Wal-Mart's Health Plans for 2012 to Increase Premiums for Smokers

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Penalty per pay period that Wal-Mart's health insurance plans will require of employees who smoke in 2012. The cost will amount to $260 to $2,340 extra per year for those who want health coverage. According to the benefits consulting firm Mercer, several other large employers also charge higher premiums to workers who smoke; among the largest employers, about 28% adjust their premiums based on workers' tobacco use. [via The New York Times]

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What Does a 400% Increase in Antidepressant Use Really Mean?

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Antidepressant prescribing has risen nearly 400% since 1988, according to data from the Centers for Disease Control and Prevention (CDC). More than 1 in 10 Americans over age 12 now takes an antidepressant, the study finds, and yet two-thirds of those with severe symptoms of depression do not take antidepressants at all.

The new research, led by CDC epidemiologist Laura Pratt, was based on responses from about 12,000 people who took part in a national annual health survey in 2005-08. The findings were released on Wednesday as a National Center for Health Statistics Data Brief.

The findings reflect the paradoxical reality of depression treatment in the U.S. While some observers complain that antidepressants are being handed out like candy, the data show that patterns of prescription generally adhere to what is known about depression prevalence in the U.S. In fact, the research suggests that depression is consistently undertreated.

First of all, depression is common: 9.1% of American adults will suffer from the illness at any given time, according to earlier CDC research. Although the current study finds that antidepressant prescriptions (11%) are more common than depression, earlier data show that about one-fifth of those prescriptions are written to treat conditions other than depression, such as anxiety disorders, pain and menopausal symptoms. That means the "excess" 2% of prescriptions aren't likely to represent overprescribing. Current rates may even reflect underprescribing: the CDC study finds that only one-third of people with symptoms are taking medication.

(MORE: What Salt and Prozac Have in Common)

Further, depression is seen twice as often in women than in men. The CDC found that women were overall 2.5 times more likely to take antidepressants than men. That could mean either that women are more likely to seek help than men (which has been shown in earlier studies) or, again, that women are also being treated for anxiety and other disorders, which skew female too.

In terms of age, depression most frequently hits people between the ages of 45 and 64. And indeed, the CDC found that Americans in this age group were more likely than other age groups to receive prescription drugs to treat it. Nearly 23% of women between 40 and 59 took antidepressants in 2005-08.

Fears of overprescribing have also centered on young people — particularly given data suggesting that some of the medications can increase suicide risk among teens — but researchers found that only 2.8% of boys and 4.6% of girls ages 12 to 17 took antidepressants. According to an analysis of data from the National Household Survey on Drug Use and Health in 2005, about 9% of teens in that age group had experienced a major depressive episode in the previous year.

(MORE: Study: How Chronic Stress Can Lead to Depression)

Perhaps the most concerning finding in the CDC report is that people who take antidepressants are taking them long term. About 60% of people had taken the medications for two years or longer, and 14% had taken antidepressants for more than a decade. On its face, that sounds scary, but since depression can be a chronic disorder, and since research shows that maintenance on antidepressants cuts the risk of relapse in half, long-term use can be appropriate. However, as with the vast majority of medications, there is not much research on long-term effects of the drugs and, clearly, such study is needed here.

The agency did find several areas where prescribing rates failed to follow trends of depression prevalence. One involved race: although blacks and Hispanics are more likely to be depressed than whites, the data showed that antidepressants were taken by 14% of whites, compared with just 4% of blacks and 3% of Hispanics.

Moreover, although depression is much more common among the poor and unemployed, there was no difference in prescribing rates by income.

(MORE:
Even for the Insured" href="http://healthland.time.com/2011/07/21/timely-treatment-for-depression-hard-to-get-even-for-the-insured/">Timely Treatment for Depression Hard to Get, Even for the Insured)

The real story here is that depression is depressingly common in the U.S. and that depression sufferers aren't getting adequate treatment, especially if they are young, poor or members of a minority group. The study also found that less than a third of those taking the medications had seen a mental-health professional within the past year, which means they probably get their prescriptions as their only treatment from a primary-care doctor.

But our overburdened mental-health system isn't a sexy story — at least not compared with tales about heedless, pill-popping hedonists and the antidepressant makers who supply them.

Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland's Facebook page and on Twitter at @TIMEHealthland.

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Asthma drugs may increase attacks in kids: report

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By Genevra Pittman

NEW YORK | Tue Oct 25, 2011 5:19pm EDT

NEW YORK (Reuters Health) - One class of drugs used to prevent wheezing and shortness of breath in people with asthma may increase kids' risk of being hospitalized for an asthma attack, according to a new analysis from the U.S. Food and Drug Administration.

However, researchers said, it's possible that when the drugs, called long-acting beta-agonists or LABAs, are used in combination with inhaled corticosteroid medications, that extra risk disappears.

"These studies confirm our recommendations at the FDA that are already (on drug labels) for children and adolescents to use inhaled corticosteroids and LABAs together in one asthma product," said Dr. Ann McMahon, who led the study.

But, she added, the researchers weren't completely convinced from the data they had that inhaled corticosteroids take away all extra risk.

According to the Centers for Disease Control and Prevention, seven million children in the U.S. have asthma (about nine percent), and the rate has been climbing steadily in recent years.

Some kids and adults with asthma are prescribed LABAs to relax muscles around the airway and prevent symptoms like wheezing. But there's also evidence that long-term use of the drugs may slightly increase the risk of sudden serious symptoms.

LABAs are also used by people with chronic obstructive pulmonary disorder, or COPD.

The FDA report combines safety data from over 100 studies including about 60,000 people with asthma. The original trials were done by companies that market LABAs.

