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.

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?

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).

Long overdue scrutiny of the Long Term Care providers

According to the New York Times, the House Committee on Energy and Commerce is conducting an investigation on how long term care insurance companies handle policyholder claims – and they have begun by asking two of the largest sellers of LTC insurance to produce documents for their investigation.

According to what the committee has uncovered in court documents,

Conseco, Penn Treaty [the two largest LTC insurance sellers] and other insurers developed policies that rejected policyholders’ claims because they had failed to submit unimportant paperwork, filled out the wrong forms after receiving them from the insurance companies or because facilities had been deemed inappropriate even though they were licensed by state regulators. In California alone, nearly one in every four long-term care claims was denied in 2005.

We all need long term care insurance. And when we pay our monthly LTC insurance premiums, we expect our claims to be approved. Imagine, nearly 25% of all LTC claims in California were denied in 2005. 25%! That's ridiculous

It’s about time the federal government has begun to step in – in representation of its people and not in representation of the corporations.

90-day warranty for your surgery

Well, it has come to this: a hospital system that is selling a 90-day warranty for the surgeries they perform (at the moment, just heart bypass surgery).

Under the typical system, missing an antibiotic or giving poor instructions when a patient is released from the hospital results in a perverse reward: the chance to bill the patient again if more treatment is necessary. As a result, doctors and hospitals have little incentive to ensure they consistently provide the treatments that medical research has shown to produce the best results.

Researchers estimate that roughly half of American patients never get
the most basic recommended treatments — like an aspirin after a heart attack,
for example, or antibiotics before hip surgery. (New York Times)

Under the program/ warranty called ProvenCare which began last year, doctors under the Geisinger Health System have to follow 40 essential steps prior to any bypass surgery. The results of the first year were released last month at a meeting at the American Surgical Association. The results were overall very positive: in-hospital mortality decreased to 0% from 1.5%, readmissions to ICU decreased from 2.9% to .9%, etc.

While we commend the fact that the Geisinger Health System is trying to "get it right" the first time they perform a surgery so as to reduce health care costs, our question is: why not do this to begin with without having to charge insurers and employers an extra charge for this warranty? The warranty sounds great, but the costs will eventually trickle down to those insured (via higher premium health insurance rates). Why should the insured carry the burden of this warranty? Shouldn't hospitals want to give the best pre- and post- treatment to their patients?

Techno-doping?

The New York Times has a very thought provoking article, "Debate on Amputee Sprinter: Is He Disabled or Too-Abled?" regarding an ongoing debate in the world's Track and Field arena. A double amputee is seeking to become the first amputee runner to compete in the Olympics. Using a pair of "j-shaped blades" as his "feet," Oscar Pistorius has already won the 100 and 200 meters events in the Paralympic World Cup and is on pace to qualify for the 4X400 meter relay representing South Africa in the 2008 Olympics in Beijing.

However the debate is:
"Do prosthetic legs simply level the playing field for Pistorius, compensating for his disability, or do they give him an inequitable edge via what some call techno-doping? "

Who would have thought that being a double amputee could be considered an advantage? Due to modern technology, this is now the case.

The world governing body for track and field argues that they cannot accept "something that provides advantages" (ie. Mr. Pistorius’s prosthetic limbs) and have urged him to focus on the Paralympics because "it affects the purity of sport. Next will be another device where people can fly with something on their back."

With all due respect, how can prosthetic limbs be compared to, what the governing body is in essence describing as, a rocket backpack? We would understand the governing body's concern if the prosthetic feet had, perhaps, a rocket or propeller attached to them. But this is not the case. Even with the prosthetic feet, Mr. Pistorius needs to train hard - like other athletes - if not more.

An associate professor who has studies amputee runners asks, "Are they looking at not having an unfair advantage? Or are they discriminating because of the purity of the Olympics, because they don't want to see a disabled man line up against an able-bodied man for fear that if the person who doesn't have the perfect body wins, what does that say about the image of man?"

This is a very interesting point. And one that the International Olympic committee should consider, should they decide to intervene.

Why shouldn't Mr. Pistorius be given a chance to compete in the Olympics? As he says, "There's nothing I can't do that able-bodied athletes can do." With hard work and dedication, you can accomplish anything you set you mind to -- Isn't this what alway preach, especially to our children?

Even if he doesn't win a medal, the fact that he competed and was in a group with the best in the world will be extremely motivational to others who are disabled. It will send out the message: YOU CAN DO IT!

