Trump Mishandling Coronavirus Information

The coronavirus, also referred to as COVID-19, has swept the world into a pandemic. There is panic worldwide as people are being ordered to stay inside to not spread or contract the virus. As the virus spreads at a rapid pace, many Americans have begun to fear the worse and are looking for answers. As citizens look to President Donald Trump, they are not getting the answers to the information they need.

Although the death count around the world and in the United States has risen within the last week, Trump continues to reassure that all will be well. When discussing the virus, the main focus is on the financial markets. To make matters worse, the appointment of Vice President Mike Pence to be in charge of all federal efforts means that all information from the federal government on the pandemic will be evaluated and vetted by Pence.

This does nothing to soothe the fears and anxieties of the public over the virus. People need clear, creditable, and informative answers based on facts about what is going to happen to the country because of this pandemic. In order for citizens to take this seriously and to avoid national panic, Trump needs to have a better handle on how the coronavirus information is delivered to the public.

In order to do this, Trump must recognize that the Vice President is not a credible authority to vet and lead this healthcare mission. A politician is not the correct leader in this pandemic and not a creditable person to deliver information. The public needs factual information from scientists and doctors the National Institutes of Health (NIH)Centers for Disease Control and Prevention (CDC)US Public Health Service, and US Food and Drug Administration (FDA).

As the coronavirus shows no signs of slowing down, this is not the time for politics. This is the time that the citizens need credible information from someone who knows what they are talking about. Without this, false information spreads and the pandemic becomes even more deadly.

How Higher Drug Prices Are Threatening Patients and the Healthcare System

In recent years, specialty pharmaceuticals used to treat autoimmune diseases have skyrocketed in costs. Medications like adalimumab, etanercept and infliximab are among the top five prescription drugs in the United States. It is evident that there has been a lack of transparency in the specialty drug supply chain and drug prices. Without price regulation, many of these drugs have suffered from extreme price increases causing many patients and even the health care system to be impacted.

From 2005 to 2015, pharmaceutical sales rose from $500 billion to $700 while at the same time profits have raised over 18 percent. In a study published by Health Affairs, researchers looked at a list of prices from both brand and generic drug names from 2005 to 2016. Newly developed drugs mostly accounted for the higher cost point, but older drugs had the biggest price difference.

Due to the rising costs, many patients are responsible for greater out-of-pocket costs. This, in turn, causes a greater financial burden on patients. Some patients may even decide to opt-out of taking their medications. For those with rheumatoid arthritis, forgoing prescription medication can cause pain, deformities, and damaged joints beyond repair.

Hospitals and health systems are also taking a hit from rising prices. From 2015 to 2017, total hospital and health system drug spending increased on average 18.5 percent from fiscal years 2015 to 2017. Growth in Medicare hospital payment rates and growth in general healthcare expenditures did not keep pace with the increases in inpatient and outpatient drug spending during this time period.

Overall medical inflation during this period was 6.4 percent, according to the study. Spending on outpatient drugs rose 28.7 percent, while inpatient drug spending rose 9.6 percent from 2015 to 2017.

While spending growth increased, hospitals were facing drug shortages––about 80 percent found it “extremely challenging to obtain drugs in short supply,” the report found.

The prices of some drugs from 2015 to 2017 fluctuated significantly more than others, largely due to market changes and competitors, including:

  • Activase, a drug used to treat heart attack (increased 18.8 percent)
  • Immunosuppressants (increased between 15 percent and 21 percent)
  • Hepatitis C drugs (price drop of 15 percent in 2017)

“While these examples address drugs with the highest total spend, there are many other drugs that are critical for patient care that have experienced price increases,” the report noted.

For example, the price of a common pain reliever, hydromorphone, more than doubled over the three-year period.

Budget impacts

When drug prices rise, hospitals have to manage their budgets for these changes. Those involved in bundled payments do not see immediate changes in CMS payments as a result of higher drug prices.

Roughly two-thirds of respondents in the study said drug price changes had a moderate or severe impact on their budgets. More than 15 percent of hospitals indicated their budgets were impacted “to a large extent.”

As a result, hospitals have had to take different approaches to control spending, including day-to-day operational shifts and system-wide strategies. For many, these efforts were ongoing and continuous.

The Impact of Diet on Arthritis

Unfortunately arthritis does not yet have a cure, but there are some habits that you can practice to help alleviate the pain of arthritis symptoms. One question that patients frequently ask is, “Are there foods that can help? What foods should I avoid?” So far, there is no conclusive evidence that eating more or less of a particular food will affect symptoms or joint function. Throughout the ages, there have been many claims made on the influence of dietary habits on arthritis. Many of these claims are mostly anecdotal, though there are some reasonable theories.

