Have a terrific Summer!

Dear Readers,

The CareTALK.com website is currently under construction and, as a result, our blog will cease for the Summer.

For the past year, it has been a pleasure sharing the CareTALK voice with you every day. We will resume serving you September 1, 2007 -- and we hope you all have a terrific Summer.

- The CareTALK Gals

Red Tape

Don't you hate it when you have to wade through a bunch of red tape? Now imagine having to do this knowing your child's life is on the line.

This is what parents have to deal with all throughout the nation when trying to enroll their children in public health care insurance --- and the state with one of the biggest paperwork burden...Texas, where one out of 5 children are uninsured.

What is the point of all the bureaucracy and red tape?

According to the following article "Health Insurance Crisis for Children," this could be intentional...the more difficult the paperwork, the more likely parents will give up trying to obtain health insurance for their children. As a result, less children will enroll in public health insurance and, thus, the state spends less.

This really is despicable and needs to be addressed --- at the federal level.

Google's health project

We have all read the rumors about Google entering the healthcare arena which have been circulating online, but this posting by Roni Zeiger, M.D., is the clearest official message from the Googlers.

In the posting Is there a doctor in the family?, Roni writes:

In addition to my medical training, I studied medical informatics before coming to Google. I learned about computer systems that are designed to remind doctors about tests and treatments that their patients should have. I can say from personal experience that it is difficult to remember everything I should be doing for my patients, or to read every new article on the latest test or drug. These systems help doctors get the information they need to deliver quality care.

I believe patients should also have access to these kinds of systems so that they can help make sure they are getting the best care. If you search online to learn more about diabetes, it should be easy to find out what the generally recommended treatments and tests are.

Now I'm part of the team here working on health and we're trying to do something about this problem. Adam Bosworth, who is leading our team, has alluded to this in previous posts such as this one as well as in some speeches he has made at healthcare conferences.

We have been talking to many medical experts to understand what the best guidelines are, and how we can determine which ones apply in different circumstances. If such guidelines were more available to patients, they might be able to, by inputting information such as age, gender or medications, learn about recommended screening tests and other preventive measures, or about harmful drug interactions. (The problem of drug interactions is reason enough to work on this: in the U.S. alone, it is estimated that over 770,000 people are injured or die each year in hospitals from adverse drug events. Many of these medical errors could be prevented if patients or doctors checked for drug interactions.)

As we work on this project, we are of course paying very close attention to privacy.

We can't wait to see Google's health project!

Ever heard of "you get what you pay for"?

Sure! Everyone has. But we also expect the reverse is true (at least normally)... the item/service which is more expensive is of better quality than that which is less expensive.

However, according to a just-released hospital study, there is "stark evidence that high medical payments do not necessarily buy high-quality patient care." (New York Times)

If this is true, then why are health care costs so much?

Because "the fact that there is no connection between quality and cost is one of the dirty secrets of medicine" according to the chief executive of the Pacific Business Group on Health, a California group of employers that provide health care coverage for workers.

Even though there are many reasons for the disparity, "the far greater disparity [between hospital payments and patient outcomes] involved commercial insurers, which must negotiate their rates hospital by hospital."

So, just because you are paying more, it does not mean you are getting the best quality healthcare.

Watch out for these symptoms!

Have you had any of the following symptoms daily (or almost daily) for past 2-3 weeks?:

• bloating
• pelvic or abdominal pain,
• difficulty eating or feeling full quickly
• feeling a frequent or urgent need to urinate.

If so, it is extremely important to see your gynecologist. These are symptoms cancer experts have identified as early symptoms of ovarian cancer.

Does having these symptoms mean you have ovarian cancer?

Not necessarily. However, if found early, your chances of survival increase. "The disease is among the deadlier types of cancer, because most cases are diagnosed late, after the cancer has begun to spread. If the cancer is found and surgically removed early, before it spreads outside the ovary, 93 percent of patients are still alive five years later. Only 19 percent of cases are found that early, and 45 percent of all women with the disease survive at least five years after the diagnosis. By contrast, among women with breast cancer, 89 percent survive five years or more." (New York Times)

"With ovarian cancer, even a few months' delay in making the diagnosis may make a difference in survival, because the tumors can grow and spread quickly through the abdomen to the intestines, liver, diaphragm and other organs."

