Friday, August 31, 2012

How YOU Can be a Smart Healthcare Consumer

Wise Health Care Consumer

Health care seems more complicated than ever these days.

How do smart consumers navigate the system?

·         Keep your own medical records.   What happens if you need help when traveling?  Make a list of your medications, providers (with phone and fax numbers) and allergies.  If you scan and save reports or test results online, you can then access them remotely while traveling.  Yes, there’s an app for that.

·         Prevent Problems.  Schedule regular checkups, and stay current with immunizations and screenings.

·         Choose Providers Carefullly.  Obtain referrals from trusted friends and professionals, check for board certification and experience.  Get a second opinion when in doubt.

·         Arrive at appointments prepared.  Come early to fill out paperwork, and have your own notepad and questions ready in advance.

·         Be wise with drugs.  Read the labels, take as directed, and be familiar with side effects and possible drug interactions.  Buy generics or purchase by mail when available to save money.  Keep first-aid, anti-itch, pain and cold remedies on hand. 

·         Save the ER for true emergencies.  Call your provider (or self treat) for low grade fevers, minor cuts, rashes and mild sunburns.  CALL 911 or go to the ER for loss of consciousness, uncontrollable bleeding, signs of stroke or heart attack, an allergic reaction with breathing difficulty, or poisoning.

Thursday, August 30, 2012


Fall is the time when many colorful fruits come into season.  Here are just a few varieties:

Lots of varieties – Jonagold, Fuji, Gala, Braeburn and Pink Lady to name a few
Eating plain for dessert or for a sweet snack
Grapes (Red, Purple, or Green)
The perfect portable snack
Taking a bunch to work
Contain 5 grams of fiber per serving
Topping a bed of baby spinach with grilled pears, pecans and goat cheese

Stock up or freeze for later use
Adding to your morning oatmeal

Monday, August 27, 2012

What Does Healthcare Reform Mean for YOU



Now that the Supreme Court has upheld much of the constitutionality of the Patient Protection and Affordable Care Act signed into law by President Obama in 2010, it is the perfect time to review many of the key provisions that could affect you!

The changes that have already taken place are:

o   Children under 19 are not able to be denied coverage due to a preexisting condition.

o   Adult children are now able to remain on their parent’s medical plan until the age of 26.

o   Lifetime maximum payouts for insurance plans were eliminated.  In addition, the annual coverage limits are going to be phased out.  Beginning on September 23, 2012 the annual limit will be increased to $2 million.

o   All new plans are now required to provide certain preventative services free of charges.  Some examples include mammograms, immunizations and colonoscopies.

o   Those who may have been refused coverage in the past due to a preexisting condition may now be eligible for coverage through their state’s “high-risk pool” program.  To learn more about this program, you can visit

o   Those who are eligible for and participate in Medicare Part D and who reach their “doughnut hole” will now be eligible to receive a 50% discount on brand-name prescription drugs and a 14% discount on generic medications.  These discounts will continue to increase until 2020 when the doughnut hole will disappear.

The highlights of what you can expect between now and 2014:

o   August 1, 2012 – insurance companies that did not spend at least 85% of the 2011 premium dollars (for any large group plans with more than 50 employees) on medical care will be required to refund the difference through refund check or by discounting future premiums. 

o   October 1, 2012 – all plans must begin to adopt rules for the safe and secure electronic exchange of health information to reduce paperwork, cost and medical errors.

o   January 1, 2013 – a new federal ruling will be in place for state Medicaid programs that choose to cover preventative services to their members at little or no cost to them.

o   October 1, 2013 – States will receive two years of additional funding to continue coverage for children that are not eligible for Medicaid.

o   January 1, 2014 – Most key provisions of the PPACA will be in place, including:

-          Those individuals whose employers do not offer them health coverage will be able to purchase state-based coverage through Affordable Insurance exchanges.  These exchanges will offer a number of different health plans that are required to cover certain services and follow mandated standards.

