Trust Funds for Social Security and Medicare to Run Out Sooner Than Projected
Due to the recession and rising unemployment rate, Social Security and Medicare are heading for bankruptcy sooner than previously expected, according to news releases from the Wall Street Journal and the Associated Press.

Trustees said that Social Security would start paying out more in benefits than it collects in taxes in 2016–1 year sooner than projected last year. The Congressional Budget Office recently projected that Social Security will collect just $3 billion more in 2010 than it will pay out in benefits. Also, the trust fund will be depleted by 2037, which is 4 years sooner than previously believed.

The Medicare fund for hospital care will pay out more in benefits than it collects this year, just as it did for the first time in 2008. The trustees project that the fund will be depleted by 2017, 2 years earlier than the date projected in 2008.

Officials estimated that Social Security beneficiaries would not receive a cost-of-living increase for the next 2 years and that a quarter of Medicare beneficiaries would pay higher-than-usual increases in monthly premiums—8% in 2010 and 15% in 2011.

The Obama administration has proposed cutting payments to private insurers and allowing the government to negotiate drug prices with pharmaceutical companies to control Medicare costs. Even if Congress approves these measures, however, the savings will not fully offset the increasing cost of the program, a news release said. Many of the savings have already been reserved to pay for the administration's plan to overhaul health care.

Breastfeeding May Lower the Mother's Risk of Health Complications
Women who have breastfed are at lower risk than mothers who have not for developing high blood pressure, diabetes, and cardiovascular disease during menopause, according to a study in Obstetrics and Gynecology.

Eleanor Bimla Schwartz, MD, a Professor of Medicine at the University of Pittsburgh Schools of the Health Sciences, and colleagues examined data from 139,681 postmenopausal women (median age 63 years) who enrolled in the Women's Health Initiative observational study or controlled trials.

Women who breastfed for more than 12 months were less likely to develop hypertension (38.6% vs 42.1%; P<.001), diabetes (4.3% vs 5.3%; P<.001), hyperlipidemia (12.3% vs 14.8%; P<.001), or cardiovascular disease (9.1% vs 9.9%; P=.008) than women who never breastfed, the study said. Over an average of 7.9 years of postmenopausal participation in the Women's Health Initiative, women who breastfed for 7 to 12 months were significantly less likely to develop cardiovascular disease compared with women who never breastfed, according to the study.

Notably, the researchers did not observe a difference in rate of obesity between the two groups of women.

Popular Weight-loss Supplement Recalled
Iovate Health Sciences, Inc. (Ontario, Canada), is recalling its Hydroxycut weight-loss products due reports that the dietary supplements may cause jaundice and liver failure, according to the US Food and Drug Administration (FDA). The FDA has received reports of 23 serious health problems and one death associated with the Hydroxycut products, a news release said. The agency said that it is still unclear what ingredients in the products are harmful.

The FDA strongly advises consumers against using Hydroxycut products; however, Hydroxycut Cleanse and Hoodia contain different ingredients from the other products and are not being recalled. The FDA recommends that people call their physicians if they are worried about any harm caused by the products.

Statins May Reduce Men's Risk of Prostate Cancer and Other Urologic Problems
In addition to lowering cholesterol and protecting against cardiovascular disease, statins may also protect men against prostate cancer and other urologic problems, according to findings presented by researchers from the Mayo Clinic (Rochester, MN) at the American Urological Association (AUA) annual meeting in Chicago.

In a study involving 2,447 men who were followed for 14 years, those taking statins were two to three times less likely to be diagnosed with prostate cancer compared with those not taking the drugs.The longer the men were taking statins, the more their risk of cancer decreased, the study said. Additionally, participants taking statins were less likely to have a biopsy to test for prostate tumors or to have elevated levels of prostate-specific antigen.

The researchers cautioned that the results are from an observational study. Doctors should not recommend statin therapy to aid in prevention of prostate cancer at this time, they said. A large, randomized trial is called for, they say.

Brown Fat Continues to Burn Calories in Adults
Three studies found that most adults have large, active deposits of brown fat, a type of fat that can burn a significant amount of calories when activated by the cold. The studies appear in the New England Journal of Medicine.

In one of the studies, researchers at Maastricht University Medical Center in the Netherlands examined 24 young men. Half of the men were lean and half were overweight. They were kept in a cool room (61¡ F) for 2 hours and then given a positron emission tomography (PET) scan to monitor tissue function and activity. Activated brown fat deposits were seen in 23 of the 24 participants, with no activation present in the most overweight individual. Lean men had about four times as much brown fat activity as the overweight men, the study said. When the men were retested without first undergoing exposure to cold, no brown fat activity was observed.

