How I'm Battling Supermarket Sticker Shock

A health-conscious eater learns to trim the fat from her budget
by Julie Upton, RD

I don't believe in skimping on good food, but my supermarket bill yesterday has forced me to confront my inner cheapskate.

My weekly shopping bill is usually just over $130, with a few odds and ends picked up midweek and the occasional meal out. This week, however, the tab was almost $165—a 27% increase. I rechecked to see if we had bought something pricey like steak or wine. No and no. The escalation of food costs has made news virtually daily, and according to the Consumer Price Index, food costs have increased more in the first quarter of 2008 than they have since 1990—and there's no sign of them heading south anytime soon.

Some of my big-ticket items were cage-free eggs ($5), organic milk ($3.50), imported cheese ($4.50), artisan seven-grain bread ($5.50), and New Zealand apples ($6). And I don't want to give most of them up.

So I researched some ways of putting my grocery shopping on a diet without ruining my healthy diet. I refuse to either spend Sundays clipping coupons or head to big-box retailers, where you can easily save 30% or more on food items, so here is what I'm doing to trim some of the fat from my weekly shopping budget.

Make a List
According food marketing specialist Phil Lempert: "Surveys of supermarketguru.com readers show that list makers spend 40% less when grocery shopping." Now I hope I can stick to only what's on the list.

Brown Bag It
Unlike my mother, who loves to cook and prefers cooking to eating out, I am not much of a cook. However, the best way to s-t-r-e-t-c-h my food budget is to eat in more often. My takeout lunch is around $10, but I can make a sandwich or have soup and salad at home for around $2.

Shop Full
I'm usually pretty disciplined when I go food shopping, but when I'm hungry I wind up with a cart filled with foods that curb my carb cravings: snack bars, pretzels, and more crackers than I know what do to with. These convenience foods are among the most expensive in the supermarket and add little nutritional value to my diet. So next time I go shopping, I'll avoid temptation and go on a full stomach.

Eating Green to Save Green
I'm going to stick to my vegetarian ways even more so now, because the foods that cost the most per serving are high-quality proteins (aka beef, poultry, and seafood). Consider this: Salmon costs about $.62/ounce and beans cost .$04/ounce, making the salmon 15 times more expensive than the beans. And, when I do eat meat, I'll make it go further financially by adding in a lot more vegetables to the dish.

Head to the Farmer's Market
I'm going to try to kick my daily New Zealand apple and South American banana habit. Living in California means that I have great locally grown berries available right now, as well as plenty of veggies. Eating in season can save you $2/pound on many fruits and vegetables. Right now, I can get fresh California-grown strawberries for less than $1/pound, whereas imported blueberries from Chile were $20/pound at the supermarket! Since berries deliver similar nutritional benefits, I'll take the strawberries, thank you.

Compare Prices
Using the unit pricing system (shelf tags), I can do my own price checks on comparable items to see which offers the best deal. Unit pricing provides the price per standard unit, often one ounce. For example, I found Tropicana orange juice costs $.09/ounce but the exotic pomegranate-blueberry juice next to it was .25/ounce—more than twice the price. In the cereal aisle, most big brands were around $.30/ounce but store brands were about $.15/ounce, or half the price.

Let me know if you're feeling my pain in the pocketbook, too—and what you're doing to save some green when shopping.

The Soaring Cost of Dental Care Is Nothing to Smile About

Let’s drill down into why it’s so expensive to have a healthy mouth
by Amy O'Connor

This is me holding my $1,200 crown (it recently popped out, hence this blog), my husband’s $450 mouth guard, and the retainer I have worn since I was a teenager.

Notice that I am not smiling. We spend far more on dental care and devices than we do on doctors, and it’s getting more expensive as we get older. Continue reading »

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The Hidden Costs of Your Doctor Visit

Are parking fees, co-pays, plus the half-day’s wages you lose sitting in my waiting room keeping you from getting the health care you need?
by Dena Rifkin, MD

I was commiserating with a patient about the cost of parking at our medical center. Depending on the length of a visit, the ticket in the garage here can cost $5 to $10. Not a fortune, but if you need to see your doctor monthly, it adds up. “Ah, doctor,” she said, “this is the problem: It is too expensive to stay healthy!”

Her comment made me think again about co-payments, that $10, $15, or $25 you fork over to see someone like me even before your insurance company decides if it will cover your entire visit and all the tests you need.

The actual charge for the visit and associated tests is much more than that, of course, though people with health insurance rarely see the actual charge for the visit. So why does the co-pay exist, if it’s such a small fraction of the total cost? Continue reading »

'Hospitalist' Physicians Help Shorten Patient Stays

(HealthDay News) -- A new breed of medical specialists, called hospitalists, can make a small but significant difference in shortening how long a patient needs to stay in the hospital, a new study shows.

The 2002-2005 study of almost 77,000 hospital stays at 45 centers showed that treatment by a hospitalist, rather than a general internist, resulted in about a half-day reduction in overall hospital stays on average, along with an average $268 drop in costs.

At the same time, researchers found no difference in the rate of either patient death or readmission when hospitalists were involved, according to the report in the Dec. 20 issue of the New England Journal of Medicine.

A hopsitalist refers to a physician who cares solely for hospitalized patients.

The term may be new to the general public, but, in the medical profession, "hospitalist has been a recognized and accepted term that has been around for about a decade," said study author Dr. Peter K. Lindenauer, an associate professor of medicine at Baystate Medical Center and Tufts University, in Boston.

In fact, "There is a Society of Hospital Medicine with 5,000 to 10,000 members, and it is estimated that there may be 20,000 hospitalists across the United States now," Lindenauer said.

"What you can't debate is the number of hospitalists around the country -- there is no going back," added Dr. Laurence McMahon, chief of the division of general medicine at the University of Michigan, in Ann Arbor.

