The American Medical Association (AMA) wants legislation to control the operation of retail clinics at the state and federal level. They will ask federal and state agencies to investigate retail health clinics that are joint ventures between retailers and pharmacy chains. The AMA contends that conflicts of interest exist because retail clinics increase prescription drugs sales and other product. The clinic is not independent of the store which sells the drugs the prescriptions, hence the conflict of interest according to the AMA.

Retail health clinics are being installed in large retail chains like Wal-Mart, CVS, Walgreen and Rite Aid. About 1000 clinics are expected to be operational by the end of 2007.Nurse practitioners or physician assistants offer basic procedures and they charge less than a doctor's practice. The clinics are supervised by a physician who does not have to be on site.

AMA members, particularly primary care physicians, are concerned that the greater accessibility of retail clinics will cost them business.

Children's Health Insurance Programs (CHIP) are state programs supported by federal funds that provide the children (usually up to age 19) of families that fall within published low-income guidelines with health insurance coverage at little or no cost to the child's family. CHIP website

One of the main complaints of families who want to apply is the complex paperwork and long administrative delays. Some even believe that states deliberately increase the red tape to save money.

The state of Texas has more uninsured children than any other state in the U.S. Recently, the state hired and trained expediters to help families complete the enrollment paperwork. Also, the state Legislature recently passed a paperwork simplification bill. Another 100,000 children could enroll, but the governor has not signed it yet.

When consumers have health plans with more out-of-pocket cost responsibility, they're more likely to select lower-cost alternatives for their health care, Booz Allen Hamilton, reports. People responsible for a greater portion of the cost are beginning to act like retail consumers, that is they tend to be more aware of both cost and quality differences. For instance, they are more likely to use generic than brand name drugs to get a minor or moderate price reduction.

When it comes to health care, there's no correlation between what we, our employers, or our insurers pay and the quality of care that we get. Where you live determines cost more than quality.

Take Pennsylvania for instance. The Pennsylvania Health Care Cost Containment Council recently published a report on hospital pricing and patient outcomes. Two Philadelphia area hospitals were the highest paid ($100,000 for heart bypass surgery) and had higher-than-average death rates. Some hospitals in other parts of the state had better outcomes (shorter hospital stays and lower death rates) at $20,000 for the same procedure.

Dementia can be predicted with 87% accuracy by a relatively simple test developed by researchers at the San Francisco VA Medical Center. The test is a combination of medical history, a physical exam, and cognitive testing. No special equipment is required and it can be given in a doctor's office or at the patient's home. The test measures the salient risk factors for dementia, including age 70 or more, low cognitive scores, poor dexterity or slow walking, a history of coronary artery bypass surgery, and a BMI of 18 or less.

Divigel, from Upsher-Smith Laboratories, is a odorless gel that dries quickly. It is applied daily on the thigh. Significantly, it absorbs directly into the bloodstream thus bypassing the liver. The FDA just approved Divigel and it will be abailable in July 2007.

The estrogen in Divigel (Estradiol gel) is identical to the primary estrogen produced by women before menopause. It is derived from plants and is available in the lowest dose of Estradiol available. Clinical trials of Divigel showed a decrease in frequency and severity of hot flashes among those tested. Side effects were minimal.

Divigel appears to be a convenient, low-dose therapy for coping with uncomfortable hot flashes. As with any estrogen hormone therapy, this product should be used at the lowest effective dose for the shortest amount of time.

A new home fertility test, the Fertell test, has recently been approved by the FDA. It tests the fertility of both men and women and can predict the likelihood of the couple conceiving with considerable accuracy. Men can test the quality of their semen in just over an hour. Women can measures FSH levels, a key predictor of female fertility.

While not as comprehensive as a physician's fertility evaluation, the Fertel test, can warn couples that something is wrong. The privacy factor makes it attractive so the test could be big. It sells for about $100 and is available at CVS and Longs pharmacies.