The upcoming CPT® and RBRVS 2009 Annual Symposium meeting is scheduled for Nov. 12-14, 2008 at the:
Hyatt Regency Chicago151 East Wacker DriveChicago, IL 60601Phone: (312) 565-1234
Hotel accomodations
Symposium attendees are responsible for their own hotel reservations. Rooms have been reserved at the Hyatt Regency Chicago.
Book your room at the Hyatt Regency Chicago , or call the hotel directly at (312) 565-1234. The group room rate per night for single or double occupancy is $239 (standard), plus tax (currently 15.4 percent).
You must mention the AMA symposium when booking your room to take advantage of the special group room rate. Remember to write down your confirmation number from the hotel to ensure your room reservation. Guest rooms are available Nov. 11–14, 2008. Reservations must be made by Oct. 21, 2008. Rooms are available on a first come, first serve basis; no additional rooms will be added.
Three ways to registerRegister online for the fastest and easiest way to register. You must have a valid credit card available to secure your space. Payment confirmations will be sent via e-mail. Please print the e-mailed confirmation for your records.
Register by telephoneCall the AMA Unified Service Center at (800) 621-8335. You must have a valid credit card available to secure your space.
Register by mailIf your company requires that you pay with a check, please print this form (PDF, 28KB). Make the check payable to “American Medical Association” and send your payment no later than Friday, Oct. 31, 2008 (no checks will be processed after this date). Payment and registration form(s) should be sent to:
CPT® and RBRVS 2009 Annual Symposium RegistrationOrder DepartmentAmerican Medical AssociationP.O. Box 930876Atlanta, GA 31193-0876
*The AMA does not accept registrations by fax or e-mail.
Registration feesDiscount rate: $750Full rate: $900Fee includes: continental breakfast, break, lunch and cocktail reception.
Registration discountsDiscounted registration rates apply for the following:
AMA members
CPT and RUC advisors or staff
Past AMA CPT or RBRVS symposia attendees
CPT® Assistant newsletter subscriber
Clinical Examples in Radiology subscriber
CPT® Network subscriber
CPT licensees
CPT® and RBRVS Symposium topicsEach presenter will discuss in detail many of the significant changes to CPT 2009 codes and descriptors, as well as 2009 payment policy and relative value unit (RVU) changes to the Medicare physician payment schedule. The following topics will be discussed:
Cardiology
Evaluation and Management
End-Stage Renal Disease Services
Spine Surgery/Neurosurgery
Medicare Medical Home Demonstration
General Surgery
Urology
Orthopaedic Surgery
Ophthalmology
Otolaryngology
Pathology and Laboratory Services
Pediatrics
Performance Measures
2008年9月27日星期六
AMA establishes the CPT ® Assistant Editorial Board
The American Medical Association (AMA) has established an editorial board for the CPT ® Assistant newsletter. The CPT ® Assistant Editorial Board will give specialty societies, payers, and other CPT stakeholders the opportunity for formal input into the process of selecting topics for articles, reviewing the publication's coding content, and contributing content for publication.
BackgroundIn 2004, the AMA's Board of Trustees responded to an AMA House of Delegates Resolution that called on the AMA to study the feasibility of developing a national standard for the utilization of codes, code combination, and modifiers that is consistent with all CPT codes, guidelines, and conventions and that would be used by all commercial and governmental payers. Shortly after the 2004 Annual Meeting, the AMA contracted with an external consulting group that specializes in evaluating and designing legislative and regulatory proposals, developing and analyzing options to achieve the strategic goals of its clients, drafting legislation, and developing ideas on a wide array of health policy and related areas.
A study was conducted based on a review of a wide range of written documents and on-line reference materials. It was also based on more than two dozen structured interviews with representatives of key stakeholders in the CPT coding community and other individuals with relevant expertise and experience. These individuals included:
Representatives of the CPT Editorial Panel, the CPT Advisory Committee, the Health Care Professionals Advisory Committee (HCPAC), and the AMA/Specialty Society RVS Update Committee (RUC)
Physician and staff representatives of national medical specialty societies, state medical associations, and national organizations representing nonphysician health professionals
Representatives of hospitals, professional coders, and coding consultants
Representatives of the Centers for Medicare and Medicaid Services (CMS), Medicare contractors, the National Center for Health Statistics (NCHS), the National Committee on Vital and Health Statistics, and other agencies within Health and Human Services
Physician and staff representatives of health insurance companies and managed care organizations and the national associations representing their interests
Individuals knowledgeable about proprietary claims editing programs
The New BoardAfter reviewing the report recommendations, it was decided that the AMA should move forward with the creation of an editorial board. The board represents a departure from the past 17 years, during which the newsletter was primarily a product of AMA staff with CPT Editorial Panel and/or CPT Advisory Committee review of content. In the past, the focus and purpose of the CPT ® Assistant was to impart coding advice from the AMA perspective based on discussion of the use and interpretation of the codes at panel meetings and as reflected in the official Panel minutes. With the creation of the editorial board, the focus of the newsletter will subtly shift from providing strict CPT coding guidance and interpretation to responding to “real world” coding issues.
BackgroundIn 2004, the AMA's Board of Trustees responded to an AMA House of Delegates Resolution that called on the AMA to study the feasibility of developing a national standard for the utilization of codes, code combination, and modifiers that is consistent with all CPT codes, guidelines, and conventions and that would be used by all commercial and governmental payers. Shortly after the 2004 Annual Meeting, the AMA contracted with an external consulting group that specializes in evaluating and designing legislative and regulatory proposals, developing and analyzing options to achieve the strategic goals of its clients, drafting legislation, and developing ideas on a wide array of health policy and related areas.