"We need to think about how these new doctors get into the health-care system and how they care for patients who are hospitalized," said Mcmahon, who also authored an accompanying editorial on the issue.

Traditionally, a person's private physician has been responsible for care after hospitalization, he said. That began to change about 30 years ago, with the emerging role of emergency room physicians and critical care physicians, Lindenauer said. "They have been assuming the role of attending physician in those situations," he said. "In some respect, the growth of the hospitalist model of care represents the completion of a series of steps toward specialization that began 30 years ago."

According to Lindenauer, the advent of the hospitalist means another question should be asked when individuals choose a private physician: Will that doctor turn over care to a hospitalist, if and when someone needs hospital care?

"It is a discussion that a patient should have with a primary-care physician when he is thinking about enrolling with that physician," Lindenauer said.

The differences shown in the study -- a shortening of length-of-stay by 0.4 days, on average -- are not great, he acknowledged, but they do add up over time.

"Shortening the length of stay by 0.4 days is small, but when you multiply it out over time by thousands of physicians, the effects can be very large. With 5,000 cases a year, [that's] a savings of 2,000 bed-days," he said.

The study was not able to assess patient satisfaction with treatment by a hospitalist rather than a primary-care physician, Lindenauer said, "But we know that efficiency is important, as important to patients as to physicians." he said.

And while full official recognition of the hospitalist speciality is yet to come, the Society of Hospital Medicine is working closely with the of American Board of Medical Specialties toward such an end, Lindenauer said.

"The differences between hospitalists and other doctors who take care of patients in hospitals are pretty minor," McMahon said. "What really is quite revolutionary is the change in how we take care of patients in the hospital."

More information
There's more on hospitalists at the Society of Hospital Medicine.


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Saving Millions of Children's Lives Is Possible

(HealthDay News) -- Millions of childrens lives could be saved by a coordinated global effort to improve nutrition and provide clean water, better sanitation and cleaner household fuels in underdeveloped countries, a new study finds.

Each year, such an endeavor would spare the lives of almost 1.5 million children in sub-Saharan Africa, 800,000 children in South Asia and nearly 50,000 children in Latin America and the Caribbean, concluded the report, which is published in the Oct. 24/31 issue of the Journal of the American Medical Association.

Targeting the interventions to the poor would maximize the number of lives saved, said study co-author Dr. Majid Ezzati, an associate professor of international health at the Harvard School of Public Health, in Boston.

"Everyone needs clean water and good nutrition," Ezzati said. "It's not that the rich don't need it but that the poor end of the income spectrum has so many problems that dealing with any one of them can have many benefits."

This week's issue of the journal is devoted to reports on poverty and human development. Its publication is part of an effort by more than 200 journals worldwide to publish papers on these global issues -- an effort launched by the Council of Science Editors and sponsored by the U.S. National Institutes of Health (NIH).

Ezzati and his colleagues gathered data to determine whether it might be possible to achieve the United Nation's Millennium Development Goals for better health.

Using data gathered by the World Health Organization and national organizations, they determined that an estimated 56 percent of the children in Latin America and the Caribbean, 87 percent in South Asia, and 83 percent in sub-Saharan Africa are exposed to preventable health risks linked to unsafe nutrition, water, sanitation and fuels.

The report does not include an estimate of the cost of eliminating such risks, however. "That would take another complete study," Ezzati said. This study does advocate getting better results from any money being spent now through improved cooperation and coordination.

"There already is some work being done, one piece at a time," Ezzati said. "What we argue is that packaging it better and aiming it at the poor will improve results."

In a statement, NIH Director Dr. Elias A. Zerhouni, said, "The scope and diversity of these critical research projects illustrate the complexity of today's major global health challenges that require multidisciplinary approaches."

Other, related reports published in the Journal of the American Medical Association and leading journals include:

• A study showing that successful programs for treating HIV/AIDS generate a continuing need for more personnel and resources.


• A program to deliver information on health and social services to people living in rural India.


• A study showing a good outcome for HIV-infected African children who get adequate pediatric care -- if intervention starts early.


• Outreach efforts to include surgery in the care offered by primary physicians in Zimbabwe and rural China.


• Successful training of Chinese family doctors to perform cataract surgery.

More information
Presentations on the papers will be Webcast live on Monday and archived by the U.S. National Institutes of Health.

High Co-Pays Cause Seniors to Go Without Meds

(HealthDay News) -- Seniors enrolled in Medicare plans that charge higher co-pays for brand name or non-preferred medications fill almost 15 percent fewer prescriptions than their peers who have a flat co-pay for all prescription medications, a new study finds.

The data highlights a tough decision for older Americans: Spend more or skip some of their medicines, including those for chronic diseases such as diabetes and high blood pressure.

"Consumers are sensitive to price. When they have to pay more, they tend to consume less," senior researcher Boyd Gilman said in a prepared statement.

Gilman and colleagues at Cambridge, Mass.-based Mathematica Policy Research Inc, analyzed spending on prescription drugs among almost 353,000 Medicare beneficiaries with employer-sponsored retiree drug coverage.

They compared spending by those in single-tiered plans to those in three-tiered prescription drug plans. Three-tiered plans charged retirees higher co-pays for using drugs that were not generic or preferred name brands, or that were less obviously medically necessary, whereas single-tier plans charged a flat $5 or $10 co-pay for all prescribed medications.

Writing in the online September issue of Health Services Research, the researchers reported that people enrolled in three-tiered plans spent 14.3 percent less on prescriptions and filled 14.6 percent fewer prescriptions compared to their peers with single-tier plans. Those in three-tiered plans typically relied on generics when they purchased medications, reported Gilman.

The data also showed that people with three-tiered plans had 57.6 percent higher out-of-pocket costs and filled 11.5 percent fewer prescriptions for ongoing medical needs such as diabetes, arthritis and high blood pressure.

"The use of prescription medications is fairly predictable. People know what drugs they need, and they can find out whether their drugs are covered by a plan, and -- if they are covered -- whether they belong to a lower-cost tier or a higher-cost tier," Gilman said.

