The new law would ban cigarette advertising and sponsorship, prohibit smoking in public and add graphic images to packaging. Indonesia is the world’s third-largest tobacco consuming country. Around 30 percent of Indonesians above the age of 10 smoke an average of 12 cigarettes a day, according to a 2008 report.

I wonder how much tobacco are in those cigarettes? …cough

more info: http://www.globalpost.com/dispatches/globalpost-blogs/the-rice-bowl/indonesia-tobacco-law-smoking-cigarette-health

Until a few years ago, condoms and abstinence were alone in that tool kit. Recent studies have added circumcision, vaginal microbicides, a daily pill for the uninfected (known as pre-exposure prophylaxis, or PrEP) and early treatment for the infected (known as “treatment as prevention”).

One study released Wednesday, known as Partners PrEP and conducted in Kenya and Uganda by researchers from the University of Washington, showed that participants who took a daily Truvada pill — a mix of tenofovir and emtricitabine — had a 73 percent lower chance of getting infected. The study was done in 4,758 “discordant couples,” those in which one partner was infected and the other was not. Partners who took a Viread pill — which contains only tenofovir — had a 62 percent lower chance.

The second study, called TDF2 and done in Botswana by the C.D.C., found that those taking Truvada had a 63 percent lower chance of infection. The subjects were 1,200 sexually active young adults.

The studies were due to be released at an AIDS conference in Rome next week. But the University of Washington study was stopped early because it was so clear that the pills were working that it would be unethical to continue distributing placebos. The C.D.C. decided to release its results simultaneously.

Information taken directly from http://www.nytimes.com/2011/07/14/health/research/14aids.html published July 13, 2011. Written by Donald G. McNeil Jr.

Let’s talk about this some more with NPR health policy correspondent Julie Rovner, who’s in our studios.

Julie, good morning.

JULIE ROVNER: Good morning.

INSKEEP: Just to clarify what’s happening here, isn’t the health care law that Congress passed last year supposed to cover or at least give people an opportunity – everybody an opportunity to get covered in a situation like this?

ROVNER: Well, yes. And assuming it doesn’t get repealed or ruled unconstitutional, it will. And it will help couples like these. But, as Jenny pointed out in her story, that won’t happen until the year 2014. And between now and then there’s a lot of frustration and consternation on the part of patients and, I might add, states.

INSKEEP: What are the options for people in a situation like the Boyles, because there must be many?

ROVNER: Well, yes. There is a new program that’s already in effect called a high-risk pool that was established into law and it’s supposed to give the uninsured a way to get insurance between now and then, sort of a bridge to coverage, if you will.

INSKEEP: High-risk pool, that just means you’re at high-risk for disease. Insurers are not really very interested in giving you anything very affordable and so you’re thrown into this pool people where you’re supposed to be able to get insurance.

ROVNER: Exactly. Now technically, this couple could get into one of these pools, which are available in every state. But there are some big catches that have kept a lot of people from signing up.

INSKEEP: Catches?

ROVNER: Catches. Yes. One big one is that in order to get into those pools you have to have been uninsured for at least six months. That means in cases like the Boyles, where they’re losing insurance at the end of the month, they’d have to wait until September before they could sign up for the program.

INSKEEP: Okay.

ROVNER: Another big obstacle in the high-risk pools is price. I did a little research. In Pennsylvania, it would cost each of the Boyles $283.20 a month or $600 for the two of them. That’s a lot less than the high-risk pools that a lot of states run on their own. But it’s still a whole lot more than the $36 a month that they’ve been paying under the plan that’s ending.

INSKEEP: Oh, okay. So the question is if you got the $600 a month or almost $600, you can benefit but if not, you’re out of luck? So how many people are signing up for the new high-risk pools under the new health care law, the National Health Care Law?

ROVNER: Well, a whole lot fewer than have been expected. Nationally, as of February 10th, there were just over 10,000 people enrolled in the plans. Now that’s a 50 percent more than there were back in November. But it’s way below the estimates that were between 200,000 and 375,000 people that were expected to enroll in the first year.

In fact, more than a few governors declined to set up their own high-risk pool programs and they let the federal government step in and do it. They were afraid that the program would be overrun with people and become too expensive.

INSKEEP: All right. Well, why has it been a flop instead?

ROVNER: Well, if you ask federal officials, of course, they say it is not a flop. They point out it’s still very new, that programs like the Children’s Health Insurance Program, which now covers more than nine million low and moderate income children, also got off to a relatively slow start. But there’s other reasons that this particular program hasn’t been all that popular. A couple we’ve already mentioned, the six-month waiting period and that it’s expensive, but there’s also the problem that a lot of people who could be enrolling in this plan just don’t know that it’s out there.