A study was conducted based on a review of a wide range of written documents and on-line reference materials. It was also based on more than two dozen structured interviews with representatives of key stakeholders in the CPT coding community and other individuals with relevant expertise and experience. These individuals included:
Representatives of the CPT Editorial Panel, the CPT Advisory Committee, the Health Care Professionals Advisory Committee (HCPAC), and the AMA/Specialty Society RVS Update Committee (RUC)
Physician and staff representatives of national medical specialty societies, state medical associations, and national organizations representing nonphysician health professionals
Representatives of hospitals, professional coders, and coding consultants
Representatives of the Centers for Medicare and Medicaid Services (CMS), Medicare contractors, the National Center for Health Statistics (NCHS), the National Committee on Vital and Health Statistics, and other agencies within Health and Human Services
Physician and staff representatives of health insurance companies and managed care organizations and the national associations representing their interests
Individuals knowledgeable about proprietary claims editing programs
The New BoardAfter reviewing the report recommendations, it was decided that the AMA should move forward with the creation of an editorial board. The board represents a departure from the past 17 years, during which the newsletter was primarily a product of AMA staff with CPT Editorial Panel and/or CPT Advisory Committee review of content. In the past, the focus and purpose of the CPT ® Assistant was to impart coding advice from the AMA perspective based on discussion of the use and interpretation of the codes at panel meetings and as reflected in the official Panel minutes. With the creation of the editorial board, the focus of the newsletter will subtly shift from providing strict CPT coding guidance and interpretation to responding to “real world” coding issues.
Chemical Weapons: Researcher Working On Their Destruction
America's war on terror includes fighting the dark side of deadly chemical agents, and Texas A&M University chemist Dr. Frank Raushel is helping with the fight by developing an enzyme that might neutralize one such chemical agent, the organophosphates. Synthetic organophosphates started their journey as insecticides in the 1930s but soon made their way into the dangerous alleys of chemical warfare during World War II. Raushel, who has been working on detoxification of organophosphates for nearly 10 years, says that the toxic properties of the organophosphate nerve agents are a serious threat to the health and well being of civilized societies. Although outlawed by several international treaties, some countries have used chemical agents during times of war. In 1988, the Iraqi Kurdish village of Halabja was exposed to multiple chemical agents, killing about 5,000 of the town's 50,000 residents. After the incident, traces of mustard gas and the organophosphates sarin, tabun and VX were discovered. Raushel, the Davidson Professor of Science at Texas A&M, has been awarded a four-year grant of $1.2 million by the National Institutes of Health to carry out his work on organophosphates. Organophosphates are neurotoxins - they attack the nervous system by blocking the function of the enzyme acetylcholine esterase, which carries nerve signals. When organs such as the lungs do not receive appropriate nerve signals, control is lost over respiratory muscles, and it usually results in death by asphyxiation. Today, some classes of organophosphates are used as insecticides while others have been categorized as chemical weapons. Researchers have discovered a bacterial enzyme, phosphotriesterase, which can recognize and destroy the toxicity of a broad spectrum of organophosphate nerve agents. What Raushel aims to do is design and characterize bacterial phosphotriesterases that are better at detecting, destroying and detoxifying those organophosphates that pose the most serious threats to human health.
Does alcohol contribute to vitamin and mineral deficiencies?
When alcohol replaces food, there can be numerous deficiencies caused by the lack of an adequate intake of nutrients. Nutritional deficiencies are common among alcoholics, but they can also be found in people who consume alcohol on a regular basis. The following are common deficiencies brought on by alcohol consumption:
Folate: Folate helps produce and maintain new cells. Alcohol interferes with dietary folate intake, folate absorption, transport of folate to necessary tissues, and the storage and release of folate by the liver.
Vitamin B12: Vitamin B12 is needed to help make DNA and to maintain healthy nerve cells and red blood cells. Studies have shown that both moderate and heavy alcohol consumption will affect vitamin B12 levels. One study showed a 5% decrease in mean serum vitamin B12 concentrations when consumption of alcohol increased from 0 to 30 grams of alcohol/day.
Vitamin A: Vitamin A is needed for vision, to regulate the immune system, for bone growth, for reproduction, cell division, and differentiation. Alcohol has been found to promote a deficiency of vitamin A and also enhance its toxicity when taken in excessive amounts.
Calcium: Calcium is needed for blood vessel and muscle contraction and expansion, for the secretion of hormones and enzymes, and for transmission of messages through the nervous system. Alcohol consumption can cause a loss of calcium in the body by increasing urinary calcium excretion. Calcium deficiency can also lead to osteoporosis.
Numerous other deficiencies will occur when alcohol replaces nutrients in a balanced diet. The damage to your liver and other organs brought on by chronic, excessive alcohol consumption will cause severe problems that can lead to vitamin and mineral deficiencies. The long-term consequences of these deficiencies far outweigh the small amount of health benefits that have been found with alcohol consumption.
Folate: Folate helps produce and maintain new cells. Alcohol interferes with dietary folate intake, folate absorption, transport of folate to necessary tissues, and the storage and release of folate by the liver.
Vitamin B12: Vitamin B12 is needed to help make DNA and to maintain healthy nerve cells and red blood cells. Studies have shown that both moderate and heavy alcohol consumption will affect vitamin B12 levels. One study showed a 5% decrease in mean serum vitamin B12 concentrations when consumption of alcohol increased from 0 to 30 grams of alcohol/day.
Vitamin A: Vitamin A is needed for vision, to regulate the immune system, for bone growth, for reproduction, cell division, and differentiation. Alcohol has been found to promote a deficiency of vitamin A and also enhance its toxicity when taken in excessive amounts.
