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6606. alistairconnor - 12/15/2005 3:43:49 PM or at least run it past your accountant.
Or build a spreadsheet and run some simulations. 6607. thoughtful - 12/15/2005 4:09:53 PM yes I can...it's a perfect example of what a crappy piece of legislation the rx benefit is. There is a notch...an unmitigatable notch...in the system which costs you big $$$. In their infinite wisdom...otherwise known as a gift to big pharma, not only will they not negotiate for lower rx prices, but you can't buy secondary insurance to cover the copays or the notch.
While I yearn for universal health coverage, not while these jamokes are in office. Can you imagine what a mess they'd make of that??? 6608. wonkers2 - 12/16/2005 5:27:52 PM Drugs, Devices and Doctors. 6609. Magoseph - 12/21/2005 1:11:43 PM Frist’s Backroom Coup Is a Shot in the Arm for Drug Industry, a Slap in the Face of Consumers--11th Hour Conference Report Rider Bars Compensation for the Injured and Absolves Reckless, Negligent Drug Companies of Responsibility
WASHINGTON, D.C. – A 45-page rider tacked on to the Defense spending bill conference report by Senate Majority Leader Bill Frist (R-Tenn.) is far more generous to drug companies than an earlier version, because it absolves drug makers of responsibility even for gross negligence or recklessness when making tainted, defective or deceptively labeled products. Worse still, legal immunity under the bill would extend to already available commercial drugs if they are used to prevent, treat or cure a designated epidemic or pandemic disease. The measure will reduce the incentive for drug makers to make safe pandemic vaccines or drugs, and will deter people from being vaccinated, Public Citizen warned today.
(continued)
6610. thoughtful - 12/27/2005 4:23:19 PM Today's NYT had an interesting piece about a rare but significant side effect they believe associated with the 'cleansers' used for prep for a colonoscopy. Side effect can be renal failure. They suggest avoiding solutions containing phosphates. Apparently it's a lot easier to take which leads people to drink far less than the recommended fluids to go with the solution. Nonphosphate solutions require drinking a gallon of water with it which is far less pleasant but not as unpleasant as a lifetime of dialysis. 6611. judithathome - 12/27/2005 10:53:22 PM Well, that's just great. That solution is so much easier to take than the other stuff and it's bad enough having to undergo the procedure, let alone cram your body full of 2 gallons of laxative. The phosphosoda is much easier....and I guess eventually, what's easier may kill you. Or at least make you wish you were dead.
6612. Magoseph - 1/9/2006 5:00:22 PM From the Los AngelesTimes:
Brain Protein May Be Linked to Depression
By LAURAN NEERGAARD
AP Medical Writer
4:03 PM PST, January 6, 2006
WASHINGTON — Scientists have discovered a protein that seems to play a crucial role in developing depression, a finding that may lead to new treatments for the often debilitating illness -- and fundamental understanding of why it strikes.
Although problems with the mood-regulating brain chemical serotonin have long been linked to depression, scientists don't know what causes the disease that afflicts some 18 million Americans -- or exactly what serotonin's role is.
The newly found protein, named p11, appears to regulate how brain cells respond to serotonin, researchers from Rockefeller University and Sweden's Karolinska Institute report Friday in the journal Science.
"We're all very excited about this discovery," said Nobel laureate Paul Greengard, a Rockefeller neuroscientist who led the research. "People have been looking for modulators of serotonin for a long time."
Said Oxford University pharmacologist Trevor Sharp, who reviewed the work: "This finding represents compelling evidence that p11 has a pivotal role in both the cause of depression and perhaps its successful treatment."
Most depression medications used today are members of the Prozac family that work by making more serotonin available to brain cells. They stem from a theory that depression patients might not have enough serotonin, a neurotransmitter, or chemical that carries signals between nerve cells.
Then scientists discovered the serotonin connection was more complicated, dependent on how well the neurotransmitter binds to receptors, or docking ports, on cell surfaces. Fourteen different serotonin receptors have been discovered.
The new research focuses on one of those receptors, dubbed the "1B" receptor, that seems to play a particularly big role in major depression.
Greengard and colleagues discovered that the p11 protein increases the numbers of these receptors on the surfaces of cells, mobilizing them so they're available for serotonin to do its job.
That led to a series of remarkable experiments, using mice as well as brain tissue saved from the autopsies of depressed patients, that found:
* Depressed people have substantially lower levels of p11 in their brain tissue than the non-depressed. So did a breed of mice, called "helpless" mice, that exhibit depression symptoms.
* Then the mice were given two older antidepressants -- one known as a tricyclic, the other an MAO inhibitor -- and electric shock therapy. Each treatment increased the amount of p11 in mice brains, even though each therapy is known to work in different ways.
* So the researchers bred mice that had no p11-producing gene. They acted depressed, and had fewer 1B receptors and less serotonin activity than regular mice. They also were less likely to improve with depression medication. Mice genetically altered to produce extra p11 acted in just the opposite way -- no depression-like behavior, and their brain cells carried extra serotonin-signaling receptors.