More information
To learn more about choosing a Medicare drug plan visit the U.S. Department of Health and Human Services.

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Emergency Room HIV Tests Cost-Effective: Study

(HealthDay News) -- Routine HIV screening in hospital emergency departments is cost-effective and actually welcomed by many patients, a George Washington University Medical School study finds.

More than 4,000 patients were offered the screening and almost 2,500 (60 percent) agreed to be tested. Of those, 26 patients (one percent) had a preliminary positive result for HIV infection.

HIV is the virus that causes AIDS.

The rapid screening kits were provided free of charge by the Washington, D.C., Department of Health, while researchers did the actual clinical work. While this approach would not be feasible over the long-term, it does suggest some models for a program of ongoing HIV testing in hospital emergency departments, said study author Jeremy Brown, research director in the university's department of emergency medicine.

He said the cost per preliminary positive HIV result was about $1,700, and about $4,900 per confirmed case of HIV infection.

"Washington, D.C., has one of the highest AIDS case prevalence rates in the United States, and our results suggest that ED HIV screening in this high prevalence area is well accepted by patients," Brown noted.

"The cost per case detected is low when compared with other methods for the early detection of HIV. For example, nucleic acid amplification has been used (for) early detection of HIV infection at a cost of over $17,000 per index case identified."

The study was expected to be presented May 16 at the annual meeting of the Society for Academic Emergency Medicine, in Chicago.

More information
The U.S. Centers for Disease Control and Prevention has more about HIV testing.

Ozone machine for car OZZON 53

We have the Technology to stop the Virus Spreading and Eliminate any future outbreaks.
Ozone is a naturally occurring component of fresh air.

It can be produced by the ultraviolet rays of the sun reacting with the Earth's upper atmosphere, which creates a protective ozone layer, or it can be created artificially with an ozone generator.

The ozone molecule contains three oxygen atoms whereas the oxygen molecule contains only two. Ozone is a very reactive and unstable gas with a short half-life before it reverts back to oxygen.

Ozone is the most powerful and rapid acting oxidizer man can produce, and will oxidize all bacteria, mould and yeast spores, organic material and viruses.

As based on the specific (medical and physiological) effects of ozone, we find the indications listed in the following table:
Gas and gas pains
See also: The story of ozone

Why Ozone?
Cost effective Installation
High Oxygen transfer rates
Minimal Maintenance as there is only one moving part in the system. Either an Air-blower when an Air disk supplies Ozone.
Injector supplies the Ozone
Makes clear and healthy water.
Increases the Oxidation power of the Water
Removes toxic Nitrite by 90%
Reduces decay processes in wastewater, fishponds and other organic contaminated ponds or Canals.

Improves the filter efficiency by 80%
Removes yellow substances from the water which putting strain on living creatures in the water.

Increases the Redox potential.
Supports biological filtration.
Reduces the B O D and C O D by 80%.
Promotes continues aerobic conditions therefore no bad smell.
Reduces heavy metal concentrations by oxidizing the metals in to sulfates.
Eliminates eutrophication in Lakes and Rivers.
Reduces Algae growth or eliminates the growth of Algae complete.
Depresses the growth of water born parasites like Mosquitoes, Tsetse Flies and other water-born deceases

Reduces Water treatment costs more than 35% savings depend on what kind of water to treat.
Place the ozone machine in the car room, the machine will generate ozone and spread out the whole vehicle room area. After testing for ten minutes the smell was eliminated. First ozone will deodorize the Contaminated Air giving the Fresh Smell of Ozone. Bad smell or undesirable smell was 100% eliminated. Ozone was known in a form of 3 oxygen atoms denoted as ozone molecule and is very high sensitive deodorize element. It destroys the undesirable molecule's structures.

more info: http://www.dreddyclinic.com/ozone_machine_for_car.htm

• Ozone machine for our patients at home
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Milk May Be Pleasant Alternative for CT Scans

(HealthDay News) -- Undergoing a scan of one's intestines isn't a pleasant experience for patients with conditions like Crohn's disease, especially since it means downing a concoction made with barium.

But a new study suggests there may be a more palatable alternative: milk.

Researchers found that milk coats the intestines well enough so that radiologists can properly view the organ in a CT scan.

The milk alternative "is interesting, and it's certainly cheap enough. Reading this, I might try it on regular patients," said Dr. Laurence Needleman, chief of CT at Thomas Jefferson University Hospital in Philadelphia.

Still, Needleman -- who's familiar with the study findings -- said milk may not be ideal for all patients, especially since it seems to produce images that are less precise.

Specific types of CT scans are often used to examine the intestines along with the liver and spleen, Needleman explained. Patients typically ingest one chemical and are injected with another; the two combine to create contrast and allow radiologists to better view the inside of the body.

In cases of Crohn's disease and other conditions, the purpose of these scans is to detect kinks or obstructions in the intestines, Needleman said.

Patients commonly drink a "contrast agent" called VoLumen, which includes barium. "I've tried it. It's one of the things I made sure I did," Needleman said. "It's not pleasant. It's not a positive experience to drink it. Drinking four glasses of milk probably will be easier."

In the new study, researchers compared VoLumen to milk in patients who were about to undergo CT scans of the abdominal/pelvic area.

Of those, 62 drank VoLumen, while 106 drank two doses of whole milk (one 400-600 milliliter glass, then a 200-400 milliliter glass -- a total of as much as one liter).

The study findings were to be presented Wednesday in Chicago at the annual meeting of the Radiological Society of North America.

The researchers found that VoLumen was better at allowing radiologists to view certain kinds of images. However, 42 percent of VoLumen patients reported abdominal side effects -- Needleman said it can cause diarrhea -- while only 25 percent of the milk patients did.

As to cost, VoLumen was $18 per patient compared to $1.39 for those who drank milk.