We keep talking so much about how this new coverage isn’t going to start until 2014, people have no idea that some of its already begun.

INSKEEP: Okay, so let’s get back to the Boyles, this couple that we’ve profiled. They’ve got a problem, they’ve got a problem now. What options do they have?

ROVNER: Well, for actual health insurance between now and 2014, there are not that many options unless, obviously, one of them finds a job that offers employee health insurance. In the meantime, they can probably get primary care from a community health center. There’s more than 1,200 health centers that serve more than 20 million people every year, most of them low income or uninsured.

INSKEEP: Just to be clear, there’s a lot of states where there are cutbacks in health coverage that people have today or have had up until today. You say there are some other options? But aren’t there efforts in Congress to cut back on the options?

ROVNER: Yes, there are. The budget bill that’s moving through Congress right now would cut funding by more than a billion dollars and it might make that kind of service a lot harder to come by.

INSKEEP: How are the problems in various states going to affect the national debate then, over health care?

ROVNER: Well, nearly every state is struggling with budget shortfalls. Health costs are a huge part of every state’s health problem. The nation’s governors are coming to Washington later this month and they are going to be talking about what they want to do about the Medicaid program, a huge, huge budget issue, and what they’re going to do about health costs. It’s a really big issue. So there’s a lot more to come on this subject.

INSKEEP: Julie, it’s always a pleasure to talk with you.

ROVNER: Thank you, Steve.

INSKEEP: That’s NPR health policy correspondent Julie Rovner.

Scientists have finally confirmed what the rest of us have suspected for years: Bacon, cheesecake, and other delicious yet fattening foods may be addictive.

A new study in rats suggests that high-fat, high-calorie foods affect the brain in much the same way as cocaine and heroin. When rats consume these foods in great enough quantities, it leads to compulsive eating habits that resemble drug addiction, the study found.

Doing drugs such as cocaine and eating too much junk food both gradually overload the so-called pleasure centers in the brain, according to Paul J. Kenny, Ph.D., an associate professor of molecular therapeutics at the Scripps Research Institute, in Jupiter, Florida. Eventually the pleasure centers “crash,” and achieving the same pleasure–or even just feeling normal–requires increasing amounts of the drug or food, says Kenny, the lead author of the study.

“People know intuitively that there’s more to [overeating] than just willpower,” he says. “There’s a system in the brain that’s been turned on or over-activated, and that’s driving [overeating] at some subconscious level.”

In the study, published in the journal Nature Neuroscience, Kenny and his co-author studied three groups of lab rats for 40 days. One of the groups was fed regular rat food. A second was fed bacon, sausage, cheesecake, frosting, and other fattening, high-calorie foods–but only for one hour each day. The third group was allowed to pig out on the unhealthy foods for up to 23 hours a day.

Not surprisingly, the rats that gorged themselves on the human food quickly became obese. But their brains also changed. By monitoring implanted brain electrodes, the researchers found that the rats in the third group gradually developed a tolerance to the pleasure the food gave them and had to eat more to experience a high.

They began to eat compulsively, to the point where they continued to do so in the face of pain. When the researchers applied an electric shock to the rats’ feet in the presence of the food, the rats in the first two groups were frightened away from eating. But the obese rats were not. “Their attention was solely focused on consuming food,” says Kenny.

In previous studies, rats have exhibited similar brain changes when given unlimited access to cocaine or heroin. And rats have similarly ignored punishment to continue consuming cocaine, the researchers note.

The fact that junk food could provoke this response isn’t entirely surprising, says Dr.Gene-Jack Wang, M.D., the chair of the medical department at the U.S. Department of Energy’s Brookhaven National Laboratory, in Upton, New York.

“We make our food very similar to cocaine now,” he says.

Coca leaves have been used since ancient times, he points out, but people learned to purify or alter cocaine to deliver it more efficiently to their brains (by injecting or smoking it, for instance). This made the drug more addictive.

According to Wang, food has evolved in a similar way. “We purify our food,” he says. “Our ancestors ate whole grains, but we’re eating white bread. American Indians ate corn; we eat corn syrup.”

The ingredients in purified modern food cause people to “eat unconsciously and unnecessarily,” and will also prompt an animal to “eat like a drug abuser [uses drugs],” says Wang.

The neurotransmitter dopamine appears to be responsible for the behavior of the overeating rats, according to the study. Dopamine is involved in the brain’s pleasure (or reward) centers, and it also plays a role in reinforcing behavior. “It tells the brain something has happened and you should learn from what just happened,” says Kenny.

