Healthcare Shopper News

My friend, Bill is dying of cancer. He probably has two or three days left. He's not conscious and while the caretakers say that he can recognize my voice, I doubt it. He's being given a lot of drugs including morphine, but they don't seem to give him peace. His body struggles as if he is trying to free himself from unseen restraints. Perhaps he's pain-free, but he definitely does not seem comfortable. However, I was able to say goodbye to Bill with a smile on my face because of something his wife told me a few minutes earlier. She said, "Bill spent the last five days of his conscious life smoking pot." Now, if you knew Bill you'd know how utterly preposterous that statement sounds. Bill was a retired Pediatric Cardiologist. He voted Republican all his life until he voted for Obama. He did not waste money or words. And he definitely had never smoked marijuana.

Some weeks back, Bill's internist suggested that he consider medical marijuana as a way to restore his appetite which had been destroyed by chemotherapy. Later Bill decided to give it a try. Bill and his wife found a dispensary nearby after a brief internet search. They called the dispensary and were told they would need a referral letter and that a "doctor" would be on the premises that afternoon. At the time, Bill could only walk short distances and he was very weak, but they went over to the dispensary. They stood in a queue of seemingly able-bodied young men also seeking relief from something. The doctor relieved them of $140 and provided each with the referral letter. Bill's wife said that she was less than impressed with the certification process and ventured an opinion that "Bill was the only truly ill individual that doctor would see all week." The young dispensary clerks were very helpful. They suggested that Bill purchase two thumb sized buds "one of indica for pain and one of sativa for depression". Bill also picked out a nice psychedelic pipe. Once home, bill tried it. His wife said that once he felt the effects of the first puff a little smile brightened his face. He smoked some more and the smile broadened. His wife chuckled as she remembered his fondness for the stuff. She said, "I'd ask him if he'd like anything and he usually answered, "I believe I'll have some of that marijuana." It made Bill happy at the end of his journey. What a gift!

I agree with those that say that medical marijuana is mostly used by recreational pot smokers, but I know that there are other people like Bill who are truly ill and can't get anything from the medical community that works as well as marijuana to put a smile on their faces.

We are beginning to see a two tiered system of health care delivery in America - the publicly insured and the privately insured. Medicare is single payer public insurance. Virtually every American age 65 or over is covered by Medicare. as a result Medicare has way more bargaining power to negotiate fees for medical services than any private insurance company. Those of you on Medicare have probably been shocked to see how little Medicare pays doctors, hospitals, and other health care providers. It's not unusual to see Medicare pay only 10% of the providers' bill, leaving them to write off 90%. Most health care providers need Medicare patients for volume - pays the overhead, etc. So they are figuring out how to provide a lower level of service for Medicare patients - similar to creating products for lower price points.

Second Rate Treatment

I'll give you an example: Yesterday, I was treated at the Newport Beach Orthopedic Surgery Center for a procedure I've had several times over the last couple of years - an epidural steroid injection (ESI) to treat back pain. Previously, I was treated in a state of the art operating room with lots of staff showing great concern for my well being. The procedure was done under sedation so I was very comfortable throughout. That was when I was covered by private insurance. My Medicare experience was different. This time I was not treated in the surgery center but in one of the regular examination rooms crammed with equipment. The same highly trained doctor performed the ESI procedure, but she was assisted by only one x-ray technician. I was told there would be no sedation. I discovered that enduring an ESI procedure without sedation is on a par with enduring a root canal - about 30 minutes of tedium punctuated by moments of pain, all the while imagining that at any moment something terrible will happen. I was shown out of the room as the next patient was ushered in - mass production style. I had just experienced what I consider to be second rate treatment. I was not a happy camper. A day later, I'm thinking, "The outcome is what really matters. My back is pain free today. So the (pardon the pun) "bare bones" epidural treatment was apparently just as effective as the "premium" treatment." If American medicine comes to this, I can live with it, may not like it, but I can live with it.

The Public Good

As a nation, we are struggling to reform the most expensive health care system in the world. It's gotten to the point that health care spending threatens our nation. We are undoubtedly going to end up with a lot more people on public health plans, not a universal single payer plan like Medicare for everyone, but certainly an expansion of Medicaid to cover the uninsured poor and an expansion of CHIP for the children of low income families. We may also get a public healthcare option to compete with private health insurance.

Private Insurance for the Affluent

Germany has a two tiered health care system of public insurance and private insurance. People with public insurance get good treatment for low premiums. People who pay more for private insurance get spa-like treatment that seems over the top even by US standards. Private health insurance in the US should find it easy to capture the affluent market, offering plans that provide personalized services, 24/7 access to their doctors, private rooms when hospitalized, etc. Over the long term, they may not be able to compete with public insurance for the masses, because public insurance will negotiate lower fees for medical services from providers than private insurance.

I could live with that. What about you?

How does this sound? - 24/7 access to your doctor, same day office visits, no waiting, more face time, and house calls. Like a nostalgic picture of medicine practiced in small town America 50 years ago? Nope. It exists today for some Americans willing and able to pay. It's called Concierge Medicine.

A new sitcom called Royal Pains, on the USA Network, will expose the medical concierge concept to the masses. Royal Pains' central character is Dr. Hank Lawson, a fictional ER doc who loses his job in a prominent New York hospital because he breaks rules to try to save a patient. While attending a ritzy party in the Hamptons, Hank brilliantly diagnoses the medical condition of one of the wealthy guests and provides lifesaving treatment on the spot. Overnight, he becomes the most sought after doc in the Hamptons social set.

