Drug companies maintain large sales forces that call on doctors and hospitals to promote the companies' pharmaceutical products. The New England Journal of Medicine published a survey recently measuring the extent of the physicians complicity. Of the physicians surveyed, 80% accept free drug samples or free food from their drug reps. Nearly 30% accept payments for services like promotional speeches and consulting.

One of the more remarkable activities of the pharmaceutical sales representatives is the promotion of "off label" uses of a drug. That is, influencing doctors to prescribe a drug for uses that do not have FDA approval. Take for example, Gabapentin - a drug manufactured by Parke-Davis and approved only for treatment of a specific type of epilepsy, Parke-Davis reps promoted Gabapentin for the "off label" treatment of migraine and certain psychiatric conditions (a broader market and larger sales potential than the FDA approved use). After the visits, almost half of the doctors told researchers* that they intended to prescribe Gabapentin more widely or recommend it to colleagues.

* Published in PLoS Medicine, Lisa Bero, PhD, University of California, San Francisco, the researchers said,

Wal-Mart Stores has announced that they will open retail health clinics in up to 2,000 stores over the next five years or so. Wal-Mart already has walk-in medical clinics in 75 stores across 12 states. Retail health clinics provide unmatched convenience. Wal-Mart's clinics offers walk-in appointments seven days a week. Nurse practitioners deliver preventive and routine care for $45 to $65 per visit.

I'm sure this is a good business opportunity for Wal-Mart, but there's no denying they are providing a service to customers in an underserved portion of the communities in which they operate. Most retail clinic customers are uninsured and in some cases would have used an hospital emergency room otherwise.

Workers' compensation insurance claims are more frequent and more expensive for employees who are obese according to a recent Duke University study*. Nearly twice as many claims were filed by the heaviest workers. Most of the claims are for falls, slips, and injuries to the joints. Compared to the cost of the medical claims for those workers with normal BMI, the severely obese cost almost 7 times more, and the moderately obese over 3 times more. The number of work days lost by the very obese is 13 times higher.

Companies have more incentive that ever to foster healthy lifestyles for their employees such as healthy options in the cafeteria and in-house gyms. It makes financial sense.

* Archives of Internal Medicine, April 23, 2007; Ostbye, T.

More parents are taking their children to walk-in retail medical clinics. For one reason the clinics are more plentiful - over 300 now with an additional 2,000 by the end of 2008. You can find them in Walgreens Drug Stores, and at some WalMart and Target stores. Parents who use them say it's more convenient than going to a doctor's office for minor stuff like routine tests and innoculations. Indeed, over 70 percent of parents wfo used the retain walk-in clincs said they wiould return. Health insurance generally covers the cost of these visits.

This trend is up for retail clinic care for children according to the National Poll on Children's Health conducted by the University of Michigan.

The walk-in clinics are typically staffed by nurse practitioners and physicians assistants, something that worrier Primary Care Doctors and Pediatritions. Most of the kids (89%) using retail walk-ins have an established physician. This does present a challenge to coordination of care. Until we have electronic medical records through our medical system, parents will have to be responsible for beiong the communication link between their child's primary physicians and the retail clinic.

American workers value their health insurance benefits more than ever before. Perhaps realizing that their employers are paying 200% to 300% more that a few years ago, most U.S. workers employed at large businesses consider health coverage to be the most important part of their benefits packages including retirement benefits.

In February 2007, the National Business Group on Health surveyed 1,619 employees at mid-sized companies (2,500 employees or more). The majority of those queried said that would sooner take a pay cut than give up any health benefits. Over two thirds said they are satisfied with their health coverage. Even those who didn't like their coverage said that they would not want to purchase their own health insurance.

American workers are happy with the status quo when it comes to health insurance, but their employers can't afford to support their habit much longer. Something's gotta give.

