Quality of Life for Cats with Heart Disease

Reynolds C, Oyama M, Rush J et al: Perceptions of quality of life and priorities of owners of cats with heart disease, J Vet Intern Med 24:1421, 2010.

A shared goal of veterinarians and the owners of cats with heart disease is to provide high quality of life (QoL) while achieving the extension of quantity of life. Because heart disease in cats is rarely cured with treatment, therapy is directed to palliation of clinical sings and maximizing survival time with a progressive disease. Treatment usually consists of medications that improve QoL. This study utilized a questionnaire to owners of 239 cats with heart disease to help identify important parameters when assessing their cat’s QoL, the importance of quality versus quantity of life, and willingness to trade survival time for QoL. Deemed important to QoL were parameters such as appetite, owner interaction, sleep patterns, and litter box habits. Most owners did not feel it was difficult to administer oral medications to their cat though a large enough number indicated their cat was extremely difficult to medicate. The level of concern by owners increased as the number of medications and dosing frequency increased. Owners have significantly greater concern over pet suffering than concern over life expectancy. Most (93%) of owners were willing to trade survival time for good QoL. These priorities and concerns of owners of cats with heart disease should be taken into account by veterinarians in their pursuit to provide optimal care. [VT]

Related articles:
Payne J, Luis Fuentes V, Boswood A et al: Population characteristics and survival in 127 referred cats with hypertrophic cardiomyopathy (1997 to 2005), J Small Anim Pract 51:540, 2010.

More on cat health: Winn Feline Foundation Library
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Reynolds C, Oyama M, Rush J et al: Perceptions of quality of life and priorities of owners of cats with heart disease, J Vet Intern Med 24:1421, 2010.

A shared goal of veterinarians and the owners of cats with heart disease is to provide high quality of life (QoL) while achieving the extension of quantity of life. Because heart disease in cats is rarely cured with treatment, therapy is directed to palliation of clinical sings and maximizing survival time with a progressive disease. Treatment usually consists of medications that improve QoL. This study utilized a questionnaire to owners of 239 cats with heart disease to help identify important parameters when assessing their cat’s QoL, the importance of quality versus quantity of life, and willingness to trade survival time for QoL. Deemed important to QoL were parameters such as appetite, owner interaction, sleep patterns, and litter box habits. Most owners did not feel it was difficult to administer oral medications to their cat though a large enough number indicated their cat was extremely difficult to medicate. The level of concern by owners increased as the number of medications and dosing frequency increased. Owners have significantly greater concern over pet suffering than concern over life expectancy. Most (93%) of owners were willing to trade survival time for good QoL. These priorities and concerns of owners of cats with heart disease should be taken into account by veterinarians in their pursuit to provide optimal care. [VT]

Related articles:
Payne J, Luis Fuentes V, Boswood A et al: Population characteristics and survival in 127 referred cats with hypertrophic cardiomyopathy (1997 to 2005), J Small Anim Pract 51:540, 2010.

More on cat health: Winn Feline Foundation Library
Join us on Facebook
Follow us on Twitter

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Limit set on popular procedure on spines

Blue Cross is under fire for seeking to curb use of expensive spinal fusions.

By Alan M. Wolf
alan.wolf@newsobserver.com

Posted: Saturday, Dec. 25, 2010

More Information

• By the numbers
  3,593: number of spinal fusion surgeries Blue Cross and Blue Shield of North Carolina covered last year, up 22 percent from 2007.
  $105 million: amount the insurer paid in claims for the procedures last year, up 44 percent from 2007.
  Nine: number of medical associations that signed a Dec. 15 letter to Blue Cross, urging changes to its new policies, which take effect Jan. 1.
  3.7 million: Blue Cross members statewide.

The state's largest health insurer is coming under fire from surgeons across the country for implementing tougher restrictions on an increasingly common type of spinal surgery.
Blue Cross and Blue Shield of North Carolina's new rules, which take effect Jan. 1, are designed to reduce overuse of spinal-fusion surgery, a costly and controversial procedure to ease patients' lower back pain . The Chapel Hill-based insurer says it wants to ensure the surgeries are approved based on the latest medical evidence.

"We are not going to stop coverage, but we do want to make sure the ones being done are appropriate," said Dr. Don Bradley, Blue Cross' chief medical officer. "In some cases, we're seeing technology being used when more conservative measures might be more appropriate."
But some spine surgeons worry that the restrictions will limit care for thousands of patients and could set a new coverage standard among other insurers.

A coalition of surgeons representing nine medical associations, including the American Association of Neurological Surgeons and the North American Spine Society, wrote to Blue Cross this month, urging the company to reconsider.


The group also suggested various changes that would ease the new restrictions.
"If this intrusion into the physician-patient relationship goes unchallenged, other insurers will follow suit," said Dr. John Wilson, a neurosurgeon at Wake Forest University Baptist Medical Center who is president of the N.C. Neurological Society and one of nine physicians who signed the letter to Blue Cross.
"It will be a progression of ever-more restrictive policies that will handcuff us as we try to treat patients," Wilson said.