Unheard of 10 years ago, concierge medical practices have grown to about 5,000 practitioners nationwide. Concierge practices are generally for the affluent but run the gamut in terms of what they charge for the privilege of membership. Perhaps the most obvious market for concierge medicine is the affluent elderly. But not necessarily, take Steven Knope, MD, for example. Dr Knope is a sports medicine internist. He's a four-time Ironman triathelete. His Tucson, AZ practice focuses on preventive medicine including a two-hour physical, nutritional analysis with a staff nutritionist, and fitness analysis with a personal trainer in his in-office gym. Dr. Knope's concierge patients pay an annual retainer of $6000 each.

The Concierge Medicine / LA practice in the Brentwood section of Los Angeles serves a wealthy clientele similar to that depicted in Royal Pains. Medical Director, Raphael Darvish MD, says that not all of his patients are wealthy. Some are just very health conscious. The practice has two other doctors in addition to Dr. Darvish serving about 1,000 patients. Memberships range from $2,000 to $10,000 annually depending on age and other factors. Concierge Medicine / LA features the presidential physical which is similar to the comprehensive physical Obama receives each year.

Concierge doctors say this style of medical practice is very rewarding to them in ways other than financial. The pace is relaxed and they get to build relationships with their patients.

Childbirth is an example of how the intensive and expensive U.S. brand of medicine has failed to deliver better results and may be doing more harm than good.

As the number one cause of hospital admissions, childbirth accounts for more than $79 billion in hospital charges alone. Pregnancy is the most expensive condition for both private insurers and Medicaid.

The financial toll of maternity care on private insurers (employers) and Medicaid (taxpayers) is huge. Maternity care therefore plays a considerable role in escalating healthcare costs, which increasingly threaten the financial stability of families, employers, and federal and state budgets.

Cesareans Out of Control

The cesarean rate in the U.S. is higher than in most other developed nations. And in spite of a standing government goal of reducing such deliveries, the U.S. has set a new record every year for more than a decade. Once reserved for cases in which the life of the baby or mother was in danger, the cesarean is now routine. The most common operation in the U.S., it is performed in 31% of births, up from 4.5% in 1965.

Among privately insured patients, uncomplicated cesareans run about $13,000. nearly twice as much as a comparable vaginal birth. Cesareans account for a disproportionate amount (45%) of delivery costs.

The problem, experts say, is that the cesarean -- delivery via uterine incision -- exposes a woman to the risk of infection, blood clots and other serious problems. Cesareans also have been shown to increase premature births and the need for intensive care for newborns.The typical American newborn is delivered at 39 weeks, down from the full 40. Even without such complications, cesareans result in longer hospital stays.

Oxytocin Induction Adds Risk

Inducing childbirth -- bringing on or hastening labor with the drug oxytocin, also raises the risk of complications that lead to cesareans. Experts say miscalculations often result in the delivery of infants who are too young to breathe on their own.

Despite of or perhaps because of all this intervention, childbirth in the U.S. doesn't measure up. The U.S. lags behind other developed nations on key performance indicators including infant mortality and birth weight. More intervention, such as cesareans, is linked with declining outcomes, such as neonatal intensive care admissions

Informed Mothers must Fight the System

If an expectant mother has had a cesarean with her first baby, she will have a difficult time holding out for a vaginal birth with her second one. With a toddler underfoot, most mom's would opt for vaginal delivery if for no other reason than faster recovery. But finding a physician to deliver her second child by vaginal delivery will be difficult.

Most U.S. physicians discourage vaginal deliveries after a cesarean because of some widely publicized cases several years ago in which the uterus split disastrously along the prior incision. The modern C-section in the United States is the low transverse, an incision in the bottom part of the uterus, from side to side. Those heal better. All the studies say, in those types of incisions, the risk is less than 1%, probably a half percent that it will open during labor. Doctor's will insist on a C-section again for the second birth because of a 1% chance of a uterine rupture.

Over time, Cesarean births have become a profit center in many hospitals, There's a wide variation in cesarean rates among hospitals: cesareans range from 16% to 62% of births. There's no justification for that kind of variation. That means a lot of women are getting unnecessary cesareans.

Yes. Your hospital bill is negotiable.

What hospitals accept for payment is not set in stone. There's the hospital's list of charges and then there's what they actually collect. Hospitals are required to offer discounted or free care to patients who meet financial eligibility guidelines. And most will negotiate with any patient having difficulty paying their bill. It's best to have such discussions before care takes place. It can enable the hospital's billing office to help find some assistance, such as Medicaid, Medicare or private and hospital charity assistance if the patient is eligible. Uninsured patients have the right to negotiate even after hospital care has been given, with the best deals often offered to people who agree to share their financial information and show a willingness to start paying the bill. Here are 7 tips to help you save money on your hospital bill.

1. Let your doctor know your financial circumstances

Get a full picture of what will be done during your stay, as well as any related tests and follow-up visits. If you're worried about paying the hospital bill, ask whether it's safe to delay the treatment or procedure. Perhaps you need surgery for a sinus condition that's bothersome but not life-threatening. A delay, if approved by your doctor, is an especially good idea if you or a spouse is in line for a job that will pay health benefits or if you've maxed out your flexible spending account for the year. Also ask if there are tests that can be avoided safely, such as for cholesterol and glucose if you've recently had those checked.

2. Choose a non-hospital if possible

One way of saving money might be to avoid the hospital for some procedures. Consider having tests and procedures, such as colonoscopies, MRIs and CT scans, done in independent surgery or imaging centers, or at an accredited doctor's office. This can save hundreds of dollars. Hospitals have far higher expenses, including a large physical plant, a larger staff and the need to write off millions of dollars in care for people who don't pay or who pay at a reduced cost. Your doctor should be able to recommend independent.