Diet impacts many aspects of health, so it is possible that it can affect arthritis. Researchers are currently interested in the role of the microbiome in health and disease. The microbiome refers to the large population of microorganisms living within our bodies. We know that diet impacts the microorganisms in the intestinal tract and that these organisms may affect immune function. Because rheumatoid arthritis is an autoimmune condition, there is a possibility that changes in the microbiome can affect the activity and severity of rheumatoid arthritis.

Previously on this blog, I covered foods that can help arthritis pain, and this month I’m following up with some more healthy nutritional ideas for you to consider. One idea that is supported by medical evidence is weight control. Being overweight is a major risk factor for osteoarthritis, and weight loss can reduce the stress on joints. One study found that losing a pound of body weight reduces the load on your knees by four pounds. The best way to reach that healthy weight is to keep a healthy diet rich in vegetables and low in fat and to engage in regular  physical activity.

This blog was originally published on

Not Enough Pediatric Rheumatologists

A child who does not receive adequate treatment for a rheumatic condition may suffer dire lifelong consequences. Over 300,000 children have been diagnosed with rheumatic diseases, yet fewer than 400 pediatric rheumatologists practice in America. Rheumatologists who treat adults are doing their best to meet this care deficit, but they generally lack the expertise of pediatric specialists. The shortage persists amidst efforts to promote awareness of the need.


The structure of medical education may be a primary cause of the subspecialist shortage. The fellowships for pediatric rheumatology requires additional schooling. Because rheumatology is mainly an outpatient field, pediatrics residents do not normally have opportunities to see this field and develop an interest in it. Those residents who do observe pediatric rheumatology patients typically only see the sickest ones; they rarely study the spectrum of patients and how innovative therapies are reshaping the landscape of care for rheumatological diseases.


The American College of Rheumatology is striving to change this unfortunate scenario. In 2001, it initiated a residency program that pairs residents with mentors. The program has encouraged 73 percent of its students to pursue pediatric rheumatology training. Duke has set up a similar program that is turning more residents on to this subspecialty. Professors note that enabling the residents to survey the scope of inpatient and outpatient care has a significant impact.


These gains have not yet been enough to alleviate the shortage, which is expected to worsen. Meanwhile, more rheumatologists who specialize in adult care are forced to deal with pediatric patients. Pediatric specialists hope to increase awareness and provide counsel to these physicians.


The doctors who have not obtained specialized education to work with children face critical challenges with performing exams and prescribing medications for younger, smaller patients. Also, these adult rheumatologists often do not consider how differently children metabolize medications. The doctors need to consider the particular emotional needs of the sick children as well.


Most of the physicians who do treat children report dealing mainly with older teens. Although many of these adult rheumatologists are confident in diagnosing the most prevalent rheumatologic disease (JIA), many lack confidence in treating it. This trepidation could carry significant ramifications. Doctors must consider the impact of inflammatory conditions on a child’s growth when devising treatments. They need to understand how to take advantage of the limited chances to make progress with these patients during their formative years.


The Arthritis Foundation estimates that about one in four children receives proper care from a pediatric rheumatologist. Eight U.S. states have none of these specialists, and five states have only one. The average age of these doctors is over 50 years, so their retirement is critically imminent.


This stark reality shapes an increasing dilemma of access, but rheumatologists remain hopeful. They point to the host of resources that the ACR and disease foundations provide to educate care providers and families. Pediatric rheumatologists are also standing together and reaching out to promote awareness to future physicians.


Originally posted at

Rheumatoid vs Osteoarthritis: What’s the Difference?

Osteoarthritis (OA) and rheumatoid arthritis (RA) are both forms of inflammation of the joints but they are actually very different types of a broader condition called arthritis. There are many forms of arthritis, including gout, but RA and OA are two of the most common, affecting a combined 32 million people in the United States alone. Despite their similarities, the diseases have different causes and symptoms that can vary quite a bit in spite of some overlap.

What Is Osteoarthritis?

OA is a degenerative joint disease affecting the cartilage. Also known as wear-and-tear arthritis, it’s caused by a breakdown in cartilage of the joints that leads to pain and inflammation as bone rubs against bone without the protective cushion of the cartilage. OA may begin in a single joint and get progressively worse. This disease is most common among older adults with 70% of people over 70 showing some evidence of OA. It’s the most common form of arthritis.

What Is Rheumatoid Arthritis?

Rheumatoid arthritis also affects the joints but it’s considered an autoimmune disease that causes chronic inflammation of the lining of the joint and sometimes organs as well. As an autoimmune disorder, RA happens when the body believes the soft lining of the joints is a threat and attacks it much like it would a virus. RA usually affects multiple joints in the body and an estimated 75% of people with RA are women. Unlike OA, which usually occurs in older people over 65, rheumatoid arthritis is usually diagnosed between 30 and 60. There is no known cause of RA.

