Pre-Order the new Kindle! Amazon's new Kindle ebook reader will be released on August 27. It's sleeker, lighter, brighter, has longer battery life and double the storage and costs less than previous models!
You can pre-order the New Kindle today.
Please Take Our Survey We've designed a very short survey to help us improve our site, its contents and the topics that we may cover in the future. After reading today's article, please take a few minutes to complete the survey.
Quote of the Day "Okay, you've convinced me. Now go out there and bring pressure on me." - President Franklin D. Roosevelt (In response to a business delegation).
What’s New?  Check out the Silver Buzz Cafe group on Facebook.
“Green” Blogging 
We believe in protecting our environment, so the Silver Buzz Cafe web site is hosted on a server in a "green", energy conserving data center. 100% of the power for the datacenter is bought from suppliers that use renewable energy sources, such as hydroelectric, windmill and solar plants.
Read more... |
 The government estimates that around 20% of Medicare claims are fraudulent. If true, that amounts to around $75 billion of wastage within the system every year. One of the aims of the Government Accountability Office (GAO) during the formulation of the recent health care reform bills was to focus on the problem and reduce Medicare fraud to help pay for new provisions. A draft bill aimed at addressing the problem, H.R.5044 – “Medicare Fraud Enforcement and Prevention Act of 2010″, was introduced on April 15th. but it received little attention in the wake of the bigger bills. Powerful supporters, including AARP, are now throwing their weight behind the bill.
The stated goals of the bill are: “To provide for enhanced penalties to combat Medicare and Medicaid fraud, a Medicare data-mining system and biometric technology pilot program, and a GAO study on Medicare administrative contractors.” The bill doubles many of the current penalties for infractions and removes loopholes in the wording of current legislation. It also instructs the GAO to conduct a one year study of Medicare administrative contractors, including Recovery Audit Contractors, regarding the following areas:
- Training and expertise in identifying fraud, including the education levels of the key individuals tasked to identify or refer potential cases of fraud, and whether the Centers for Medicare & Medicaid Services (CMS) should be providing more training to contractors, or require contractors to hire experts with greater medical training.
- Acquisition and implementation of data mining software among Medicare administrative contractors, if applicable, and the ability or availability of such software to provide real-time data mining capabilities.
|
Bringing technology to bear
The bill also adds two important new technology requirements to the Medicare system. The first requires enhanced screening of payments and claims, including real-time access for people (such as fraud prevention staff) who need it, plus better data sharing capabilities. The second could be very effective but may also be highly controversial. It mandates a five year long pilot program of a biometric system designed to ensure that individual who are deemed to have received services were actually physically present when they were delivered and billed for.
Biometric systems use a unique physical characteristic of a person, such as a fingerprint, eye scan, ear contours or voice print, to identify them. The ultimate system would combine one or more of these measurements with a DNA sample. This is great, in theory, because a fraudulent provider wouldn’t be able to get authorization for a service 100% covered by Medicare and bill for it without actually providing the service. This kind of fraud occurs when periodic services, such as dialysis, are provided frequently. It’s easy for the patient to overlook a few rogue line items in a summary of the services they’ve received.
Privacy concerns
The downside is that the government will have to maintain a database of this personal information and either collect details from every provider for every patient visit or release the information to them so that they can be used when that a patient checks in and out. Many people will regard this as an intrusion into their privacy, even though they are receiving a government benefit. The dangers of a security breach are quite worrying. What if somebody accesses the details, produces a latex version of your fingerprint and then obtains free Medicare services that you get billed for. Even more worrying, what if the information is shared with law enforcement agencies and the person who stole your identity robs a bank or kills someone, leaving your fingerprints at the scene?
It will be interesting to see what positions the Democrats and Republicans take on this one. The provisions in the bill are designed to cut the cost of Medicare fraud, but they carry quite large expenses up front, to update and introduce technology. The privacy issues may generate heated debate. Both parties have agreed on the need to reduce Medicare fraud, but the Republicans would prefer to do that by eliminating Medicare altogether. We’ll cover the debate as it unfolds.
 There are an estimated 37 million people worldwide, including 5.3 million in the United States, who live with some form of dementia, with Alzheimer’s disease being the most prevalent. This figure is expected to increase rapidly over the next 20 years as populations age. In earlier articles we reported new brain scanning techniques that show promise in detect the early onset of Alzheimer’s and the discovery that a group of genes called sirtuins are involved in the aging process.
New research1 by Gizem Donmez, Leonard Guarente and colleagues at the Massachusetts Institute of Technology (MIT) has shown that activating sirtuin also appears to suppress Alheimer’s and destroying it made the disease much worse. Dr. Guarente said that the protein’s protective power against other diseases made him wonder if it might also help against Alzheimer’s. The MIT team used genetically engineered mice that tend to develop Alzheimer’s-like symptoms.