Overeating caused the levels of a certain dopamine receptor in the brains of the obese rats to drop, the study found. In humans, low levels of the same receptors have been associated with drug addiction and obesity, and may be genetic, Kenny says.

However, that doesn’t mean that everyone born with lower dopamine receptor levels is destined to become an addict or to overeat. As Wang points out, environmental factors, and not just genes, are involved in both behaviors.

Wang also cautions that applying the results of animal studies to humans can be tricky. For instance, he says, in studies of weight-loss drugs, rats have lost as much as 30 percent of their weight, but humans on the same drug have lost less than 5 percent of their weight. “You can’t mimic completely human behavior, but [animal studies] can give you a clue about what can happen in humans,” Wang says.

Although he acknowledges that his research may not directly translate to humans, Kenny says the findings shed light on the brain mechanisms that drive overeating and could even lead to new treatments for obesity.

“If we could develop therapeutics for drug addiction, those same drugs may be good for obesity as well,” he says.

via Fatty foods may cause cocaine-like addiction – CNN.com.

Image Source: hpb.gov.sg

Now that the big health bill is law, people have more questions than ever. How will it affect their families and their health care? NPR’s health policy correspondent, Julie Rovner, explains some of the key provisions in the new law.

My son is going to turn 23 in June. Under the new health bill, he can stay on our plan until he’s 26, but I’ve heard this doesn’t go into effect for six months. Do we have to enroll him in alternative insurance in those intervening months, or will he be allowed to stay on that plan continuously? — Patricia Fontana of Berkley, Calif.

This is a provision that doesn’t take effect for six months, and actually, most people won’t have a chance to enroll their children in their plans until their next open season. For some people, it won’t be until next January.

So, yes, you’re going to have to find other insurance. For those with employer-provided insurance, under COBRA they can pay to add their young adult children to their plan, but this can be very expensive. For healthy young people, you can probably find some cheaper insurance for them in the intervening months, and that’s what most people are going to have to do.

This year, adults who are uninsured because of pre-existing conditions will have access to affordable insurance though a temporary subsidized high-risk pool. Can you explain the high-risk pool? If I am eligible, will my husband and daughter be covered, too? — Sarah Tamor of Santa Monica, Calif.

A national high-risk pool is supposed to start in 90 days to cover those who have been uninsured for six months and have pre-existing conditions. There’s $5 billion to help subsidize it, but the premiums could still be pretty high, as they are in most of the state high-risk pools that exist. And the premiums can vary by age — older people can be charged four times as much as younger people.

You have to have been uninsured for six months in order to be eligible. I don’t think your husband and daughter will be allowed to join unless they are also high-risk, and they probably wouldn’t want to because premiums will be high.

Insurance companies won’t have to insure those with pre-existing conditions until 2014, so a national high-risk pool will be there in the interim.

It looks like with the new law, we could find a policy in the risk pool right away if we were uninsured for six months, but if we have insurance — even if it is inadequate — we can’t change until 2014, when the [restrictions on] adult pre-existing conditions go away. Are these really our only options? — Audrey Hagan of Jackson, Wyo.

I’m afraid so. In this new interim risk pool that we were just talking about, you need to be uninsured for six months, and premiums are likely to be high. These are for people who have no other options. The idea is to give people something in the interim. But this couple has insurance, even though they write that it’s inadequate.

This high-risk pool is really for those who have nothing and want something to tide them over until 2014, when insurers can’t turn them away for pre-existing conditions.

I am a small-business owner, and every year my premium has gone up by at least 20 percent. Will the new health care law help keep the cost of health insurance down? — Katherine MacColl, Conway, Mass.

That is certainly the hope. It’s doubtful anyone really thinks this new law will bring premiums down. The idea is that it will stop premiums from going up as fast.

There is a large effort in this bill to protect small businesses. There is a tax break that goes into effect right away that will be from 35 percent of the premium up to 50 percent of the premium. There will be these new exchanges that will begin in 2014 that will hopefully help create competition that will help keep premiums lower, if not low. That will help small businesses, again.

There are a lot of things in this law that hopefully will create changes in the way health care is delivered and paid for that will help stem the growth of health care costs. But no one is suggesting this is the magic bullet.

How does the new law affect people who have insurance through the TriCare program? That’s the private insurance plan for Defense Department workers and military families.

It turns out that people with TriCare won’t be affected by the new law, and that’s both good and bad.

It’s good in that if you have TriCare, it means that you won’t have to go out and buy any other insurance. TriCare is sufficient to cover the individual mandate that you have insurance.