Symptoms of RA vs OA

Both RA and OA cause joint pain although the type, duration, and even location of the pain can vary. As a general rule, osteoarthritis causes pain in an affected joint after repeated activity or use. It usually causes stiffness in the joints in the morning for 30 minutes or less with pain that worsens later in the day. After inactivity, the joints may become stiff or swollen. A hallmark of OA is the development of bone spurs, enlargements called Heberden’s or Bouchard’s nodes, and reduced range of motion.

Rheumatoid arthritis also causes joint swelling, pain, and stiffness. There may be warmth and redness around the joint as well as reduced range of motion. RA also causes morning joint stiffness but it usually lasts for more than 60 minutes. A hallmark of RA is symmetrical joint involvement. While OA may affect one knee, for example, RA would affect both.

Osteoarthritis usually affects weight-bearing joints like the knees, hip, and back along with smaller joints in the fingers. Rheumatoid arthritis typically affects joint pairs, usually smaller joints like the ankles or small joints in the hands and feet.


Originally posted at

Tai Chi as Fall Prevention

As you age, the ability to balance becomes more difficult, which is often why the elderly have frequent rates of falling. Without balance, you lose mobility, and your overall health suffers because the lack of balance leads to a lack of physical inactivity. This is why it’s so important to remain active at all age levels.


Any kind of physical activity is great and helps keep your body functioning well, but a recent study showed that there’s even a specific kind of exercise to aid with balance: Tai Chi.


Tai Chi, which is an ancient Chinese art, was originally used for self-defense purposes but has since developed into a form of exercise that has many benefits for reducing stress and improving balance. Although similar to yoga in that you move from pose to pose while breathing deeply, they are two entirely separate exercises and should not be confused for each other.


The research group found that the “Tai Ji Quan: Moving for Better Balance” intervention (Tai Ji Quan is another name for the practice) reduced falls by 58% when compared to just stretching. When compared with multimodal exercise intervention, fall rates reduced by 31%, according to Fuzhong Li, Ph.D., and colleagues in JAMA Internal Medicine.


The findings from Tai Ji Quan: Moving for Better Balance (TJQMBB) have a lot of practical application, the study reported. As an exercise that requires no equipment, is low-cost and does not require a particular amount of space, Tai Chi is accessible to groups of all incomes and abilities. It’s a simple way to improve lower-body strength and balance, as well as increase the amount of time you practice physical activity throughout the day.


This study, which focused on those ages 70 and up, also showed that it’s not too late to practice activities that reduce fall-related risks. As an added bonus, Tai Chi exercises the mind, too, which is another issue that seniors often face.


Of course, there is still much research to do, as the study covers a limited scope. Researchers share their study with the acknowledgment that they relied on the participants to report their falls, though they did review medical records and followed up monthly to ensure as much accuracy as possible. These results are also limited to participants who were able to travel to exercise classes and were primarily white, but overall, the study shows great promise in terms of giving the elderly an affordable option to help increase their balance abilities.


Originally published at on September 13, 2018

About Dr. Micha Abeles, Connecticut-Based Rheumatologist

Dr Micha Abeles

Dr. Micha Abeles, an accomplished rheumatologist in Meriden, Connecticut.

Throughout his career that spans more than four decades, Micha Abeles has not only attained board certification in rheumatology as well as internal medicine, but he has also acquired an impressive history of publications, papers, book chapters, and editorials. Many of these studies are still referenced today, and have set the groundwork for many other important discoveries in fibromyalgia, arthritis, lupus, and gout studies. He was instrumental in the clinical trials that eventually led to the development of two significant arthritis medications, Humira and Enbrel, and continues to serve as a dedicated physician to his patients as a private practitioner.

Micha Abeles began his career in medicine at the State University of New York at Buffalo (SUNY Buffalo) after completing his residency in internal medicine. From there, Micha enlisted in the United States Army has a major and chief of the outpatient department at the Fort Monroe U.S. Army base in Virginia. It was here that he received a commendation for his outstanding clinical skills, but also for his shining ability to maintain a positive morale on the base. He organized events such as chess and table pool competitions, which made a significant impact on the future of his career. Once leaving the army, Micha Abeles was given the opportunity to become a fellow of rheumatology at the University of Connecticut, thanks to his glowing recommendations. Although he didn’t know it at the time, this fellowship and eventual certification in rheumatology would soon shape the course of his career.

Post-fellowship, Micha Abeles became the Associate Director of the UConn Multipurpose Arthritis Center. This federally-funded grant allowed him to conduct numerous clinical trials sponsored by many pharmaceutical companies across the country. These studies brought attention and funds back to the university, as well as gave Dr. Abeles firsthand experience in running these trials before beginning his own original research.