Calcium: Calcium is needed for blood vessel and muscle contraction and expansion, for the secretion of hormones and enzymes, and for transmission of messages through the nervous system. Alcohol consumption can cause a loss of calcium in the body by increasing urinary calcium excretion. Calcium deficiency can also lead to osteoporosis.
Numerous other deficiencies will occur when alcohol replaces nutrients in a balanced diet. The damage to your liver and other organs brought on by chronic, excessive alcohol consumption will cause severe problems that can lead to vitamin and mineral deficiencies. The long-term consequences of these deficiencies far outweigh the small amount of health benefits that have been found with alcohol consumption.
Are there any safety concerns with sugar alcohols?
Sugar alcohols are regulated as either GRAS or a food additive. The FDA has filed GRAS affirmation petitions for isomalt, lactitol, maltitol, HSH, and erythritol. Sorbitol is on the GRAS list, while mannitol and xylitol are listed as additives.
The reason that sugar alcohols provide fewer calories than sugar is because they are not completed absorbed in our body. For this reason, high intakes of foods containing some sugar alcohols can lead to abdominal gas and diarrhea. Any foods that contain sorbitol or mannitol must include a warning on their label that "excess consumption may have a laxative effect." The American Dietetic Association advises that intakes greater than 50 grams/day of sorbitol or greater than 20 grams/day of mannitol may cause diarrhea.
The presence of sugar alcohols in foods does not mean that you can eat unlimited quantities. Sugar alcohols are lower in calories, gram for gram, than sugar. They are not calorie-free, and if eaten in large enough quantities, the calories can be comparable to sugar-containing foods. You will need to continue reading the food labels for the calorie and carbohydrate content regardless of the claim of being sugar-free, low-sugar, or low-carb.
What are nonnutritive sweeteners?
The use of nonnutritive sweeteners began with the need for cost reduction and continued on with the need for calorie reduction. Since the 1950s, nonnutritive sweeteners have become a weight-loss wonder that allowed us to have our sweets without the calories and cavities. These sweeteners are also referred to as intense sweeteners, alternative sweeteners, very low-calorie sweeteners, and artificial sweeteners. The celebration and consumption of nonnutritive sweeteners came to a halt in the '70s when cancer connections were discovered. To this day, there is a great deal of controversy surrounding the safety of nonnutritive sweeteners. For every compelling positive argument in favor of using these sweeteners, there is an equally compelling negative argument opposing their use.
The five FDA-approved nonnutritive sweeteners are saccharin, aspartame, acesulfame potassium, sucralose, and neotame. Each of these is regulated as a food additive. These sweeteners are evaluated based on their safety, sensory qualities (for example, clean sweet taste, no bitterness, odorless), and stability in various food environments. They are often combined with other nutritive and/or nonnutritive sweeteners to provide volume that they lack on their own and a desired flavor. An Acceptable Daily Intake (ADI) for each additive has been established. The ADI is the amount of food additive that can be consumed daily over a lifetime without appreciable health risk to a person on the basis of all the known facts at the time of the evaluation.
The reason that sugar alcohols provide fewer calories than sugar is because they are not completed absorbed in our body. For this reason, high intakes of foods containing some sugar alcohols can lead to abdominal gas and diarrhea. Any foods that contain sorbitol or mannitol must include a warning on their label that "excess consumption may have a laxative effect." The American Dietetic Association advises that intakes greater than 50 grams/day of sorbitol or greater than 20 grams/day of mannitol may cause diarrhea.
The presence of sugar alcohols in foods does not mean that you can eat unlimited quantities. Sugar alcohols are lower in calories, gram for gram, than sugar. They are not calorie-free, and if eaten in large enough quantities, the calories can be comparable to sugar-containing foods. You will need to continue reading the food labels for the calorie and carbohydrate content regardless of the claim of being sugar-free, low-sugar, or low-carb.
What are nonnutritive sweeteners?
The use of nonnutritive sweeteners began with the need for cost reduction and continued on with the need for calorie reduction. Since the 1950s, nonnutritive sweeteners have become a weight-loss wonder that allowed us to have our sweets without the calories and cavities. These sweeteners are also referred to as intense sweeteners, alternative sweeteners, very low-calorie sweeteners, and artificial sweeteners. The celebration and consumption of nonnutritive sweeteners came to a halt in the '70s when cancer connections were discovered. To this day, there is a great deal of controversy surrounding the safety of nonnutritive sweeteners. For every compelling positive argument in favor of using these sweeteners, there is an equally compelling negative argument opposing their use.
The five FDA-approved nonnutritive sweeteners are saccharin, aspartame, acesulfame potassium, sucralose, and neotame. Each of these is regulated as a food additive. These sweeteners are evaluated based on their safety, sensory qualities (for example, clean sweet taste, no bitterness, odorless), and stability in various food environments. They are often combined with other nutritive and/or nonnutritive sweeteners to provide volume that they lack on their own and a desired flavor. An Acceptable Daily Intake (ADI) for each additive has been established. The ADI is the amount of food additive that can be consumed daily over a lifetime without appreciable health risk to a person on the basis of all the known facts at the time of the evaluation.
What is the difference between GRAS foods and food additives?
The World Health Organization (WHO), the Scientific Committee on Food (SCF) of the European Commission, the Joint Expert Committee of Food Additions (JECFA) of the United Nations Food and Agricultural Organization, and the United States Food and Drug Administration (FDA) are each involved.
In the United States, sweeteners fall under the Generally Recognized as Safe (GRAS) list or as food additives under the 1958 Food Additives Amendment to the Federal Food, Drug, and Cosmetic Act. According to the FDA, "Regardless of whether the use of a substance is a food additive use or is GRAS, there must be evidence that the substance is safe under the conditions of its intended use. FDA has defined "safe" as a reasonable certainty in the minds of competent scientists that the substance is not harmful under its intended conditions of use. The specific data and information that demonstrate safety depend on the characteristics of the substance, the estimated dietary intake, and the population that will consume the substance."