The surgeon groups requested a meeting with Blue Cross executives before the rules kick in one week from today to discuss the new policy. But the insurer responded in an e-mail message that because of the holidays, a meeting could not be scheduled until the third week of January.
Wilson estimates that he performs about 100 spinal-fusion surgeries a year. Only a small percentage of his practice's patients would be ineligible for coverage under the new Blue Cross rules.
"Even if it's just a few patients, if we're limited in how we can help them, it doesn't sit right with us," he added.
The new spine-surgery rules come as Blue Cross faces increasing pressure to keep costs down and control premiums. The company announced plans in July to slash administrative costs up to 20 percent by 2014.
"The tendency is to label us as the big, bad insurance company," Bradley said. "We understand folks rely on us to cover the things that should be covered. They also assume that we're making decisions about appropriate care" to keep premiums affordable.

Blue Cross reports that it covered 3,593 spinal fusion surgeries last year, up 22 percent from 2007. The insurer paid $105 million in claims for the procedures last year, up 44 percent from 2007. The procedures require longer hospital stays and cost more than three times the amount of a simpler surgery, according to the Journal of the American Medical Association.

The new rules will require patients and physicians to get approval before spinal-fusion surgery. The insurer still will cover the surgery for some ailments, such as scoliosis, injury and tumors.
But Blue Cross won't cover the surgery for degenerative disk disease. The condition is caused by aging disks and can cause debilitating back pain.

"We feel that to completely omit this as a covered procedure under any circumstance is overly restrictive," the national group of surgeons wrote in their letter to Blue Cross.
The surgeries involve implanting rods and screws to repair vertebrae. JAMA reports that patients who had a complex fusion procedure were nearly three times as likely to develop a life-threatening complication and that the surgeries didn't result in dramatically better outcomes.

But spinal implants have become a booming business for surgeons and medical-device companies since winning Food and Drug Administration approval in 1995. Minneapolis-based Medtronic is the biggest maker of spinal implants, accounting for about half of the $7 billion market last year, The Wall Street Journal reported.

Critics in Congress and elsewhere are calling for a review of Medicare's coverage of the procedures. Spinal-fusion claims cost Medicare $2.24 billion in 2008, up nearly 400 percent since 1997 after adjusting for inflation, The Wall Street Journal reported.
Blue Cross has tried to work with physicians for several years to develop guidelines on the procedures, but it hasn't stemmed the surge in the number performed, Bradley said.
"We have tried the kinder, gentler approach," he said. "It's unfortunate that it takes looking at each case each time, but other approaches haven't really worked."

A Blue Cross patient or surgeon could appeal any denial of coverage, and the process would include at least one review by a physician who isn't employed by the insurer, Bradley said.
In late September, the company notified spine surgery practices across the state about the new rules. Before issuing the new policy, officials met with several spine surgeons in the Chapel Hill area and incorporated their input into the new rules.

In some cases, where doctors have tried physical therapy and other types of treatment, the only other option may be surgery, Wake Forest's Wilson said. "To say you're not going to cover them at all, you're hurting some patients," he added. "We don't want there to be patients left suffering."
Blue Cross continually reviews its coverage policies and makes adjustments based on the latest medical guidelines, Bradley said. But the new rules will take effect Jan. 1, despite the outcry from surgeons.
"We always listen to providers," he said. "It's unlikely we would not implement this. But if there's new data that says our criteria are incorrect, we'll be open to that."

Subscribe to The Charlotte Observer.

Read more: http://www.charlotteobserver.com/2010/12/25/1933698/limit-set-on-popular-procedure.html#ixzz19MkLdATa

Blue Cross is under fire for seeking to curb use of expensive spinal fusions.

By Alan M. Wolf
alan.wolf@newsobserver.com

Posted: Saturday, Dec. 25, 2010

More Information

• By the numbers
  3,593: number of spinal fusion surgeries Blue Cross and Blue Shield of North Carolina covered last year, up 22 percent from 2007.
  $105 million: amount the insurer paid in claims for the procedures last year, up 44 percent from 2007.
  Nine: number of medical associations that signed a Dec. 15 letter to Blue Cross, urging changes to its new policies, which take effect Jan. 1.
  3.7 million: Blue Cross members statewide.

The state's largest health insurer is coming under fire from surgeons across the country for implementing tougher restrictions on an increasingly common type of spinal surgery.
Blue Cross and Blue Shield of North Carolina's new rules, which take effect Jan. 1, are designed to reduce overuse of spinal-fusion surgery, a costly and controversial procedure to ease patients' lower back pain . The Chapel Hill-based insurer says it wants to ensure the surgeries are approved based on the latest medical evidence.

"We are not going to stop coverage, but we do want to make sure the ones being done are appropriate," said Dr. Don Bradley, Blue Cross' chief medical officer. "In some cases, we're seeing technology being used when more conservative measures might be more appropriate."
But some spine surgeons worry that the restrictions will limit care for thousands of patients and could set a new coverage standard among other insurers.

A coalition of surgeons representing nine medical associations, including the American Association of Neurological Surgeons and the North American Spine Society, wrote to Blue Cross this month, urging the company to reconsider.