So what are you waiting for? If you have these symptoms, make an appointment to see your gynecologist. If it turns out to be nothing at all or just something minor (such as irritable bowel syndrome), great!

It's better to be safe than sorry.

Didn’t think some doctors are conflicted? Think again.

Documents gathered for a lawsuit at the Federal District Court in Boston showed that the "profits that doctors could make by prescribing drugs went from a minor source of income to the major driver of incomes for oncologists." In fact. a "Bristol-Myers document from 2001 shows that oncologists made about 65 percent of their revenue, and a similar percentage of their net income, on drug profits." (New York Times)

Can you believe this?

Doctors are being enticed by the pharmaceutical companies to prescribe their drugs. In fact, "industry documents that have emerged in a federal civil lawsuit in Boston show that big pharmaceutical companies sometimes calculated to the penny the profits that doctors could make from their drugs. Sales representatives shared those profit estimates with doctors and their staffs."

This is just one more area in where the healthcare system (and the doctors we are supposed to trust) has failed us.

How much is your health worth -- $-wise?

Believe or not, some economists are trying to answer this specific question which can then be used by health insurance companies in deciding whether a particular drug or treatment is covered.

So what have the economists come up with?

One year of life = at least $100K (based on the fact that "Keeping a patient with kidney failure alive on dialysis costs about $70,000 per year."-New York Times)

Using a test called standard gamble in which people are asked to imagine having the symptoms of a certain disease (pain, loss of function and shortened life expectancy) and then asked if they would undergo an operation which, if successful, would cure them, and if not, would kill them, economists found the following:

• Faced with severe diabetes, including blindness, most in the study would undergo an operation even if there was only a 42% success rate.
• Those will sever stroke would undergo an operation with a lower success rate.
• Those with sleep apnea would undergo an operation only if the success rate was a minimum of 90%.

But overall, why are the economists even focusing on this?

Because "once they know how to rank the 'costs' of various diseases, economists can determine the worthiness of a particular treatment. To do so, they use the 'quality-adjusted life-year,' or QALY. ... QALYs offer a single figure that can measure value of every treatment, from drugs to surgeries to preventive care, like vaccines and cancer screenings."

Whether we agree or not with this (rather cold) manner of evaluating the "value" of a treatment, this is one way in which health insurances are determining whether to cover a drug or treatment.

Drink your milk

How any times have you heard your parents tell you to drink your milk or have you seen the ads and commercials that say "Milk: It does a body good"?

Well, according to two studies, it really does a body really good-- especially in terms of preventing cancer.

Two studies released in the past week have reported that high "levels of vitamin D and calcium in their diets have a lower risk of breast cancer compared to women with lower intakes of these nutrients" and that "dietary supplementation of these nutrients reduces the risk of multiple types of cancer". The results of the first study apply to premenopausal women while the results of the second study apply to all women.

The first study showed that in premenopausal women, those who took a high dosage of calcium were 39% less likely to develop breast cancer and those who took a high dosage of vitamin D were 35% less likely to develop breast cancer. Unfortunately, there was no significant different in those who were postmenopause.

The second study, which focused on different types of cancer, found that those taking both calcium and vitamin D were 60% less likely (than those who didn’t taken supplements) to get cancer. Those taking calcium alone were 47% less likely to get cancer.

Scientists don't know for sure if these results hold true for men, but due to previous studies, they believe it may.

So... what are you waiting for?

Go drink your tall glass of milk.

Remember, Milk: It does a body good.

A step closer to the cure for Alzheimer's?

Did you know that lab tests have been conducted such that "scientists not only can give rodents Alzheimer's — they have also figured out how to take it away"? (New York Times). Granted, "curing mice is a lot simpler than curing people" but this offers some hope to finding a cure for the disease in humans.

And the company conducting these extensive tests?

Wyeth.