The guidelines about what constitutes a sweetener to be on the GRAS list versus being listed as a food additive are as follows:
For a GRAS substance, generally available data and information about the use of the substance are known and accepted widely by qualified experts, and there is a basis to conclude that there is consensus among qualified experts that those data and information establish that the substance is safe under the conditions of its intended use.
For a food additive, privately held data and information about the use of the substance are sent by the sponsor to FDA and FDA evaluates those data and information to determine whether they establish that the substance is safe under the conditions of its.
Throughout the remainder of this article, you will learn about the positive and negative sides of the story behind each of the FDA approved nutritive and nonnutritive sweeteners.
In the United States, sweeteners fall under the Generally Recognized as Safe (GRAS) list or as food additives under the 1958 Food Additives Amendment to the Federal Food, Drug, and Cosmetic Act. According to the FDA, "Regardless of whether the use of a substance is a food additive use or is GRAS, there must be evidence that the substance is safe under the conditions of its intended use. FDA has defined "safe" as a reasonable certainty in the minds of competent scientists that the substance is not harmful under its intended conditions of use. The specific data and information that demonstrate safety depend on the characteristics of the substance, the estimated dietary intake, and the population that will consume the substance."
The guidelines about what constitutes a sweetener to be on the GRAS list versus being listed as a food additive are as follows:
For a GRAS substance, generally available data and information about the use of the substance are known and accepted widely by qualified experts, and there is a basis to conclude that there is consensus among qualified experts that those data and information establish that the substance is safe under the conditions of its intended use.
For a food additive, privately held data and information about the use of the substance are sent by the sponsor to FDA and FDA evaluates those data and information to determine whether they establish that the substance is safe under the conditions of its.
Throughout the remainder of this article, you will learn about the positive and negative sides of the story behind each of the FDA approved nutritive and nonnutritive sweeteners.
Energy Drinks: The Report
Energy drinks are popular with teens and young adults, Griffiths found in his research. In a 2007 survey of 496 college students, 51% said they had consumed at least one energy drink during the past month.
Bad reactions to energy drinks have been reported to U.S. poison control centers, Griffiths writes in the report, published in the journal Drug and Alcohol Dependence. From 2002 to 2004, he says, 41 cases of caffeine abuse from caffeine-enhanced beverages were reported.
In a report of nine cases of adverse reactions to the energy drink Redline, the patients reported nausea and vomiting, high blood pressure, tremors, dizziness, and numbness.
Data also suggest those who drink the energy drinks may combine them with alcohol, Griffiths tells WebMD. In the college student survey, 27% said they mixed alcohol and energy drinks at least once in the past month. One danger to that: Users may feel alert enough to drive, even if they are inebriated.
Griffiths worries that the energy drinks are sometimes "gateways" to use of other substances. In one study, college students who used energy drinks were more likely to later use stimulants for recreational use, he says.
Energy Drinks: Industry View
Storey, of the American Beverage Association, took exception with Griffiths' view. "It's a review, not a study," she says of his report. "We need to be careful about taking too much out of one review. He looked at some studies."
In a statement issued by the association, officials note that most "mainstream" energy drinks typically contain half the caffeine found in regular coffeehouse coffee. A 16-oz cup of coffeehouse coffee has about 320 milligrams of caffeine, according to the statement, while a typical 16-oz mainstream energy drink has 160 mg.
If labels should be required on energy drinks, Storey says, coffeehouse coffee should also be required to label caffeine content.
Most companies market their energy drinks responsibly, the association contends. Only a few companies give the products illicit or suggestive names (such as Cocaine, an energy drink that triggers controversy).
"Energy drinks can be part of a balanced lifestyle when consumed sensibly," the statement reads.
Energy Drinks: Griffiths' Response
Griffiths stands by his proposal to require warning labels on the energy drinks with the highest caffeine content, although he is not certain what that threshold should be.
There's a difference, he says, in the marketing of energy drinks and marketing of traditional caffeine beverages. The energy drink makers, he says, ''are marketing to vulnerable populations."
SOURCES: Roland Griffiths, PhD, professor of psychiatry and neuroscience, Johns Hopkins University School of Medicine, Baltimore, Md. Maureen Storey, PhD, spokeswoman, American Beverage Association, Washington, D.C. Siobhan DeLancey, FDA spokesperson. Reissig, C. Drug and Alcohol Dependence, manuscript received ahead of print.
©2008 WebMD, LLC. All Rights Reserved.
Bad reactions to energy drinks have been reported to U.S. poison control centers, Griffiths writes in the report, published in the journal Drug and Alcohol Dependence. From 2002 to 2004, he says, 41 cases of caffeine abuse from caffeine-enhanced beverages were reported.
In a report of nine cases of adverse reactions to the energy drink Redline, the patients reported nausea and vomiting, high blood pressure, tremors, dizziness, and numbness.
Data also suggest those who drink the energy drinks may combine them with alcohol, Griffiths tells WebMD. In the college student survey, 27% said they mixed alcohol and energy drinks at least once in the past month. One danger to that: Users may feel alert enough to drive, even if they are inebriated.
Griffiths worries that the energy drinks are sometimes "gateways" to use of other substances. In one study, college students who used energy drinks were more likely to later use stimulants for recreational use, he says.
Energy Drinks: Industry View
Storey, of the American Beverage Association, took exception with Griffiths' view. "It's a review, not a study," she says of his report. "We need to be careful about taking too much out of one review. He looked at some studies."