3. Shop hospital costs

Some websites, like Vimo or Healthgrades , can tell you what many area hospitals charge. (Vimo is free. Healthgrades charges about $8 for a report.) Finding the least expensive hospital can lower your out of pocket costs greatly. For instance, costs for a caesarean section in Southern California vary from $18,000 to $30,000, excluding doctor costs, depending on the hospital selected.

4. Check out financial assistance

Meet with a financial counselor at the hospital as soon as possible. Hospitals are required by law to let patients, insured or not, know about the availability of charity care, discounts and government programs that can cover all or part of their bill and about any other programs that can help take care of hospital charges. You may qualify for free or discounted care if your income is below 350% of the federal poverty or your medical costs are more than 10% of your family's annual income.

5. Be prepared when checking in to the hospital

Expect hospitals to ask for payment for the deductible and any other patient share of the bill before service. You don't always have to pay the deductible or your share of the hospital bill immediately, but you do have to come up with a plan to pay it off. Don't use a credit card to pay a hospital bill, unless you're sure you'll be able to pay it off in full by the due date. Letting the credit card bill go past one cycle adds interest fees and could increase your interest rate. Also, it's virtually impossible, to negotiate charges once they've been paid by credit card. A better idea is to ask the hospital for a no-interest rate payment plan. If you can't foot your share of the bill, hospitals might be able to discount your deductible, copay or coinsurance if you qualify under its financial screening process.

6. Get an itemized statement

Insured patients will typically get a summarized billing statement; the insurer gets more specific cost information. Request an itemized bill and ask the hospital for deciphering help if needed. Hospital bills often have errors in them, including misplaced decimal points, charges for tests or procedures not done, even care on days you weren't in the hospital. Look for charges you think were unnecessary. For example, if you recently had a cholesterol blood test, but the bill shows another one you were not told about beforehand. If your bill is huge, you may want to hire a medical billing advocate.

7. Don't ignore your bill

A bill for cancer surgery or an appendectomy or a meniscus repair has to be paid. Ignoring it will simply result in it being turned over to a collection agency. You cannot negotiate with the hospital to lower your bill once it's been turned over to a collection agency.

I'm pretty sure none of us would volunteer to go under the surgeon's knife, unless it's for cosmetic surgery, of course. Unfortunately, surgery is a necessity for some of us if we want to stay in good health. Very often, it's not the operation that's a difficult experience but what comes after it. Unless you're undergoing a relatively minor procedure, recovery is a pretty slow and sometimes painful process. But if you follow the rehab program your doctors map out for you religiously, there's no reason why you shouldn't be on the road to normalcy soon enough. If you've just undergone a surgery or know someone who has, here are a few tips for a successful and speedy recovery:

1. Thinking makes it happen: It may sound magical, but it's true; it's all in your mind. So if you think you feel better, you actually will feel better. You must stay in a positive frame of mind and think about recovering step by step rather than worrying and obsessing over the aches and pains that are sure to be a part and parcel of the aftermath of a surgery. It's a natural healing process, one that is necessary for you to get better. Rather than thinking of the pain, real or imagined, try and focus your mind on other activities. Watch television, read a book, (unless you've had eye surgery), play a board game or cards with friends and family members, work on puzzles, and if you're able to get out of bed, keep yourself busy with something or the other, activities that don't tax your weak body any more than is necessary.

2.Rehabilitation is necessary: Almost all surgeries come with their own rehab programs. You must follow them religiously if you want to get better in the fastest possible time. Yes, some exercises and routines may cause discomfort and even a little pain, but as long as your doctor says it's normal, you must keep up with the therapy for as long as necessary. Remember though, not to overdo things in your eagerness to get back to normal

3. Following instructions is important: If you need to take medication, do so; if you have to go to the hospital for regular check ups, do so; if you're not supposed to lift heavy things, don't; if you're supposed to follow a certain diet, do so; in short, do all that your doctor says you must and stay away from all that you're not supposed to do. It's extremely important to follow post-surgical instructions if you want to avoid complications and recover in the fastest possible time.

4. Going a step further: If you've undergone heart surgery, once you're back to normal, it's best you adopt a lifestyle that's suitable to the kind of illness you've suffered and the type of surgery you've had. So you need to stay fit with a mild form of exercise, eat the right kinds of foods, and avoid strain on your heart. Similarly, for an orthopedic surgery that involves joints, you need to keep up with your physiotherapy even though you don't feel any pain because your muscles must be strong enough to prevent similar injuries in the future. You goal after a major surgery must be to prevent similar situations from arising again, which is why you need to take steps and follow a lifestyle that keeps you as far away from the hospital as possible.

By-line: This article is written by Kat Sanders, who regularly blogs on the topic of online surgical technologist schools at her blog iScrub.

Hey people, wake up. When faced with the choice of buying groceries or your prescription medications, it's time to get smart. There are plenty of ways to save money on your drugs if you're willing to educate yourself and put in a little effort. You'll also have to learn about pharmaceuticals, know your health plan, become a savvy healthcare shopper. So, before you skip a dose, read on to learn 7 ways to score cheaper drugs.