The pharmaceutical company has "dedicated more than 350 scientists exclusively to Alzheimer's research, and they are working on 23 separate projects for medicines to possibly treat the disease." This dedication to finding a cure is outstanding – however, one of their motivations (and one could argue, their main motivation) is a huge financial payout if their research is successful. Already it seems financial analysts are looking favorably at their stock.

Finding a cure for Alzheimer's is today's version of the Holy Grail. It is estimated that by 2050, 13.2M Americans will have the disease and the drugs that are currently available do nothing to stop the progression of the disease. As a result, there are other companies dedicating their resources to finding a cure – and results of studies conducted will be discussed during the international Alzheimer's meeting in Washington.

We have hope that the cure will be discovered soon – especially with all these companies dedicating their resources and money. We only have to be aware that when the cure is found, it will be extremely costly (the current treatment for Alzheimer's is expensive – possibly up to $20K/yr). Therefore, our country needs to help so that every American has health insurance. In addition, when the time is right, perhaps the government can also step in and negotiate the cost of the treatments so that those who suffer from Alzheimer's can afford the treatment.

Stem cell research is still a hot topic for debate

And it will remain a hot issue the next couple of days now that the House passed a bill that would relax the restrictions our president place on stem cell research in which research can only done on the embryonic stem cells from only 80 or so cell lines (though many lines turned out to be useless).

Many consider embryonic stem cell research to be the key to finding cures for many (for now) incurable diseases such as juvenile diabetes, Alzheimer's, Parkinson's, etc. Opponents of the research point to the recent study in which scientists "succeeded in creating embryonic stem cells without using eggs or destroying embryos" (New York Times). However, this has yet to be done using human cells – which may offer a different result.

Our president, a major opponent of stem cell research, stated "I am disappointed the leadership of Congress recycled an old bill that would simply overturn our country's carefully balanced policy on embryonic stem-cell research" (New York Times). Perhaps he should think about this. If Congress is recycling an old bill, and the bill passed even AFTER the findings of the above study were released, then perhaps Congress believes it is a worthy cause worth pursuing. (Btw, the bill passed by a vote of 247 to 176)

Universal healthcare is not the only solution

Yes, everyone is talking about "universal healthcare" asking that in a nation as rich as ours, why can't we provide affordable health insurance to everyone in this country?

However, if you really think about it, this is only part of the solution. As the private health insurance premiums increase each year, more and more people will have to switch to government assisted health programs which would in turn place more burden on the federal budget for which we will have to pay for with our taxes (in other words, higher taxes). Why are the premiums increasing so much? One reason (among so many others) is the escalating medical spending. According to the Congressional Budget Office, healthcare costs are projected to take up 12% of our country's GDP by the year 2030 (as opposed to the nearly 4% it takes up now).

According to the Dartmouth Atlas of Health Care, the treatment you receive depends heavily on where you live. For example, if you live in Idaho Falls, Idaho, you are 20 times more likely to receive a lumbar fusion than if you lived in say, Bangor, Me – to alleviate the same type of back pain. "The Dartmouth researchers adjust the numbers to take into account age, race and sex, which is another way of saying that there is no good explanation for the huge variations they find." (New York Times)

Why this waste? After the surgery, the patient will more than likely have to take medications. And what about the high cost of prescriptions drugs? Perhaps it's about time our government stops helping the pharma companies with their profits and starts helping us (and themselves) by allowing the government to negotiate for lower drug prices and perhaps even allow the importation of medications from overseas.

What is going on?

Yes, there have been many articles that have been written about doctors being conflicted when providing their professional opinion regarding a prescription drug. And, there have even been articles exposing the fact that some doctors receive payments for promoting their drugs. We can understand the need to be wary (unfortunately) regarding a doctor's professional advice/opinion in the medical field. But resorting to death threats?

That is what two prominent cancer prostate experts are dealing with after they had, at an FDA panel, publicly opposed (and voted against) the approval of Provenge, a controversial new drug which was found in two small clinical trials to extend the lives of those with prostate cancer. "An F.D.A. advisory panel endorsed the effectiveness of the drug by a 13-4 vote in March. The panel voted 17-0 that the drug was generally safe, although there were signs it could increase the risk of strokes." The FDA "said in May that it would not approve Provenge without more evidence that it was safe and effective." (New York Times)

We are not condoning or condemning either side. However, we are condemning the death threats these experts have received – possibly from patients advocating for the drug. As the New York Times suggested, that level of advocacy "could discourage rational discussion of drugs or deter experts from serving on government advisory committees."

