, according to a recent study at the Carlos III Institute in Spain. Researchers recommend a diet with less protein and fat and more nuts, vegetables and carbohydrates, to correct low levels of vitamins D and achieve a better overall dietary balance.

If you are in a high risk group or are peri-, post-, or active menopausal age, talk to your doctor. Ensuring bone health now could prevent many future health issues.