1. Insist on Generics

A generic drug is a pharmaceutical no longer under patent protection. An example of a generic drug, one used for diabetes, is metformin. A brand name for metformin is Glucophage. (Brand names are usually capitalized while generic names are not.) A generic drug, one used for hypertension, is metoprolol whereas a brand name for the same drug is Lopressor. Generics are sold over the counter or at low cost as a generic prescription. Generic drugs are copies of brand-name drugs that have exactly the same dosage, intended use, effects, side effects, route of administration, risks, safety, and strength as the original drug. In other words, their pharmacological effects are exactly the same as those of their brand-name counterparts. They are every bit as safe and affective. Some people become concerned because generic drugs are often substantially cheaper than the brand-name versions - generally at least 70% cheaper. They wonder if the quality and effectiveness have been compromised to make the less expensive products. The FDA requires that generic drugs be as safe and effective as brand-name drugs. So there's no truth in the myths that generic drugs are manufactured in poorer-quality facilities or are inferior in quality to brand-name drugs. The FDA applies the same standards for all drug manufacturing facilities, and many companies manufacture both brand-name and generic drugs. In fact, the FDA estimates that 50% of generic drug production is by brand-name companies. Another common myth is that generic drugs take longer to work. The FDA requires that generic drugs work as fast and as effectively as the original brand-name products.

Sometimes, generic versions of a drug have different colors, flavors, or combinations of inactive ingredients than the original medications. Trademark laws in the United States do not allow the generic drugs to look exactly like the brand-name preparation, but the active ingredients must be the same in both preparations, ensuring that both have the same medicinal effect.

Over the next three years, drugs with $100 billion of annual sales will become generics as their patents run out, including the cholesterol-lowering statin - Lipitor, asthma medication - Advair and antipsychotic - Seroquel. That means big savings for you.

Some big retailers like Walmart and Target take drug savings to the limit. Walmart's $4 Prescriptions Generic Program has been a groundbreaking success. Target followed with their own version. They offer hundreds of prescription drugs and more than 1,000 over-the-counter medications at only $4 per 30-day supply, or $10 for a 90-day supply. The list of eligible drugs in the $4 prescriptions represents up to 95 percent of the prescriptions written in the majority of therapeutic categories.

2. Shop Online for Brand Name Drugs

If you must fill a prescription for a brand name drug, always ask your doctor for a written prescription for a 90 day supply so that you can fill your Rx by mail order. With that prescription, you'll be able to shop for the lowest rates possible. I strongly suggest you begin by shopping online even if you eventually buy from a local pharmacy. Start your shopping at PharmacyChecker.com. where you can compare prices from a long list of mail order suppliers. You'll be amazed at the wide range of prices for the same product. For instance, recently posted prices for Lipitor 20 mg tablet ranged from a low of $1.24 per pill to a high of $4.78 per pill. All of the suppliers with the lower prices are foreign suppliers, most are based in Canada, the United Kingdom, New Zealand, and Singapore. The lowest price from a U.S. supplier was $3.80 per pill, so you can see there is a strong financial incentive to buy from a foreign supplier. Do I recommend that? I can't because I don't have enough proof that it's 100% safe to buy your brand name drugs outside of the U.S.. Personally, I feel comfortable doing it. I guess because I view these countries - Canada in particular - as trustworthy. I have ordered prescription drugs from foreign suppliers for years without incident. Even if you are uncomfortable doing so and end up buying your prescription from an online supplier in the U.S., you will be getting the best U.S. price available.

3. Split Pills to Double Your Savings

The pharmaceutical companies price their pills pretty much the same regardless of dosage. For example, a 20 mg dose costs the same as a 40 mg dose. So if you buy the 40 mg pill and cut it in half you'll cut your drug bill in half. What could be simpler? Critics say the practice can lead to uneven dosing, but that can be minimized with a simple pill splitter that you can purchase at the drug store for a couple of bucks. Don't try cutting pills with a knife or razor blade. You'll never get it exactly right. Round pills are the easiest to split. Oval or elongated pills, like Lipitor, require a somewhat more elaborate splitter.

Many Lipitor users and many physicians do not realize that the cost to the individual is around $1,300 per year regardless of whether they need the 80 mg tablet, the 40 mg tablet, the 20 mg tablet or the 10 mg tablet. (The 10 mg tablet is slightly cheaper.)

• Splitting the 80 mg Lipitor tablet into quarters will save $1,001 per year.
• Splitting the 80 mg Lipitor tablet in half will save $668 per year.
• Splitting the 40 mg Lipitor tablet in half will save $655 per year.

Not all drugs can be split, including time-released medications, capsules and gels. United HealthCare has a website that lists the drugs and their strengths that it considers safe to split.

4. Ask Your Doc for Free Samples

Big pharmaceutical makers ply doctors with samples as part of their marketing efforts to get them to prescribe their drugs. You might as well enjoy some of their largess. But you should know that using free samples of prescription drugs is a potentially risky practice for several reasons. For one, drug manufacturers typically use free samples to promote the newest and most expensive drugs. When the freebies stop, you'll probably be reluctant to switch to something cheaper. Once you start on a drug you tend to stay on it, even if there is a good generic. That's one reason the drug companies spend billions of dollars on sampling. Secondly, free samples don't show the side effects or precautions on the label, and you might not receive accompanying literature. Also, the medication won't be entered into your pharmacy's computer system, which screens for harmful interaction or duplication with other drugs and supplements you take, allergies you might have, and unacceptable doses. Having said that, let's say you are already taking a maintenance medication for a chronic condition and you can no longer afford to pay for it. Get over your pride and ask your doctor for a month or two supply to get you over the hump. Just one month of samples will reduce your annual expense for a drug by almost 10%.