The group also suggested various changes that would ease the new restrictions.
"If this intrusion into the physician-patient relationship goes unchallenged, other insurers will follow suit," said Dr. John Wilson, a neurosurgeon at Wake Forest University Baptist Medical Center who is president of the N.C. Neurological Society and one of nine physicians who signed the letter to Blue Cross.
"It will be a progression of ever-more restrictive policies that will handcuff us as we try to treat patients," Wilson said.

The surgeon groups requested a meeting with Blue Cross executives before the rules kick in one week from today to discuss the new policy. But the insurer responded in an e-mail message that because of the holidays, a meeting could not be scheduled until the third week of January.
Wilson estimates that he performs about 100 spinal-fusion surgeries a year. Only a small percentage of his practice's patients would be ineligible for coverage under the new Blue Cross rules.
"Even if it's just a few patients, if we're limited in how we can help them, it doesn't sit right with us," he added.
The new spine-surgery rules come as Blue Cross faces increasing pressure to keep costs down and control premiums. The company announced plans in July to slash administrative costs up to 20 percent by 2014.
"The tendency is to label us as the big, bad insurance company," Bradley said. "We understand folks rely on us to cover the things that should be covered. They also assume that we're making decisions about appropriate care" to keep premiums affordable.

Blue Cross reports that it covered 3,593 spinal fusion surgeries last year, up 22 percent from 2007. The insurer paid $105 million in claims for the procedures last year, up 44 percent from 2007. The procedures require longer hospital stays and cost more than three times the amount of a simpler surgery, according to the Journal of the American Medical Association.

The new rules will require patients and physicians to get approval before spinal-fusion surgery. The insurer still will cover the surgery for some ailments, such as scoliosis, injury and tumors.
But Blue Cross won't cover the surgery for degenerative disk disease. The condition is caused by aging disks and can cause debilitating back pain.

"We feel that to completely omit this as a covered procedure under any circumstance is overly restrictive," the national group of surgeons wrote in their letter to Blue Cross.
The surgeries involve implanting rods and screws to repair vertebrae. JAMA reports that patients who had a complex fusion procedure were nearly three times as likely to develop a life-threatening complication and that the surgeries didn't result in dramatically better outcomes.

But spinal implants have become a booming business for surgeons and medical-device companies since winning Food and Drug Administration approval in 1995. Minneapolis-based Medtronic is the biggest maker of spinal implants, accounting for about half of the $7 billion market last year, The Wall Street Journal reported.

Critics in Congress and elsewhere are calling for a review of Medicare's coverage of the procedures. Spinal-fusion claims cost Medicare $2.24 billion in 2008, up nearly 400 percent since 1997 after adjusting for inflation, The Wall Street Journal reported.
Blue Cross has tried to work with physicians for several years to develop guidelines on the procedures, but it hasn't stemmed the surge in the number performed, Bradley said.
"We have tried the kinder, gentler approach," he said. "It's unfortunate that it takes looking at each case each time, but other approaches haven't really worked."

A Blue Cross patient or surgeon could appeal any denial of coverage, and the process would include at least one review by a physician who isn't employed by the insurer, Bradley said.
In late September, the company notified spine surgery practices across the state about the new rules. Before issuing the new policy, officials met with several spine surgeons in the Chapel Hill area and incorporated their input into the new rules.

In some cases, where doctors have tried physical therapy and other types of treatment, the only other option may be surgery, Wake Forest's Wilson said. "To say you're not going to cover them at all, you're hurting some patients," he added. "We don't want there to be patients left suffering."
Blue Cross continually reviews its coverage policies and makes adjustments based on the latest medical guidelines, Bradley said. But the new rules will take effect Jan. 1, despite the outcry from surgeons.
"We always listen to providers," he said. "It's unlikely we would not implement this. But if there's new data that says our criteria are incorrect, we'll be open to that."

Subscribe to The Charlotte Observer.

Read more: http://www.charlotteobserver.com/2010/12/25/1933698/limit-set-on-popular-procedure.html#ixzz19MkLdATa

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As Spinal Fusion Volume Grows, So Do Profits for Surgeons & Device Makers

Report outlines controversies over device-heavy spine procedures and surgeon-manufacturer relationships.

Are financial relationships with medical device companies and profitable reimbursement margins inducing spine surgeons to perform more fusions than necessary? A recent report in the Wall Street Journal explores several controversies associated with the growing market for these device-heavy spine surgeries. Medicare paid $343 million for spinal fusion procedures in 1997, compared to $2.24 billion in 2008 — a nearly 400% increase, according to the Journal's analysis of Medicare data. Within the medical community, doctors are divided between more conservative spine surgeons who believe fusion should be used sparingly to treat a small number of conditions, such as scoliosis, and surgeons who advocate using fusion to relieve chronic back pain or to treat degenerative disk disease, one of the most hotly debated uses of the procedure.  Blue Cross and Blue Shield of North Carolina announced earlier this year that it would stop paying for spinal fusions performed to treat aging disks beginning on Jan. 1, 2011. Nine medical associations, including the American Association of Orthopaedic Surgeons, recently sent a letter to the insurer to express concerns over the new policy and advocate for less restrictive language. One thing is certain: The increase in spinal fusions has been a boon for the companies that make and sell the hardware and implants used in spinal fusion surgery, which can cost tens of thousands of dollars for a single procedure.  Meanwhile, companies like Medtronic, the largest manufacturer of spinal implants, pay surgeons millions of dollars in royalties for their help in developing new technologies. Medtronic and the surgeons who collaborate with the company say the payments are a legitimate way for surgeons to give input on new devices and do not create a conflict of interest. Critics, including some members of Congress, argue that they are essentially kickbacks designed to boost medical device sales.  In response to this criticism, Medtronic began disclosing its payments to surgeons publicly on its website in June, and many doctors who partner with device makers say they disclose these relationships to their patients. A provision in the Affordable Care Act requires all companies to disclose such payments made to physicians by 2013. Read the full WSJ report here. Irene Tsikitas

