Category: Daily News

Researchers led by a team from The University of Texas Medical Branch at Galveston were able to dramatically reduce the pain of fibromyalgia patients with medication that targeted insulin resistance.

This discovery could dramatically alter the way that some forms of chronic pain can be identified and managed. Dr. Miguel Pappolla, UTMB professor of neurology, said that although the discovery is very preliminary, it may lead to a revolutionary shift on how fibromyalgia and related forms of chronic pain are treated. The new approach has the potential to save billions of dollars to the health care system and decrease many peoples’ dependence on opiates for pain management.

The UTMB team of researchers, along with collaborators from across the U.S., including the National Institutes of Health, were able for the first time, to separate patients with fibromyalgia from normal individuals using a common blood test for insulin resistance, or pre-diabetes. They then treated the fibromyalgia patients with a medication targeting insulin resistance, which dramatically reduced their pain levels. The study was recently published in PlosOne.

Fibromyalgia is one of the most common conditions causing chronic pain and disability. The global economic impact of fibromyalgia is enormous – in the U.S. alone and related health care costs are about $100 billion each year. Despite extensive research the cause of fibromyalgia is unknown, so there’s no specific diagnostics or therapies for this condition other than pain-reducing drugs.

“Earlier studies discovered that insulin resistance causes dysfunction within the brain’s small blood vessels. Since this issue is also present in fibromyalgia, we investigated whether insulin resistance is the missing link in this disorder,” Pappolla said. “We showed that most – if not all – patients with fibromyalgia can be identified by their A1c levels, which reflects average blood sugar levels over the past two to three months.”

Pre-diabetics with slightly elevated A1c values carry a higher risk of developing central (brain) pain, a hallmark of fibromyalgia and other chronic pain disorders.

The researchers identified patients who were referred to a subspecialty pain medicine clinic to be treated for widespread muscular/connective tissue pain. All patients who met the criteria for fibromyalgia were separated into smaller groups by age. When compared with age-matched controls, the A1c levels of the fibromyalgia patients were significantly higher.

“Considering the extensive research on fibromyalgia, we were puzzled that prior studies had overlooked this simple connection,” said Pappolla. “The main reason for this oversight is that about half of fibromyalgia patients have A1c values currently considered within the normal range. However, this is the first study to analyze these levels normalized for the person’s age, as optimal A1c levels do vary throughout life. Adjustment for the patients’ age was critical in highlighting the differences between patients and control subjects.”

For the fibromyalgia patients, metformin, a drug developed to combat insulin resistance was added to their current medications. They showed dramatic reductions in their pain levels.

Other authors include UTMB’s Clark Andersen and Xiang Fang as well as Laxmaiah Manchikanti from Louisiana State University School of Medicine Health Sciences Center; Nigel Greig from the National Institutes of Health; Fawad Ahmed from St. Michael’s Pain & Spine Clinics; Michael Seffinger from the College of Osteopathic Medicine of the Pacific and Andrea Trescot from the Pain and Headache Center in Eagle River, Alaska.  

Insurance agent Francis Okyere, 67, self-surrendered yesterday at the Los Angeles County Superior Court after being charged with four felony counts of grand theft.

The charges arose from an investigation by the Department of Insurance’s Investigation Division, Valencia Regional Office, into multiple complaints filed by clients of Okyere alleging that their insurance policies were canceled despite paying Okyere for the coverage.

The investigation revealed that, between July 2015 and September 2016, Okyere misappropriated at least $65,456 in insurance premiums payments from four small business owners and used those funds for his personal benefit.

Okyere’s actions left the business owners uninsured against potential liability and workers compensation claims.

Okyere will be arraigned on July 11, 2019 and bail was set at $30,000. The case is being prosecuted by the Healthcare Fraud Division of the Los Angeles County District Attorney’s Office.

The Department of Insurance Legal Division filed an Accusation against Okyere on December 18, 2018 and is seeking to revoke his insurance license. If anyone has information on this investigation, we urge them to call the department at 661-253-7500.

The Organisation for European Economic Cooperation (OEEC) was established in 1948. Other countries joined in, starting with Japan in 1964. Today, 36 OECD member countries worldwide identify problems, discuss and analyse them, and promote policies to solve them.

The OECD has just reported that opioid use has reached crisis proportions not only in the United States but also in Canada and some European countries, as prescription opioid painkillers have become much more common.

“The United States is by no means alone in facing this crisis,” the Organization for Economic Cooperation and Development said in its report. The Paris-based policy forum said deaths linked to opioid use were also rising sharply in Sweden, Norway, Ireland, and England and Wales.

Ilicit opioids constitute a significant product of international illicit trade. Heroin is a semi-synthetic opiate synthesised from morphine and is the most prevalent illicit opioid worldwide. Approximately twice as potent as morphine, heroin has a high potential for problematic use. In recent years, fentanyl and fentanyl analogues have become much more prominent in the illicit drugs scene in many countries.

The majority of those who die in Europe are men, accounting for 3 out of 4 deaths. However, in the United States, opioid use has been rising among pregnant women, particularly among those on low incomes. Having a mental health disorder was also associated with a two-fold greater use of prescription opioids in the US.

