Red Wine & Vascular Disease

The so-called “French Paradox” has often been invoked to explain the putative cardiovascular benefits of red wine consumption.  As most everyone knows, the French culture is, shall I say, very accepting of rich sauces and tobacco.  Yet, the incidence of cardiovascular disease in France, while not negligible, is at least much smaller than expected in view of prevalent dietary and smoking habits.  The per capita consumption of wine in France, estimated at 60 liters (about 15 gallons!) per person per year, is exceeded by only one other country (Luxembourg) in the world.  The United States is way down on the list of oeniphilic countries, with the average American downing a relatively paltry 7 liters of wine per year!  Not surprisingly, the high per capita consumption of red wine in France has been suggested as a possible contributing factor to the relatively low incidence of cardiovascular disease in that country.  Indeed, there has been quite a lot of research dedicated to the health effects of red wine.  Powerful antioxidants, called polyphenols, are known to be abundant in red wine.  These compounds also exert anti-inflammatory effects, and also appear to stimulate the cells that line blood vessels (endothelial cells) to release nitric oxide.  A new study published in the current issue of the journal Circulation evaluated this latter putative effect of red wine polyphenols using cultured human umbilical vein endothelial cells.

Human umbilical vein endothelial cells were cultured for 20 hours with various concentrations of alcohol-free red wine polyphenols, and the amount of nitric oxide secreted by the cells was then measured.  The study found that red wine polyphenols increased the secretion of nitric oxide from the endothelial cells in a dose-dependent fashion.  At the highest concentrations of red wine polyphenols, a three-fold increase in nitric oxide synthesis was measured, as well as a greater than two-fold increase in the enzyme (eNOS) that plays a critical role in the release of nitric oxide from endothelial cells.  This finding is potentially very important, as endothelial cell eNOS and nitric oxide are thought to improve blood vessel function throughout the body (including the coronary arteries of the heart), and may reduce the risk of atherosclerotic cardiovascular disease.  The alcohol component of wine is also thought to provide cardiovascular benefits by thinning the blood so that it is less likely to form blood clots in already narrowed arteries.  The findings of this study may help to explain the so-called “French Paradox,” and the apparent improvement in cardiovascular disease patterns seen among people who consume red wine regularly.  Of course, alcoholic beverages, including red wine, should always be consumed in moderation to avoid the potentially serious health problems associated with excessive drinking, and one should never drink and drive.

HMOs & Quality of Care Scores

The explosive growth of managed care in the United States over the past decade was a response to widespread concerns about the spiraling costs of healthcare in our society.  The theory was something along the lines that the intensive regulation and streamlining of healthcare assets (by HMOs) to match—but not exceed—the needs of patient beneficiaries would, in turn, lead to a more efficient use of costly medical resources.  Economies of scale could be achieved so as to allow for savings at all levels of healthcare delivery.  Or so they said….  But, a funny thing happened on the way to this utopian healthcare ideal: most HMOs soon learned that the average American patient doesn’t want to be told that a CAT scan, or a new medication with fewer side effects, are too expensive, and that other less expensive alternatives will have to suffice.  HMO horror stories soon abounded across the land, and many HMO physicians themselves began to publicly complain that their employers were refusing to authorize specialized care deemed to be necessary, and based upon their best medical advice.  In this context, a number of state and federal oversight agencies began to encourage HMOs to report on their access-to-care and quality-of-care statistics.  The HMOs have generally been allowed to voluntarily report such data, and those companies choosing not to self-report such information are usually not punished.  In this week’s Journal of the American Medical Association, a new study looks at the impact of HMO quality-of-care reporting with subsequent trends in self-reporting in later years. 

A total of 329 HMOs publicly disclosed quality-of-care data in 1997.  However, in the subsequent year (1998), 161 (49%) of these HMOs failed to publish their quality data again.  In 1999, 23% of the HMOs that had reported their data in the previous year went on to withdraw from public disclosure.  When the HMOs were ranked according to their overall quality scores in this study, it was discovered that the HMOs reporting cumulative scores in the lowest third in 1997 were almost 4 times more likely to withdraw from public disclosure in 1998.  Among the HMOs reporting quality data in 1998, those HMOs within the bottom third of quality score rankings were nearly 6 times as likely to withhold reporting in 1999 when compared with HMOs ranking in the top third!

The study concludes that voluntary self-reporting of health care quality statistics by HMOs is counterproductive with respect to the original goals of such disclosure.  HMOs with very high quality scores are very likely to publicly report their data, while HMOs with poor quality-of-care statistics are much more likely to refrain from publishing such information.  (Bet you didn’t need a high-powered research study to reach this conclusion…!)