Report outlines controversies over device-heavy spine procedures and surgeon-manufacturer relationships.

Are financial relationships with medical device companies and profitable reimbursement margins inducing spine surgeons to perform more fusions than necessary? A recent report in the Wall Street Journal explores several controversies associated with the growing market for these device-heavy spine surgeries. Medicare paid $343 million for spinal fusion procedures in 1997, compared to $2.24 billion in 2008 — a nearly 400% increase, according to the Journal's analysis of Medicare data. Within the medical community, doctors are divided between more conservative spine surgeons who believe fusion should be used sparingly to treat a small number of conditions, such as scoliosis, and surgeons who advocate using fusion to relieve chronic back pain or to treat degenerative disk disease, one of the most hotly debated uses of the procedure.  Blue Cross and Blue Shield of North Carolina announced earlier this year that it would stop paying for spinal fusions performed to treat aging disks beginning on Jan. 1, 2011. Nine medical associations, including the American Association of Orthopaedic Surgeons, recently sent a letter to the insurer to express concerns over the new policy and advocate for less restrictive language. One thing is certain: The increase in spinal fusions has been a boon for the companies that make and sell the hardware and implants used in spinal fusion surgery, which can cost tens of thousands of dollars for a single procedure.  Meanwhile, companies like Medtronic, the largest manufacturer of spinal implants, pay surgeons millions of dollars in royalties for their help in developing new technologies. Medtronic and the surgeons who collaborate with the company say the payments are a legitimate way for surgeons to give input on new devices and do not create a conflict of interest. Critics, including some members of Congress, argue that they are essentially kickbacks designed to boost medical device sales.  In response to this criticism, Medtronic began disclosing its payments to surgeons publicly on its website in June, and many doctors who partner with device makers say they disclose these relationships to their patients. A provision in the Affordable Care Act requires all companies to disclose such payments made to physicians by 2013. Read the full WSJ report here. Irene Tsikitas

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Diet key to longer life, even when you're old

Adults ages 70-79 who ate healthy foods had lower risk of death over a 10-year period, study finds 

By Rachael Rettner 

Even in your elder years, eating healthy foods can help you live longer, a new study suggests.

In the study, older adults who ate mainly healthy foods — such as vegetables, fruit, poultry, low-fat dairy products and whole grains — had a lower risk of death over a 10-year period than those who ate less-healthy foods, including high-fat dairy products.

"Some people have suggested in the past that it doesn't maybe matter too much what people eat at an older age," said study researcher Amy Anderson, of the department of Nutrition and Food Science at the University of Maryland. "But our study, and previous studies, support the idea that that older adults can affect their health and longevity by following a dietary pattern that is high in healthy foods."
Anderson and her colleagues examined the eating habits and quality of life of about 2,500 adults, ages 70 to 79, from Pittsburgh and Memphis, Tenn. Participants answered a questionnaire designed to assess their typical diet. They also indicated whether their health was excellent, very good, good, fair or poor.
Story: Being 'chilled out' can increase risk of obesity The researchers grouped the participants based on their diets:

• Those who ate mainly healthy food
• Those who ate mainly high-fat dairy products, such as ice cream and cheese, and had a lower intake of poultry, low-fat dairy products, rice and pasta
• Those who ate mainly meat and fried foods and drank alcohol
• Those who ate mainly refined grains
• Those who ate mainly breakfast cereals
• Those who ate mainly sweets and desserts — such as doughnuts, cakes and candy — and had a lower intake of fruit, fish, other seafood and dark green vegetables

The researchers followed up with the participants for an average of 10 years, during which 739 died. Those in the high-fat dairy product group were 40 percent more likely to die during this time period than those in the healthy food group. Those in the sweets and desserts group had a 37 percent higher risk of death than those in the healthy food group.

Those in the healthy food group also reported more years of healthy life, when they rated their health as excellent, very good or good.

Interestingly, those who ate mostly meat and fried foods and drank alcohol did not have a higher risk of death than those who ate healthy food after the researchers took into account other factors that could affect the results, such as age, gender, race, education, physical activity and total calorie intake. It's possible that eating plant-based foods counteracted the deleterious effects of eating animal fat, the researchers said. Those who consumed meat, fried foods and alcohol also ate slightly more vegetables, fruits and whole grains than those in the high-fat dairy products group and those in the sweets and desserts group.


