In his book, Dr. Cohen explains how three decades ago the Federal government tried to “fix” the problem of overweight adults by recommending low-fat diets for all Americans. They were wrong. As a result, four times as many Americans are overweight. Because most Americans believe that bad advice, they gain weight as they try to diet. The government blocks efforts to help those who are overweight or who may suffer from Type 2 Diabetes, unless they conform to that misguided government policy.

Dr. Cohen’s weight-loss program has helped many. In addition to losing weight, people suffering from Type 2 Diabetes have been able to come completely off medications and reverse their disease. His book has been featured on The Diabetes Power Show. Dr. Cohen developed his approach using a mathematical model that predicts the ability of a weight reduction of diet to suppress hunger. That model showed that diets are not equal, and the approach pushed by the government increases hunger, causing dieters to fail.

The book explains how Dr. Cohen studied older medical practices as a Fellow in the History of Medicine to find similarities to the approach he was using. He found parallels both in 19^th century Germany as well as 2400 year old recommendations of Hippocrates, the founder of rational Western medicine. The book offers practical, modern advice on how to use weight naturally, as was done in times past.

Dr. Cohen is a Board-Certified physician specializing in Preventive Medicine and a Fellow of the American College of Preventive Medicine. He trained in Preventive Medicine at Johns Hopkins University where he served as Chief Resident of Preventive Medicine. He has served as the Deputy Director of the New York State Research Institute on Addictions. He now practices in Kansas.

Once symptoms start, there’s only a tiny window of time for stroke victims to get life-saving treatment. Now, research from the Stanford University School of Medicine has cracked that window open a bit wider.

If a patient arrives at the emergency room within three hours of experiencing stroke symptoms, doctors can administer a potent clot-busting medication and often save critical brain tissue. But if more than three hours have passed, current clinical guidelines say the medication should not be used.

But the new study suggests that the traditional three-hour time window is too short. By combining data from multiple clinical trials, Maarten Lansberg, MD, PhD, assistant professor of neurology and neurological sciences at Stanford, and colleagues from Belgium and Germany showed that treatment can benefit patients up to 4.5 hours after they experience their first symptom. Their findings will be published online May 28 in the journal Stroke.

Every year, more than 750,000 Americans experience a stroke, or brain attack, due to a sudden drop in blood flow to the brain. Most strokes are ischemic, meaning they’re caused by a blocked artery. For these strokes, a medication called tissue plasminogen activator, or tPA, can open blocked blood vessels and help restore blood flow to the brain.

“We’ve known that this treatment works for ischemic stroke since 1995,” said Lansberg, the lead author of the study. “But in the United States, only about 3 percent of stroke patients end up getting treated. Most of them are ineligible because they come to the hospital after the three-hour time window.”

The timing of treatment is important, because giving a strong blood thinner like tPA during a stroke can cause bleeding inside the brain. The longer a patient waits to get treatment, the more likely it is that the risks of treatment will outweigh the benefits.

“Doctors from all over the world have tried to increase the treatment time window,” Lansberg said. But evidence from individual clinical trials has been confusing: Some studies demonstrated a benefit from treatment after three hours, while others were inconclusive or reported no benefit.

“Individually, the studies were too small to be convincing,” said Greg Albers, MD, professor of neurology and neurological sciences and director of the Stanford Stroke Center, who was not involved in the study. “Most of the studies showed a trend but weren’t statistically significant.”

But when Lansberg and colleagues combined data from all four of the major tPA stroke trials to date, they saw a much clearer picture. Among a total of 1,622 patients who arrived at the hospital between three and 4.5 hours after their symptoms started, treatment with tPA improved the odds of a favorable outcome by 31 percent.

“A favorable outcome means that patients are either completely back to normal or they have minimal symptoms, like some numbness or a slight facial droop,” Lansberg said. “But they can do everything in their normal life that they were able to do before the stroke happened.”

The study, funded by grants from the National Institutes of Health, found no change in the death rate among patients treated with tPA during the three- to 4.5-hour window. In other words, treatment improved outcomes without negatively affecting mortality.

Lansberg collaborated with Vincent Thijs, MD, PhD, professor of neurology at the University Hospitals of Leuven in Belgium, and Erich Bluhmki, PhD, who works for Boehringer Ingelheim Pharma GmbH & Co. Boehringer Ingelheim manufactures tPA for use in Europe.

A second study, also led by Lansberg and published online in Stroke on April 16, further supports these findings. Using data from six previous trials, the researchers calculated the likelihood that patients would benefit or be harmed by tPA treatment. Out of 100 patients treated three to 4.5 hours after the onset of stroke, the study estimated 16.9 patients would benefit and only 3.4 would be harmed.

“Although this is not as good as treatment at an earlier time, it is still a highly significant benefit for patients treated in this group,” Lansberg said.

Stanford doctors have already started to incorporate the new data into their clinical decision-making, Albers said. Although the FDA has not approved tPA for use more than three hours after the onset of symptoms, physicians can offer the treatment to patients as an “off-label” use.

“Until these data came out, we were treating patients up to three hours,” Lansberg said. “Now, after carefully explaining the risks and benefits, we give patients the option to get treatment up to 4.5 hours after their symptoms start.”

Albers estimates that roughly 15 percent of patients at Stanford come in during the three- to 4.5-hour time window. “It varies by location,” he said, “because if you live in a remote area, you’re less likely to get to the hospital in time. But with 750,000 strokes happening every year in the United States, it’s quite a large number of patients who could potentially benefit.”

Despite a longer window for treatment, Lansberg stressed the classic mantra of stroke researchers: “‘Time is brain’ still holds true,” he said. “When your brain doesn’t get the sugar and oxygen it needs, your brain cells die. For every minute you wait, your chances of getting better from the treatment drop.”

Health savings account (HSA) owners are overwhelmingly satisfied with their accounts, and 91 percent believe such accounts should remain an option for Americans, according to a nationwide survey released today by OptumHealth. More than 80 percent of respondents cite their ability to save for future health care expenses as the primary reason for opening and depositing money into their HSAs. The survey also found that 70 percent of HSA participants make $75,000 a year or less in income.

“HSAs have very strong support across a broad range of income levels and are helping people be better health care consumers,” said Chad Wilkins, chief executive officer for OptumHealth Financial Services.

OptumHealth’s survey found 82 percent of HSA owners are satisfied with their accounts; 78 percent believe the continued availability of HSAs should be part of any health care reform that may occur; and 74 percent agreed they would recommend an HSA to a friend or family member. Three out of 10 respondents said that they wouldn’t have health insurance if it were not for their HSAs.

The study also showed that HSA owners are engaged with their financial and physical well-being. For example, 64 percent of the respondents said they inquired about generic options for medication and 47 percent indicated they asked their care providers about charges.

HSA owners also agree that people need to become more engaged in their health care. The survey found that 83 percent of respondents agreed people should research health care options and try to get the best price — just like they do for other major consumer purchases; 72 percent of respondents said that individuals should be responsible for helping to manage their own health care costs.

Employers are increasingly turning to consumer directed health plans (CDHPs) and HSAs to provide health coverage to their employees and dependents. According to a Watson Wyatt Worldwide and National Business Group on Health survey, 51 percent of companies now have a CDHP in place, a 9 percent increase from last year. Inside Consumer-Directed Healthcare reported that the number of HSAs grew about 40 percent year-over-year as of January 2009 and average savings balances grew 45 percent.

“With increased employer demand, more HSA use by consumers and the positive responses from our survey, it is clear that these accounts are valued as a tool to help people meet their health care needs,” Wilkins said.