The drugs include Merck's Foradil and GlaxoSmithKline's Serevent.

Compared to all patients who didn't take LABAs, adults and kids who were prescribed the drugs were 27 percent more likely to end up in the hospital, or in rare cases die or require intubation, because of an asthma attack.

That extra risk was greatest in the youngest study participants. Kids between age four and 11 who were taking a LABA were 67 percent more likely to have an asthma-related hospitalization than those who weren't getting the medication.

That means that over a one-year period, there would be an extra three hospitalizations for every 100 kids taking LABAs.

A small number of people of all ages who were regularly taking an inhaled corticosteroid together with a LABA didn't seem to have any extra risk of hospitalization, according to the report published in Pediatrics.

"Although we were able to be somewhat reassured... it was a small enough sample that we didn't feel entirely confident, and we need to have further analysis," McMahon told Reuters Health.

The finding of an extra hospitalization risk in people taking LABAs alone isn't new. Last year, after other research suggested that risk, the FDA began requiring drugmakers to write on LABA labels that the drugs should not be used without a long-term asthma control medication like an inhaled corticosteroid.

Some asthma medications, including GlaxoSmithKline's Advair and AstraZeneca's Symbicort, contain both a LABA and corticosteroid. The FDA recommends such combined products for kids with asthma.

"The thing that's new in this paper... is they've highlighted the fact that younger-age children may have a higher risk" when taking a LABA alone, said Dr. Scott Weiss, as asthma researcher from Harvard Medical School in Boston who was not involved in the report.

Weiss reported financial ties to the drug company Novartis, and was formerly linked to GlaxoSmithKline and AstraZeneca.

McMahon said the analysis wasn't designed to examine the reason for extra risks due to LABA use in kids, and didn't want to speculate. But Weiss said it could be related to their smaller airways.

He agreed that it's important for future studies to look directly at the issue of serious attacks in LABA users to determine the underlying cause behind those attacks -- and whether they're directly due to the medications themselves.

Still, he told Reuters Health, "Nobody is really prescribing a LABA on its own -- that's basically off the market."

SOURCE: bit.ly/txNP6y Pediatrics, online October 24, 2011.

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Vitamin E May Increase Risk of Prostate Cancer

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Adding to the evidence that regularly taking dietary supplements may do more harm than good, researchers at the Cleveland Clinic have found that men taking vitamin E are not protected from prostate cancer, and may even be at higher risk for disease, compared with men not using the supplements.

The new study is only the latest blow to E, a popular supplement that has been touted as a powerful way to prevent everything from prostate and breast cancer to heart disease, vision loss and Alzheimer's. In recent years, however, in-depth studies have broken vitamin E's healthy spell, finding that people who take it are no better off than people who don't.

Still, based on animal studies and early population studies, scientists had believe that vitamin E supplementation could be a smart and inexpensive way to prevent prostate tumors, given that the vitamin's antioxidant effects may combat potentially damaging changes to the DNA in prostate cells.

"This finding was surprising, because all the evidence previously suggested that vitamin E may be protective against prostate cancer," says the Cleveland Clinic's Dr. Eric Klein, lead author of the new study published in the Journal of the American Medical Association.

MORE: Multivitamins, Dietary Supplements Linked to Death in Older Women

The current study is a follow-up to one of the first rigorous studies of the effects of vitamin E and selenium on prostate cancer risk, published by Klein and colleagues in 2008. That study, in which men were randomly assigned to take either supplement, or both together, or a placebo, Klein and his team found no difference in cancer risk among any of the groups, suggesting that vitamin E offered no protective anticancer benefit. Based on those results, the study was stopped. Additional analysis revealed that vitamin E may even boost risk of developing tumors.

To further understand what was going on, Klein continued the study with the majority of participants, who had stopped taking supplements but had agreed to continue providing information on their prostate cancer status for an additional 18 months.

In that time, Klein and his team found that even after the men had stopped taking vitamin E, their risk of prostate cancer remained higher than that of men who had originally been assigned a placebo. "The effect seemed to continue even after the supplements stopped," he says, suggesting that vitamins have powerful effects on body systems that may have lasting consequences. "People have to get out of the idea that taking vitamins is innocuous, and that their effects stop when they stop taking them."

Klein doesn't know exactly how vitamin E may increase the risk of prostate, but is hoping that his biobank of tissue samples from participants in the trial, which contains their starting levels of vitamin E and selenium, might provide some clues. By accounting for these baseline levels of the vitamin, he or others hope to determine whether it's vitamin E itself, or whether it's the dose of the vitamin, that may be contributing to prostate cancer. For example, people who are deficient in vitamin E may be able to take supplements safely and may even benefit from some anticancer effect, while those who are already getting enough of the vitamin may, by taking extra doses, trigger some as-yet unknown mechanism that prompts prostate cancer cells to grow abnormally.

MORE: Eating Fruits and Veggies May Outwit Bad Heart Genes

So, it's still possible that vitamin E supplements may help prevent some disease. So far, the most promising results are with Alzheimer's patients. In some studies, people with early signs of dementia show slower rates of cognitive decline if they take vitamin E than if they don't. But even here, the evidence isn't strong enough for doctors to recommend that those on the road to Alzheimer's take E to ward off their disease.

Overall, it seems, the growing consensus is that unless you need supplements to treat a specific deficiency, nutrients and vitamins are best obtained through a healthy diet. And that goes for E as well, says Klein, since it won't help you avoid cancer. "There doesn't seem to be much benefit to taking vitamin E if you are otherwise healthy," says Klein.

Alice Park is a writer at TIME. Find her on Twitter at @aliceparkny. You can also continue the discussion on TIME's Facebook page and on Twitter at @TIME.

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