While previous work has linked diet to length of life, many of these studies aimed to score a person's eating habits based on how well they match up with a specific food regimen, such as the Mediterranean diet. But the new study examined participants' overall diets before classifying them into the appropriate groups.

Since participants all lived in two U.S. cities, the results don't necessarily apply to those living elsewhere, the researchers said. Also, the subjects' diet was assessed just once during the study, and the researchers don't know if eating patterns changed over time, Anderson said.
Those that ate healthy food closely adhered to the current dietary guidelines for Americans, which are aimed at reducing chronic disease, including heart disease and diabetes, she said. It's possible that those in the healthy food group had an extended life span because they had a reduced rate of chronic disease.
The results will be published in the January 2011 issue of the Journal of the American Dietetic Association.

Adults ages 70-79 who ate healthy foods had lower risk of death over a 10-year period, study finds 

By Rachael Rettner 

Even in your elder years, eating healthy foods can help you live longer, a new study suggests.

In the study, older adults who ate mainly healthy foods — such as vegetables, fruit, poultry, low-fat dairy products and whole grains — had a lower risk of death over a 10-year period than those who ate less-healthy foods, including high-fat dairy products.

"Some people have suggested in the past that it doesn't maybe matter too much what people eat at an older age," said study researcher Amy Anderson, of the department of Nutrition and Food Science at the University of Maryland. "But our study, and previous studies, support the idea that that older adults can affect their health and longevity by following a dietary pattern that is high in healthy foods."
Anderson and her colleagues examined the eating habits and quality of life of about 2,500 adults, ages 70 to 79, from Pittsburgh and Memphis, Tenn. Participants answered a questionnaire designed to assess their typical diet. They also indicated whether their health was excellent, very good, good, fair or poor.
Story: Being 'chilled out' can increase risk of obesity The researchers grouped the participants based on their diets:

• Those who ate mainly healthy food
• Those who ate mainly high-fat dairy products, such as ice cream and cheese, and had a lower intake of poultry, low-fat dairy products, rice and pasta
• Those who ate mainly meat and fried foods and drank alcohol
• Those who ate mainly refined grains
• Those who ate mainly breakfast cereals
• Those who ate mainly sweets and desserts — such as doughnuts, cakes and candy — and had a lower intake of fruit, fish, other seafood and dark green vegetables

The researchers followed up with the participants for an average of 10 years, during which 739 died. Those in the high-fat dairy product group were 40 percent more likely to die during this time period than those in the healthy food group. Those in the sweets and desserts group had a 37 percent higher risk of death than those in the healthy food group.

Those in the healthy food group also reported more years of healthy life, when they rated their health as excellent, very good or good.

Interestingly, those who ate mostly meat and fried foods and drank alcohol did not have a higher risk of death than those who ate healthy food after the researchers took into account other factors that could affect the results, such as age, gender, race, education, physical activity and total calorie intake. It's possible that eating plant-based foods counteracted the deleterious effects of eating animal fat, the researchers said. Those who consumed meat, fried foods and alcohol also ate slightly more vegetables, fruits and whole grains than those in the high-fat dairy products group and those in the sweets and desserts group.


While previous work has linked diet to length of life, many of these studies aimed to score a person's eating habits based on how well they match up with a specific food regimen, such as the Mediterranean diet. But the new study examined participants' overall diets before classifying them into the appropriate groups.

Since participants all lived in two U.S. cities, the results don't necessarily apply to those living elsewhere, the researchers said. Also, the subjects' diet was assessed just once during the study, and the researchers don't know if eating patterns changed over time, Anderson said.
Those that ate healthy food closely adhered to the current dietary guidelines for Americans, which are aimed at reducing chronic disease, including heart disease and diabetes, she said. It's possible that those in the healthy food group had an extended life span because they had a reduced rate of chronic disease.
The results will be published in the January 2011 issue of the Journal of the American Dietetic Association.

Read More

Low Vitamin D Levels Common in Breast Cancer

Dec. 14, 2010 (San Antonio) -- More than half of women with breast cancer have low vitamin D levels, British researchers report.

"Women with breast cancer should be tested for vitamin D levels and offered supplements, if necessary," says researcher Sonia Li, MD, of the Mount Vernon Cancer Centre in Middlesex, England. The findings were presented at the San Antonio Breast Cancer Symposium.

Some studies have suggested a link between low vitamin levels and breast cancer risk and progression, but others have not, she says. No studies have proven cause and effect.

Previous research suggests a biologic rationale for vitamin D putting the brakes on breast cancer development and spread, Li says.

Breast cancer cells have vitamin D receptors, and when these receptors are activated by vitamin D, it triggers a series of molecular changes that can slow cell growth and cause cells to die, she says.

Even if it does not have a direct effect on the tumor, vitamin D is needed to maintain the bone health of women with breast cancer, Li says. That's especially important given the increasing use of aromatase inhibitors, which carry an increased risk of bone fractures, she says.

Vitamin D is found in some foods, especially milk and fortified cereals, and is made by the body after exposure to sunlight. It is necessary for bone health.

Dec. 14, 2010 (San Antonio) -- More than half of women with breast cancer have low vitamin D levels, British researchers report.