"It's a very important finding," said Dr. Thomas Insel, director of the National Institute of Mental Health, which funded the research. "This gives us a new set of targets for drug development," but also "suggests a whole new area of investigation for trying to ... ultimately discover does this have anything to do with why some people get depressed and others don't."
The researchers don't yet know whether a genetic defect or some other factor is responsible for altering p11 levels.
"The p11 is upstream of the receptor, and now the question is what is upstream of the p11," Greengard said.
But Sharp noted that bouts of depression often are associated with serious stress, and that p11 is part of a protein family known to be sensitive to certain stress-related hormones.
Greengard's lab now is researching the potential for p11-related therapies.
But the discovery likely will aid research into other diseases that also depend on cell-based receptors.
"We're finding that other molecules control other receptors, so I think this may open up quite a major new area of approach to developing therapeutic drugs," Greengard said.
On the Net: Government depression information: http://www.nimh.nih.gov 6613. thoughtful - 1/9/2006 9:19:55 PM Multiple health problems with one root cause: Diabetes
An estimated 800,000 adult New Yorkers - more than one in every eight - now have diabetes, and city health officials describe the problem as a bona fide epidemic. Diabetes is the only major disease in the city that is growing, both in the number of new cases and the number of people it kills. And it is growing quickly, even as other scourges like heart disease and cancers are stable or in decline.
Have you exercised today? Have you switched from white bread to whole grain? Do you know the sugar content in your morning cereal?
Even making a few simple substitutions and adding 10 minutes of walking after every meal can make drastic changes in your risk of diabetes and all the diabetes-related issues: kidney disease, amputation, blindness... 6614. thoughtful - 1/9/2006 9:21:20 PM One in three children born in the United States five years ago are expected to become diabetic in their lifetimes, according to a projection by the Centers for Disease Control and Prevention. The forecast is even bleaker for Latinos: one in every two 6615. alistairconnor - 1/10/2006 10:57:38 AM Winter makes you SAD? Lighten up
According to the company which installed the boxes, all the average Sad sufferer needs is up to an hour a day under one of its light boxes. "Sad is believed to be due to the brain and body not getting enough light," says Kat Nilsson, the centre's programmes manager. "We wanted to not only debate the issue but offer people who may be suffering from Sad the chance to test one of the most popular treatments."
The science is well known: lack of light causes an increase in melatonin (the hormone that makes us sleepy at night), and a reduction of serotonin, which regulates our happy moods. But experts differ as to whether Sad, which is usually accompanied by lethargy and cravings for carbohydrates, is a severe form of winter blues or a separate disorder. According to a new theory it may be linked to hibernation patterns and a once-valuable evolutionary adaptation that prepared women for pregnancy. 6616. jexster - 1/28/2006 12:59:33 AM HEADLINE: Health Care Confidential
BYLINE: By PAUL KRUGMAN
BODY:
American health care is desperately in need of reform. But what form should change take? Are there any useful examples we can turn to for guidance?
Well, I know about a health care system that has been highly successful in containing costs, yet provides excellent care. And the story of this system's success provides a helpful corrective to anti-government ideology. For the government doesn't just pay the bills in this system -- it runs the hospitals and clinics.
No, I'm not talking about some faraway country. The system in question is our very own Veterans Health Administration, whose success story is one of the best-kept secrets in the American policy debate.
In the 1980's and early 1990's, says an article in The American Journal of Managed Care, the V.H.A. ''had a tarnished reputation of bureaucracy, inefficiency and mediocre care.'' But reforms beginning in the mid-1990's transformed the system, and ''the V.A.'s success in improving quality, safety and value,'' the article says, ''have allowed it to emerge as an increasingly recognized leader in health care.''
Last year customer satisfaction with the veterans' health system, as measured by an annual survey conducted by the National Quality Research Center, exceeded that for private health care for the sixth year in a row. This high level of quality (which is also verified by objective measures of performance) was achieved without big budget increases. In fact, the veterans' system has managed to avoid much of the huge cost surge that has plagued the rest of U.S. medicine.
How does the V.H.A. do it?
The secret of its success is the fact that it's a universal, integrated system. Because it covers all veterans, the system doesn't need to employ legions of administrative staff to check patients' coverage and demand payment from their insurance companies. Because it covers all aspects of medical care, it has been able to take the lead in electronic record-keeping and other innovations that reduce costs, ensure effective treatment and help prevent medical errors.
Moreover, the V.H.A., as Phillip Longman put it in The Washington Monthly, ''has nearly a lifetime relationship with its patients.'' As a result, it ''actually has an incentive to invest in prevention and more effective disease management. When it does so, it isn't just saving money for somebody else. It's maximizing its own resources. In short, it can do what the rest of the health care sector can't seem to, which is to pursue quality systematically without threatening its own financial viability.''
Oh, and one more thing: the veterans' health system bargains hard with medical suppliers, and pays far less for drugs than most private insurers.
