You've probably seen those TV commercials for Requip (ropinirole), the first drug approved to treat "restless leg syndrome", a condition whose signature feature is creepy-crawly leg sensations that interfere with sleep and rest in nearly 1 of every 10 adults.

But if taken too long, the drug can actually backfire, causing symptoms to worsen, say doctors who specialize in treating the condition. At this point, you can't just up the dose. The drug is part of the problem. They say that treatment that rotates through different types of medications may be needed for many patients

In the wake of FDA approval for Requip and Mirapex (pramipexole), along with the attendant heavy advertising, It's important for both primary care physicians and patients alike to understand the risks of relying on these medications for too long.

There are excellent cosmetic surgeons throughout the world. However, Americans seeking surgery abroad requires homework. Consider establishing a relationship with a local board certified plastic surgeon before going on your trip. Then, if complications arise when you return home, a qualified surgeon will be familiar with your goals and procedures.

Unless you have met the surgeon on a prior visit, and have seen the surgery facility, how do you know that you will be comfortable with him or her, and feel secure in proceeding with surgery? Remember, a successful; doctor-patient relationship is based on confidence and trust, not on perceived savings and price. Make sure you are fully comfortable with the surgeon providing your care.

What are the risks of long flights and any additional land travel before and after surgery? Will travel have an impact on my surgical outcome? Will I have to stay longer at the tourist destination to decrease the risk of post-surgical deep vein thrombosis (DVT) before I get on a plane?

Is there an increased risk of DVT in the legs, or pulmonary embolism (blood clots in the lungs) associated with long air travel before and after surgery?

What is the surgeon's training?

Be sure that your physician has specific training in cosmetic surgery procedures through an accredited plastic surgery residency program and/or fellowship. What specialty certification does the surgeon hold? The International Society for Aesthetic Plastic Surgery is a good source for finding qualified cosmetic surgeons.

Illinois joins a growing list of states taking early steps toward mandatory health insurance. An Illinois state task force on Thursday approved a plan to require all residents to obtain health care coverage through their employers, public health programs or private insurance. The program would cost the state government and employers more than $5 billion annually. Under the plan, all state residents, including undocumented immigrants and college students, would be required to obtain health insurance or face penalties.

A state agency would be established to manage the program. State legislators will meet next year to discuss the proposal.

Read story in at ChicagoTribune.com, A new plan to insure all - Proposal would require Illinoisans to get health coverage

Health insurance companies are beginning to reveal the costs of health care services, a move that might ultimately change what providers charge and how much consumers pay. Charges for services can vary by as much as 30% depending on the provider, according to Cigna. In January 2007, Cigna in 58 markets will begin to offer the Cigna Care Network, which will include doctors who score well on quality and cost-efficiency measures.

The American Medical Association in November passed a resolution seeking laws that would prohibit insurers from creating networks "based solely on economic criteria." Nancy Nielsen, head of AMA's House of Delegates, said, "You have to look very carefully at those efficiency numbers. Some are only about costs. That's where it gets tricky. That's where the biggest fights and negotiations are."

Insurers contend their efficiency measures will not be based solely on costs but add that actions need to be taken to address the cost disparities in health care. Charles Cutler, national medical director for Aetna, said, "The more people understand the cost of health care, the better off we will be." Brian Klepper of the Center for Practical Health Reform said, "We're at the leading edge of a huge change" .

Most U.S. adults say they are in good or excellent health, according to a new Gallup poll. Of those polled, 79% rated their physical health as "excellent" or "good," while 21% said it was "only fair" or "poor." Self-ratings for mental health were even higher: 86% said their mental health was "excellent" or "good," while 14% rated it "only fair" or "poor."

Are Americans really as healthy as we claim? That's not clear. The poll didn't include specific health questions -- such as "What is your blood pressure?" -- and participants weren't asked for medical records for confirmation.

As for demographics, the analysis shows that younger adults, Republicans, men, people with higher incomes, whites, and churchgoers are most likely to rate their physical and mental health highly.

When offered a choice of plans, relatively few employees (19%) select Consumer Directed Health Plans CDHPs (a combination of a high-deductible PPO health plan and a Health Savings Plan). This is a major reason why CDHP enrollment has not accelerated rapidly in the group insurance market. In comparison, based on a member survey, the industry trade group America’s Health Insurance Plans estimates that 23 percent of all new polices in the individual market were HSA-eligible plans.