Among the states considering universal health insurance - Massachusetts, Vermont, California, Pennsylvania and Illinois - the impact of mandatory health insurance on small businesses is a big concern. All of these proposals require employers to provide health insurance or to contribute state pools. Opponents of change, say that the proposed plans will hurt small businesses. But when you look closer at these proposals, you see that they can actually help small business by providing an option, the state pool, to either being uninsured of paying for group health insurance. Very small companies - less that 10 employees - and self employed individuals would see the gratest benefit. They make up the the biggest part to the working uninsured because insurance costs too much or because they are uninsurable due to pre-existing health conditions. State sponsored plans will provide them anoption they don't have now.

Who cares what's going on with health care in Maine?

After all, it's a sparsely populated and relatively poor state surrounded by Canada. But in the world of Universal Health Care, Maine is a leader - the first state to pass universal health care into law. Maine Gov. John Baldacci pushed universal health insurance through the legislature over two years ago. Maine's, DirigoChoice, the state's subsidized insurance program, is open to all residents regardless of pre-existing health conditions. The premiums of low income residents are subsidizeed by the state.

Even so not enough people signed up for the program. Now Gov. Baldacci, is proposing making health insurance mandatory. Those who can afford to pay (incomes more than 400% of the federal poverty level) would have to buy health insurance. The premiums of lower income individuals would be susudized by the state. Employers could either pay - offer group health insurance to employees - or play - contribute to a state fund.

The mandatory element was missing in the original Maine plan as it is also in New York and New Jersey with disastrous results. Basically the healthy avoid paying premiums and wait until they need medical care before signing up. Insurance is based on the claim-free paying the costs of the claimants. Everybody has to be in the pool.

Politicians are once again beating the drum for "mental health parity". Basically they want insurance companies to be required to provide similar health insurance benefits for mental health care as they provide for physical health care. For example, insurance should cover a psychotherapy office visit with a nominal copayment. It's the kind of feel-good issue that politicians love because it enjoys widespread support and after all, who's going to speak against it? ....I will.

Too much of what passes for mental health care is untested or faddish. For instance, family interventions for drug addiction and alcoholism, while currently popular with the media (there's a TV show called "Intervention"), are totally without statistical evidence of success. In fact, less confrontational treatment modalities are more successful. Insurance mandates that give money to mental health practioners with virtually no strings attached are not going to help the tens of millions of Americans with drug addiction or alcoholism.

Insurance companies need to cover treatments that are proven to work. Coverage needs to be tied to outcomes. We're not ready for blanket mandates in mental health care.

Bladder infections infect women 400% more often than men. E. coli bacteria causes virtually all urinary tract infections in the bladder. It's a pesky infection to get rid of. More often than not, the infection returns after antibiotic treatment. Repeated antibiotic use is expensive, can cause liver and kidney damage, and could lead to antibiotic-resistant bacteria, so a successful treatment would be welcomed.

Researchers* at Duke University found that some bacteria hide in tiny niches in the baldder lining, where the antibiotics can't get at them. They come out again and multipy a few weeks after antibiotic treatment. But forskolin, an extract of the coleus plant, flushes out the imbedeed E-Coli colonies from their hiding places and into the urine, where the antibiotic kills them. Forskolin has been used for centuries to treat a wide variety of symptoms including urination pain. Forskolin, a common herbal treatment, is available in health food stores.

* Soman Abraham, Ph.D. a microbiologist at Duke University published the results April 8, 2007, in the Journal Nature Medicine.

Some doctors are complaining about a recent UnitedHealthcare letter that says that they may fine providers $50, reduce their fees, or kick them out of the UnitedHealthcare network if they regularly refer patients to out-of-network labs. UnitedHealthcare says they will use the penalty only for the worst offenders after first speaking with the physicians.

UnitedHealthcare wants doctors to use LabCorp, its national in-network laboratory. Some physicians prefer Quest Diagnostics - previously contracted with UnitedHealthcare nationally. UHC says they want to prevent members from paying higher out-of-network costs. Indeed, consumers are often blindsided with big out-of-pocket expenses (as much as seven times more than in-network costs) if their doctor refers them to an out-of-network lab - whether by inattention, habit, or his or her own agenda. Most health plan members won't know what happened when they get the bill.

