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ByLauranNeergaard TheAssociatedPress WASHINGTON Americans consider insurance and a good bedside manner in choosing a doctor, but will that doctor provide high- quality care? A new poll shows that people don't know how to determine that. Being licensed and likable doesn't necessarily mean a doctor is up to date on best practices. But consumers aren't sure how to uncover much more. Just 22 percent of those questioned are con- fident they can find informa- tion to compare the quality of local doctors, according to the poll by The Associated Press-NORC Center for Pub- lic Affairs Research. Today, 6 in 10 people say they trust doctor recommen- dations from friends or fam- ily, and nearly half value re- ferrals from their regular physician. The poll found far fewer trust quality informa- tion from online patient re- views, health insurers, rat- ings web sites, the media, even the government. "I usually go on references from somebody else, because it's hard to track them any other way," said Kenneth Murks, 58, of Lexington, Ala- bama. His mother suggested a bone and joint specialist af- ter a car accident. "I guess you can do some Internet searches now," he added, but questions the ac- curacy of online reviews. The United States spends more on health care than most developed nations, yet Americans don't have bet- ter health to show for it. A recent government report found we miss out on 30 percent of the care recom- mended to prevent or treat common conditions. At the same time, we undergo lots of unneeded medical testing andoutmodedorinappropri- ate therapies. About half believe better care is more expensive, even as the government, insurers and health specialists are pushing for new systems to improve quality while hold- ing down costs. It's hard to imagine buy- ing a car without checking rankings, but checking out a doctor is much more dif- ficult. Many specialists say standardized measures of health outcomes are key, though very little is available. Doctors who listen are important, but "some of the nicest doctors are the least competent," cautioned Dr. Elliott Fisher of the Dart- mouth Institute for Health Policy and Clinical Practice. Higher-quality care actually tends to be less expensive, by keeping people healthy and out of the hospital, and avoiding errors and the com- plications of unneeded care, he said. HEALTHCARE Checkdoctors'vitals,beforetheycheckyours By Lindsey Tanner The Associated Press CHICAGO Disadvantaged teens may get more than an academic boost by at- tending top-notch high schools — their health may also benefit, a study suggests. Risky health behavior including binge-drinking, unsafe sex and use of hard drugs was less common among these kids, com- pared with peers who went to mostly worse schools. The teens were otherwise similar, all from low-in- come Los Angeles neigh- borhoods who applied to top public charter schools that admit students based on a lottery system. The researchers com- pared behavior in almost 1,000 kids in 10th through 12th grade who were ad- mitted to the high-per- forming schools and in those who went elsewhere. Overall, 36 percent of the selected kids engaged in at least one of 11 risky behav- iors, compared with 42 per- cent of the other teens. The study doesn't prove that the schools made the difference and it has limi- tations that weaken the re- sults,includingalargenum- ber of students who refused to participate. Still, lead au- thor Dr. Michael Wong said the results echo findings in less rigorously designed re- search and they fit with the assumption that "better ed- ucation will lead to better health." Wong is an inter- nist and researcher at the University of California, Los Angeles. The study involved mostly Latino students who applied to one of three top-performing pub- lic charter schools from 2007 to 2010. About half of the kids had parents who didn't graduate from high school and most didn't own their own homes. Results were published onlineMondayinPediatrics. Teens were given com- puterized questionnaires to answer in private, to im- prove the chances for accu- rate self-reporting. Standardized test scores were obtained from the California Department of Education. The results aren't a referendum on charter schools but the lottery sys- tem they use for enroll- ment made the compari- son fairer, Wong said. Despite the limitations, the study "is a beautifully conducted natural exper- iment" that could occur because there's more de- mand for high-performing schools than there is space available, said Kelli Komro, a professor of health out- comes and policy at the University of Florida in Gainesville. She was not involved in the research. Because the Los Ange- les schools' lottery system selects students randomly, not on grades or other dif- ferences, the study design "mimics a randomized con- trolled trial, the gold stan- dard in health research," Komro said. Most of the selected kids chose to attend those schools, while 83 percent of those not picked went to schools with worse per- formance records. EDUCATION Students' health benefits from top schools