It’s bad if you have an adult child who’s 24 or 25 — you won’t be able to keep them on your TriCare, because TriCare only covers dependents up to age 23. A lot of people are upset by that, and there’s already been a bill introduced in the House that would allow people on TriCare to keep their dependents on TriCare until age 26.

I’m a medical student. I’ve heard from some doctors that reimbursements will decline. For those of us who have the choice of going into primary care or specializing, what will the economic incentives be? — Josh Roarke of Alexandria, Va.

In fact, there are incentives in this law to enlarge the pool of primary care doctors. One big one, which was added very late, is that they are going to increase payments for Medicaid primary care doctors to what Medicare pays. That will be a big increase.

There is increased loan forgiveness — up to $50,000 — for primary care doctors who join the National Health Service Corps. They go off and practice in underserved areas.

There’s going to be more primary care residency slots, and there will be other inducements for primary care doctors. As I mentioned earlier, there will be changes in the way doctors are paid and health care is organized, so those will be other kinds of longer term changes in the medical system that are supposed to encourage doctors to become primary care doctors. On the other hand, there’s not that much to be done about the fact that medical school is very expensive and that specialists will still be paid more than primary care doctors.

When will the “Cadillac” plan taxes come into play, and who will they affect? How do you know if you have a plan considered to be “Cadillac”? — Lisa Kantrowitz of Malvern, Pa.

The tax applies to very high-end plans, and it doesn’t take effect until the year 2018. Your plan has to be worth more than $10,200 for a single person and $27,500 for family coverage — that includes both what you and your employer pay if it’s employer provided insurance. Those plans can be worth more if you’re a retiree or in a high-risk profession, like a police officer or firefighter. Dental and vision coverage don’t count toward those totals.

How will the health care law be enforced? Who’s determining the rules and regulations, and who’ll be helping them with their specific cases?

The Department of Health and Human Services, with assistance from the Department of Labor, will be largely responsible for enforcement. But people are correct when they say that the Internal Revenue Service will play a role in this, because you will have to declare on your income taxes whether or not you have health insurance — that’s the individual mandate. If you don’t have insurance, that’s how you’ll pay the penalty that will be required — with your taxes.

via Your Health Bill Questions Answered : NPR.

Senate Republicans forced late-night changes to a bill amending President Obama’s landmark health care legislation early Thursday, a move that bounces the package of “fixes” back to the House for another vote.

A spokesman for Senate Majority Leader Harry Reid said Republicans consulting with the Senate parliamentarian identified problems with “two minor provisions” relating to Pell grants for low-income students. Democrats were using a procedure called budget reconciliation to speed the bill’s passage and block a filibuster, but the Pell grant sections were found to violate reconciliation rules that all provisions must directly impact the budget.

Democrats called the development a minor glitch and said they believe they have a comfortable margin of passage in the House.

“I expect to get this bill back from the Senate sometime later this afternoon, and I would expect a couple of hours thereafter we will have the bill on the floor for final passage and it will pass the House and be sent to the president,” House Majority Leader Steny Hoyer told CBS’ The Early Show Thursday.

The two provisions are expected to be formally removed from the bill on Thursday, and the Senate is expected to take a final vote that afternoon. A final vote in the House could come as soon as Thursday night.

The Senate announcement followed a nine-hour marathon session stretching past 2 a.m. in which Democrats defeated 29 Republican amendments — any one of which would have sent the legislation back to the House.

Although President Obama signed the health care overhaul into law Tuesday, the package of changes sought by the House still needed to get through the Senate. So Republicans sought to gum up the process by issuing the barrage of amendments.

One by one, Democrats voted down GOP proposals that, for example, would have rolled back cuts to Medicare and barred tax increases for families earning less than $250,000. They also defeated an amendment that would have prohibited federal money for the purchase of Viagra and other erectile dysfunction drugs for sex offenders. Sen. Tom Coburn (R-OK) introduced the amendment, saying it would save millions of dollars. Sen. Max Baucus (D-MT) called the proposed change “a crass political stunt.”

Democrats noted that nearly every reconciliation bill has been subject to last-minute revisions. But lawmakers didn’t rule out the possibility that Republicans could scuttle other sections of the reconciliation bill.

Despite the glitch, Obama was expected to go ahead with a trip to Iowa City, where as a presidential candidate, he offered a blueprint for fixing health care.

White House spokesman Robert Gibbs said that “the president believes it is important to continue to talk about the many aspects of the law that will do precisely what he said they’re intended to do.”

He added that those included help for small businesses to provide their employees coverage and allowing parents to keep their children on policies through the age of 26.