Hope for family caregiver in NY State

Did you know that no one - not spouses, children, parents - can make decisions about life sustaining treatment (or even look at medical records) for incapacitated patients – unless the patients has a living will, or health care proxy? Even worse, they aren't even allowed to move the patient to a hospice.

According to the New York Times, The Family Health Care Decisions Act, if passed, will allow family members (or close surrogates), after a "decent" process, to make choices regarding life sustaining treatment. "Those decisions must reflect as nearly as possible the patient's wishes, taking into account moral and religious beliefs. Where those wishes are unknown, decisions would be made in the patient's best interests." With this measure, NY will follow in the footsteps of most other states who already allow family members to make healthcare decisions for their incapacitated loved ones.

This is desperately needed because, unfortunately, the majority of the population does not have living wills or health care proxies – especially the younger population. CareTALK tries to educate and encourage you to get a living will or a health proxy so that there is no question as to what your end-of-life wishes are. In addition, your loved ones are grieving enough if you become incapacitated – don't put additional stress on them by having them guess what you would have wanted. Get a living will.

We sincerely hope Gov. Spitzer can help break this 15-year-old stalemate so as to allow family members in NY to act as decision makers for patients unable to direct their own care.

More conflicts…

We had previously written how a study in the New England Journal of Medicine indicated that “94 percent of more than 3,000 physicians surveyed reported some type of relationship with the pharmaceutical industry" which could be something as simple as receiving free pens to "receiving payments for consulting, giving lectures and even enrolling their patients in trials."

It turns out that payments to doctors is estimated to total hundreds of millions of dollars per year - and these payments have risen due to competition between drug makers - especially Amgen and Johnson & Johnson. In fact, The New York Times has uncovered (from documents given to the paper) that Amgen paid a group of six doctors in a medical practice $2.7 million for prescribing $9M worth of its drug for anemia patients last year. Imagine... the doctors were basically receiving almost 30% commission for the anemia drug they prescribed. As if this wasn't bad enough, the FDA released a report yesterday stating there was "no evidence indicated that the medicines either improved quality of life in patients or extended their survival, while several studies suggested that the drugs can shorten patients’ lives when used at high doses." To add further conflict, not only do these doctors gets payments from the pharma companies, but then they also receive reimbursements from Medicare – often at a price over what the doctor paid.

According to Amgen, these payments "were a normal commercial practice." Even though it's a "common" practice, does that mean this shouldn't be changed?

NO!

These payments should be deemed illegal – for the good of everyone in this country --- especially considering that doctors receive even higher payments if they agree to exclusively use the company's drug.

This needs to stop.

New meaning to the phrase "wearing your jewels"

How do you wear your jewels? On your ears? Around your neck? On your fingers?

How about on your skin?

That's right. An article in the New York Times, "New Hope at the Beauty Counter: Bling in a Jar," describes several skin products that are using pulverized jewels – such as diamonds, rubies, pearls, etc— inside their facial and body creams.

Why the luxurious ingredients? Whatever happened to Ponds or Oil of Olay? Well, "manufacturers claim that, when pulverized, distilled or blended with oils, precious metals and stones can tighten, clarify and reverse the signs of age." Ahh… so beauty does come at a price – a pretty high price if you use these creams. For instance, La Prairie’s Cellular Radiance Concentrate Pure Gold (which contains 24 karat gold flecks) runs about $525 for a 1oz bottle.

However, do these really work? Should you run out and buy a bottle or two?

According to Dr. Vincent DeLeo, chairman of the dermatology department at St. Luke's-Roosevelt Hospital and Beth Israel Medical Centers in New York, "if you can see [precious metals used in creams] after you use it, it's not doing anything but sitting on a dead layer of skin."

Would you buy a cream with diamonds, pearls, rubies, other precious metal and jewels? Tell us, we’d like to know.

Eat Chocolate (dark chocolate, that is)!!

Some of you may have known this already… but now it's official. According to the New York Times, a new study has found that "eating dark chocolate may be almost as effective at lowering blood pressure as taking the most common antihypertensive drugs."

GREAT!

Bring on the dark chocolate! However, eat in moderation ---your hips and belly might not thank you if you eat too much of it.

Lifestyle Medicine

How many of you are guilty of having (or know people who have had) liposuction, heart surgery, or other surgery, yet the lifestyle that helped cause the condition remained the same after the surgery – ie. excessive stress, eating unhealthy foods, etc.?