In a statement issued by the association, officials note that most "mainstream" energy drinks typically contain half the caffeine found in regular coffeehouse coffee. A 16-oz cup of coffeehouse coffee has about 320 milligrams of caffeine, according to the statement, while a typical 16-oz mainstream energy drink has 160 mg.
If labels should be required on energy drinks, Storey says, coffeehouse coffee should also be required to label caffeine content.
Most companies market their energy drinks responsibly, the association contends. Only a few companies give the products illicit or suggestive names (such as Cocaine, an energy drink that triggers controversy).
"Energy drinks can be part of a balanced lifestyle when consumed sensibly," the statement reads.
Energy Drinks: Griffiths' Response
Griffiths stands by his proposal to require warning labels on the energy drinks with the highest caffeine content, although he is not certain what that threshold should be.
There's a difference, he says, in the marketing of energy drinks and marketing of traditional caffeine beverages. The energy drink makers, he says, ''are marketing to vulnerable populations."
SOURCES: Roland Griffiths, PhD, professor of psychiatry and neuroscience, Johns Hopkins University School of Medicine, Baltimore, Md. Maureen Storey, PhD, spokeswoman, American Beverage Association, Washington, D.C. Siobhan DeLancey, FDA spokesperson. Reissig, C. Drug and Alcohol Dependence, manuscript received ahead of print.
©2008 WebMD, LLC. All Rights Reserved.
Energy Drinks: Caffeine Content
Griffiths and his colleagues contacted more than two dozen makers of energy drinks, asking for caffeine content. Here are some of the findings:
(The caffeine content is in milligrams per serving. Although serving sizes vary, Griffiths contends that most people will drink the entire can, whatever the number of ounces.)
Red Bull: 80 milligrams per 8.3-ounce serving
Tab Energy: 95 mg per 10.5-oz serving
Monster and Rockstar: 160 mg per 16-oz serving
No Fear: 174 mg per 16-oz serving
Fixx: 500 per 20-oz serving
Wired X505: 505 mg per 24-oz serving
In comparison, according to Griffiths:
Brewed coffee: 200 milligrams per 12-oz serving
Instant coffee: 140 mg per 12-oz serving
Brewed tea: 80 mg per 12-oz serving
Mountain Dew: 54 mg per 12 oz. serving
Dr. Pepper: 41 mg per 12-oz serving
Pepsi Cola: 38 mg per 12-oz serving
Coca-Cola Classic: 34.5 mg per 12-oz serving
Canned or bottled tea: 20 mg per 12-oz serving
Some of the energy drinks have lower caffeine contents, Griffith says. Among the lower doses:
Bomba Energy has 75 mg per 8.4-oz serving
(The caffeine content is in milligrams per serving. Although serving sizes vary, Griffiths contends that most people will drink the entire can, whatever the number of ounces.)
Red Bull: 80 milligrams per 8.3-ounce serving
Tab Energy: 95 mg per 10.5-oz serving
Monster and Rockstar: 160 mg per 16-oz serving
No Fear: 174 mg per 16-oz serving
Fixx: 500 per 20-oz serving
Wired X505: 505 mg per 24-oz serving
In comparison, according to Griffiths:
Brewed coffee: 200 milligrams per 12-oz serving
Instant coffee: 140 mg per 12-oz serving
Brewed tea: 80 mg per 12-oz serving
Mountain Dew: 54 mg per 12 oz. serving
Dr. Pepper: 41 mg per 12-oz serving
Pepsi Cola: 38 mg per 12-oz serving
Coca-Cola Classic: 34.5 mg per 12-oz serving
Canned or bottled tea: 20 mg per 12-oz serving
Some of the energy drinks have lower caffeine contents, Griffith says. Among the lower doses:
Bomba Energy has 75 mg per 8.4-oz serving
Energy Drinks: The Back Story
Since Red Bull, the first energy drink to hit the U.S. market, launched in 1997, the market has boomed, Griffiths says, now totaling at least $5.4 billion a year in the U.S. Hundreds of brands are available.
Although the FDA limits the caffeine contents of cola-type soft drinks to 71 milligrams per 12 fluid ounces, no such limit is required on energy drinks, Griffiths tells WebMD.
"Makers of so-called "energy" drinks generally market them as dietary supplements," says Siobhan DeLancey, an FDA spokesperson. Dietary supplements are regulated differently than food. The FDA does not approve or review the products before they are marketed.
Although the FDA limits the caffeine contents of cola-type soft drinks to 71 milligrams per 12 fluid ounces, no such limit is required on energy drinks, Griffiths tells WebMD.
"Makers of so-called "energy" drinks generally market them as dietary supplements," says Siobhan DeLancey, an FDA spokesperson. Dietary supplements are regulated differently than food. The FDA does not approve or review the products before they are marketed.
Products Need Warning Labels, Scientist Says; Industry Contends They're Safe to Drink
Sept. 24, 2008 -- Caffeinated energy drinks that promise super alertness -- and sometimes imply better sports performance -- should carry labels that specify their amount of caffeine, says a Johns Hopkins University scientist.
Drinks with the highest caffeine content should also warn of potential health dangers, says Roland Griffiths, PhD, a professor of psychiatry and neuroscience at Johns Hopkins University School of Medicine, Baltimore, and senior author of a new report on the beverages.
"Many of these drinks do not label the caffeine content," he says, and some energy drinks contain as much caffeine as found in 14 cans of soda.
The industry begs to differ, with spokespeople pointing out that most "mainstream" energy drinks contain the same amount of caffeine, or even less, than you'd get in a cup of brewed coffee. If labels listing caffeine content are required on energy drinks, they should also be required on coffeehouse coffee, says Maureen Storey, PhD, a spokeswoman for the American Beverage Association.