"We hope that substituting milk for other contrast agents will reduce the number of people who refuse imaging tests because they do not want to drink the oral contrast, especially children,"
Dr. Lisa Shah-Patel, a radiology resident at St. Luke's-Roosevelt Hospital in New York City, said in a statement. She is one of the study's authors.

But Dr. Raul N. Uppot, assistant radiologist at Harvard Medical School, is skeptical that milk will be a viable alternative. "I don't believe we should sacrifice image quality for improved tolerability," he said, adding that some patients may not be able to drink milk due to allergy, lack of ability to tolerate milk products, or existing bowel disease.

"This is only a small study, and when applied to the larger population of patients undergoing CT, I feel you will run into more complaints of discomfort and diarrhea (with milk)," he said.

In addition, Uppot said, "most patients at our institution tolerate the VoLumen with a few complaints of diarrhea."


More information
There's more on CT scans at RadiologyInfo.

Cancer Combo Therapy Is Cost-Effective

(HealthDay News) -- Combination cancer treatments are initially more expensive than single-agent cancer therapies, but they offer better results for patients and prove more cost-effective in the long term, a new study finds.

A team at the Fox Chase Cancer Center in Philadelphia explained that single cancer treatments may cost more in the long run due to expenses associated with treating patient complications and cancer recurrence.

The findings were to be presented Tuesday at the annual meeting of the American Society for Therapeutic Radiology and Oncology, in Philadelphia.

The study authors analyzed 47 months of treatment costs and clinical outcomes for 66 Medicare patients with locally advanced laryngeal cancer who took part in a clinical trial between 1991 and 1996. The trial was designed to compare three treatment regimens -- two that combined chemotherapy and radiation therapy and one that used radiation therapy alone.

"In overall survival rates, there was no significant difference among the three treatment arms," lead author Dr. Andre A. Konski, a radiation oncologist and director of clinical research in the radiation oncology department at Fox Chase Cancer Center, said in a prepared statement.
"However, patients receiving induction chemotherapy as well as radiation or concurrent chemo-radiation therapy had better outcomes in terms of disease-free survival, local and regional control and preservation of their larynx [voice box]," Konski said.

"In our subsequent economic analysis, these better outcomes translated into significant savings of dollars that were spent on treating patients for complications and recurrences that occurred with the less effective therapy of radiation by itself," he added.

Konski and his colleagues found that "radiation alone costs less in and of itself -- the expected mean 47-month cost of that treatment was $57,357 -- compared to the two treatment arms that included chemotherapy. Concurrent chemo-radiation cost a little more ($57,870) and represented an incremental increase of $697 per life year of overall survival and $2,048 per disease-free life year."

"Induction chemotherapy plus radiation therapy was the most cost effective. At a 47-month cost of $49,018, this treatment saved $7,031 per disease-free and $9,336 per life year of total survival," Konski said.

More information
The American Academy of Family Physicians has more about cancer treatments.

Cheat Disease by Changing Your Environment

It has become clear to many that efforts to halt the growing epidemics of obesity, high blood pressure, diabetes, heart disease and cancer are failing.

Many experts believe a primary reason is easy access to unhealthful foods and busy lives that squeeze out exercise.

As a result, many new preventative health initiatives in states, cities and communities are being inaugurated across the United States.

On September 28, the American Cancer Society (ACS) concluded that only by creating a "social environment that promotes healthy food choices and physical activity" can the United States reduce cancer deaths linked to obesity and lack of exercise.

In response, on October 6 the American Heart Association and the Clinton Foundation announced an agreement with several food companies to adopt the ACS' nutritional guidelines for snacks sold in schools. Other initiatives, sponsored by government agencies, universities, or private businesses, are growing in number.

Current U.S. health spending is $2.2 trillion a year, and it could reach $4 trillion by 2015. Taking care of the sick accounts for roughly 96 percent of these costs, with only about 4 percent going toward prevention.

USA Today October 18, 2006

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Angioplasty Beats Bypass for High-Risk Male Patients

(HealthDay News) -- Angioplasty may be a safe and more cost-effective option for men at high risk of death from heart bypass surgery, researchers report.

Some men are at high risk for death during bypass surgery due to their age, prior open-heart surgery, recent heart attack, or decreased heart function, note researchers reporting in the Sept. 12 issue of Circulation.

This new study compared three- and five-year health outcomes and economic costs among 445 high-risk male heart patients, average age 67. Of those, 218 had angioplasty and 227 had coronary artery bypass grafting surgery.

The procedures were done between 1995 and 2000.
At the five-year mark, the average cost was 19 percent lower ($18,732 less) for angioplasty patients, and the cost difference was achieved without adversely affecting survival. Bypass offered no significant advantages over angioplasty in terms of quality of life, which further supports the use of angioplasty for high-risk male patients, the researchers said.

Previous research found that angioplasty was cheaper than bypass initially, but the difference in cost effectiveness narrowed significantly after five years.

"Since the time those studies were done, angioplasty techniques have improved and patients are getting stents, which help prevent the arteries from closing up again," lead researcher Kevin Stroupe, a health economist at the Edward Hines Jr. VA Hospital in Illinois, said in a prepared statement.

"Our study ... showed that angioplasty maintains a significant cost advantage with no adverse impact on survival rates, even after five years," he said.

More information
The Society for Vascular Surgery has more about angioplasty and stenting & EDTA.