"Women with breast cancer should be tested for vitamin D levels and offered supplements, if necessary," says researcher Sonia Li, MD, of the Mount Vernon Cancer Centre in Middlesex, England. The findings were presented at the San Antonio Breast Cancer Symposium.

Some studies have suggested a link between low vitamin levels and breast cancer risk and progression, but others have not, she says. No studies have proven cause and effect.

Previous research suggests a biologic rationale for vitamin D putting the brakes on breast cancer development and spread, Li says.

Breast cancer cells have vitamin D receptors, and when these receptors are activated by vitamin D, it triggers a series of molecular changes that can slow cell growth and cause cells to die, she says.

Even if it does not have a direct effect on the tumor, vitamin D is needed to maintain the bone health of women with breast cancer, Li says. That's especially important given the increasing use of aromatase inhibitors, which carry an increased risk of bone fractures, she says.

Vitamin D is found in some foods, especially milk and fortified cereals, and is made by the body after exposure to sunlight. It is necessary for bone health.

Read More

Consumer Reports Warns Pregnant Women Against Canned Tuna

Pregnant women and children have long been warned that they should be wary of eating certain kinds of seafood because of the risk of mercury contamination. It's a real threat — mercury is a neurotoxin, and exposure in-utero at high levels can damage an infant's developing cognitive skills.

Seafood can pose a danger because mercury — usually from the emissions of coal-fired power plants and other industrial sources — can accumulate in the tissue of fish, especially in predators high on the food chain. That includes tuna, and white (albacore) tuna is known to be especially high in mercury. The Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) both recommend that women of childbearing age and young children should eat no more than 12 ounces a week of light tuna, including 6 ounces of white tuna. (More on Time.com: 5 Pregnancy Taboos Explained (or Debunked))

But that may not be safe enough. Consumer Reports tested 42 samples of tuna from cans bought in and around New York and found that white tuna usually contains far more mercury than light tuna — and that women and children should be even more cautious about eating the fish.

After analyzing the tests, the magazine's fish-safety experts concluded that pregnant women should avoid eating all tuna as a precaution. Children over 45 lbs. should stick to no more than 12.5 ounces of light tuna or 4 ounces of white tuna a week, while lighter children should have no more than have 4 ounces or less of light tuna or 1.5 ounces or less of white tuna, dependent on their weight. (Download a copy of the report here.)

Why the stricter warnings? Every sample that Consumer Reports tested had measurable levels of mercury, ranging from 0.018 to 0.774 parts per million (ppm). Samples of white tuna ranged from 0.217 ppm to 0.774 ppm and averaged 0.427 ppm — enough that by eating 2.5 ounces of any of the tested samples, a woman would exceed the daily mercury intake considered safe by the EPA. (More on Time.com: Study: Restless Leg Syndrome During Pregnancy May Recur)

Samples of light tuna ranged from 0.018 ppm to 0.176 ppm. That's low on average, but about half the tested samples contained enough mercury that eating a single can would exceed the EPA's limit for women of child-bearing age.

Indeed, it's the outliers that pose a particular danger, not so much the average. While light tuna especially on average doesn't contain that much mercury, there's the danger of spikes in certain samples — and there's no way for pregnant women to know if the canned tuna they're eating contains unusually high levels of mercury. But the Consumer Reports study shows that it is a real threat that cautious women should take seriously.

Of course, limiting your seafood intake has its own risks. Omega-3 fatty acids — found in fish — are thought to help in developing fetal nervous systems, and they're well-known to reduce the risk of heart attack and stroke. The National Fisheries Institute, a trade group, noted that none of the canned tuna it tested — even the outliers — exceeded the FDA's allowable limit of 1 ppm or more. (That's the point at which the FDA is allowed to pull products from the shelves, though that's never been done.) The group also noted — cheekily — that Consumer Reports had apparently served tuna tartare at its recent holiday party, so it can't be that dangerous. (More on Time.com: Photos: Pregnant Belly Art)

Of course, the FDA's safety limits on mercury have long been considered too lax — and compared to the rest of the world, they are. It will be a long time before we have definitive science on just how much mercury pregnant women can be exposed to without ill effect, but most people would agree that this is a time for the precautionary principle.

Pregnant women and children have long been warned that they should be wary of eating certain kinds of seafood because of the risk of mercury contamination. It's a real threat — mercury is a neurotoxin, and exposure in-utero at high levels can damage an infant's developing cognitive skills.

Seafood can pose a danger because mercury — usually from the emissions of coal-fired power plants and other industrial sources — can accumulate in the tissue of fish, especially in predators high on the food chain. That includes tuna, and white (albacore) tuna is known to be especially high in mercury. The Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) both recommend that women of childbearing age and young children should eat no more than 12 ounces a week of light tuna, including 6 ounces of white tuna. (More on Time.com: 5 Pregnancy Taboos Explained (or Debunked))

But that may not be safe enough. Consumer Reports tested 42 samples of tuna from cans bought in and around New York and found that white tuna usually contains far more mercury than light tuna — and that women and children should be even more cautious about eating the fish.