Drinks with the highest caffeine content should also warn of potential health dangers, says Roland Griffiths, PhD, a professor of psychiatry and neuroscience at Johns Hopkins University School of Medicine, Baltimore, and senior author of a new report on the beverages.
"Many of these drinks do not label the caffeine content," he says, and some energy drinks contain as much caffeine as found in 14 cans of soda.
The industry begs to differ, with spokespeople pointing out that most "mainstream" energy drinks contain the same amount of caffeine, or even less, than you'd get in a cup of brewed coffee. If labels listing caffeine content are required on energy drinks, they should also be required on coffeehouse coffee, says Maureen Storey, PhD, a spokeswoman for the American Beverage Association.
Cafe society takes on health care
GOOD, a do-gooder media company “serving people who want to live well and do good” and Starbucks are partnering to provide “The GOOD Sheet,” a weekly page that explores key political topics. It’s an exclusive arrangement, so you won’t see these sheets at Peet’s. For 11 weeks leading up to and following the US presidential election, GOOD Sheets will be produced and distributed on specific topics, including gas prices, voter turnout and the environment.
Health care is the topic for the second Sheet. You can see a reproduction here in case you miss it at Starbucks. It includes quite a bit of interesting information such as:
“A look at what’s wrong”
Spending breakdowns
International comparisons of costs and outcomes
A matrix of “how to health the system,” which lays out various alternatives (like single payer), compares them on key dimensions, and notes which aspects Obama or McCain have endorsed
Along the bottom is a timeline of “how we got into this mess,” covering key events and trends over the past couple hundred years
I like the idea of the GOOD Sheet. It presents useful, relevant information in a visually compelling way without dumbing down the issue or taking too strong a stance in favor of a particular outcome. I can imagine the Sheet elevating the discussion about health care to a level where arguments are productive and informed.
The next topic is immigration, which is another area where it would be beneficial to elevate the conversation.
Although I’m not a frequenter of Starbucks –I don’t drink coffee and don’t like the atmoshphere– GOOD Sheets might just get me to go.
+del.icio.us +Digg it
Posted in Policy and politics
Health care is the topic for the second Sheet. You can see a reproduction here in case you miss it at Starbucks. It includes quite a bit of interesting information such as:
“A look at what’s wrong”
Spending breakdowns
International comparisons of costs and outcomes
A matrix of “how to health the system,” which lays out various alternatives (like single payer), compares them on key dimensions, and notes which aspects Obama or McCain have endorsed
Along the bottom is a timeline of “how we got into this mess,” covering key events and trends over the past couple hundred years
I like the idea of the GOOD Sheet. It presents useful, relevant information in a visually compelling way without dumbing down the issue or taking too strong a stance in favor of a particular outcome. I can imagine the Sheet elevating the discussion about health care to a level where arguments are productive and informed.
The next topic is immigration, which is another area where it would be beneficial to elevate the conversation.
Although I’m not a frequenter of Starbucks –I don’t drink coffee and don’t like the atmoshphere– GOOD Sheets might just get me to go.
+del.icio.us +Digg it
Posted in Policy and politics
Army Can Boost Mission Success by Better Managing Environmental Considerations
By better managing environmental issues during deployments, U.S. Army units can gain tactical and strategic advantages that will help in combat and post-conflict operations, and boost overall mission success, according to a RAND Corporation study issued today.
The study finds that commanders have not usually given environmental concerns high priority during planning, despite the effect environmental conditions can have on troop health, safety and security, and the importance they have for the local population.
Researchers recommend that Army leaders give more weight to strategic, operational and tactical aspects of environmental considerations during planning and operations, and develop comprehensive standards and best practices to address environmental issues during contingencies.
This is consistent with the Army's new counterinsurgency doctrine, which highlights the importance of environmental improvements (especially sewage, water and trash) to gain support of the local population.
U.S. experience in Iraq suggests that providing clean water, electricity, sewage and trash management can tip the balance between the local residents supporting the U.S. mission or the insurgency, according to the study. Public opinion surveys suggest that Iraqis care about these issues almost as much as security.
Environmental considerations encompass anything related to the environment that affects the planning and execution of military operations or is affected by those operations. They include (but are not limited to) clean water, sewage-related infrastructure, soldier health, compliance with environmental laws, sustainability, protection of historical and cultural sites, and management of agricultural and natural resources.
“Perhaps the most underappreciated aspect of environmental considerations is the role that they can play in achieving U.S. national objectives in counterinsurgency and stability operations,” said report co-author David Mosher, a researcher at RAND, a non-profit research organization.
In countries where environmental conditions and infrastructure are severely degraded, clean drinking water, effective sewage and trash systems, and viable farmland are crucial to local inhabitants. Providing these things can influence whether inhabitants support the local government and U.S. goals and objectives.
“Commanders and planners can take steps in the combat phase to preserve existing environmental infrastructure and resources that will be vital once combat has ended,” Mosher said. “Determining what to preserve will demand that leaders and planners take a strategic view of the operation, including what the end result ought to be.”
The Army also can have a positive influence on the environment. In operations in Afghanistan, Iraq and the Balkans, U.S. soldiers have helped to build wells, sewage treatment plants and other water infrastructure systems, which were beneficial to both U.S. soldiers and local communities, said report co-author Beth Lachman.
In Iraq, the U.S. Army Corps of Engineers is helping to restore the Mesopotamian Marshlands that are significant to both regional and migratory bird species, and the local economy.
Environmental issues can also affect soldier health and safety, the costs of an operation, the logistical burden of supporting forces, and diplomatic relations. The study finds that long deployments and extended post-conflict operations like those in Iraq, Afghanistan, and the Balkans expose U.S. forces to a variety of environmental problems. At one base camp in Afghanistan, legacy pollution problems caused short-term respiratory illnesses for U.S. soldiers until the problem was identified and addressed.