As Congress wrangles with legislative details, discontent over changes to the nation’s health care system spilled over into threats of violence against lawmakers who voted for the overhaul.

The FBI is investigating at least four incidents in which bricks were thrown through the windows of Democratic offices in New York, Arizona and Kansas, including Rep. Louise Slaughter’s district headquarters in Niagara Falls, N.Y. And at least 10 members of Congress reported received threatening emails, phone calls and faxes.

Some of the worst threats targeted Michigan Rep. Bart Stupak, an anti-abortion Democrat who cast a key vote for the overhaul in exchange for an executive order prohibiting federal funding of abortion. One man called Stupak’s office to say he hopes the congressman gets cancer and dies, while a female caller said “millions of people wish you ill” and “those thoughts will materialize into something that’s not very good for you.”

Hoyer said he takes such threats “very seriously.”

“The bottom line is, we need to be very careful in public life that our rhetoric doesn’t incite to violent acts,” the Maryland Democrat told a TV news show Thursday. Hoyer said dealing with difficult issues in a civil and peaceful manner is “at the core of our democracy.”

via GOP Forces Health Amendments Bill Back To House : NPR.

The health care bill that President Obama signs into law Tuesday promises to fundamentally change the competitive landscape for many U.S. businesses. Although many will now face higher taxes and more regulation, there’s also a big upside: They’ll gain access to millions of new customers.

For more than a year, health care companies have closelywatched the debate in Washington, trying to figure out what it might mean for the industry.

There have been so many iterations of this, it’s been hard to follow the good news,” said Dan Mendelson, CEO of Avalere Health, which advises companies about health care policy. “Right now … the die has been cast and these companies can move on and try to plan strategy.”

Mendelson said that for most companies, the bill approved Sunday night is neither very good nor very bad.

“Across each of the different segments there are pieces that will be good and pieces that will be more challenging,” he said.

New Customers

On the plus side, the bill will bring as many as 30 million new paying customers into the health care system. Many small businesses that don’t now provide health care coverage will be required to do so, and they’ll be given tax credits to make it easier. That has enormous implications for drug makers, hospitals, nursing-home companies and firms that make defibrillators and artificial joints.

Jeffrey Kleintop, chief market strategist for LPL Financial, said many of these companies have been struggling to expand their customer base. Now, almost overnight, it’s been done for them.

“Historically, the key for these industries really hasn’t been pricing,” Kleintop said. “A lot of these companies just don’t make money by jacking up prices each year. On average, their prices stay relatively flat. It’s really all about volume.”

Kleintop noted that a huge percentage of prescriptions never get filled in the U.S. each year because patients can’t afford them. Now they can. In fact, drug makers have a lot to gain from the bill.

“They’re going to get a new base of customers they don’t have today, and a third party for the most part will be picking up the tab for brand drugs, and that will lead to a nice new source of revenue,” said Edward Kaplan, senior vice president of The Segal Co., a human resources consulting firm.

Some Downsides

There is a downside for drug companies. They’ll have to pay big fees, and there will be new restrictions on how much they can charge for their products. But on balance, they’ll probably come out ahead, which is why the pharmaceutical industry supported the bill.

The picture is also mixed for insurance companies. Although President Obama and other Democrats railed against the insurance industry in the run-up to the vote, Kaplan says insurance companies will see some benefits.

“I think most of the insurance companies will see a 10 percent increase in potential market share without a lot excessive regulation,” he said.

But there will be new regulations. Policies will be sold on state-supervised marketplaces called exchanges. There will be restrictions on the premiums insurers can charge, and new requirements that they accept customers with pre-existing medical conditions. Insurers will face new excise taxes. But Kaplan said he thinks insurance companies will be able to adjust over the long haul.

“The reality is these insurance companies have a way of understanding risk and measuring risk and passing on that risk to the market,” Kaplan said.

Some insurance companies are likely to have a tougher time than others. Among those most affected are those in the Medicare Advantage program. Funding for the program will be cut, which could push up costs, making it less attractive to the senior citizens it serves.

But for the most part, insurance companies, like the health care industry as a whole, have survived the health care bill in much better shape than they feared. Now they have t

via Health Care Firms See Mixed Blessing In Overhaul : NPR.

Dependent children can remain on their parents’ health insurance plans until age 26.

Senior citizens will get more help paying for drugs in Medicare.

People with health problems that left them uninsurable can qualify for coverage through a federal program.

Tax credits will be given to small businesses that offer health insurance to their workers

Children will be able to get insurance-even if they have pre-existing conditions

 All new insurance plans must offer and cover preventative care