After analyzing the tests, the magazine's fish-safety experts concluded that pregnant women should avoid eating all tuna as a precaution. Children over 45 lbs. should stick to no more than 12.5 ounces of light tuna or 4 ounces of white tuna a week, while lighter children should have no more than have 4 ounces or less of light tuna or 1.5 ounces or less of white tuna, dependent on their weight. (Download a copy of the report here.)

Why the stricter warnings? Every sample that Consumer Reports tested had measurable levels of mercury, ranging from 0.018 to 0.774 parts per million (ppm). Samples of white tuna ranged from 0.217 ppm to 0.774 ppm and averaged 0.427 ppm — enough that by eating 2.5 ounces of any of the tested samples, a woman would exceed the daily mercury intake considered safe by the EPA. (More on Time.com: Study: Restless Leg Syndrome During Pregnancy May Recur)

Samples of light tuna ranged from 0.018 ppm to 0.176 ppm. That's low on average, but about half the tested samples contained enough mercury that eating a single can would exceed the EPA's limit for women of child-bearing age.

Indeed, it's the outliers that pose a particular danger, not so much the average. While light tuna especially on average doesn't contain that much mercury, there's the danger of spikes in certain samples — and there's no way for pregnant women to know if the canned tuna they're eating contains unusually high levels of mercury. But the Consumer Reports study shows that it is a real threat that cautious women should take seriously.

Of course, limiting your seafood intake has its own risks. Omega-3 fatty acids — found in fish — are thought to help in developing fetal nervous systems, and they're well-known to reduce the risk of heart attack and stroke. The National Fisheries Institute, a trade group, noted that none of the canned tuna it tested — even the outliers — exceeded the FDA's allowable limit of 1 ppm or more. (That's the point at which the FDA is allowed to pull products from the shelves, though that's never been done.) The group also noted — cheekily — that Consumer Reports had apparently served tuna tartare at its recent holiday party, so it can't be that dangerous. (More on Time.com: Photos: Pregnant Belly Art)

Of course, the FDA's safety limits on mercury have long been considered too lax — and compared to the rest of the world, they are. It will be a long time before we have definitive science on just how much mercury pregnant women can be exposed to without ill effect, but most people would agree that this is a time for the precautionary principle.

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Top Spine Surgeons Reap Royalties, Medicare Bounty

Norton Hospital in Louisville, Ky., may not be a household name nationally. But five senior spine surgeons have helped put it on the map in at least one category: From 2004 to 2008, Norton performed the third-most spinal fusions on Medicare patients in the country.

The five surgeons are also among the largest recipients nationwide of payments from medical-device giant Medtronic Inc. In the first nine months of this year alone, the surgeons—Steven Glassman, Mitchell Campbell, John Johnson, John Dimar and Rolando Puno—received more than $7 million from the Fridley, Minn., company.

Medtronic and the surgeons say the payments are mostly royalties they earned for helping the company design one of its best-selling spine products.

Corporate whistleblowers and congressional critics contend such arrangements—which are common in orthopedic surgery—amount to kickbacks to stoke sales of medical devices. They argue that the overuse of surgical hardware ranging from heart stents to artificial hips is a big factor behind the soaring costs of Medicare, the government medical-insurance system for the elderly and disabled.

Medtronic says it can't develop new medical products that improve patients' lives without the help of surgeons. It says the royalties it pays them are legitimate but it doesn't give detailed information about what intellectual property each recipient contributes. It says it doesn't pay its collaborating surgeons royalties on the devices they personally use in their patients, removing any financial incentive for them to do more surgeries than necessary.

Norton's Dr. Glassman cited this policy as a safeguard against any conflict of interest and said the royalties he and his colleagues receive are "legitimate." He added that they inform their patients of their financial ties with Medtronic. Norton Hospital said it has policies "to prevent direct conflicts of interest." The other Norton surgeons didn't respond to requests for comment put to them through Norton and Dr. Glassman.

Using a Medicare database that tracks hospitals' billing, The Wall Street Journal was able to ascertain that Norton is among the most aggressive practitioners of spinal fusion in the country.

Spinal fusion has become one of medicine's most controversial procedures. It involves fusing together two or more vertebrae to alleviate back pain, usually with the help of metal plates, rods and screws implanted in the patient's back. Tens of thousands of dollars of hardware can go into a single surgery.

Medtronic is the biggest maker of spinal implants. Last year, its spine business generated world-wide sales of $3.5 billion, accounting for half of the roughly $7 billion spinal-implant market.

Conservative spine surgeons argue that a spinal fusion is appropriate only for a small number of conditions, such as spinal instability, spinal fracture or a severe curvature of the spine known as scoliosis, and that financial incentives have caused the procedure to become overused. Others say it's a useful tool to treat patients who have debilitating back pain and have tried other options like physical therapy to no avail.

The Journal consulted several experts to determine which back conditions are commonly thought to require a fusion and which are subject to the most debate. The most hotly debated use of spinal fusion surgery centers on patients who merely suffer from aging disks, a condition known as degenerative disk disease.

One health insurer, the nonprofit Blue Cross and Blue Shield of North Carolina, announced in September that it would stop paying for spine fusions performed on such patients beginning on Jan. 1. The insurer said that the procedures are "considered not medically necessary."