We've all read about improving our lifestyle, and healthy living/aging - but why is it that some doctors don't focus on trying to change the patient's lifestyle for the better? Granted, it's hard enough getting the doctor to focus and spend time with you while in the examination room, but s/he should provide specifics on how to change your lifestyle to not only treat disease--but also to prevent it.

The obstacle, like so many others, is time and money. Counseling each patient takes time and unfortunately, it's not reimbursed by Medicare or health insurance.

However, this should not matter!

"Symptomatically treating disease without assessing patients' lifestyles or offering them guidance on how to change is ‘irresponsible and bordering on neglect.' " (NYTimes, "Teaching Doctors to Teach Patients About Lifestyle")

We agree.

Oversight for nursing homes receives a failing grade

Finding a nursing home for your loved one is difficult – especially one which you can trust will care for him/her the way s/he deserves. The least you can expect is that the nursing homes are regulated – at least by the government – especially if Medicare/Medicaid is paying for a patient’s stay. However, according to the New York Times article, "Oversight of Nursing Homes Is Criticized," a new report has been released by Congressional investigators stating the Department of Health and Human Services (HHS) "fails to hold homes with a long history of harming residents accountable for the poor care provided." The government can legally impose, for compliance problems, a stiff penalty of up to $10K/day taken from the Medicare/Medicaid reimbursements owed to the nursing homes. However, this authority is seldom used.

For example:
The report found "that a nursing home was still open even though it had repeatedly been cited for 'poor quality care,' poor nutrition services, medication errors and employing people who had been convicted of abusing patients."

How can this be?

Considering "about 1.5 million people live in the nation's 16,400 nursing homes on any given day, more than 3 million people receive nursing-home care at some point in the year [and] Medicaid and Medicare pay for more than two-thirds of patients," why is there such failure to hold these nursing homes accountable? Some argue that stiff penalities would cause the nursing homes to shut down. If the nursing homes are not providing the care they should be and abusing their patients, they should be shut down! Would you risk putting your loved one in a nursing home in that situation?

Neither would we.

"Botox-on-the-go"

While running errands or getting your nails done, why not stop by the local Botox Center for a quickie?

That's right, forget the appointments, forget the long waiting times. Just like you go to a nail salon to (primarily) get your nails done, you can now go to a Botox-only storefront office -- quick, easy, cheap(er) than the dermatologist, and you come out of the store looking years younger in 30 minutes (15 if it's a follow-up visit). This is even quicker than getting a manicure!

According to the New York Times article, "The Little Botox Shop Around the Corner," two plastic and reconstructive surgeons will be opening up a store front office offering just Botox injections in midtown Manhattan, across the street from Bloomingdale's (why not get a "younger you" to complement that outfit you just bought at Bloomie's?). You have to admit this idea is great - especially since their target audience for that location are the shoppers, those who live and work in the area (ie, they can get the injections during lunch hour), and even tourists who'd get the injections on a whim. In addition, there would be general practitioners with basic training and experience using Botox who would be administering the injections.

However, the one negative that some experts are concerned about is the fact that stores like this might trivialize the seriousness of these injections – ie. not everyone may be suitable for it and the injections should be administered by "dermatologists and surgeons who have extensive training in facial anatomy and aesthetics and long experience injecting Botox."

Do you think this will become the next "nail salon" phenom where we will see one every 5 blocks (in the city)?

Be trained by a Pro-athlete

By a retired pro-athlete, that is.

More and more, retired pro-athletes are becoming personal trainers during their retirement -even though many do not have a certification in personal training. After all, as one athlete said in the New York Times article, "Those Who Can, Do. Those Who Retire, Teach," "I'm certified in life. My experience speaks for itself."

Sure, it would be great to attend a class taught by Karim Jabbar, Bobby Neely, or Diamond Dallas Page – especially if you’re one of their fans. But is this enough? If they don't need to be certified, why should others?

Many of them have had years of training due to their respective sports. But because they were trained themselves and know what their bodies could endure, should they be personal trainers for others? If they believe so strongly, why not get certified? For example, Mr. Jabbar is certified by the National Academy of Sports Medicine and has taken 70 hours of continuing education.

Would it be great to be trained by a retired pro-athlete. Sure! Do they have the experience in training? Of course! However, why not become certified so there is no dispute as to whether they should be training others or not?