In a second study, Swedish researchers kept five volunteers in a cool room for 2 hours and then gave them PET scans while intermittently putting one foot of each individual in an ice-water bath. PET scans revealed active brown fat deposits each time. In three of the volunteers, the tissue was then biopsied and confirmed to be brown fat.

In the third study, C. Ronald Kahn, MD, and Aaron M. Cypess, MD, PhD, of the Joslin Diabetes Center in Boston, examined PET scans performed on 1,972 patients for various reasons over a 3-year period. Active brown fat was visible in 7.5% of the women and 3.1% of the men. None of the patients were exposed to cold, and many of them were elderly, overweight, and diabetic. These conditions may explain why this study showed a much lower prevalence of detectable brown fat compared with the other studies.

Limiting Work Hours for Medical Residents Could Increase Costs
Allowing residents to work fewer hours and take longer naps during their shifts will cost the nation's teaching hospitals an estimated $1.6 billion a year, according to a study in the New England Journal of Medicine.

The study follows new Institute of Medicine (IOM) recommendations, which include naps during extended shifts, a 16-hour limit for shifts without naps, and reduced workloads.

Teryl K. Nuckols, MD, MSH, of the Division of General Internal Medicine and Health Services Research at the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues estimated that adopting the IOM recommendations will cost major teaching hospitals about $3.2 million annually. The total cost for implementing these changes would range from $1.1 to $2.5 billion, depending on the cost to hire substitute providers such as physician assistants, nurse practitioners, or other physicians to cover shifts.

The total would also be affected by how many costly patient injuries could be averted. If patient errors declined by 10% as a result of adopting the recommendations, the additional cost for each patient admitted to the hospital would increase by only $17, according to the study. If patient errors increased by 10%, cost per patient admission would increase $266.

Using Herbal Supplements May Cause Complications During Plastic Surgery
Taking herbal supplements within 2 weeks before undergoing plastic surgery can be dangerous, according to a report in the Aesthetic Surgery Journal.

David J. Rowe, MD, lead author and an Assistant Professor of Plastic Surgery at University Hospitals Case Medical Center in Lyndhurst, OH, said that the plastic surgeon's main concerns are interaction of herbal supplements with other medications, cardiovascular effects, bleeding, and sedative effects.

More than 40% of plastic surgery patients use herbal supplements in the 2 weeks before undergoing surgery, and as many as 70% of those patients may not disclose the use of alternative medications to their surgeon or conventional health care provider, the study found. Patients must be aware that full disclosure of all medications—both those that are prescribed and those that are obtained over-the-counter—is extremely important to their health and safety.

The authors recommend that patients be provided with a comprehensive list of supplements that must be avoided before surgery to minimize potential surgical complications.

FDA Calls for Label Changes on Two Testosterone Gels
The US Food and Drug Administration (FDA) announced that it is requiring the manufacturers of AndroGel 1% (Unimed Pharmaceuticals, Inc., Marietta, GA) and Testim 1% (Auxilium Pharmaceuticals, Malvern, PA) to include a boxed warning on the products' labels about the risk of secondary exposure and the steps that should be taken to reduce this risk, according to an FDA news release.

Both products, which are approved for use in men who no longer produce testosterone or produce it in very low amounts, are applied once daily to the shoulders or upper arms. Only AndroGel 1% is approved for application to the abdomen. The current labels instruct users to wash their hands after using the product and to cover the treated skin with clothing.

As of December 1, 2008, the FDA received reports of eight cases of secondary exposure to testosterone in children ranging in age from 9 months to 5 years. Since that time, additional reports of secondary exposure have been received by the agency and are under review. In most of the cases, users of these products failed to follow instructions, resulting in direct contact between treated skin and the child, the FDA said.

Of the fully reviewed cases, adverse events reported included inappropriate enlargement of the genitalia (penis or clitoris), premature development of pubic hair, advanced bone age, increased libido, and aggressive behavior. In most cases, the signs and symptoms regressed when the child no longer was exposed to the product. However, in a few cases, enlarged genitalia did not fully return to age-appropriate size, and bone age remained modestly greater than the child's chronological age.

The FDA also is requiring that the manufacturers of these products develop medication guides as part of a risk evaluation and mitigation strategy.

David S. Boyer, MD, is a Clinical Professor of Ophthalmology at the University of Southern California Keck School of Medicine, Department of Ophthalmology, in Los Angeles. He is a member of the Retina Today Editorial Board. Dr. Boyer may be reached at +1 310 854 6201; fax +1 310 652 7250; or via e-mail: VITDOC@aol.com.