How it works
The team found that activating the sirtuin seemed to protect the brains of the Alzheimer’s-prone mice used in the experiment in two ways. It activated a system that protects brain cells against stress and it enhanced an enzyme whose activity avoids the buildup of the plaque that is characteristic of Alzheimer’s, particularly of a toxic component called A-beta peptide. Reducing the amount of A-beta peptide is only helpful in the presence of Alzheimer’s, but turning on the other mechanism could provide general protection for the brain. The M.I.T. researchers concluded that activating sirtuin, “is a viable strategy to combat Alzheimer’s disease and perhaps other neurodegenerative diseases.” They are also trying to determine whether it can help counter Parkinson’s and Huntington’s disease.
Some drugs that activate sirtuin already exist, including some based on resveratrol, found in red wine and other foods, and small-molecule chemicals designed to mimic resveratrol. The company that developed the drugs, Sirtris, is testing them against diabetes and other diseases, but their current drugs do not cross the blood-brain barrier, so they would not work against Alzheimer’s. However, Sirtris’s Chief Executive Officer, George P. Vlasuk, said that the company has developed other sirtuin-activating chemicals that do reach the brain and are in preclinical trials. Should resveratrol prove ineffective, Sirtris also has two small-molecule chemical drugs, known as 2104 and 2379, that can be given in much smaller doses and which are also in clinical trials.
1 An early review of the research is available in Cell, Volume 142, Issue 2, 194-196, 23 July 2010 – doi:10.1016/j.cell.2010.07.006 – in an article with the title “Giving Alzheimer’s the Old One-Two” – Michael S. Wolfe and Dennis J. Selkoe.
 Parkinson’s disease is the second most common neurodegenerative disease in the United Kingdom and is currently affecting about 120,000 people there. More than half a million Americans are affected by it any given time and about 50,000 Americans are diagnosed with Parkinson’s every year. Those numbers are likely to increase as people are living longer and the disease becomes more prevalent as we age.
“Parkinson’s disease affects movement, producing motor symptoms, such as tremor, rigidity, bradykinesia (slowness of movement) and postural instability. It also produces non-motor symptoms, including autonomic dysfunction, cognitive and neurobehavioral problems, and sensory and sleep difficulties.
Most people with Parkinson’s disease are described as having idiopathic Parkinson’s disease (having no specific known cause). There are far less common causes of Parkinson’s disease including genetic, toxins, head trauma, cerebral anoxia, and drug-induced Parkinson’s disease.” – Wikipedia.
Induced pluripotent stem (IPS) cells
Stem cells have the ability to become any kind of cell found in the human body. The earliest experiments involved stem cells derived from human embryos, but there was a breakthough in 2007 when scientists developed induced pluripotent stem (IPS) cells, which can originate from many parts of the body. Pluripotency refers to a stem cell that has the potential to differentiate into any of the three germ layers: endoderm (interior stomach lining, gastrointestinal tract, the lungs), mesoderm (muscle, bone, blood, urogenital), or ectoderm (epidermal tissues and nervous system). Induced pluripotent stem cells are artificially constructed from cells that don’t have that property themselves.
Pluripotent cells (natural or induced) lack the ability to develop into embryos. However, they have proven able to exhibit many of the advantages of embryonic stem cells without any of the ethical downsides.
Using IPS cells to try to treat Parkinson’s
An Oxford University team will use adult stem cells to study the potential of using a person’s stem cells to treat Parkinson’s disease. They will use skin cells to grow the kind of neurons that die in the brains of Parkinson’s sufferers. Researchers will be take skin cells from 1,000 patients with early stage Parkinson’s and will then convert them into nerve cells carrying the disease to learn more about the brain disorder.
The new technique is particularly useful because it is difficult to obtain samples of diseased nerve tissue from patient biopsies. It will enable the researchers to create limitless quantities of nerve cells for use in experiments and to test new drugs. In this study the researchers will compare the functioning of cells taken from patients with the disease and those without to better understand why dopamine neurons die in patients with Parkinson’s.
Related articles: Search: Parkinson’s
 With more than 65 million people in the United States serving as informal caregivers, generally for family members, it’s important that they learn how to find their way through the entangled web of information connected to the cared person’s case. Most health care organizations are moving, or have moved, to electronic record keeping, but that doesn’t mean that a caregiver can automatically access that information, even if they are closely related to the patient. Luckily, Blue Cross® and Blue Shield® of Georgia have compiled a summary of the things that caregivers should know, especially about people who are on Medicare.
It’s very important that when you’re dealing with government programs, such as Medicare, or large bureaucracies, particularly health care insurers and providers, you have all of the relevant information at hand and that you know your and the patient’s rights. It’s also important to know when to seek extra help, especially when you’re finding it harder to cope. You can’t be a good caregiver if you’re running yourself into the ground, physically or mentally. There are organizations that can help you. They may be a part of a provider’s services, a government initiative or a charity.