5. Know Your Health Insurance Plan

If you have health insurance, the first step in saving is to learn how your plan works.
Health plans give members an incentive to choose cheaper medicines through a tiered system of co-payments. The least expensive drugs - usually generics - might have a co-payment of $10 or $15 for a 30-day supply. The next tier is usually for brand name drugs that are on your insurance company's drug formulary list. Each insurance company has its own drug formulary list. Non-formulary drugs are either not covered at all or require that you pay much more out of pocket. Specialty drugs such as injected, infused, oral, or inhaled medications that require close supervision by a doctor tend to be higher in cost as well. Many lower cost health plans have adopted deductibles of $500 or more applied specifically to the prescription drug benefit. Typically the deductible does not apply to generics. You will usually have lower costs if you fill prescriptions through the mail or at particular pharmacies.

6. Look for Discount Programs

Recognizing that costs for name-brand prescriptions can be steep, many pharmaceutical manufacturers may offer discounts or rebates to keep your business. For example, drug maker, AstraZeneca, has a program that limits your co-payment for the statin, Crestor, to $25 for a 30-day supply. A host of programs offer uninsured patients help getting prescription medicines for free or at a discount from pharmaceutical companies including , Merck and GlaxoSmithKline. Some offer discount cards good for their own medicines only. AstraZeneca has one discount card just for Medicare Part D recipients.

Another option is the PS Card, which offers discounts on prescriptions filled at over 56,000 drugstore and supermarket pharmacies nationwide, including CVS, Rite Aid, Walgreens, Wal-Mart and Target. Founder Jim Robbins, a former United HealthCare executive, has negotiated discounts at these retailers, which he passes along to cardholders. Robbins earns his cut by collecting a small referral fee on each prescription. The card is free and anyone can sign up at the PS Card Website. There are many other free prescription card offers. To find them simply Google "prescription drug discount card".

7. Lower Income Patients Should Seek Assistance

There are hundreds of programs nationwide that help low-income patients (usually less than $30,000/yr annual income for a single person or $40,000/yr for a couple, and family) obtain medications at little or no cost. Many are listed with the Partnership for Prescription Assistance, a drug industry-managed clearinghouse. About half the programs are run by large pharmaceutical companies. The rest are sponsored by makers of generic drugs, private foundations and government agencies. The partnership has helped about 5.5 million people nationally. People who apply can get free drugs or low cost prescriptions for just $3 to $5.

To access the drug assistance programs, call the clearinghouse at (888) 477-2669 weekdays from 8 a.m. to 8 p.m. Eastern time or go to the PPARx website. You'll have to answer some screening questions to determine your financial eligibility and medical condition.

For example, here is the information provided by one company - AstraZeneca.

Patient applications are evaluated on a case-by-case basis by the Program. Eligibility is based on income levels and absence of private prescription insurance, third-party coverage, or participation in a public program including the Medicare Limited-Income Subsidy. Income eligibility is based on levels at or below $30,000 for an individual; $40,000 for a couple; $50,000 for family of three; $60,000 for a family of four. The Program requires proof of income and US residency (Social Security #, work visa # or green card #). Patients approved into the Program will receive an acceptance letter and should receive their shipment of product within 1-2 weeks. Patients denied to the program will receive a denial letter if the individual does not meet the eligibility guidelines of the Program. Enrollment is for 12 months with reapplication at month 10.

Product(s) covered by program:

Accolate®
Arimidex®
Atacand®
Atacand® HCT
Casodex®
Crestor®
Faslodex®
Merrem I.V.®
Nexium®
Nexium® I.V. Injection
Nexium® Oral Suspension
Pulmicort Flexhaler®
Pulmicort Respules®
Rhinocort Aqua®
Seroquel XR®
Seroquel®
Symbicort®
Toprol® XL
Zoladex®
Zomig ZMT® Oral Disintegrating Tablets
Zomig® Nasal Spray
Zomig® Tablets

Watch out for scams. If you call a number and they say it will cost you $100 to join, or they ask for your checking account number, you should hang up quickly.

Barack Obama's American Recovery and Reinvestment Act of 2009 was signed on February 17, and is already beginning to filter out funds to hopefully stimulate the economy. One of the principal goals of the package is to reform the health care system while creating jobs and insuring more Americans. Through measures to support the unemployed, integrate cutting-edge information technology systems into medical networks, and insuring more children, the act may in some way affect how you receive health care. Find out how.

1. Health care industry set to go tech

One of Obama's umbrella strategies for reforming health care and stimulating the economy involves pumping money into health care technology systems. He hopes to create a health information network for hospitals, rural and urban clinics, and other health care centers by making all medical records electronic; making existing medical technologies more accurate and effective; and reducing errors in medical care. This technology boost to the health care system will, Obama hopes, save money, create jobs, and improve the standards and delivery of health care and medical information. The Dallas Business Journal reports that the stimulus package will invest $19 billion for health information technology.
2. The unemployed will still receive health care benefits, at least temporarily

Obama plans to ease the burden of health care costs for the unemployed and reduce the number of uninsured Americans by extending Medicaid benefits to the unemployed, at least for a time. Individuals who get unemployment checks would also be able to receive Medicaid, as would their spouses and children who are under the age of 19, reported the New York Times in January. States will receive federal aid to help ease Medicaid costs. In late February 2009, TheState.com reported that Obama "released $15 billion in economic stimulus Medicaid funds for states" to disperse.