By Marilynn Marchione The Associated Press New details from two studies reveal more side ef- fects from niacin, a drug that hundreds of thousands of Americans take for cho- lesterol problems and gen- eral heart health. Some prominent doctors say the drug now seems too risky for routine use. Niacin is a type of B vita- min long sold over the coun- ter and in higher prescrip- tion doses. Some people take it alone or with statin medicines such as Lipitor for cholesterol problems. Niacin users' main com- plaint has been flushing, so drug companies have been testing extended-release and combining other med- icines with it to minimize that problem. Introduced in the 1950s, the drug hadn't been rigorously tested un- til recent years when mak- ers of prescription versions were seeking market ap- proval. The two studies were testing prescription ver- sions of niacin, and the bottom line — that it didn't help prevent heart prob- lems any more than statins alone do — has already been announced. Some of the side effect informa- tion, including a troubling rise in deaths among nia- cin users in one study, also was known but many doc- tors have been waiting for full details and verification of the results before draw- ing firm conclusions about the drug's safety and effec- tiveness. Those details are in this week's New England Jour- nal of Medicine. The larger study sug- gests that "for every 200 people that we treat with niacin, there is one excess death," plus higher rates of bleeding, infections and other problems — "a com- pletely unacceptable level" of harm, said Dr. Donald Lloyd-Jones of Northwest- ern University in Chicago. "Niacin should not be used routinely in clinical prac- tice at all." He co-led a panel for the American Heart Asso- ciation and American Col- lege of Cardiology that re- cently issued new choles- terol treatment guidelines. The group did not recom- mend niacin but said it could be considered for cer- tain patients. If the panel had seen the new results, it "almost certainly" would have recommended against niacin's routine use, Lloyd- Jones said. Heart specialists stress that patients never should stop taking any medi- cine without first talking with their doctors. Many have shied away from nia- cin since the initial results came out, but more than 700,000 prescriptions for various niacin drugs are written each month in the U.S. The top brand is Nias- pan, long sold by Abbott Laboratories and now by AbbVie, which had nearly $900 million in sales in the U.S. alone last year, accord- ing to IMS Health, a health data firm. The larger of the two studies tested Tredaptive — a Merck & Co. combo of niacin and an anti-flush- ing medicine — in nearly 26,000 people already tak- ing a statin. Full results confirm there was a 9 per- cent increase in the risk of death for those taking the drug — a result of bor- derline statistical signifi- cance, meaning the differ- ence could have occurred by chance alone, but still "of great concern," Lloyd- Jones wrote in a commen- tary in the medical journal. The drug also brought higher rates of gastroin- testinal and muscle prob- lems, infections and bleed- ing. More diabetics on the drug lost control of their blood sugar, and there were more new cases of diabetes among niacin users. The initial results in De- cember 2012 led Merck to stop pursuing approval of Tredaptive in the U.S. and to tell doctors in dozens of countries where it was sold to stop prescribing it to new patients. Prompted by that study, leaders of an earlier one that tested a different ni- acin drug, Niaspan, re-ex- amined side effects among their 3,414 participants and detailed them in a letter in the medical journal. Besides more gastroin- testinal, blood-sugar and other complications, the new report details a higher rate of infections and a trend toward higher rates of serious bleeding. The consistency of the results on studies testing multiple types of niacin "leaves little doubt that this drug provides little if any benefits and imposes seri- ous side effects," said Yale University cardiologist Dr. Harlan Krumholz. "It's an astonishing re- versal of fortune" for nia- cin, one of the very earli- est cholesterol treatments, he said. "This is a billion- dollar drug and it never really had the evidence to warrant that sort of block- buster status." The studies were on pre- scription niacin; risks and benefits of over-the-coun- ter forms are unclear. Lloyd-Jones said nia- cin still may be appropri- ate for some people with very high heart risks who cannot take statins, and for people with very high triglycerides that can't be controlled through other means. MEDICATION MARKLENNIHAN—THEASSOCIATEDPRESS In this 2013photo, a pharmacist works at his desk located next to the prescription pick up counter in New York. Studies see new risks for ch ol es te ro l dr ug n ia ci n (530) 528-1220 331 Elm Street, Red Bluff See all of our hearing aid prices online at www.entpatient.com Includes no risk 30 day trial period. Fee-for-Service Pricing. Offer valid for one Unitron Shine + Hearing Aid any style. 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