Medicare Drug Benefit Won't Help All Equally

(HealthDay News) -- Although the new Medicare drug benefit is likely to result in small savings for most seniors, these savings aren't likely to be divided equitably among all groups, a new study finds.
The most vulnerable seniors, namely blacks, Hispanics, low-income seniors and seniors with chronic disease, still face sizable out-of-pocket costs, according to the study that appears in the January/February issue of Health Affairs.
"Although people are going to save money on average out-of-pocket costs, the benefit is not ideally structured to help people with chronic diseases," said study author Dr. Walid Gellad, a research fellow and internist in general medicine at Brigham and Women's Hospital in Boston. "In general, the benefits are not going to be equally distributed."
"Most experts would say these findings are predictable," added Robert M. Hayes, president of the Medicare Rights Center in New York City. "Fundamentally, when we have a for-profit insurance industry administering a benefit, of course sicker people will be paying more and more because they cost more, but also because the insurance companies have every financial incentive to find customers who don't need expensive medications. Some refer to it as a 'sick tax.' If you need the benefit, it'll help you the least."
Ironically, the study appears alongside another study in the journal that reports overall prescription drug cost growth is actually slowing.
Medicare Part D, a prescription drug benefit created to ease the financial burden of soaring drug costs for America's seniors, became effective Jan. 1. The plan works with private plans to supplement drug costs.
So far, the plan seems to have gotten off to an uneven start. The Los Angeles Times reported recently that one man spent 15 1/2 hours trying to get through to his mother's insurer on the phone. And Hayes said he's considering bringing in a psychologist to help his young staffers who are getting calls from people they can't help. "They're so upset," he said. "My education director just asked if we could bring in secondary trauma counseling."
While much research has focused on the low-income segment of the population that is eligible for both Medicare and Medicaid, those who are not eligible for such subsidies are often left out of analyses, Gellad said.
Gellad and his colleagues analyzed out-of-pocket drug spending for seniors over the age of 65 who were not eligible for additional subsidies and who did not have prescription coverage through their employers. Within this group, the study authors focused on the "most vulnerable" groups, including ethnic and racial minorities, the "near poor" and those with three or more chronic health conditions.
Overall, the study found that seniors will save $478 under the new drug benefit, but these savings are not divided equally. Blacks stand to save 26.9 percent of their current out-of-pocket costs, Hispanics 23.3 percent and whites 34.3 percent. Blacks and Hispanics will save an estimated $237 less annually than whites, the study concluded.
"Blacks and Hispanics are going to save, but they will save less than whites both in absolute dollars and as a percent of their current out-of-pocket costs," Gellad said.
The near poor, or seniors with incomes below $21,450 who don't qualify for subsidies, will save $525 annually on average. "It's a decent amount of money but they still have $957 in out-of-pocket costs, which is still a lot when you consider their income," Gellad pointed out.
More than one-third (35 percent) of people with three or more chronic conditions will have total costs that fall into the so-called "donut hole," the gap in coverage resulting from the deductible and benefit structure. This means they may end up paying 100 percent of the cost of any new medications, the study concluded.
Should people with employer-sponsored coverage join the Medicare drug benefit, they will end up paying $123 more in out-of-pocket costs, the study found.
"Dually eligible people are going to have great savings but no one seems to talk about these other people," Gellad said. "Do we need to expand subsidies to include these people who are still poor, and are still going to have trouble with medicines?"
Despite the continuing individual burden of health-care costs, another study in the same issue of the journal found a slowing in U.S. health spending in 2004, to its lowest level in four years.
This decline was aided largely by a decline in prescription drug spending, the study found.
National health-care spending grew 7.9 percent in 2004, down from 8.2 percent in 2003, while growth of drug spending slowed to single digits (8.2 percent) for the first time in a decade.
Despite this modest good news, U.S. health spending is still huge, at $1.87 trillion in 2004, according to the report, which was prepared by economists from the Centers for Medicare and Medicaid Services. This amounted to $6,280 per person. That total spending figure is nearly twice that of a decade ago.
"There's never going to be a rational expenditure of U.S. health dollars until we get something like a Medicare for America program going," Hayes said. "We will continue to waste billions and billons of dollars unless we have a rational health-care system and, at this point, there's no system at all."
More information
Visit Medicare for more on the new prescription drug benefit.

Health Tip: Using Generic Drugs

(HealthDay News) -- As the cost of prescription drugs continues to soar, patients and doctors alike are turning to generic alternatives. But are they the same?
Yes, says the U.S. Food and Drug Administration. Generics are chemically identical to their brand-name counterparts, and are equally safe and effective.
Like brand-name drugs, prescription generics must also be approved by the FDA.
Brand-name drugs are more expensive because the manufacturers must pay hefty fees for creating and patenting new drugs, says the FDA. A new drug is protected by patent for a number of years, but once that patent expires, other drugmakers are able to produce the bioequivalent generic at a lower cost.
If you're currently taking a brand-name prescription drug, ask your doctor or pharmacist about whether there's a generic alternative.
Last reviewed: 07/26/2006 Last updated: 07/26/2006

Chilling out in Chiang Mai

Published on May 15, 2004
The Northern capital boasts a wealth of spas, all geared to treating stressed minds and abused bodiesChiang Mai spas are a modern take on an old concept, where modern seekers of good health, fitness and beauty immerse themselves in hot tubs much as how the ancients did.

The oldest known spa dates back 5,000 years to Merino, Italy and it’s believed that Egyptians used mineral baths for therapeutic practices during the same era. Most early spas were located near natural hot springs, but in 600 BC water in rustic cauldrons was heated by sizzling hot stones.Later, the Greeks discovered hydrotherapy for ailments such as jaundice and rheumatism, and more than 2,000 years ago the Romans introduced hot water to fun and decadence.

