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Vol. 107 July 15, 2014 Update on Sunscreens

In drugs, Pediatrics on July 15, 2014 at 12:17 PM

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“Consumers continue to [erroneously] perceive high-SPF sunscreens as more effective than lower ones.”
- Consumer Reports, July 2014

 

My last blog on sunscreens a year ago was largely based on a testing of products by Consumer Reports. So is this one.

1. The FDA does NOT test sunscreen products before they are put on sale.
The FDA does require manufacturers to meet certain standards in order to label their product with these three terms:
“SPF  number “- level of protection from UVB rays that cause sunburn
“broad spectrum” – also protects against UVA rays that can increase skin aging
“water-resistant” – claims protection for 80 minutes after immersion
In 2011 the FDA requested more data from manufacturers about sunscreen sprays and is currently evaluating it.

2. Any SPF over 30 provides little more protection, and will cost you more.
SPF 15 = 93% protection
SPF 30 = 97% protection
SPF 50 = 98% protection
SPF 100 = 99% protection

3. Sunscreen for kids is a marketing gimmick.
Though half of parents who use sunscreen on their children think that sunscreen for kids is “safer” and “gentler”, that is simply NOT true. The FDA makes no distinction in standards for children’s sunscreens and the ingredients of most “children’s” sunscreens are identical to and are present in the same concentration as regular sunscreen. Some may  be reformulated to be “tear-free” or “sting-free”, but that is the only difference.

4. Use more of it, and earlier than you think.
Apply the sunscreen at least 15 minutes before exposure because the chemicals take that long to interact before providing protection. Apply at least an ounce (2 tablespoons or one shot glass full) to cover your face and body adequately.  Reapply every 2 hours.

5. “Natural” sunscreens are no safer nor more effective than “chemical” ones.
There are no effective “natural” sunscreens, however defined, on the market. Zinc oxide and titanium oxide are natural minerals, but if used in their natural (unprocessed) state your zinc oxide covered nose would be black and covered with lead! Sunscreen lotions with zinc oxide and titanium oxide NANOPARTICLES are clear, neither black nor white, but nanoparticles still have their safety critics. “Natural” sunscreens, often labeled as “mineral” rather than “chemical”, can also clump and lose uniformity of SPF.

6. The jury (NIH and the FDA) is still out on the safety of nanoparticles in sunscreens, but the risk appears to be very small.
Nanoparticles do not penetrate skin cells and actually provide very good protection against the effects of the sun, but the potentials effects of inhalation (powders) or ingestion (lip balm) have generated some caution. Nanoparticles have long been used in a whole variety of cosmetics, combine with cells in very tiny amounts, and are approved in sunscreens in Europe. According to the Environmental Working Group, a watch-dog  organization that has been monitoring the use of  nanoparticles in cosmetics for years, “Nanoparticles are a lower hazard than most sunscreen ingredients approved for the U.S. market.”

7. Sunscreen sprays are not recommended.
Correct spray patterns are key for good protection, even spraying the same area twice is recommended, and it is not a good thing to breathe in the spray. The best way to use a spray is to spray it in your hand and then apply it, so why bother with a spray? The FDA is investigating the potential risks of spray sunscreens; like standing too close to a grill after you have sprayed and getting burned when the propellant ignites.

A selected list of products (not all recommended) Consumer Reports tested: (7 of 24 tested products were “recommended”)
(scores are result of UVB and UVA protection measured by wave length and effects of a soak in the tub for 80 minutes: 100 is the maximum)

Up and Up  Sport Spray (Target)           SPF 50     $0.80 per ounce    score: 90 Rec.
Coppertone Water Babies                        SPF 50     $1.38 per ounce     score: 81 Rec.
Equate Ultra Protection (Walmart)      SPF 50      $0.56 per ounce    score: 80 Rec.
No-Ad Sport                                                SPF 50      $0.63 per ounce    score: 69
Up and Up Kids (Target)                         SPF 50      $0.64 per ounce    score: 39
Banana Boat Kids                                     SPF 50      $1.25 per ounce     score: 16

References:
1. Consumer Reports, July 2014, “The Truth About Sunscreens”.

Vol. 106 July 1, 2014 Whas’up with Obamacare?

In current events, government, health care reform, politics on July 1, 2014 at 10:48 PM

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My nomination to the
“Understatement Hall of Fame”

“I think that probably no one fully anticipated when you have a law
that phases in over time how much confusion that creates for a lot of people.”

- Health and Human Services Secretary Kathleen Sebelius, April 8, 2013

The news media (and a lot of republicans) have not been ranting or raving about Obamacare lately. They seem to be preoccupied with Immigration laws, Tea Party challengers in Congressional primaries, and Hilary’s uptick in her campaign (aka “book tour”). I thought it might be helpful to look at “where Obamacare is at”.

82 out of 87 provisions are in effect
Of the 87 provisions in the Affordable Care Act signed March 3, 2010 (over 4 years ago!) 82 are in effect in today. Granted there have been some postponements in deadlines for enforcement and some delays in implementation of certain sections, but overall Obamacare is apparently plugging along very well. Only 3 additional provisions are slated to go into effect for 2015 to 2018. Kaiser Foundation has an interactive website to track each provision and its implementation status if you really want to know all the details.