-          Many of those who are able to afford health coverage but choose not to obtain it will be required to purchase coverage or pay a fee to offset the cost for the uninsured Americans.  Those Americans who earn less than 133% of the poverty level will eligible to enroll in Medicaid.

-          Tax credits will become available to those who earn between 100% and 400% of the poverty level to help them pay for affordable insurance options.  They may also qualify for other savings including reduced co-payments, coinsurance and deductible amounts.

-          Limitations on annual coverage dollars will be eliminated

-          Adults can no longer be refused coverage because of preexisting conditions.

-          Insurance companies will be prohibited from charging higher rates to individuals and small groups based on gender or health status. 

-           To learn more about the upcoming healthcare reform changes that could affect you, check our blog and visit


Content adapted from

Wednesday, August 22, 2012

Stroke Risk Higher After Bypass Than Angioplasty: Analysis

About 1 in 80 surgery patients, 1 in 300 angioplasty patients have stroke complication, new review shows

By Kathleen Doheny
HealthDay Reporter

MONDAY, Aug. 20 (HealthDay News) -- The potential for a stroke is far more common after a bypass than after angioplasty, new research reports, even though the risk after either heart procedure is still relatively low.

A team of researchers analyzed the results of 19 clinical trials involving nearly 11,000 patients who were assigned randomly to get coronary artery bypass graft surgery (CABG) or angioplasty, also called PCA (percutaneous coronary intervention), a procedure in which a balloon is used to re-open the clogged artery.

"At 30 days, stroke was about four times more common with bypass surgery compared to PCA," said study author Dr. Gregg Stone, a professor of medicine at Columbia University Medical Center in New York City.

Stroke is an important complication to track, Stone noted, adding, "Next to death, it is probably the most feared complication."

The new analysis is published online Aug. 21 in JACC: Cardiovascular Interventions. It will also be published in the Aug. 28 issue of the Journal of the American College of Cardiology.

In bypass surgery, a healthy artery or vein taken from the patient is grafted, or connected, to other arteries in the heart to bypass the blocked vessel. In angioplasty, a catheter is inserted into the vessel to the point of blockage, and then a balloon is inflated to clear it. Sometimes a stent is used to keep open the vessel.

Stone's team looked at the patients' stroke rates 30 days and a year after the procedures.

At 30 days, 1.2 percent of the surgery patients had suffered a stroke, compared with .34 percent of the angioplasty patients. At the one-year mark, 1.83 percent of the surgery patients and .99 percent of the angioplasty patients had had a stroke.

Put another way: "The likelihood of stroke is about 1 in 80 for patients who have surgery and 1 in 300 for patients who have angioplasty," Stone said.

The finding held, he added, even after researchers took into account the extent of disease and other variables.

While some patients clearly need surgery, Stone said, some have disease that could be treated either way. For those patients, he said, the findings about stroke can be weighed into their decision about which treatment to choose.

The study findings echo what cardiologists have long believed, said Dr. Kirk Garratt, director of interventional cardiology at Lenox Hill Hospital in New York City.

In bypass surgery, he said, there is naturally more trauma to the body than there is during angioplasty.

The new analysis, he said, "confirms what has been accepted by cardiologists."

While some patients have the option of either procedure, such as patients with only one or two blockages, surgery is indicated if a patient has multiple blockages, Garratt added.

According to the U.S. Centers for Disease Control and Prevention, hospital discharge data from 2009 shows about 415,000 bypass graft surgeries and 605,000 angioplasties or atherectomy (a similar procedure) were done that year.

More information

To learn more about heart disease, go to the American Heart Association.

SOURCES: Kirk Garratt, M.D., director, interventional cardiology, Lenox Hill Hospital, New York City; Greg Stone, M.D., professor, medicine, Columbia University Medical Center, New York City; Aug. 21, 2012, JACC: Cardiovascular Interventions and Aug. 28, 2012, Journal of the American College of Cardiology

Last Updated: Aug. 20, 2012

Copyright © 2012 HealthDay. All rights reserved.