From the employee’s vantage point, employee cost sharing is much higher in CDHPs. Not only are average annual deductibles more than a thousand dollars more than in PPO plans, but CDHPs also typically use coinsurance for physician office visits while traditional plans primarily rely on copayments.

On the other hand, if an employee does not expect to use many health care services, higher cost sharing is not so serious a consideration, and the employer’s contribution to the savings account makes a CDHP a savings vehicle.

Lacking historical experience, health plans and employers initially may have priced CDHPs too high to guard against favorable selection—where healthier-than-average people enroll. Employers also may have set similar monthly contributions for employees in CDHPs. If plans and employers did overprice CDHPs, then subsequent increases in premiums in the next few years are likely to be more modest in CDHPs than traditional plans, thereby increasing the appeal of CDHPs.

In the employer-based market CDHP enrollment may ultimately take off in a manner similar to the early experience of PPOs. For the moment, however, CDHPs have gained only a toehold in the employer-based market, and health plans appear to be more enthusiastic about consumer-directed health care than are employers, who in turn are more enthusiastic than employees.

See full article in Health System Change, Behind the Slow Growth of Employer-Based Consumer-Driven Health Plans

Based on a mix of factors, including personal health (such as exercise and obesity), clinical care, health insurance coverage, and health care policies the nonprofit United Health Foundation in partnership with the American Public Health Association and the Partnership for Prevention published a new "healthiest state" ranking.

The healthiest are:

Minnesota

Vermont

New Hampshire

Hawaii

Connecticut

Minnesota has topped the annual list 11 times since 1990. Minnesota's strengths include a low rate of heart disease deaths, a low premature death rate, and a low percentage of people without health insurance.

At the bottom of the list:

Arkansas

Tennessee

South Carolina

Mississippi

Louisiana

SOURCES: United Health Foundation: "America's Health Rankings: A Call to Action for People and Their Communities," 2006 edition. News release, United Health Foundation.

Lisa Dubay, a research scientist at the Johns Hopkins Bloomberg School of Public Health, and researchers at the Urban Institute found that more than half of Americans without health insurance cannot afford to purchase it and are ineligible for public assistance programs.

56% of uninsured U.S. residents are ineligible for public health programs and cannot afford coverage

25% of of uninsured U.S. residents are eligible but not enrolled in public health programs

20% of uninsured U.S. residents can afford insurance but have not purchased it

74% of uninsured children are eligible for public assistance

This study goes a long way toward putting a number on the target for public healthcare assistance. There's been too much shooting from the hip on both sides of the "uninsured problem". Again it seems obvious that the children that remain uninsured should be the first priority.

A radiation therapy known as I.M.R.T for prostate cancer may be emerging as yet another example of the way financial incentives can influence medical decisions. Among several widely used treatments for prostate cancer, I.M.R.T. stands out for the money it makes the doctors who recommend it - $47,000 or more a patient.

That is many times the fees that urologists make on other accepted treatments for the disease, which include surgery and radioactive seed implants. And it may help explain why urologists have started buying multimillion-dollar I.M.R.T. equipment and software, and why many more are investigating it as a way to increase their incomes.

Helping drive the trend is a Texas company, Urorad Healthcare, which sells complete packages of I.M.R.T. technology and services, and hopes to persuade even more urologists to buy them. “Join the Urorad team and let us show your group how Urorad clients double their practice’s revenue,” the company says in a marketing pitch to doctors on its Web site.

Urologists who have purchased the new multiple beam systems say they are embracing a superior way to treat prostate cancer. But because there is little research directly comparing I.M.R.T. with the other treatments, there is little consensus among urologists about which approach is best.

If the patient has insurance, the added expense may not be a concern for him. And like the other treatments, the new therapy can be highly effective. But doctors say that prostate cancer treatments should be tailored to the individual.

See full New York Times Story - "Profit and Questions on Prostate Cancer Therapy"

Probably the best hope for moving health care reform forward lies at the state level rather than the federal. In fact, individual states have taken the lead in health care reform so far. But, there's no way this is going to get done without federal resources - state ingenuity and federal resources.

Federal lawmakers have introduced three bills that would would encourage states to propose health care reform plans, which would be reviewed by a commission or task force that would recommend the best ideas for fast-track approval by Congress.

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