Ten California counties will get $540 million in federal money over the next 3 years to cover 180,000 low-income adults who don't qualify for "Medi-Cal". This program targets adults because virtually all California children have health insurance - through either private coverage or public programs.

Governor Schwarzenegger helped negotiate the deal with federal officials with a promise of new approaches for providing care to people who would otherwise get health care at emergency rooms. The counties will provide preventive care and follow-up treatment for chronic conditions like diabetes.

The uninsured generally don't have routine physical exams, As a result, high blood pressure can go undetected leading to higher rates stroke and death. Sound logical? Yes. And now there's data to back it up.

The Journal of the Society of General Internal Medicine published a study (April 2007 issue) that found people with no health insurance are less likely to be aware of having high blood pressure and if they were disgnosed they were less likely to be well controlled than people with health insurance.

The study found that people who lack of health insurance don't use primary care resources, The health disparity between the haves and the have nots seems likely to dontinue to grow.

A combination of two different migraine medications - sumatriptan and naproxen sodium - and releives migrain symptoms better than taking eother one alone. Combining two different types of treatment for migraine results in better symptom relief than taking either one of the medications, according to a study in the

About 3000 migraine patients at 118 U.S. clinical centers recieved a single tablet containing both sumatriptan (85 mg) and naproxen sodium (500 mg), or sumatriptan alone, or naproxen sodium alone or a placebo. The meds were used at the start of a moderate to severe migraine.

The sumatripan-naproxen sodium combination was more effective than placebo for headache relief at two hours after dosing. The rate of nausea was the same between sumatriptan-naproxen sodium and placebo. For sustained releif up to 24 hours, sumatriptan-naproxen sodium was superior to momotherapy.drug; NSAID) compared with placebo and single therapy with either of the drugs. ); or placebo, to be used after onset of a migraine with moderate to severe pain.

This is new inforamtion, results a study by Jan Lewis Brandes, M.D published in April 4 issue of JAMA. If you are being treated for migraine with either sumatriptan or naproxen sodium with less than wonderful results, talk to your physician about combination therapy.

Americans worry more about health care costs than the Iraq war. Harris Interactive conducted an online survey in February that analyzed responses from 2,758 adults accross the U.S.. When asked about healthcare costs, 85% of those surveyed were "concerned" or "very concerned" whereas 79% said they were similarly concerned about Iraq.

Giving rewards to employees to quit smoking or lose weight is apparently working for some companies because it reduces their overall health care costs, including health insurance, in the long run. Company wellness programs also follow employees with chronic illnesses, like diabetes and make recommendations. Becuase of equal treatment HIPAA rules imposed on employers, employees are getting discounts of up to 20% on their company insurance premiums just for signing up for the wellness programs whether or not they manage to alter their lifestyles.

A few years ago, professional and small business associations were a source of health insurance for many self employed Americans. They offered group health insurance coverage to association members, some of whom could not obtain individual health insurance because of pre-existing medical conditions.

Insurance companies began dropping associations in the mid-nineties, spurred by state mandates that required all groups to offer to include all members even those with potentially expensive medical conditions. Unlike employers, associations, unlike employers, don't pay any portion of premiums, so only those members who need the guaranteed acceptance of group coverage, namely those with pre-existing medical conditions, enrolled in the association plans. Young and healthy members opted for lower-cost individual policies, leaving the association plans with higher medical costs forcing the insurer to raise premiums to the point where only the sickest members remained in the plan.Insurers call this adverse selection. At that point, the underwriter waa looking for any legal excuse to drop the group.

Today, only a small fraction of the 1,020 associations surveyed offer health insurance. Since the self-employed and workers in small firms account for two thirds of the uninsured workers, the closing of this source of coverage impacts the number of uninsured American workers.