Let’s look at the various steps that you should take to make sure that you’re well equipped with the information you’ll need:
- Gather information
- Get permission to access information and programs
- Enrol in chronic disease programs
- Know your rights
- Investigate getting extra help
- Take care of yourself
Gather Information
It’s wise to gather together at least the following information before you contact any health care or government organization:
- Health plan membership card.
- Medicare card (if eligible).
- A list of doctors, including specialists.
- A list of medicines and dosages, including ones that are no longer taken, if possible.
- Information about the person’s medical conditions, both treated and untreated.
Explain that the information is needed to advocate on the patient’s behalf with their doctors, hospitals and insurance companies. Some will be loathe to hand over control, but if they are able to be with you when you’re requesting services or information they’ll soon understand the reasons.
Get permission to access information and programs
The Health Insurance Portability and Accountability Act (HIPAA) is an important law that protects patient privacy. Providers and insurers cannot readily disclose a person’s health information, even to their own spouse or child. Caregivers must file the proper paperwork with all of the pertinent organizations. There are several ways to access the patient’s information. The most important are:
- Durable power of attorney – this can be established with the assistance of an attorney. It can cover some or all of the decision making powers that an individual could make for themselves if they weren’t ill.
- Authorization to Disclose Personal Health Information – this is available from a health benefits company. The member can use the form to authorize someone else to see their health care information, while specifying just how much information that person can see.
- Appointment of Representative form – allows beneficiaries to designate someone to participate on their behalf in Medicare appeals and grievances.
Enrol in chronic disease programs
The Centers for Disease Control and Prevention (CDC) estimates that eight out of 10 Americans age 65 or older are living with some form of chronic illness. Those enrolled in a Medicare plan may have access to free programs to help them manage their diseases. These programs are generally administered by nurses or other licensed personnel. The goal is to help prevent acute episodes through better disease management. Many government and private plans even follow-up with members after their hospitalization.
You should check the benefits available to patients with chronic diseases with the relevant health care provider. Even the uninsured may be able to find some charitable organizations that are willing to help.
Know your rights
Once the patient has signed and filed the disclosure or authorization paperwork (which may need notarizing if it isn’t signed in the presence of the provider or government agency) caregivers can speak to a customer care agent on a beneficiary’s behalf. They may also be able to access the beneficiary’s information, such as Medicare records, online, including claims history, provider network and drug formularies.
Unfortunately, health insurers act first to protect their profits, then to provide the minimum benefits that have been contracted for. The new health care reform bills are gradually making it harder for insurers to reduce or withdraw coverage, but there’s still a long way to go. ALWAYS challenge a refusal to offer service. If a beneficiary ever disagrees with any Medicare decision, including a denial, they have the right to appeal it. They can usually invoke independent arbitration mechanisms if they disagree with the opinion of a private insurer, but the channels may vary between States.
Investigate getting extra help
Low-income people with a Medicare prescription drug plan may also be able to obtain extra help through the Social Security office. They may be eligible for assistance with monthly prescription drug premiums, annual deductibles and prescription copayments.
If the health care bills are getting on top of you it may be time to find a professional or volunteer medical billing advocate (see the article below). You should also check Benefits Checkup, an organization that has compiled information about a wide range of useful resources in one convenient online location. It tracks more than 1,550 benefit programs throughout all 50 states and the District of Columbia. It has identified more than $7.6 billion in benefits for those in need since being launched in 2001.
Don’t forget that there are a myriad of support groups and charities out there that can help you find detailed information on a condition, contact other caregivers or sufferers to share information and help you find resources that might be otherwise hard to locate or afford. We’ve listed some on our Useful Sites and Charities pages, but Google is an extremely powerful tool. It’s often faster to use it to locate information on a particular site than combing through it yourself. A Google search such as “Appointment of Representative form site:www.medicare.gov” (substitute the site address) will generally find what you need.
Take care of yourself
Research carried out by the Alzheimer’s Association shows that caregivers face an increased risk of developing depression. It’s natural to grieve about a loved one’s disease. However, if sadness or worry persist to the extent that they prevent decision making, interrupt daily living, or discourage participation in normal activities, then it may be time to get some help. Primary care physicians and insurance programs may offer help, including referrals to other resources. Caregivers with access to Employee Assistance Programs (EAP) should also find them useful.
You can’t provide the best care if you aren’t taking care of yourself, so make sure that you:
- Get enough sleep.
- Eat healthily.
- Exercise, or at least go for a walk as often as you can.
- Don’t try to do everything yourself.
- Arrange to take an occasional day off.
- Maintain a sense of humor.