3. Children's Health Insurance Program Reauthorization Act of 2009

The Senate and House reformed the Children's Health Insurance Program under this legislation, which extends insurance to nearly 4 million more children by reworking the Social Security Act. The program will help families of low-income children who do not qualify for Medicaid pay for their health insurance, and states will still be able to set their own income eligibility requirements. The program is funded by a tax increase on cigarettes.
4. Governors hold power over releasing funds

While the federal government has designed and approved the health care stimulus package, governors are in charge of actually releasing funds, creating eligibility requirements when appropriate, and overseeing the implementation of the stimulus plan in their states. In late February, governors like Louisiana's Bobby Jindal ®, opposed many parts of the economic plan and may reject at least some of the money that is coming to their state from the federal government. The New Orleans Times-Picayune reports on Nola.com that Jindal will most likely accept the Medicaid supplements, but according to Medical News Today, other governors are begrudging about accepting funds that are meant to be used in a specific way. Instead, governors like New Hampshire Gov. John Lynch (D) are arguing for more flexibility in how they disperse the federal funds.
5. Federal government helps states fund COBRA for unemployed

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives individuals who are laid off, retired, switching between jobs, or have dependents at the time they stop working the option to continue their group health benefits for a limited time. Some beneficiaries may have to pay for the group rate insurance, however, but the U.S. Department of Labor holds that "COBRA generally requires that group health plans sponsored by employers with 20 or more employees in the prior year offer employees and their families the opportunity for a temporary extension of health coverage." Under Obama's stimulus plan, the federal government will provide states with subsidies to help offset the costs of COBRA. They will pay for up to 65% of COBRA premiums "for eligible workers who are involuntarily terminated," according to the accounting firm Amper, Politziner and Mattia. Qualifying workers include those who have been involuntarily terminated on and after September 1, 2008, and qualifying employers include those who are subject to COBRA legislation, as well as small employers who are subject to State Continuation legislation.
6. Job training funding for those entering health care industry

In another measure to stimulate the economy while improving health care standards, Obama plans to increase job training opportunities for those entering the health care industry. The stimulus budget has allotted $750,000,000 "for a program of competitive grants for worker training and placement in high growth and emerging industry sectors," $500,000,000 of which will go to renewable energy programs. The rest will be distributed by the Secretary of Labor "giving priority to projects that prepare workers for careers in the health care sector."
7. Preventive care takes precedent

In his address to Congress in February, Barack Obama outlined the promised benefits of his economic stimulus benefits, highlighting the fact that the health care reform boasts "the largest investment ever in preventive care, because that is one of the best ways to keep our people healthy and our costs under control." According to a report by NPR, this move would also create jobs, at least in the short term, even if it did not result in sustainable medical research projects, as hoped.
8. A contract for accountability

In order to promote accountability in health care reform and to make sure that all of this funding is actually helping the economy and the health care industry, Obama's plan includes a contract between the federal government and the Institute of Medicine. The stimulus package outlines that the $1.5 million contract will require the Institute to "produce and submit a report to the Congress and the Secretary [of Health and Human Services] by not later than June 30, 2009, that includes recommendations on the national priorities for comparative effectiveness research" that will eventually be subjected to public commentary and review.
9. Health IT dominates in all areas of medical industry

The stimulus package lists several ways in which new health care information systems and technologies will help the facilitation of medical care and the industry as a whole. These include the exchange of patient medical records and a subsequent reduction in wait times at hospitals and health care facilities; the increase of telemedicine technologies for those living in rural areas and who do not have access to cutting edge medical resources; "technologies that help reduce medical errors;" and "technologies that meet the needs of diverse populations."
10. Total health care stimulus cost: $150 billion

The total cost of all these (and more) health care reforms under the American Recovery and Reinvestment Act of 2009 is $150 billion, according to the Dallas Business Journal, including $17 billion for Medicare and Medicaid incentive programs, $2 billion for technology grants, and $19 billion for a health information technology movement.

We hear a lot of advice about nutrition, some of it accurate, a lot of it not so much. Some of the nonsense causes us a good deal of discomfort in the form of guilt. Perhaps we feel "not good enough" because of our failure to live up to imagined standards of healthy eating. Here are 7 healthy food legends that you can stop worrying about.

1. Coffee is bad for you

Coffee drinking, in moderation actually does your body's health far more good than harm. Coffee comes from plants, which have helpful phytochemicals that act as antioxidants. One set of antioxidants appears to increase insulin sensitivity, which might explain a lowered risk of type 2 diabetes in people who sip java. A Harvard study of more than 125,000 coffee drinkers found that women cut their risk of type 2 diabetes by 30 percent. Other studies suggest that coffee cuts the risks of Parkinson's disease, colon cancer, cirrhosis and gallstones. Drinking coffee gives your brain a boost, too. Two to three cups a day is the recommended limit for most people.

What about the concern that coffee is dehydrating? It can be. It depends on the dose. Coffee is only a diuretic at high doses -- above 575 milligrams - about 3 cups daily. If you exceed that amount of coffee, drink more water to offset the diuretic effect.

Contrary to popular belief, coffee does not increase your likelihood of getting hypertension. Coffee does increase your blood pressure, but only for a few minutes.

2. Chocolate Causes Acne

Chocolate has been found not to cause nor aggravate outbreaks of acne. These results are backed up by research that shows acne in no way is affected by chocolate. Nor, for that matter, do greasy foods, pizza, or salty snacks, or dairy cause or aggravate acne.

If you do have an outbreak of zits repeatedly after eating a specific food, stay away from that food for a while. Much research suggests that foods do not cause acne, but it has not been proven as fact. If on eating the same food again after a few days the result is an outbreak, the chances are it is an allergic reaction rather than an outbreak of acne.

Acne forms when the oil glands make too much sebum, a waxy substance that along with dead skin cells can clog pores. Bacteria grow and irritate the blocked pore given the red and swollen look to them. Androgen hormone production is at its highest during the teenage years, which stimulates sebaceous glands to enlarge and make more sebum.

Teenagers are not the only ones with acne. Women who are pregnant or in their 40s can have outbreaks, but by the time a person is 50 it usually has run its course. During the teenage years, boys are more susceptible to stronger breakouts than girls, but when they reach around 40, the women take the lead in numbers of flare-ups.

