Atlanta, GA, United States (AHN) – U.S. teens are not eating enough fruits and vegetables, according to a new study by the U.S. Centers for Disease Control and Prevention.

The findings, based on data complied from nearly 10,800 students in grades nine through 12 who took part in the National Youth Physical Activity and Nutrition Study 2010, found median consumption was 1.2 times per day for both fruits and vegetables.

Median fruit consumption was much higher among males than females, and much higher among grade nine students than among students in grades 10 and 12.

A little more than 28.5 percent, or one in four, of the high school students ate fruit less than once a day, and 33.2 percent ate vegetables less than once a day.

Only 16.8 percent of students ate fruit at least four times a day, and only 11.2 percent ate vegetables at least four times a day.

Vegetable consumption was lowest among Hispanic and black students, the study found.

Researchers said the findings show that most high school students do not meet the daily fruit and vegetable recommendations, and more needs to be done to see the recommendations are met.

The researchers wrote in the Nov. 25 issue of the CDC’s Morbidity and Mortality Weekly Report, “The infrequent fruit and vegetable consumption by high school student highlights the need for effective strategies to increase consumption.”

Steps have already been taken at schools throughout the country to remove sugary snacks, sodas, high fat, high salt and low nutrient dense foods. New programs such as farm-to-school initiatives, school gardens and salad bars aim to improve access to both fruits and vegetables.

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Washington, DC, United States (KaiserHealth) – By agreeing today to hear challenges to President Obama’s 2010 health care law, the Supreme Court set the stage for a decision — probably in late June and in the midst of the presidential campaign — that could be among its most important in decades.

The case, which will probably be argued in March on a date still to be announced, is especially momentous because it not only will determine the fate of President Barack Obama’s biggest legislative achievement but also will cast important light on the Supreme Court’s future course under Chief Justice John Roberts on issues of federal government power.

The central issue — but not the only important one — is whether Congress exceeded its constitutional powers to regulate interstate commerce and to levy taxes when it adopted the so-called “individual mandate” at the heart of the health care law.

That provision would require millions of people starting in 2014 to buy commercial health insurance policies or pay financial penalties for failing to do so.

The court also agreed to decide a challenge to the Affordable Care Act’s provision essentially requiring states greatly to expand their Medicaid spending.

The court made clear that if it decides to strike down the individual mandate or Medicaid provision, it will also decide which of the 975-page law’s hundreds of other provisions should go down too, by divining whether Congress would have wanted some or all of them to be effective even without the voided provision or provisions.

Finally, the court agreed to decide whether — as one federal appeals court ruled — the litigation surrounding the individual mandate must be deferred until 2015 because of the 1867 “Anti-Injunction Act,” which bars courts from striking down tax laws before they take effect.

The court allocated an extraordinary five and one-half hours — the most time in many decades for related challenges to a single new law — for argument on all these issues combined.

How The Case Got Here

The court’s announcement Monday centered on a challenge to the law by 26 state governments. The 11th Circuit Court of Appeals in Atlanta voted in August to strike down the individual mandate but to leave standing the rest of the health law, including the Medicaid expansion. All three of the petitions granted today involve that case.

In other action, though, the D.C. Circuit and the 6th Circuit, centered in Cincinnati, have upheld the individual mandate, with opinions supporting the Obama position by two of the nation’s leading conservative judges, the D.C. Circuit’s Laurence Silberman and the 6th Circuit’s Jeffrey Sutton.

Another appeals court, the 4th Circuit, said courts have no power to decide the individual mandate issue until 2015, when the first monetary penalties will be due for failing to comply with the individual mandate to buy health insurance. This decision held that the penalty provision is a “tax” within the meaning of the Anti-Injunction Act, as described above.

If the justices agree that the Anti-Injunction Act applies, this year’s case will be perhaps the greatest anticlimax in Supreme Court history. And, the justices’ assignment of a full hour of oral argument to this question suggests that some take this issue very seriously.

Meanwhile, the purpose of the individual mandate is to force millions of Americans to obtain health insurance — whether they want to or not — in order to offset the costs that health insurers would bear under the health care law’s requirement that they sell insurance to everyone without charging those with especially costly health problems more than healthy people.

The lower court judges who have struck down the mandate have cited as their reasoning the lack of any precedent for Congress to require people to buy a commercial product they don’t want and the government’s failure to show how — if the individual mandate is upheld — a limit enforceable by the courts could be applied to this exercise of congressional power.

As background, the two Supreme Court decisions since’37 that have struck down acts of Congress as exceeding the commerce power, one in’95 and one in 2000, stressed that Congress’ commerce power must be restrained by some principle that could be enforced by the judicial branch of government.

Defenders of the individual mandate stress other Supreme Court precedents suggesting that even economic decisions that have a tiny direct effect on interstate commerce — such as a person’s decision not to buy health insurance — cumulatively have major effects on interstate commerce and thus can be regulated by Congress.

With the court’s announcement today, none of the justices recused themselves from hearing the case. Some conservative opponents of the health care law have suggested that Justice Elena Kagan should recuse herself because of her prior work as President Obama’s Solicitor General. And some liberals have suggested that Justice Clarence Thomas should recuse himself because of his wife Virginia Thomas’s political activities opposing the health care law. But the decision on recusal is left to each individual justice and it would have been announced with today’s order.