The Roman thermae was an elaborate technology of aqueduct systems carrying mineral waters throughout complex private chambers, steam rooms and public baths. In an effort to outdo their predecessors, each emperor would increase the size and extravagance of their spa, with the Diocletian capable of holding 6,000 bathers.The thermae or spa has since spread to resorts around the world offering sport, refreshment and therapeutic facilities. But they vanished with the fall of the Roman Empire and, apart from a brief revival during the Middle Ages, the concept was lost until its modern resurrection.Today’s spas have been updated to treat the stressed minds and abused bodies of modern humans. “It’s mainly a matter of education,” says Chitra Klanprayoon, co-owner of Chiang Mai’s Ban Sabai Spa Village.“

Greater knowledge of oneself might bring on a need to change, shed a few kilos, detoxify the body, relax the mind, and that’s where the modern spa comes in. We can provide a mixture of holistic and contemporary treatment, with some wellness spas seeking medical evaluations by physicians before giving prescriptions and advice on treatment,” adds fellow co-owner Matthias Froelich.Chiang Mai has a perfect environment for rejuvenation, with Lanna culture being a vital ingredient. Lanna – meaning “Land of One Million Rice Fields” – holds with traditions of tranquillity, politeness and living with nature and forms a philosophical base for spas in northern Thailand.

Natural surroundings, such as the mountainous landscape, hot springs, herbs and organic products also play a large part in this ideal setting for disease prevention, recuperation, comfort for the terminally ill or simply a place where one can be pampered.In the past eight years, many spas have developed in the Chiang Mai area, and 20 of them belong to the Thai Lanna Spa Association, of which Chitra Klanprayoon is president.“This organisation is essential,” she says.

“The word spa is being used for a greater variety of services these days and the public must be assured of what association members have to offer. Our spas can guarantee high quality and effective therapy from qualified doctors and staff, and we must not be confused with night-time entertainment places.”The association proudly took part in the first World Congress of Holistic Medicine, held in Chiang Mai last month. Supported by the World Health Organisation, Thai Ministry of Public Health, the event was seen as a major step toward the region’s endeavour to become a regional centre for medical and therapeutic care.

Apart from 50 presentation booths, lecturers and delegates attended from more than 20 different counties.The gathering also revealed the remarkable diversity of spas, and how many spas succeed by concentrating on specific therapies and themes.The Ban Sabai Spa Village, for example, specialises in detoxification courses for colon irrigation, life management, dietary advice, weight loss and fasting. Set in lush tropical gardens a few minutes from downtown Chiang Mai, guests are invited to drown their troubles in the swimming pool or salt flotation tank.

There is a range of single remedies and mixed therapy packages to tone up the body and evaporate stress including steam baths and assorted massages. Aromatherapy can help to achieve meditation and the beauty conscious can treat themselves to a manicure, pedicure and body wax. Prices range from Bt450 for a single therapy to Bt5,500 for the six-hour Jasmine Spa Package.Day visitors are welcome and for guests staying over, luxurious Lanna style villas are available at Bt4,800 per night. Each one contains a whirlpool, steam room, sauna and outdoor bathroom with aromatic plants. Standard rooms in similar design are Bt2,700.Ban Sabai Spa Village is an ideal place to improve your mental and physical condition or simply be thoroughly spoiled.For seekers of spiritual enlightenment, there’s the Tao Garden Health Spa, beautifully situated in a mountainous area 30 kilometres north of Chiang Mai

.Paths wind their way though more than 30 hectares of shrub lands shrouded by trees and lead to the Immortal and Lao Tzu’s Meditation Halls, and the Ba Shen Memorial Hall for Tai Chi, Tao Yin and Chi Nei Tsang activities. A swimming pool and gym are nearby.The body cleansing programmes here follow a Taoist or Chinese regimen supported by modern medicine and the spa is especially pleased with its Karsai Nei Tsang genital massage for both sexes. This manipulation of the sexual organs may help alleviate impotency, frequent and difficult urination, painful menstruation and intercourse, and low libido.

Chi Nei Tsang is a stomach massage, but one designed to soothe both body and mind. Stress and worry move from the brain to create physical obstructions in the tummy. This therapy not only clears out toxins and smoothes knotted intestines, but also provides spiritual well-being.Sitting in the Dark Room is a departure from the physical. Totally devoid of light or sound, this method of detachment, meditation and discovery of one’s inner self is endured by some for as long as three weeks, while others might start screaming shortly after the light goes out.Individual spa treatments start at Bt300, and there are inexpensive beauty preparations. One- to seven-day packages range from Bt1,900 to Bt32,300, without accommodation, which is priced from Bt3,200 to Bt5,300 and includes use of facilities.Some spa goers prefer vigorous sport to blissful tranquillity, and that’s where the Northern Heritage Resort & Spa comes in.

Located 25 kilometres east of Chiang Mai Airport and surrounded by forested mountains, one can jump out of the jacuzzi and straight onto the first tee of the challenging Chiang Mai – Lamphun Golf Club. And if 18 holes on this magnificent championship course aren’t enough there’s cycling, trekking, pool, snooker, tennis and karaoke.Five spa pavilions – spread around the swimming pool – are waiting to rejuvenate worn out bikers, adventurers and foot sloggers with a large selection of therapies. The athlete’s rejuvenation course costs Bt6,200 and a sport massage is Bt2,500.For those who might have overdone things, an in-house medical centre is linked to Chiang Mai Ram Hospital.Back in the spa, one can experience the benefits of soaking in Dead Sea minerals for Bt8,000. Or how about a bath in red wine for Bt7,400? There are many packages, and prices can be found on the resort’s website. Luxury rooms and suites in a hotel environment go from Bt3,500 to Bt10,500 per night and log cabins cost up to Bt12,000. There are special rates for long term guests.

The Chiangmai Oasis Spa has adopted the Roman concept of unadulterated pleasure. After negotiating the stepping stones in the fish pond and soaking up the warm greeting at reception, it’s easy to forget that you’re bang in the middle of town.Escape the rigours of modern living. Slip out of the office to a haven of fragrant flowers and fountains and into a relaxing steam room. Or watch your troubles float away in the bubbles from the bath. The Oasis is a place to be pampered by therapists trained to take care of your every need.

At the two villas you’ll find steam rooms, private gardens, and alfresco showers and jacuzzis. Once settled into this perfect setting, there is an exciting menu of treatments to ponder.This day spa provides many individual therapies and six packages, and the proprietors are particularly proud of their Tibetan style “hands on” foot massage.