The relationship between the Army and the environment is a two-way street, according to the study. On the one hand, soldiers and operations affect the environment; on the other, the environment affects soldiers and operations, especially because many contingency operations are often conducted in locations that have significant legacy pollution and other environmental problems.
The study finds that base camps raise a host of environmental issues. In most contingencies over the last 20 years, U.S. forces have remained in theater much longer than expected. As a result, base camps that were hastily constructed for temporary use are occupied for many years and often have inadequate environmental systems and procedures, such as insufficient waste management.
Pollution from base camps can affect relations with locals, cause health problems for soldiers, and require costly cleanup efforts. The authors state that Army leaders should anticipate longer stays and design and build base camps accordingly.
Operations that require less fuel, water and other resources, and produce less waste, will reduce the logistics burden. A well-designed, efficient base camp can reduce the resources required to sustain it and free logistics assets to support U.S. troops or reduce the number of convoys that must travel along dangerous roads, the report finds.
Environmental conditions can also extend beyond national borders because air and water pollution may travel great distances, affecting diplomatic relations with countries that could be crucial to the mission's success.
The authors make several recommendations:
Improve policy and guidance for environmental considerations in contingency operations. Work with the Department of Defense to develop guidance that would clarify the need to anticipate and address environmental issues in contingency operations.
Encourage an environmental ethic throughout the Army that extends to contingency operations.
Better incorporate environmental considerations into planning, particularly those that relate to achieving U.S. strategic objectives and to base camps.
Improve pre-deployment and field environmental training so that soldiers and leaders understand the importance of the environment in contingency operations and techniques for reducing the Army's impact.
Invest more in environmental resources and good environmental practices for field operations, including training for base camp managers and unit environmental personnel, developing efficient base camp designs, and creating new technologies to manage and reduce the environmental effects of Army operations.
Use a “sustainability” model for planning for and managing environmental issues during contingency operations to reduce the logistic burdens and costs of base camps, decrease waste streams and lessen the need for cleanup.
Other authors of the study are Michael D. Greenberg, Tiffany Nichols, Brian Rosen, Henry H. Willis. The report, “Green Warriors: Environmental Considerations in Army Contingency Operations,” is available at www.rand.org.
The study was prepared by the RAND Arroyo Center, which provides objective analytic research on major policy concerns to leadership of the U.S. Army, with an emphasis on mid- to long-term policy issues intended to improve effectiveness and efficiency. The center also provides the Army with short-term assistance on urgent problems and acts as a catalyst for needed change.
The study finds that commanders have not usually given environmental concerns high priority during planning, despite the effect environmental conditions can have on troop health, safety and security, and the importance they have for the local population.
Researchers recommend that Army leaders give more weight to strategic, operational and tactical aspects of environmental considerations during planning and operations, and develop comprehensive standards and best practices to address environmental issues during contingencies.
This is consistent with the Army's new counterinsurgency doctrine, which highlights the importance of environmental improvements (especially sewage, water and trash) to gain support of the local population.
U.S. experience in Iraq suggests that providing clean water, electricity, sewage and trash management can tip the balance between the local residents supporting the U.S. mission or the insurgency, according to the study. Public opinion surveys suggest that Iraqis care about these issues almost as much as security.
Environmental considerations encompass anything related to the environment that affects the planning and execution of military operations or is affected by those operations. They include (but are not limited to) clean water, sewage-related infrastructure, soldier health, compliance with environmental laws, sustainability, protection of historical and cultural sites, and management of agricultural and natural resources.
“Perhaps the most underappreciated aspect of environmental considerations is the role that they can play in achieving U.S. national objectives in counterinsurgency and stability operations,” said report co-author David Mosher, a researcher at RAND, a non-profit research organization.
In countries where environmental conditions and infrastructure are severely degraded, clean drinking water, effective sewage and trash systems, and viable farmland are crucial to local inhabitants. Providing these things can influence whether inhabitants support the local government and U.S. goals and objectives.
“Commanders and planners can take steps in the combat phase to preserve existing environmental infrastructure and resources that will be vital once combat has ended,” Mosher said. “Determining what to preserve will demand that leaders and planners take a strategic view of the operation, including what the end result ought to be.”
The Army also can have a positive influence on the environment. In operations in Afghanistan, Iraq and the Balkans, U.S. soldiers have helped to build wells, sewage treatment plants and other water infrastructure systems, which were beneficial to both U.S. soldiers and local communities, said report co-author Beth Lachman.
In Iraq, the U.S. Army Corps of Engineers is helping to restore the Mesopotamian Marshlands that are significant to both regional and migratory bird species, and the local economy.
Environmental issues can also affect soldier health and safety, the costs of an operation, the logistical burden of supporting forces, and diplomatic relations. The study finds that long deployments and extended post-conflict operations like those in Iraq, Afghanistan, and the Balkans expose U.S. forces to a variety of environmental problems. At one base camp in Afghanistan, legacy pollution problems caused short-term respiratory illnesses for U.S. soldiers until the problem was identified and addressed.
The relationship between the Army and the environment is a two-way street, according to the study. On the one hand, soldiers and operations affect the environment; on the other, the environment affects soldiers and operations, especially because many contingency operations are often conducted in locations that have significant legacy pollution and other environmental problems.
The study finds that base camps raise a host of environmental issues. In most contingencies over the last 20 years, U.S. forces have remained in theater much longer than expected. As a result, base camps that were hastily constructed for temporary use are occupied for many years and often have inadequate environmental systems and procedures, such as insufficient waste management.