I don't want to idealize the veterans' system. In fact, there's reason to be concerned about its future: will it be given the resources it needs to cope with the flood of wounded and traumatized veterans from Iraq? But the transformation of the V.H.A. is clearly the most encouraging health policy story of the past decade. So why haven't you heard about it?
The answer, I believe, is that pundits and policy makers don't talk about the veterans' system because they can't handle the cognitive dissonance. (One prominent commentator started yelling at me when I tried to describe the system's successes in a private conversation.) For the lesson of the V.H.A.'s success story -- that a government agency can deliver better care at lower cost than the private sector -- runs completely counter to the pro-privatization, anti-government conventional wisdom that dominates today's Washington.
The dissonance between the dominant ideology and the realities of health care is one reason the Medicare drug legislation looks as if someone went down a checklist of things that the veterans' system does right, and in each case did the opposite. For example, the V.H.A. avoids dealing with insurance companies; the drug bill shoehorns insurance companies into the program even though they serve no real function. The V.H.A. bargains effectively on drug prices; the drug bill forbids Medicare from doing the same.
Still, ideology can't hold out against reality forever. Cries of ''socialized medicine'' didn't, in the end, succeed in blocking the creation of Medicare. And farsighted thinkers are already suggesting that the Veterans Health Administration, not President Bush's unrealistic vision of a system in which people go ''comparative shopping'' for medical care the way they do when buying tile (his example, not mine), represents the true future of American health care. 6617. arkymalarky - 1/28/2006 1:40:43 AM For the lesson of the V.H.A.'s success story -- that a government agency can deliver better care at lower cost than the private sector -- runs completely counter to the pro-privatization, anti-government conventional wisdom that dominates today's Washington.
This is the bottom line of almost all the bullshit that's been trotted out since well before Bush took office, and it hasn't shown to be true in a single instance where it's been applied. Costs are higher, quality is lower, outcomes are less desirable when private corporations run government services. 6618. wonkers2 - 1/28/2006 7:14:58 AM For profit health care is just what it sounds like! And most of U.S. health care is of the for profit variety--for the profit of the drug companies, the medical equipment makers, the insurance companies and the doctors. Why it's so expensive is no mystery. Recent articles show that the money spent on our lawmakers at the federal and state levels is peanuts compared to what the drug and medical equipment makers shower on doctors in order to get them to prescribe or use their products. 6619. judithathome - 1/28/2006 8:09:20 AM compared to what the drug and medical equipment makers shower on doctors in order to get them to prescribe or use their products.
And every single drug rep I've seen is a leggy bleached blond with very expensive clothes and veneered teeth and they all seem to show up when it's time for my appointment with the doc. 6620. arkymalarky - 1/28/2006 7:43:08 PM Right Wonk. I try to explain that to people who want to privatize public schools. The first motive is profit, not educating kids, and it's actually more expensive with less benefit for teachers, even in private schools where the first priority is education rather than profit.
I think states should pass laws that drug reps aren't allowed to visit doctor's office during appointment hours. 6621. wonkers2 - 2/8/2006 5:24:25 PM Now they tell us!Here. 6622. thoughtful - 2/8/2006 9:29:19 PM Yup, just as I had learned from schwarzbein. The low-fat diet thing is a myth. The first study that put them onto it was a poorly designed study that included having people quit smoking in addition to following a low-fat diet. Results for whatever reason created this false paradigm that it was the diet that did it when in fact it was the smoking.
Latest thinking is that transfats are the bad fats and having a balance of fats in the diet is best including the omega-3s and 6s and 9s.
Also that the syndrome x including diabetes, high bp and abdominal fat is a result of excess carbs in the diet and the insulin rush that that requires.
So do the schwarzbein for best health: every meal consists of protein, carb, fat and nonstarchy vegetable. Drink lots of water. Moderate exercise. Sleep well and lower stress. Eat sufficient protein for your body (6-8 oz per day for women 8-12 oz per day for men) don't worry about fat as your body won't let you overeat it, and control the intake of carbs to control your weight. Opt for healthy carbs (from starchy vegetables, whole grains) over empty carbs (cakes and pies). Eat real food with minimal processing and without chemicals. Avoid alcohol and artificial sweeteners.
All pretty basic, sound advice. 6623. Ulgine Barrows - 3/3/2006 1:26:18 PM Moderation! 6624. anomie - 3/4/2006 11:56:37 AM IV sedation works well for dental work. I had been stressing about "going under" and getting a wisdom tooth and moler removed for about a month now. I had the fight or flight, or approach/avoidance turmoil going on right up to when they started the IV yesterday. But then I woke up and it was over. I had no awareness at all of what was going on or even of time passing. Residual pain is very mild and I can look forward to fewer head and ear aches. Best of all I can finally stop obsessing about the procedure. 6625. arkymalarky - 3/4/2006 6:47:21 PM I had an epidural for my hysterectomy last spring. I just couldn't get beyond being stressed about "going under" either. I wasn't even worried about the surgery, even though they had to do a cesarian-type incision. I hadn't been under anesthesia since I had my tonsils out when I was 8.
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