Meanwhile, as is customary, the Court announced the grants of review with no comment or indication of the vote. Any four justices can agree to review a case. And, given the importance of the issues, with federal appeals courts divided, today’s announcement was widely expected.

Most but not all Supreme Court experts predict — some very confidently, some cautiously — that the Court will uphold the law. The Supreme Court’s four liberals are certain to uphold the law. They would need only one more vote to prevail. While Justice Clarence Thomas seems a sure vote to strike the law down, Chief Justice John Roberts and Justices Anthony Kennedy, Antonin Scalia and Samuel Alito are harder to call.

A decision in June — or before — would help make the future of health care law a central issue in the 2012 presidential campaign.

Taylor, an author and journalist, is a nonresident fellow at the Brookings Institution.

– Provided by Kaiser Health News.

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New York, NY, United States (KaiserHealth) – For many adults, a routine visit to a primary care physician might involve blood tests, a urinalysis, an electrocardiogram, maybe a bone density scan. Too often, however, these tests are inappropriate and they cost a bundle, according to a recent study, not only for the health care system but also for individuals, who are increasingly footing more of the bill for their care.

The study, led by physicians from the Mount Sinai Medical Center and the Weill Cornell Medical College in New York, was published online in October in the Archives of Internal Medicine. The researchers examined the cost of common primary care practices that were identified as being overused earlier this year in a study by another group of physicians, known as the Good Stewardship Working Group. .

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The working group, for example, had noted that blood and other diagnostic tests were often ordered even for patients who had no related symptoms or risk factors and said they should be discontinued in those cases. Also included on its list were imaging studies such as CT scans or MRIs for low back pain and Pap tests to screen for cervical cancer in teenagers.

Among the frequently inappropriate pediatric practices were writing prescriptions for antibiotics for children with sore throats who didn’t have a strep infection; recommending cough medicines for children with upper respiratory infections and ordering imaging tests for the heads of kids who took a spill but didn’t exhibit red-flag symptoms such as dizziness or loss of consciousness.

The newest study, using data from federal medical surveys, estimated that 12 of those unnecessary treatments and screenings accounted for $6.8 billion in medical costs in 2009. The activity most frequently performed without need was a complete blood cell count at a routine physical exam. In 56 percent of routine physicals, doctors inappropriately ordered such tests, accounting for $32.7 million in unnecessary costs. In terms of dollars, the biggest-ticket item by far was physicians ordering brand-name statins before trying patients on a generic drug first: That accounted for a whopping $5.8 billion of the $6.8 billion total.

Minal Kale, an internist at Mount Sinai School of Medicine and lead author of the study, says $6.8 billion was a conservative estimate of the cost of the inappropriate care. She notes, for example, that the study didn’t evaluate the cost of additional testing or procedures that result from an abnormal blood test reading result or imaging scan, even though in the absence of symptoms or risk factors the follow-up may be unnecessary and even cause harm. “The financial and other emotional results of that can be significant,” she says.

The original list of primary care activities upon which Kale and her colleagues based their financial analysis was developed by the Good Stewardship Working Group under a grant from the American Board of Internal Medicine Foundation and published first online in May. Working group members were composed of internists, family physicians and pediatricians who are part of the National Physicians Alliance, a group of 22,000 doctors that advocates universal, affordable health care.

The working group focused on common activities that no physician would argue against, says Stephen Smith, a family physician and professor emeritus at Brown University’s Alpert Medical School, who co-authored that group’s paper. That’s why you don’t see more controversial practices like the PSA blood test for prostate cancer, which was recently removed from the U.S. Preventive Services Task Force’s list of recommended screenings for most men. “What we were trying to do was change [physicians'] mindset, not cause firestorms of controversy,” says Smith.

So why would physicians continue to order tests and prescribe pricey drugs when there’s clear evidence that they’re not necessary in many cases and may even cause harm by exposing people to unneeded care?

One of the main reasons is the way doctors are trained, Smith says. “I think all of us practicing in the U.S. were raised in an educational environment where we got dinged if we didn’t order certain tests,” he says.

Defensive medicine also plays a role. “Nobody ever gets sued for ordering unnecessary tests,” says Doug Campos-Outcalt, a family physician in Phoenix and a past president of the Arizona Academy of Family Physicians.

And patient expectations drive some of the spending as well, say physicians, who note that sometimes simple directives, such as drinking less alcohol or getting more exercise, aren’t what patients want to hear. “If a doctor says, ‘Let’s talk about weight control,’ patients aren’t usually too happy,” says Campos-Outcalt. “They feel like there should be some testing.”

Doctors alone can’t turn the tide. Improving patient education and communication with doctors is key to helping change practice patterns, says Smith.

Still, one expert is encouraged that doctors came up with this list of wasteful spending, rather than leaving it to government bean counters. “It’s only the doctors that can get into the clinical detail and find out what sorts of things are not producing a benefit and might cause harm,” says H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, whose work has questioned whether much of the preventive screening people receive is helpful.

The dollar amounts identified in the current study may be a good start, but they don’t even begin to address the country’s spending issues, he says. In 2009, health spending grew to $2.5 trillion and accounted for 17.6 percent of the gross domestic product.

Kale suggests that specialist care be the next target that physicians take aim at to identify inappropriate, overused activities. Specialist income, after all, is primarily generated through procedures, while primary care is often conversation-based. “We have more to gain by examining [specialist care] more closely,” she says.

– Provided by Kaiser Health News.

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