Thursday, August 16, 2012

New Diet Pills Offer Option to Off-Label Obesity Drugs


July 30, 2012, 6:50 p.m. ET

Piper Miguelgorry started gaining weight in her 30s and 40s, after having three sons. The environmental researcher from Folsom, Calif., tried many diet regimes, without success, until she found a weight-loss center in nearby Roseville, where phentermine, a prescription appetite suppressant, was part of the plan, along with a high-protein, low-carb diet.

"Much to my surprise, I lost 50 pounds," says Mrs. Miguelgorry, 58, who has kept it off for more than a year. She also beat Type 2 diabetes and cut her cholesterol in half. She credits phentermine with helping reduce her craving for carbohydrates and plans to stay on it indefinitely.

Two diet pills just approved by the FDA, Qsymia and Belviq, won't be available for several months, but some doctors have been prescribing the ingredients of Qsymia (a migraine drug and phentermine, an old diet pill) to patients for years specifically for weight loss. Melinda Beck on Lunch Break explores the risks and side effects. Photo: AP.
Physicians who treat obesity hailed the Food and Drug Administration's recent approval of two new diet drugs—the first in 13 years—as a new era in weight-loss management. But some obesity specialists, including those at prestigious medical centers, have been prescribing medications to help patients lose weight for decades, both on and off-label.

Those medications include phentermine and several other stimulants approved for weight loss in the 1950s, as well as drugs to treat diabetes, depression and attention-deficit disorder that have weight-loss as a side effect.

One of the newly approved drugs, Qsymia, is a combination of phentermine and topirimax, a drug for easing seizures and migraines that also tends to make people feel full. The other, Belviq, works on brain receptors for serotonin, a neurotransmitter than triggers feelings of satisfaction.

Physicians can legally prescribe medications for uses not specifically approved by the FDA. But most obesity doctors do so cautiously given the history of diet pills removed from the market due to serious side effects including death.

"The fact that we've got two new drugs approved will reaffirm to the public that this truly is a medical problem and there's a place for pharmacotherapy," says Ed Hendricks, head of the Center for Weight Loss Management, which treated Mrs. Miguelgorry.

While some experts argue that people who are obese should simply eat less and exercise more, many physicians who treat obesity say it is driven by biological changes in the body, not lack of willpower.

"People say, 'Why are you treating a lifestyle problem with medication?' If you think that, you don't understand obesity," says Louis Aronne, director of the Comprehensive Weight Control Program at New York Presbyterian Hospital/Weill Cornell Medical College. He says there is mounting evidence that in some people, neurons in the hypothalamus that should recognize when the body has stored sufficient fat and either cut food intake or boost energy expenditure aren't working properly. Medications can help, says Dr. Aronne, who oversaw clinical trials of Qsymia.

In trials of 3,700 obese and overweight patients, those who took Qsymia for one year lost 6% to 9% more of their body weight than those on a placebo. Nearly 70% lost at least 5% of their weight.

With Belviq, of nearly 8,000 patients studied, those on the drug lost about 4% more than those on placebo. All were also counseled to exercise and eat a reduced calorie diet. The FDA says people who don't lose at least 5% of their weight in 12 weeks should discontinue the drugs.

People who eat very large portions or think about food all the time, even right after a meal, aren't getting biochemical signals to stop eating and may find drugs helpful, says Robert F. Kushner, clinical director of the Comprehensive Center on Obesity at Northwestern University.

People who eat for emotional reasons tend to benefit less, although drugs can help clarify their motivations. "If you give a medication that makes them feel full, but they still keep eating, it becomes very clear that it really is emotional," says Dr. Kushner, chairman of the American Board of Obesity Medicine.

The new drugs are FDA approved for patients with a body mass index of 30 or higher, or with a BMI of 27 and high blood pressure, diabetes, high cholesterol or sleep apnea. People with very large amounts of weight to lose may benefit more from bariatric surgery, or a combination, doctors say. The drugs aren't covered by most insurance companies. They are expected to be available this fall.