An increase in prescription and over-prescription of opioids for pain management is among the factors driving the crisis. Governments should review industry regulations to ensure they protect people from harm as, since the late 1990s, manufacturers have consistently downplayed the problematic effect of opioids.

Doctors should improve their prescribing practices, for instance through evidence-based clinical guidelines and increased surveillance of opioid prescriptions. Governments can also regulate marketing and financial relationships with opioid manufacturers. Coverage for long-term medication-assisted therapy, such as methadone and buprenorphine, should be expanded.

Strengthening the integration of health and social services, such as unemployment and housing support, and criminal justice systems would help improve treatment for people with Opioid Use Disorder.

NCCI’s Chief Actuary Kathy Antonello, FCAS, FSA, MAAA, delivered the company’s highly anticipated State of the Line Report, which provided the audience with a detailed description of 2018 industry results, market indicators, and trends.

The workers compensation Calendar Year 2018 combined ratio for private carriers was 83%. This is the fifth consecutive year that the workers compensation line of business has posted an underwriting gain. Total market net written premium volume increased to $48.6 billion in 2018.

The Calendar Year 2018 workers compensation combined ratio of 83 is the lowest on record since the 1930s. The industry’s favorable combined ratio results over the last several years has been primarily driven by notable improvement in the underlying loss ratios. Underwriting discipline appears to have contributed to these results in what seems to be a perpetual low interest rate environment, with low investment returns.

The combined ratio is typically expressed as a percentage. A ratio below 100 percent indicates that the company is making an underwriting profit, while a ratio above 100 percent means that it is paying out more money in claims that it is receiving from premiums.

On an accident-year basis, the industry-reported 2018 workers compensation combined ratio was 97%. NCCI expects this accident year’s combined ratio to develop favorably over time.

Other market indicators and trends highlighted in NCCI’s 2019 State of the Line Report included:

— NCCI estimates that as of Year-End 2018, the overall reserve position for private carriers is a $5 billion redundancy. A redundant workers compensation reserve position has not been observed in at least 25 years.
— On a preliminary basis, average lost-time claim frequency across NCCI states declined by 1% in 2018.
— In NCCI states, the preliminary 2018 average indemnity accident year claim severity increased by 3% relative to the corresponding 2017 value. Medical lost-time claim severity increased by 1%.
— The workers compensation Residual Market Pool premium volume was approximately $1 billion during 2018, representing a residual market share of about 7%.

A California jury has awarded a couple more than $2 billion in a verdict against Monsanto, a subsidiary of Bayer. This is the third recent court decision involving claims that the company’s Roundup weed killer caused cancer.

The jury in Alameda County, just east of San Francisco, ruled that the couple, Alva and Alberta Pilliod of Livermore, Calif., contracted non-Hodgkin’s lymphoma because of their use of the glyphosate-based herbicide. They were each awarded $1 billion in punitive damages and an additional $55 million in collective compensatory damages.

Many legal experts believe the damages will be drastically reduced on appeal.

The verdict represents the third such legal setback for the company in California since mid-2018. In March, a San Francisco jury awarded $80 million to a man who blamed his cancer on his extensive use of Roundup. In August 2018, another San Francisco jury awarded $289 million to a fourth plaintiff. On appeal a judge later slashed that payout to $78 million. Bayer is appealing each of these verdicts. The company insists there is no link between Roundup and non-Hodgkin’s lymphoma.

The outcome of these cases may be incentive for applicant attorneys to file workers’ compensation cases for agricultural workers who have been exposed to the product, and who have been diagnosed with cancer.

“Bayer is disappointed with the jury’s decision and will appeal the verdict in this case, which conflicts directly with the U.S. Environmental Protection Agency’s interim registration review decision released just last month, the consensus among leading health regulators worldwide that glyphosate-based products can be used safely and that glyphosate is not carcinogenic, and the 40 years of extensive scientific research on which their favorable conclusions are based,” the company said in a statement.

At least one environmental group praised the verdict.

Ken Cook, president of the Environmental Working Group, said: “The cloud hanging over Bayer will only grow bigger and darker, as more juries hear how Monsanto manipulated its own research, colluded with regulators and intimidated scientists to keep secret the cancer risks from glyphosate.”

Four years ago, a United Nations-sponsored scientific agency declared that Roundup probably causes cancer. As NPR’s Dan Charles reported, the finding from the International Agency for Research on Cancer caused Monsanto to launch a fierce campaign to discredit the IARC’s conclusions.

“Internal company emails, released as part of a lawsuit against the company, show how Monsanto recruited outside scientists to co-author reports defending the safety of glyphosate, sold under the brand name Roundup. Monsanto executive William Heydens proposed that the company ‘ghost-write’ one paper. In an email, Heydens wrote that ‘we would be keeping the cost down by us doing the writing and they would just edit & sign their names so to speak.’ Heydens wrote that this is how Monsanto had ‘handled’ an earlier paper on glyphosate’s safety.”

More than 13,000 other lawsuits have been filed against its subsidiary, Monsanto, the maker of Roundup.

After three jury verdicts in California, a trial is scheduled for August in St. Louis County in Missouri, the site of Monsanto’s former headquarters.