Pollution from base camps can affect relations with locals, cause health problems for soldiers, and require costly cleanup efforts. The authors state that Army leaders should anticipate longer stays and design and build base camps accordingly.
Operations that require less fuel, water and other resources, and produce less waste, will reduce the logistics burden. A well-designed, efficient base camp can reduce the resources required to sustain it and free logistics assets to support U.S. troops or reduce the number of convoys that must travel along dangerous roads, the report finds.
Environmental conditions can also extend beyond national borders because air and water pollution may travel great distances, affecting diplomatic relations with countries that could be crucial to the mission's success.
The authors make several recommendations:
Improve policy and guidance for environmental considerations in contingency operations. Work with the Department of Defense to develop guidance that would clarify the need to anticipate and address environmental issues in contingency operations.
Encourage an environmental ethic throughout the Army that extends to contingency operations.
Better incorporate environmental considerations into planning, particularly those that relate to achieving U.S. strategic objectives and to base camps.
Improve pre-deployment and field environmental training so that soldiers and leaders understand the importance of the environment in contingency operations and techniques for reducing the Army's impact.
Invest more in environmental resources and good environmental practices for field operations, including training for base camp managers and unit environmental personnel, developing efficient base camp designs, and creating new technologies to manage and reduce the environmental effects of Army operations.
Use a “sustainability” model for planning for and managing environmental issues during contingency operations to reduce the logistic burdens and costs of base camps, decrease waste streams and lessen the need for cleanup.
Other authors of the study are Michael D. Greenberg, Tiffany Nichols, Brian Rosen, Henry H. Willis. The report, “Green Warriors: Environmental Considerations in Army Contingency Operations,” is available at www.rand.org.
The study was prepared by the RAND Arroyo Center, which provides objective analytic research on major policy concerns to leadership of the U.S. Army, with an emphasis on mid- to long-term policy issues intended to improve effectiveness and efficiency. The center also provides the Army with short-term assistance on urgent problems and acts as a catalyst for needed change.
A Government Takeover of Health Care? If Only!
"I want families making decisions about health care, not the federal government."
This, of course, is John McCain's--and every conservative's--favorite line about proposals for universal health care. So in case anybody is visiting this site for the first time, and perhaps hasn't followed this debate, here are the essential points.
1. Obama has not proposed to have the federal government take over health insurance. He would set standards for what private insurance must provide--and how private insurance carriers must sell their policies. That means making sure everybody gets benefits as good as what members of Congress gets and making sure everybody can get coverage. Most Americans think those are good things--and they are right.
2. Obama would create a public health plan, something that looks like Medicare, into which anybody can enroll. One reason for doing this is to provide a safety check on private plans: If private insurers know they must compete with a public plan, they can't play the same games--that is, they can't try to exclude people with serious medical conditions or short-change beneficiaries. Private insurers have been known to do these things. It's possible everybody could end up in the public plan--but, if so, that would only be because everybody wanted to join. (What Obama is proposing looks a lot like this.)
3. For the record, if we did have a government-controlled health care system in this country, we'd probably be better off. The most popular insurance program in America is Medicare, a government-run health care system. Most experts will tell you that the most efficient, high-quality health care in this country comes from the Veterans Administration (thanks mostly to its high-tech patient information system). That's as close to socialized medicine as you'll find in this country. But nothing Obama has proposed would come close to putting everybody into a VA-like system. (Also, for what it's worth,sSome of the best health care systems in the world--namely the systems in France and Taiwan--are truly government-run.)
4. Nobody should know the benefits of govenrment-run health care better than McCain, who over the years has benefitted from eligibility in the VA system, the Federal Employees Health Benefits Plan, and Medicare.
5. McCain's health plan would not make health insurance more affordable and accessible. More likely, it will lead to people losing good coveage. And the impact will be felt most by those with pre-existing medical conditions--that is, the people who need insurance the most. More on that here and here and here.
This, of course, is John McCain's--and every conservative's--favorite line about proposals for universal health care. So in case anybody is visiting this site for the first time, and perhaps hasn't followed this debate, here are the essential points.
1. Obama has not proposed to have the federal government take over health insurance. He would set standards for what private insurance must provide--and how private insurance carriers must sell their policies. That means making sure everybody gets benefits as good as what members of Congress gets and making sure everybody can get coverage. Most Americans think those are good things--and they are right.
2. Obama would create a public health plan, something that looks like Medicare, into which anybody can enroll. One reason for doing this is to provide a safety check on private plans: If private insurers know they must compete with a public plan, they can't play the same games--that is, they can't try to exclude people with serious medical conditions or short-change beneficiaries. Private insurers have been known to do these things. It's possible everybody could end up in the public plan--but, if so, that would only be because everybody wanted to join. (What Obama is proposing looks a lot like this.)
3. For the record, if we did have a government-controlled health care system in this country, we'd probably be better off. The most popular insurance program in America is Medicare, a government-run health care system. Most experts will tell you that the most efficient, high-quality health care in this country comes from the Veterans Administration (thanks mostly to its high-tech patient information system). That's as close to socialized medicine as you'll find in this country. But nothing Obama has proposed would come close to putting everybody into a VA-like system. (Also, for what it's worth,sSome of the best health care systems in the world--namely the systems in France and Taiwan--are truly government-run.)
4. Nobody should know the benefits of govenrment-run health care better than McCain, who over the years has benefitted from eligibility in the VA system, the Federal Employees Health Benefits Plan, and Medicare.
5. McCain's health plan would not make health insurance more affordable and accessible. More likely, it will lead to people losing good coveage. And the impact will be felt most by those with pre-existing medical conditions--that is, the people who need insurance the most. More on that here and here and here.
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