The ironic part of this is, unlike most of the other panel members, both experts "actually treat patients with prostate cancer [and] they argued that the evidence fell short of proving that the drug worked, and that they did not want to give patients false hope."

Isn't this what we want?

9 Million

That is the number of uninsured children in this country.

Have you ever had a tooth infection? It can be painful - but is hardly ever fatal... unless you don't take care of it.

Yes, Medicaid does offer aid. But what if you can't find a dentist that took Medicaid and you can’t afford the treatment? This is what occurred to a 12 year old. The (common) tooth infection became a brain infection which would require emergency treatment at a cost of ¼ million dollars. Unfortunately, this victim died before he could receive the emergency treatment he needed.

"When uninsured children do get medical care, that care is often inferior." According to Families USA, "an uninsured child is twice as likely to die when hospitalized, when compared to an insured child."

Take a look at some photos of our uninsured children.

Aren't our children this country's future? If so, they why isn't this country taking care of them?

Alternative therapy for cancer?

Have you ever been told or have heard that shark cartilage can help patients with lung cancer live longer?

Sorry to be the bearer of bad news, but according to the results of a rigorous study, shark cartilage does not help patients live longer.

However, according to the New York Times, "two smaller studies showed some preliminary but encouraging evidence that two other complementary therapies, ginseng and flaxseed, might have some benefit for cancer patients."

The flaxseed study showed the tumors on the prostates that were removed from men with prostate cancer had grown 30-40% more slowly for those men who had taken flaxseed than for those who didn't.

"The ginseng study suggested that the herb might help fight fatigue, which is common in people with cancer... About one-quarter of the patients who took 1,000 or 2,000 milligrams a day of powdered extract of ginseng root reported that their fatigue had become 'moderately better' or 'much better.' That contrasted with only one-tenth of those who took either a smaller amount of ginseng or a placebo."

These studies do not mean that you should take these alternative as a replacement for chemotherapy or other proven therapies. However, taking ginseng or flaxseed as a supplement will, at best, aid in your treatment and, at worse, do nothing (ie. it will not harm you).

Genetic testing… the next "hot" thing?

As everyone knows, our DNA is like a blueprint that contains all our genetic information used in the development and function of all living organisms. With the advancement of technology, everyday people (ie. all of us) can undergo tests to learn our genetic information – relatively inexpensively. In fact, some insurance companies may even cover the costs of some genetic tests – such as the Genomic Health test which "looks at the activity of 21 different genes in tumors" (Forbes.com, The Telltale Tumor).

Genetic testing is the cover story(ies) of the June 18th issue of Forbes. Not only can we see if we have a mutated gene that can make us more vulnerable to cancer or heart disease, but there are genetic tests that can be taken on a tumor that can detect DNA flaws which could cause the tumor cells to grower more rapidly than regular cells.

Why is this significant?

With this knowledge, you can decide whether you can even consider foregoing chemotherapy after a tumor removal or your doctor can see whether s/he will need to change your treatment.

Did you know that a flaw on chromosome 9 "may boost the risk of early heart attack by as much as 70%"? Did you also know that 21% of the population has this flaw? That's about 1 in every 5 people. Are you that 1 in 5? Of course, if you live a healthy lifestyle, your lifestyle will mitigate the risk.

Did you know that 1 out of every 10 people have two copies of a diabetes-promoting gene that could "double the risk of diabetes compared with the average person"? Well, if you are so willing, you can order a mail-in test online for $500 to see if you have this diabetes-promoting gene.

Genetic testing is becoming very popular – especially since knowing your genetic information is like having a crystal ball into your future. With the genetic information, you can plan on what treatments you want (or need) or the lifestyle you need to pursue (ie. if you have the flaw in chromosome 9, then you have no choice but to lead a healthy lifestyle in order to counter the risk of a heart attack).