The Journal mined hospitals' Medicare claims to see what proportion of fusions performed fall in this category. Due to a three-decade-old court ruling guarding the confidentiality of physician information, the paper is barred from disclosing what it found regarding the five Norton surgeons.

Critics of the court ruling and of the privacy policies of the federal Medicare program argue that making such information public would help taxpayers understand where their money is going, and potentially deter abusive or wasteful practices.

But the Journal is permitted to disclose its findings for Norton Hospital as a whole, where 27 surgeons performed one or more spine fusions in 2008.

At Norton, spinal fusions on patients who only suffered from aging disks accounted for 24% of the 2,475 fusions the hospital performed for Medicare between 2004 and 2008, compared with 17% nationally. This placed it 11th in percentage terms out of 60 hospitals that performed 1,000 or more spine fusions in those years, and fourth in raw count. Norton ranked third nationally in the overall numbers of spine-fusion surgeries.

In emailed responses to questions, Dr. Glassman said he and his four colleagues "do not overuse spine fusion procedures," and argued that the diagnostic codes the Journal based its analysis on "do not convey indication for spinal fusion with the specificity that you are attributing to this data."

Norton Hospital in Louisville, Ky., may not be a household name nationally. But five senior spine surgeons have helped put it on the map in at least one category: From 2004 to 2008, Norton performed the third-most spinal fusions on Medicare patients in the country.

The five surgeons are also among the largest recipients nationwide of payments from medical-device giant Medtronic Inc. In the first nine months of this year alone, the surgeons—Steven Glassman, Mitchell Campbell, John Johnson, John Dimar and Rolando Puno—received more than $7 million from the Fridley, Minn., company.

Medtronic and the surgeons say the payments are mostly royalties they earned for helping the company design one of its best-selling spine products.

Corporate whistleblowers and congressional critics contend such arrangements—which are common in orthopedic surgery—amount to kickbacks to stoke sales of medical devices. They argue that the overuse of surgical hardware ranging from heart stents to artificial hips is a big factor behind the soaring costs of Medicare, the government medical-insurance system for the elderly and disabled.

Medtronic says it can't develop new medical products that improve patients' lives without the help of surgeons. It says the royalties it pays them are legitimate but it doesn't give detailed information about what intellectual property each recipient contributes. It says it doesn't pay its collaborating surgeons royalties on the devices they personally use in their patients, removing any financial incentive for them to do more surgeries than necessary.

Norton's Dr. Glassman cited this policy as a safeguard against any conflict of interest and said the royalties he and his colleagues receive are "legitimate." He added that they inform their patients of their financial ties with Medtronic. Norton Hospital said it has policies "to prevent direct conflicts of interest." The other Norton surgeons didn't respond to requests for comment put to them through Norton and Dr. Glassman.

Using a Medicare database that tracks hospitals' billing, The Wall Street Journal was able to ascertain that Norton is among the most aggressive practitioners of spinal fusion in the country.

Spinal fusion has become one of medicine's most controversial procedures. It involves fusing together two or more vertebrae to alleviate back pain, usually with the help of metal plates, rods and screws implanted in the patient's back. Tens of thousands of dollars of hardware can go into a single surgery.

Medtronic is the biggest maker of spinal implants. Last year, its spine business generated world-wide sales of $3.5 billion, accounting for half of the roughly $7 billion spinal-implant market.

Conservative spine surgeons argue that a spinal fusion is appropriate only for a small number of conditions, such as spinal instability, spinal fracture or a severe curvature of the spine known as scoliosis, and that financial incentives have caused the procedure to become overused. Others say it's a useful tool to treat patients who have debilitating back pain and have tried other options like physical therapy to no avail.

The Journal consulted several experts to determine which back conditions are commonly thought to require a fusion and which are subject to the most debate. The most hotly debated use of spinal fusion surgery centers on patients who merely suffer from aging disks, a condition known as degenerative disk disease.

One health insurer, the nonprofit Blue Cross and Blue Shield of North Carolina, announced in September that it would stop paying for spine fusions performed on such patients beginning on Jan. 1. The insurer said that the procedures are "considered not medically necessary."

The Journal mined hospitals' Medicare claims to see what proportion of fusions performed fall in this category. Due to a three-decade-old court ruling guarding the confidentiality of physician information, the paper is barred from disclosing what it found regarding the five Norton surgeons.

Critics of the court ruling and of the privacy policies of the federal Medicare program argue that making such information public would help taxpayers understand where their money is going, and potentially deter abusive or wasteful practices.

But the Journal is permitted to disclose its findings for Norton Hospital as a whole, where 27 surgeons performed one or more spine fusions in 2008.

At Norton, spinal fusions on patients who only suffered from aging disks accounted for 24% of the 2,475 fusions the hospital performed for Medicare between 2004 and 2008, compared with 17% nationally. This placed it 11th in percentage terms out of 60 hospitals that performed 1,000 or more spine fusions in those years, and fourth in raw count. Norton ranked third nationally in the overall numbers of spine-fusion surgeries.

In emailed responses to questions, Dr. Glassman said he and his four colleagues "do not overuse spine fusion procedures," and argued that the diagnostic codes the Journal based its analysis on "do not convey indication for spinal fusion with the specificity that you are attributing to this data."

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