Chocolate has been blamed for many ailments in addition to acne, including tooth decay, obesity, and lacking of food value. Recent scientific studies have suggested chocolate boosts the serotonin in the brain that produces a calming effect and stability. Chocolate lovers will be pleased to know that nutritionists believe chocolate plays a nutritional role in a balanced diet. The facts are that chocolate carries about one-third of an adult's daily requirement of antioxidants.

3. Eating at night makes you fat.

You had plenty to eat at dinner, but late at night the fridge starts calling your name. It's not about being hungry, more about being tired, bored, or just a habit formed after years of indulging in a mid-night snack immediately before going to bed. It's quiet at night, no one is around to see you eat, and it's a peaceful time to enjoy your favorite foods. Eating before going to bed won't make you any fatter that the snack you had at mid-afternoon. Several authoritative studies suggest that gaining weight is the result of too many calories overall. Another important fact of metabolism is that our bodies do not stop working, even when we are sleeping! Hearts are beating, blood is circulating, lungs are functioning, brains are even working. This all takes energy -- meaning we are still burning calories. The time of day you eat has nothing to do with weight gain.

More to the point, it's the type of foods you tend to eat late at night. Favorite foods for after-dark munching include ice cream, potato chips, chocolate, desserts -- you get the picture. Your body does not process food differently after dark, but nighttime tends to be the most sedentary time of the day, when your calorie needs are minimal. The bottom line: Eating after dinner tends to pack on the pounds. You can have that snack, but make it fruits and veggies.

4. Drink at least 8 glasses of water a day

We need to drink eight to ten glasses of water per day to be healthy is one of our more widely-known basic health tips. But do we really need to drink that much water on a daily basis? Some nutritionists insist that half the country is walking around dehydrated. We drink too much coffee, tea and sodas containing caffeine, which prompts the body to lose water, they say; and when we are dehydrated, we don't know drink enough.

The origins of the glasses per day figure are hard to put a finger on. Some say the number was derived from fluid intake measurements taken decades ago among hospital patients on IVs; others say it's less a measure of what people need than a convenient reference point, especially for those who are prone to dehydration, such as many elderly people.

Kidney specialists do agree that the 8-by-8 rule is a gross overestimate of any required minimum. To replace daily losses of water, an average-sized adult with healthy kidneys sitting in a temperate climate needs no more than one liter of fluid, about four 8-ounce glasses. According to most estimates, that's roughly the amount of water most Americans get in solid food. In short, though doctors don't recommend it, many of us could cover our bare-minimum daily water needs without drinking anything during the day.

Doctors from a wide range of specialties agree: By all evidence, we are a well-hydrated nation. Furthermore, they say, the current infatuation with water as an all-purpose health potion; tonic for the skin, key to weight loss is a blend of fashion and fiction and very little science.

Additionally, the idea that one must specifically drink water because the diuretic effects of caffeinated drinks such as coffee, tea, and soda actually produce a net loss of fluid appears to be erroneous. The average person retains about half to two-thirds the amount of fluid taken in by consuming these types of beverages, and those who regularly consume caffeinated drinks retain even more: Regular coffee and tea drinkers become accustomed to caffeine and lose little, if any, fluid. The same goes for tea, juice, milk and caffeinated sodas: One glass provides about the same amount of hydrating fluid as a glass of water. The only common drinks that produce a net loss of fluids are those containing alcohol and usually it takes more than one of those to cause noticeable dehydration, doctors say.

The best general advice is to rely upon your normal senses. If you feel thirsty, drink; if you don't feel thirsty, don't drink unless you want to. The exhortation that we all need to satisfy an arbitrarily rigid rule about how much water we must drink every day, it turns out, is an urban legend in search of a cheap magic bullet.

5. Fresh is always better than frozen

The vitamins and nutrients in fresh fruits and vegetables break down over time as they are exposed to light and air. Considering that some produce arrives at the grocery store up to two weeks after harvest, and often sits on the shelf for some time thereafter, frozen produce can actually be better than "fresh" in some cases. In addition, fresh produce may be improperly stored in transit and in-store, resulting in lost vitamins. Frozen produce: it's generally processed and flash-frozen close to the source of harvest, retaining its nutrients.

When buying fresh produce, look for what's in season and locally grown, as these selections will be freshest and relatively high in nutrients. Buy your not-in-season produce frozen to keep a good variety of fruits and vegetables in your diet while not compromising nutritional value.

When you compare fresh versus frozen vegetables, find out when vegetables are in season in your part of the world. That's when you want to buy fresh over frozen. If possible, always buy from a farmer's market that sources its produce from local growers. The less time your vegetables have spent in transit, the fresher and riper they'll be.

5 Tips for choosing fresh or frozen:

1. If you're making a special dish and it calls for a vegetable that is not in season in your part of the world, choose frozen over fresh.
2. Frozen vegetables are often not as rich in taste as fresh vegetables are, and the texture is a little different. If you or the people you're serving have a preference, shop accordingly. For example, frozen mushrooms tend to be tasteless and frozen broccoli tends to be tough.
3. When buying frozen vegetables, choose items with the "U.S. Fancy" label over the "U.S. No. 1" or "U.S. No. 2." That way you know you'll be getting the vegetables of the best size, shape and color. Also avoid any frozen vegetables with ingredient lists that include sugar, salt or anything else. The only ingredient should be the vegetable itself.
4. When you compare fresh versus frozen vegetables, take into account how much space you have available in your refrigerator and your freezer, and how long before you're going to use them.
5. Shop for vegetables with your budget in mind. Vegetables that are in season are cheaper than those that are not, as they're more plentiful and have less distance to market.