Most of the drugs currently prescribed for weight loss suppress appetite by affecting neurotransmitters, which send signals in the brain. Stimulant medications are among the most powerful. The FDA approved several stimulants—including phendimetrazine (marketed as Bontril) and diethylpropion (Tenuate)—specifically for weight loss in 1959. They remain on the market today.

How They Work

Drugs sometimes prescribed for weight loss work in various ways.

·         Stimulants rev up the central nervous system.

·         Antidepressant drugs such as buproprion (Wellbutrin) affect brain chemistry.

·         The diabetes drug metformin (Glucophage) reduces the impact of blood sugar. Liraglutide (Victoza) boosts a gut hormone to promote fullness.

·         The FDA-approved obesity drug orlistat (Xenical, Alli) blocks fat absorption.

·         Naltrexone (Depade, ReVia) blocks opiod receptors and makes food less appealing.

The best known is phentermine, half of the popular fen-phen combination in the 1990s until fenfluramine was linked to heart-value damage and discontinued in 1997. Because they are potentially addictive, phentermine and the others are approved for short-term use only. "But all of us use it long-term," says Dr. Kushner. Dr. Hendricks, who says he has treated 15,000 patients with phentermine, alone and in combinations, over 23 years, and says that patients who keep taking it tend to maintain their weight loss. Drs. Aronne, Hendricks and Kushner all consult for drug makers.

ADHD drugs including Ritalin and Adderall also suppress appetite in some patients, but most obesity doctors use older generic stimulants. Patients with heart disease, high blood pressure, hyperthyroidism or glaucoma should not use stimulants.

The diabetes drug Metformin helps decrease the amount of sugar the body absorbs from food and increases the body's response to insulin. Some patients can experience dangerously low blood sugar.

It is unclear why bupropion (Wellbutrin) doesn't make patients gain weight the way other antidepressants do, but it may help ease cravings. (Last month, GlaxoSmithKlein agreed to pay a $3 billion fine in part for promoting Wellbutrin for weight-loss and other off-label uses.)

Naltrexone (Depade, ReVia) helps alcoholics stop drinking by blocking opiod receptors in the brain, diminishing the kick booze provides. It may make food less rewarding the same way. Side effects, in rare cases, may include liver damage.

Some clinics promote human chorionic gonadotropin (hCG), an infertility treatment, as a way to "reset metabolism" when combined with a 500-calorie-a-day diet. But obesity experts say there is no evidence that hCG works better than a placebo. The FDA has warned seven companies to stop selling over-the-counter hCG and making unsupported claims.

Respected obesity experts say consumers should be wary of purported diet drugs sold over the Internet, as well as doctors who sell drugs from their offices, with little or no evaluation or without a comprehensive weight-loss plan.

Diet Drugs Over the Years

Medications the FDA approved, rejected or the makers withdrew

Years on the U.S. Market
Drug (Brand Name)

Discontinued due to potential for abuse

Phentermine and other anoretics
Appetite suppressants; approved for short-term use only


'Rainbow pills'
Amphetamine, digitalis, diuretics combined; discontinued after links to several deaths

Fenfluramine (Pondimin)
Often combined with phentermine in 'fen-phen'; withdrawn after links to heart value problems

Dexfenfluramine (Redux)
Similar to fenfluramine; withdrawn after links to heart value problems

Sibutramine (Merida)
Withdrawn due to risk of heart attack, stroke

Orlistat (Xenical, Alli)
Blocks fat absorption

2007 (rejected)
Rimonabant (Acomplia)
Suspected link to suicidal thoughts

2011 (rejected)
Combines an antidepressant and an alcoholism drug; now undergoing more trials

Qsymia, Belviq
Approved after additional data submitted

A version of this article appeared July 31, 2012, on page D1 in the U.S. edition of The Wall Street Journal, with the headline: New Diet Pills Offer Option To Off-Label Obesity Drugs.