Massages range from Bt550 to Bt2,500 and most of the scrubs, wraps, facials and hydrotherapy cost less than Bt1,000. Packages start at Bt1,900. Or lash out Bt5,400 for a fully gratifying four hour Oasis Experience.So for the body pampering, health conscious, sporty and decadent – when in Chiang Mai, do as the Romans did.
Bob Kimmins

The Nation

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U.S. Panel Endorses Cervical Cancer Vaccine for Girls

THURSDAY, June 29 (HealthDay News) -- A U.S. advisory panel recommended Thursday that 11- and 12-year-old girls be routinely vaccinated against the virus that causes cervical cancer.

The National Advisory Committee on Immunization Practices also recommended that the vaccine, called Gardasil, be administered to girls as young as 9, at the provider's discretion, and for women up to age 26 who have not previously been vaccinated against the sexually transmitted human papillomavirus (HPV).

"The Advisory Committee on Immunization Practices made a historic vote today to recommend routine use of HPV vaccine for girls aged 11 to 12," Dr. Anne Schuchat, director of the National Center for Immunizations and Respiratory Diseases at the U.S. Centers for Disease Control and Prevention, said at a Thursday news conference. "It's a very important day -- a breakthrough for women's health."

Some religious conservatives and other critics have expressed concern that giving the vaccine to children could encourage underage sex. But, according to Schuchat, no controversy arose at the panel's recent public meetings.

The panel's recommendation was hailed by health experts.

"It's a wonderful thing. It's good news all around," said Dr. Connie L. Trimble, associate professor of gynecology and obstetrics and pathology at Johns Hopkins' Sidney Kimmel Comprehensive Cancer Center, in Baltimore. Trimble is working on a therapeutic vaccine for people already infected with the virus.

The advisory committee also recommended that the vaccine be included in the Vaccines for Children Program, which provides free vaccines for children up to age 18 who are eligible for Medicaid, are uninsured or are Native American or Alaskan Native.

The recommendations will be passed along to the head of the CDC and to the U.S. Department of Health and Human Services for review, and are expected to be accepted.

Gardasil, manufactured by Merck & Co., is the first vaccine to protect against HPV, known to cause most cervical cancers.

The U.S. Food and Drug Administration approved Gardasil earlier this month for girls and women aged 9 to 26. An FDA advisory panel had signed off on the vaccine in May.

Cervical cancer is the second most common malignant disease in women globally, causing an estimated 290,000 deaths worldwide each year. In the United States, some 10,400 new cases will be diagnosed this year, and 3,700 women will die from the disease.

The main cause of cervical cancer is continuous infection with HPV, especially HPV 16 and 18, which are spread by sexual contact. The virus also causes precancerous and benign cervical lesions and genital warts, and may be implicated in some anal and oral cancers. An estimated 20 million men and women in the United States are infected with HPV but, for most, the virus shows no symptoms and goes away on its own.

In a two-year study involving more than 12,000 women, Gardasil was found to be 100 percent effective against four types of human papillomavirus: 16 and 18, which are responsible for about 70 percent of cervical cancer cases, and 6 and 11, which cause 90 percent of genital wart cases.
Merck has said the vaccine has the potential to reduce the annual number of new cervical cancer cases around the world from 500,000 to about 150,000, and cut deaths by more than two-thirds, to about 90,000.

At the annual meeting of the American Society of Clinical Oncology earlier this month in Atlanta, scientists reported that the Gardasil vaccine was also 100 percent effective against vulvar and vaginal precancerous lesions caused by HPV types 16 and 18.

Like many other vaccinations, Gardasil will require three shots over six months. Even with the vaccine, women would still need to be screened for cervical cancer caused by other types of HPV, experts noted. This is most often accomplished by having a Pap test, which is still a very accurate indicator of a woman's cervical condition.

In fact, Schuchat stressed, the vaccine "will not replace other prevention strategies, such as cervical cancer screening for women or protective sexual behaviors. Women should continue to get Pap tests as a safeguard against cervical cancer."

It's unclear whether insurance providers will pay for the cost of the vaccine -- estimated to be $120 -- for children not covered under the Vaccines for Children Program.

"We are hopeful that managed care will pick this up," Schuchat said. "Working on ensuring access is very important."

More information
Visit the National Immunization Program for more on childhood immunizations.

Integrated Medicine is the best of both worlds.

Integrated Medicine is the best of both worlds. It answers the question of, "Should I spend my money to see a conventional doctor or a naturopathic doctor?"

Integrated Medicine is both; its physicians who practice both traditional and alternative medicine. With Integrated Medicine you get a doctor that is concerned with the whole person (diet & lifestyle, mental well being, prevention of disease, and overall balance and harmony) while using the latest scientific advances. Integrated Medicine is known to have a person-centered approach, which emphasizes understanding and caring. There have been grants given by congress to the Office of Alternative Medicine (OAM) for further research into Integrated Medicine. These grants have been dispersed to major universities such as, Harvard Medical School, Columbia University, and Stanford University. Also, there have been meetings with the researchers and insurance companies like Blue Cross & Blue Shield regarding Integrated Medicine and its cost effectiveness. Integrated Medicine, focusing on changing lifestyle to promote ultimate health, would cut costs.

Facial Acupuncture: Safe and Effective?