It was in 1990 that Micha Abeles became the co-author to a fibromyalgia criteria paper, and it was at this time, for the first time, that fibromyalgia had truly been defined by medical professionals. This study then led to additional research. So many, in fact, that Dr. Abeles and his co-authors eventually produced thirty-seven publications, book chapters, and national presentations about fibromyalgia.

Currently, Dr. Abeles has become interested in antibody testing — one of his most recent publications showed that anti-nuclear antibodies (ANAs) were difficult to interpret, and that contradictory findings that were very common in laboratories made them even more challenging to understand. Micha Abeles has also co-authored several of the first papers that explained the use of methotrexate in rheumatoid arthritis and in eosinophilic fasciitis.

To stay up to date in rheumatology, Micha Abeles is a member of the American College of Rheumatology, which is a professional organization that globally represents rheumatologists and rheumatology health professionals, and also sits on the Connecticut Rheumatology Association Board of Directors.

When Dr. Abeles isn’t seeing patients or working on a new trial, he can be found reading up on the latest studies in arthritis, lupus, and the United States healthcare system.


Originally posted on Medium

These 3 Shoes May Be Contributing to Your Osteoarthritis

If you find your feet and calves are in pain after a long day at work, you may just shrug it off to spending too many hours standing. However, your feet and calves may be trying to tell you something — because that pain could be a sign of osteoarthritis. If you have the following three shoes in your closet, you may want to visit your doctor to check if you have osteoarthritis, because these shoes have been shown to contribute to the degenerative condition.

High Heels

Formally defined as any shoe higher than two inches, podiatrists and osteoarthritis experts agree that not only are these shoes bad for people with arthritis, but for anyone in general. “They’re hard on the arch and ball of the foot and can wear down joints,” says Bryan West, a podiatric surgeon based in Michigan.

Even more bad news for women who love their high heels, these shoes have actually shown to cause osteoarthritis. A study from a group of Stanford University scientists suggests that the strain of wearing high-heels of at least three-and-a-half inches can prematurely age knee joints and could contribute osteoarthritis.

Moral of the story — it’s best to leave those high heels on the sale rack and find a more comfortable shoe.

To see which other shoes can contribute to your osteoarthritis, check out Micha Abeles’ blog here.

Running is Good for Your Joints

According to a new scientific review from the Journal of Orthopedic & Sports Physical Therapy, researchers discovered that moderate levels of recreational running may support healthy knee and hip joints, reports an article from Time Magazine.

The researchers conducted a meta-analysis that combined data from 17 previous studies about recreational running and its effects on hip or knee arthritis, otherwise known as osteoarthritis (a.k.a., degenerative joint disease, or “wear-and-tear” arthritis). With a total of 114,829 people studied, the researchers found that only 3.5 percent of recreational runners developed osteoarthritis during their period of study. In addition, the researchers found that those who were not recreational runners had a 10.2 percent chance of developing osteoarthritis. This means that people who ran moderately had a lower chance of developing osteoarthritis than people who did not run at all.

In addition, a 2016 study conducted by Matt Seeley, Ph.D, associate professor of exercise science at Brigham Young University, found that running for 30 minutes reduced inflammatory proteins around the knee joint. He states that “running at a recreational level can be safely recommended as a general health exercise, with the evidence suggesting that it has benefits for hip and knee joint health.”

So, what does this mean for people with, or are susceptible to, osteoarthritis? To find out more, check out Micha Abeles’ website here.

Medicines May Help to Prevent Arthritis

Every year The European League Against Rheumatism (EULAR), which is an E.U.-based organization that represents the patient, healthcare professional and professional societies of rheumatology, holds the Annual European Congress of Rheumatology. This forum serves as a space where rheumatology professionals can connect with patient organizations, as well as to learn and engage with other professionals in rheumatology, all to achieve progress in the care of people who suffer from various autoimmune and inflammatory diseases.

This year’s conference took place in Madrid, Spain. Among the thousands of presentations, one scientific session that stood out to me (in my review of the gathering) was a meta-analysis conducted by Bruno Fautrel, MD, PhD, of the Departments of Epidemiology, Rheumatology and Clinical Immunology (from Pierre and Marie Curie University in Paris), and his colleagues. Their study suggests that the best way for patients with pre-rheumatoid arthritis to prevent a full onset of rheumatoid arthritis is to intervene with early therapy.

Patients who have pre-rheumatoid arthritis are at an important point in their medical care because this is the ideal time period to prevent full onset of rheumatoid arthritis. Patients and their providers should take into consideration contributing risk factors, such as smoking and obesity, and adjust their lifestyle accordingly. However, Fautrel and his colleagues conducted a meta-analysis of people with the disease and found that medical treatment could effectively prevent progression to rheumatoid arthritis.

To read more about the findings of this meta-analysis, visit Micha Abeles’ blog here.