Copyright 2012 Dow Jones & Company, Inc. All Rights Reserved

Wednesday, August 15, 2012

New Generics Will Save You Money

In the next 15 months, six of the top 10 drugs used by Americans will face generic competition.  Almost 15 million Americans take Lipitor for cholesterol, the diabetes drug Actos, and the anti-clotting drug Plavix.  Additional drugs going generic include Adavair, Cymbalta, Nexium, Diskus and Seroquel.  Those drugs will  be available in generic form in July of 2014.
The expiration of these patents represents an unprecedented savings opportunity since generics are often priced 90% lower than the brand names.  Lipitor, for example, may cost as little as $5 as opposed to the $40-$90 cost now. 
Sometimes, patients are afraid to switch to a generic substitute for  fear that the drug will not be as effective.  Below are some facts from the Food and Drug Administration (FDA) regarding Generic drugs.
FACT: FDA requires generic drugs to have the same quality and performance as the brand name drugs.  
  • When a generic drug product is approved, it has met rigorous standards established by the FDA with respect to identity, strength, quality, purity and potency.  Some variability can and does occur during manufacturing, for both brand name and generic drugs. When a drug, generic or brand name, is mass produced, very small variations in purity, size, strength and other parameters are permitted.  FDA puts limits on how much variability in  composition or performance of a drug is acceptable.
  • Generic drugs are required to have the same active ingredient, strength, dosage form, and route of administration as the brand name (or reference) product.  Generic drugs do not need to contain the same inactive ingredients as the brand product.
  • Through review of bioequivalence data, FDA assures that the generic product will perform the same as its respective brand name (or reference) product. This standard applies to all generic drugs, whether immediate or controlled release.
  • A generic drug must be shown to be bioequivalent to the reference drug; that is, it must be shown to give blood levels that are very similar to those of the reference product.  If blood levels are the same, the therapeutic effect will be the same.  In that case, there is no need to carry out a clinical effectiveness study and they are not required. 
  • All generic manufacturing, packaging and testing sites must pass the same quality standards as those of brand name drugs and the generic products must meet the same exacting specifications as any innovator brand name product.  In fact, many generic drugs are made in the same plants as innovator brand name drug products.
  • If an innovator of a brand name drug switches drug production to an alternative manufacturing site, or they change formulation of their brand name drug, these companies are held to the same rigorous manufacturing requirements as those that apply to generic drug companies.
FACT:  Research shows that generics work just as well as brand name drugs.
  • A recent study evaluated the results of 38 published clinical trials that compared cardiovascular generic drugs to their brand-name counterparts. There was no evidence that brand-name heart drugs worked any better than generic heart drugs. [Kesselheim et al. Clinical equivalence of generic and brand-name drugs used in cardiovascular disease: a systematic review and meta-analysis. JAMA. 2008;300(21)2514-2526]. 
FACT: When it comes to price, there is a big difference between generic and brand name drugs. On average, the cost of a generic drug is 80 to 85% lower than the brand name product.
  • An IMS National Prescription Audit shows that a typical formulary now charges $6 for generic medications, $29 for preferred branded drugs, and $40 or more for non-preferred branded drugs. [Aitken et al. Prescription drug spending trends in the United States: looking beyond the   turning point. Health Aff (Millwood). 2009;28(1):w151-60].
  • Independent research has shown that total prescription drug expenditures in the United States only increased by 4.0% from 2006 to 2007, with total spending rising from $276 billion to $287 billion. This is a sharp decrease from the 8.9% growth rate observed in prescription drug expenditures in 2006. One factor cited as a reason for the slowdown is an increase in availability and use of generic drugs [Hoffman et al. Projecting future drug expenditures--2009. Am J Health Syst Pharm. 2009;66(3):237-57].
Recently, some misinformation has raised concerns over generic drugs.  Below are some common myths in circulation.
MYTH:   FDA lets generic drugs differ from the brand name counterpart by up to 45 percent.
FACT:    This claim is false.  Anyone who repeats this myth does not understand how FDA reviews and approves generic drugs. 