Facial Acupuncture: Safe and Effective?
Provided by: DrWeil.com

Q: Is facial acupuncture really a worthwhile alternative to a facelift? -- Diane A: Facial (or cosmetic) acupuncture is being offered by some practitioners as a natural alternative to facelifts. It may provide some temporary improvement in facial muscle tone and help minimize lines and wrinkles on the face. However, you won't get the lasting results of a surgical face lift, in which excess fat is removed, the muscles underlying the face are tightened, and the skin of the face and neck are re-draped. Bear in mind that even a face lift won't stop the aging process - it gives the illusion of turning back the clock somewhat, but it doesn't stop the ticking. Afterward, you'll look younger and fresher, but after a few years, you'll again see the signs of aging that prompted you to seek the surgery in the first place.
Compared to a surgical facelift, which can cost many thousands of dollars and carries the risks of both surgery and anesthesia, facial acupuncture is far less costly and much safer. But between ten and 25 treatments may be needed before you see any effects. Acupuncturists say that treatments bring more blood and energy flow (Qi) to the face, both of which theoretically improve muscle tone. I'm told that the treatments are relaxing and have psychological benefits, both of which may add to the perceived improvements.
Facial acupuncture involves placement of needles, usually in wrinkles or sagging areas of skin. Each treatment takes about an hour or less. A facelift takes several hours, and is done under either local or general anesthesia; afterward, your face will be swollen and bruised and feel tender and numb. Most patients can resume their normal activities about two weeks after the surgery.
Facial acupuncture seems to be safe enough, but I can't vouch for lasting results, and I'm not a proponent of procedures designed to interfere with the normal aging process. (I have a whole chapter on this subject in my forthcoming book, Healthy Aging.)
Andrew Weil, MD
Last Reviewed: May 2005

Forearm Support May Cut Computer Injuries

FRIDAY, April 28 (HealthDay News) -- An "ergonomic board" that provides forearm support may relieve upper body pain and disorders that can develop from spending extended hours on a computer, a new study suggests.
The device, a board that attaches to a desk and supports the forearm, lowered the risk of developing shoulder and neck problems by nearly half and significantly reduced neck, shoulder and right arm pain associated with computer work.
"Computer-related injuries mainly occur in the neck and shoulder region. The elbow and wrist are the second most common area," explained study lead author Dr. David Rempel, professor of medicine at the University of California, San Francisco. "This study, done in people who spend 30 to 40 hours a week in front of a computer, found that a forearm support can prevent some of these injuries and decrease pain."
The findings appear in the current issue of the British journal Occupational and Environmental Medicine.
For the study, researchers evaluated the impact of two ergonomic devices on the severity and incidence of these computer-related injuries. They monitored 182 employees from two customer-service center sites for one year. The employees were randomly put into one of four groups, each receiving a different "ergonomic intervention." One group received ergonomic training; a second got the training plus a trackball mouse; a third group received the training plus forearm support; and the fourth received the training plus a trackball mouse and forearm support.
Each week the participants filled out a questionnaire, which included assessing pain in the neck, shoulders and left and right arms on a scale of 0 to 10; physicians also diagnosed any new upper body musculoskeletal disorders that developed.
The result: The forearm support boards plus ergonomic training provided the most protection against computer-related injuries. Specifically, the boards reduced the risk of neck and shoulder disorders by nearly half, compared to the group that only received ergonomic training, and resulted in an average 0.5 point drop (on the 10-point scale) in neck and shoulder pain. This may be a small drop, Rempel said, but it could be significant in a large population, said Rempel. The number of arm disorders didn't change with forearm support use, but pain in the right arm dropped by nearly three-quarters of a point, he said.
"The forearm support probably reduced the shoulder load so that the neck and shoulder weren't doing as much work. Also, it probably kept the wrist in a more straight and neutral position," he said.
Use of the trackball had mixed results. It significantly reduced left upper extremity pain and disorders, but had no effect on right upper extremity disorders. These findings were unexpected, the researchers said, since 98 percent of the participants used the mouse with their right hand.
The researchers also did a return-on-investment analysis to see if the forearm support would make financial sense to employers. The average cost per board is around $100, said Rempel. The study found that employers would recover these costs within about 10 months of purchasing the boards.
Dr. Mark Melhorn, a clinical assistant professor at the University of Kansas School of Medicine-Wichita, said, "It is reasonable to make a small investment in an arm or wrist rest if it makes the user feel comfortable. The cost associated with muscle pain can be high and the intervention cost is low."
The study also recommended other ergonomic measures to help relieve computer-related injuries. These include maintaining an erect sitting posture; a chair height that allows the thighs to be parallel to the floor; adjusting the arm support and work surface height so the forearms are parallel to the floor; a mouse and keyboard location that minimizes reach; adjusting the monitor height so its center is about 15 degrees below the visual horizon; and taking scheduled breaks.
Melhorn added that such steps are only half the solution, though, since people develop musculoskeletal disorders and muscle pain due to a combination of individual risk factors, such as age, gender and genetics, and their physical activity at home and in the workplace.
"If you take 100 people and put them in front of a computer, only 14 percent will develop muscle pain," he said. "If just the job caused these injuries, then 100 percent would have the muscle-pain condition. So you need to improve the person and the workplace. This study only addresses a small spectrum of these causes, but it's a good start in the right direction."
More information
For more on how to make your computer workstation safe and comfortable, visit the Occupational Safety and Health Administration.

Dementia Rates To Double in 20 Years

I've been warning you for some time about the Alzheimer's epidemic waiting to happen in America. Based on the latest report from Alzheimer's Disease International on dementia, however, that epidemic has arrived, and on a worldwide scale too.

These numbers will shock you:

• A new dementia patient is diagnosed every 7 seconds.
• More than 24 million patients worldwide already have dementia and, almost 5 million new cases are reported annually.
• More than 20 percent of those suffering from dementia live in China, followed closely by Western Europe and North America.
• The number of dementia patients will exceed 80 million by 2040.

Folks, neither dementia or Alzheimer's are isn't a normal part of the aging process, and you can take steps to prevent their damage naturally, safely and without the need for a drug. Here's how:

• Get moving with an exercise program today!
• Eat a healthier diet, based on your body's unique metabolic type and be sure to increase your intake of fresh vegetables, high in folate.
• Challenge your mind by learning new things.
• Avoid aluminum and mercury at all costs.
• Consume a high quality fish or cod liver oil daily.
  

BBC News December 16, 2005

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