6. Eating turkey makes people especially drowsy

Not really, but this myth is based on fact. Turkey does contain tryptophan, an amino acid which is a natural sedative. But tryptophan doesn't act on the brain unless it is taken on an empty stomach with no protein present, and the amount gobbled even during a holiday feast is generally too small to have an appreciable effect. That lazy, lethargic feeling so many are overcome by at the conclusion of a festive season meal is most likely due to the combination of drinking alcohol and overeating a carbohydrate-rich repast, as well as some other factors:

Two other factors that contribute to the desire to sleep at the dinner table are meal composition and increased blood flow to the gastrointestinal tract. Studies have shown that a solid-food meal resulted in faster fatigue onset than a liquid diet. The solid-food meal also causes a variety of substances to jump into action that ultimately leads to increased blood flow to the abdomen. This increase in blood flow and an increase in the metabolic rate for digestion can contribute to the "coma."

Those who still feel wary of turkey's purported sleep-inducing properties should find solace in the knowledge that many items we eat contain tryptophan. Milk, beef, and beans are among the foodstuffs which house this amino acid, and experts say the average serving of chicken or ground beef contains as much tryptophan as a serving of turkey does.

7. Chewing gum takes seven years to pass through your digestive system

The gum component itself is pretty indigestible, but will "pass" in a mass and will not stick your insides together, either. This one probably got going when exasperated parents tired of buying more gum after half an hour because their kids had chomped, then swallowed, their allotment. Also, swallowing gum was seen as ignorant and lower class.
If you are like me, you were warned as a child, most likely by your Auntie or Grandma, that you shouldn't swallow chewing gum because it stays in your digestive system for seven years. Thank goodness, it is not true.

The human digestive system is built to dissolve and excrete what we put in our mouths in a matter of hours, days at most, but certainly not years. This is due to the effectiveness of your digestive system. When you swallow food, it travels down your esophagus into your stomach. Here enzymes and acids go to work on the food, beginning the process of breaking the food down. From the stomach, the partially digested food is moved into the intestine, where -- with help from your liver and pancreas -- the food is broken down into its components. These components are used to fuel the body. Those elements of food that can't be used are sent to the colon, where they'll be processed into waste.

Generally, gum is made up of four general components, and our bodies can easily break down three of these. The gum's flavorings, sweeteners and softeners are all no match for human digestion. It's the gum base that (sorry) sticks around. Gum base is made mostly of synthetic chemicals, and these chemicals give gum its chewy property. It's designed to resist the digestive properties of the saliva in your mouth. But once it's swallowed, even the gum base is subjected to the same treatment as regular food, and after it's recognized as useless by your digestive system, it goes the same route as any waste product.

The origin of the gum-swallowing urban legend is much less clear. Despite the good health of those who swallow gum, this rumor persists. It's OK to swallow the occasional watermelon seed, too. Doctors are pretty sure watermelon seeds do not grow into full-fledged watermelons.

Many of our age old beliefs about children's health have been shown to be untrue, but because we have heard them all of our lives, we continue to repeat these myths. Our children will benefit if we recognize these myths and don't pass them on to future generations.

1. No sugar. It makes you hyperactive.
Sugar will not make your child hyperactive. What made your son bounce off the walls at the Halloween party then? Probably the party itself - with the added excitement and attention drawn by the child's acting out. Numerous studies have failed to find a relationship between sugar intake and hyperactivity. There are lots of good reasons for your child to cut back on sugar, but less sugar intake will not necessarily make your child calmer.

2. Stop slouching. You'll get scoliosis.
Good posture will not prevent scoliosis. About 2 out of 100 children under the age of 16, (girls more than boys) are afflicted with scoliosis or curvature of the spine. In most cases, science provides no proven answers as to causes, but doctors do know that slouching is not a cause. Make sure your child gets plenty of calcium and vitamin D to help protect her from bone problems.

3. Put on your coat or you'll catch a cold.
Colds are caused by viruses. Colds are not caused by playing outside without a coat or going outside with wet hair. Feeling cold does not cause a cold. Usually, your child catches a cold from someone else who has a cold. Kids frequently get colds at school and more frequently in winter because they are inside more. It's also proven that if your child is tired, stressed, or poorly nourished, she will be more susceptible to catching a cold.

4. It's OK, you're no longer contagious.
It is generally believed that colds are no longer contagious after symptoms appear. Not true. Colds spread most easily when symptoms are at their worst. The likelihood of catching (or passing) the virus peaks when kids are most miserable. This is because coughs and sneezes spray the air around them with virus-laden droplets. Even though your child may be almost over his cold, he can still pass on the virus if a runny nose persists. Keep your child away from other children until all symptoms are gone. His teacher and other moms will appreciate it.

5. This antibiotic will make you get well quicker.
Antibiotics won't help your child recover any faster. Most colds take 7 to 10 days for symptoms to go away. Remember, common colds and stomach flu illnesses are caused by viruses. Antibiotics are used in treating bacteria. Your body builds immunity to antibiotics, so using this powerful medicine when it's not necessary can make it more difficult to treat serious bacterial infections in the future.

6. Mommy can't kiss you, because she has a cold.
It's actually difficult to spread a cold by kissing. (We're not talking about French kissing here.) Saliva in and around the mouth contains very little cold virus. A peck on the lips, probably won't hurt. It is sneezes and coughs, both laden with viral droplets from deep in your airway, that transmit colds and flu. Washing your hands, is the best way to keep your child from catching your cold.