27 states have decided to expand their Medicaid coverage
The ACA offers federal reimbursement for 100% of the initial years cost to states expanding coverage by raising the income level of eligibility for Medicaid. The federal subsidy to the states who expand coverage will gradually decrease each year, but the maximum cost to the state will be 10% by 2020.Medicaid ACA status by state
Three more states are openly discussing the move and 29 are not moving at all.

Enrollment targets continue to be met.
As of April 2014  13.5 million individuals have been determined to be eligible to enroll (“buy health insurance”) in a “marketplace plan” (either state-created or federally run) 8.5 million individuals or two-thirds of these could be eligible for financial assistance in the form of an advanced tax credit for their health insurance purchase. 8.1 million individuals of the 13.5 million total eligible have actually selected a plan. However, no premiums have actually been billed or paid just yet.

ACOs are blossoming nationwide, particularly in the northeast corridor.
Creation of Accountable Care Organizations (ACOs) which incentivize health care providers (physicians, hospitals, and other members of the health care team) to band together to provide patient care more efficiently (“less costly”) and with improved quality. It is a lynch pin of Obamacare. According to the Levitt Partners (yes, creation of the ACOs legal entities has become another guarantor of lawyers’ retirement funds), a total 626 ACOs covering 20 million patients, or 17% of the U.S. population, now exist. Most of these individuals have purchased commercial health insurance policies (another reminder of the boon of ACA to health insurance companies)  AND most patients don’t even know that they are now in an ACO. About 2/3 of the U.S. population lives in localities with ACOs mostly concentrated in the Northeast, 40% of the general population have access to at least two ACOs, and 10% of Medicare patients are patients of an ACO.

MSSP participating ACOs
As of May 2014 about one-half of the ACOs (338) are participating in the Medicare Shared Savings Program (MSSP) covering 5 million patients in 47 states, DC, and PR. In the MSSP the ACO that “saves money” by reducing costs without compromising defined quality standards gets to keep some of that money for its providers. This is usually called “risk sharing”, and though dismissed initially as “managed care in different clothes”  reluctant providers have clearly jumped on the bandwagon. In May of 2012 the first report  period identified 27 MSSP ACOs. There are different levels of risk to ACO providers so “when you see one ACO you have seen just one ACO”. About 50% of ACOs include hospitals as members. Preliminary data about ACO performance is currently mixed, and credible  data about which models will work the best is still unavailable.

What about the cost of ACA?
Of course, increased access of individuals to effective health insurance is going to cost money. In April of this year the non-partisan Congressional Budget Office (CBO) working with the Joint Committee on Taxation REDUCED their estimate of the cost of ACA in 2014 by $5 billion (from the $36 billion originally estimated). The estimated cost over 2015-2024 wa REDUCED by $104 billion (of $1,400 billion total originally estimated).CBO est. cost of Obamacare

 

Billions of Dollars, by Fiscal Year graph

 Wrap Up Of  Whas’up with Obamacare
“First, all major parts of the ACA except the individual mandate are popular — including the insurance-market reforms, the subsidies to make insurance affordable, closure of the drug-benefit “doughnut hole,” and the incentives for most employers to provide affordable insurance as a fringe benefit. Second, lawmakers who support repeal will not want to snatch insurance coverage from an estimated 37 million people who will be insured thanks to the ACA in 2017. Third, repeal would cut into the sales and profits of health care providers and suppliers of all stripes.”  (1)

The Supreme Court ruled that the individual mandate penalizing people (via their annual tax return) who don’t purchase some form of health insurance was constitutional because the court considered it  “a tax, not a fine”. Justice Robert’s unexpected vote in favor of the ruling prompted Jay Leno to quip,”The Obamacare ruling makes Roberts the first Republican to favor an insurance law with an individual mandate since, well, Mitt Romney.”

1. “Here to Stay- Beyond the Rough Launch of the ACA”,  HJ Aaron, NEJM, June 12, 2014

 

 

 

Vol. 115 June 15, 2014 Sometimes a picture IS worth a thousand words.

In current events, humor, nutrition, Pediatrics on June 15, 2014 at 11:49 AM

 

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THE LAST OF MY “FOOD BLOGS” FOR A WHILE.

After blogs about the evils of excess added sugar, added trans fats, the obfuscation of ingredient lists, and manipulative marketing by food manufacturers  I find it easy and appropriate to finish up this series with pictures that capture more than I can write.

 

Food cartoons1

 

Some churches have come up with the ultimate answer to WWJD?  Gluten-free communion wafers!!

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Food cartoons2

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Wouldn’t it be great if parents were as paranoid about gun deaths – 500 children per year – as we are about peanut allergy deaths – 150 children and adults per year.

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Food cartoons3

As a pediatrician with 45 years of experience and a grandfather, I think that the moment depicted here is much more important in the long run for the child than reading the % of trans fat or sugar content in the ingredients list.

 

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