  • FDA recently evaluated 2,070 human studies conducted between 1996 and 2007. These studies compared the absorption of brand name and generic drugs into a person’s body. These studies were submitted to FDA to support approval of generics. The average difference in absorption into the body between the generic and the brand name was only 3.5 percent [Davit et al. Comparing generic and innovator drugs: a review of 12 years of bioequivalence data from the United States Food and Drug Administration. Ann Pharmacother. 2009;43(10):1583-97]. Some generics were absorbed slightly more, some slightly less. This amount of difference would be expected and acceptable, whether for one batch of brand name drug tested against another batch of the same brand, or for a generic tested against a brand name. In fact, there have been studies in which branded drugs were compared with themselves as well as with a generic.  As a rule, the difference for the generic-to-brand comparison was about the same as the brand-to-brand comparison.
  • Any generic drug modeled after a single, brand name drug (the reference) must perform approximately the same in the body as the brand name drug. There will always be a slight, but not medically important, level of natural variability – just as there is for one batch of brand name drug to the next.
MYTH:  People who are switched to a generic drug are risking treatment failure.
FACT:   There is no evidence for this claim. Treatment failures can and do occur when taking  generic or brand name drugs.  If someone is switched to a generic drug around the time they are relapsing, they may attribute the problem to the switch.
  • Many people who have recovered from major depression have a relapse despite continued treatment. These relapses have been shown in trials of long-term therapy. [Byrne and Rothschild. Loss of antidepressant efficacy during maintenance therapy: possible mechanisms and treatments. J Clin Psychiatry. 1998;59(6):279-88].
  • Many people who are on a seizure medications will re-experience a seizure despite continued treatment. [Randomised study of antiepileptic drug withdrawal in patients in remission. Medical Research Council Antiepileptic Drug Withdrawal Study Group. Lancet. 1991;337(8751):1175-80].
  • A percentage of people will re-experience gastric ulcers, despite an initial, positive response to and continued treatment with prescription strength antacids (cimetidine tablets;
MYTH: Generic drugs cost less because they are inferior to brand name drugs.
FACT: Generic manufacturers are able to sell their products for lower prices, not because the products are of lesser quality, but because generic manufacturers generally do not engage in costly advertising, marketing and promotion, or significant research and development. 
  • When a brand name drug comes off patent and generic drugs are permitted to compete with the brand name drug, the generic products compete by offering lower prices. Unlike the manufacturers of brand name drugs, generic drug companies do not have significant expenses to recoup for advertising, marketing and promotion, or research and development activities.
MYTH:  There are quality problems with generic drug manufacturing.  A recent recall of generic digoxin (called Digitek) shows that generic drugs put patients at risk.
FACT: FDA’s aggressive action in this case demonstrates the high standards to which all prescription drugs – generic and brand name – are held.
  • In March 2008, FDA performed a scheduled inspection of the Actavis production facility and identified products that were not manufactured to required specifications over a period of time extending back to the year 2006.  Included in this list of products was one particular lot of Digitek. 
  • Actavis detected a very small number of oversized tablets in this lot (specifically, 20 double-sized tablets in a sample of approximately 4.8 million tablets). 
  • Although Actavis attempted to remove the affected Digitek tablets through visual inspection, FDA determined that this method of removal was inadequate to assure the product’s quality and consistency in accordance with the current Good Manufacturing Practice (cGMP) regulations. 
  • Since the detection of the manufacturing problem, FDA has been actively engaged with this company to ensure that ALL potentially affected lots of Digitek tablets have been recalled.  In our best judgment, given the very small number of defective tablets that may have reached the market and the lack of reported adverse events before the recall, harm to patients was very unlikely.
  • FDA takes action whenever we find that a drug manufacturer is not following cGMPs.  Over the last ten years, FDA has taken enforcement action against many brand name and generic firms for failing to meet FDA manufacturing quality standards.