Primary source: Blue Cross and Blue Shield of Georgia
Related articles:
 In the previous article we looked at the various ways that individuals, groups and corporations seek to influence the outcome of votes on issues and for political appointments. Today we’ll take a look at political interest groups that apply various kinds of advocacy to pursue their goals. Their motives vary, with some pursuing social goals and others being focused on a short term goal. Some groups share religious or moral issues, while others may be formed by powerful individuals or corporations to pursue business interests.
Unfortunately, not all interest groups have behaved morally, fairly or within the law, so there are many regulations that now cover their constitution, legal and tax status, and the channels that they can use to reach voters and politicians. Even so, there are frequent cases of bribery, corruption, fraud and other crimes in every election season. Less powerful groups often have to opt for demonstrations, other civil actions and even civil obedience to get their message out to the politicians, public and press.
It can be difficult to enroll members for some kinds of group, such as one formed to promote the interests of an industry, because the actions of dues-paying members will almost always benefit those who don’t join the group. Why pay to join a group if you’ll benefit by their actions anyway? In other cases the members feel so strongly about their cause that they are willing to figuratively go to pitch battle for their cause whether or not anyone else wants to join in. The Pro-choice and Pro-life campaigners, who are respectively against and for women’s rights to obtain abortions, are a good example of this kind of group. Unions are a well established example of an interest group that bands together to protect individual rights, in this case against the actions of employers, or to improve employee benefits and working conditions.
The positive side of interest groups
Wikipedia has a great list of interest groups that have made a significant impact over long periods of time. They include:
- Pennsylvania Abolition Society – formed in Philadelphia in 1775 with a view to abolish slavery in the United States.
- British Medical Association – formed at a meeting of 50 doctors in 1832 for the sharing of knowledge. Their lobbying led to the Medical Act 1858 and the formation of the General Medical Council which has registered and regulated doctors in the United Kingdom (UK) to this date.
- Suffragettes – campaigned for voting rights for women after direct action and hunger strikes from 1865-1928 in the United Kingdom. Their leader, Mrs. Emily Pankhurst, chained herself to the railings of the House of Commons.
- National Rifle Association (NRA) – formed in New York is 1871 to protect the rights of gun-owners.
- Royal Society for the Protection of Birds – founded in Manchester, UK in 1889 to campaign against the ‘barbarous trade in plumes for women’s hats’.
- Sierra Club – formed in 1892 to help protect the Sierra Nevada.
- Campaign for Nuclear Disarmament – promoted the non-proliferation of nuclear weapons and unilateral nuclear disarmament in the UK since 1957. Their logo is now an international peace symbol.
- African-American Civil Rights Movement – formed to gain equal rights before the law, it was at its most active between 1955 and 1968. We now have an African-American President, a very significant milestone in our history.
- Greenpeace – formed in 1970 as the “Don’t Make a Wave Committee” to resist nuclear weapons testing in the United States. Now one of the leading environmental and wildlife protection organizations.
- Center for Auto Safety – formed in 1970 to give US consumers a voice for auto safety and quality.
- Oxfam – formed in 1942 as the ‘Oxford Committee for Famine Relief’.
Some groups started and continue as interest groups, but have become more like commercial entities in some respects. AARP (formerly the American Association of Retired People), was originally “dedicated to enhancing quality of life for all as we age.” It still operates as a non-profit advocate for its members. However, it has also spawned a commercial organization that “offers a wide range of unique benefits, special products, and services for our members.” With over 40 million members, it is one of the most powerful lobbying groups in the United States while also selling insurance, investment funds and other financial products.
The negative side of interest groups
Some interest groups started with honorable intentions but have turned to extreme civil and illegal activities to further their cause. People for the Ethical Treatment of Animals (PETA) is a non-profit corporation with 300 employees and two million members and supporters. Its slogan is “animals are not ours to eat, wear, experiment on, or use for entertainment.” Unfortunately, it has frequently been surrounded by controversy and has had some provable links with extreme organizations, some of whose members have been listed on terrorist watch lists.
The National Rifle Association lists as its goals: the protection of the Second Amendment of the United States Bill of Rights; the promotion of firearm ownership rights as well as marksmanship; firearm safety; and the protection of hunting and self-defense in the United States. Although there have been arguments that they may be misinterpreting the Second Amendment, the Supreme Court has often ruled in their favor and their training and safety courses are exemplary and a vital component of gun ownership. However, as with PETA, there is a dark side. The NRA has tended to automatically oppose any kind of gun regulation, no matter what people who look at all of the issues more objectively think. The right to buy armor-percing bullets, which could kill a police officer and have no purpose whatsoever in markmanship sports or hunting activities, was strongly supported by the NRA. We ran a satirical article last April 1st on an issue that might well get NRA support if we were members and suggested advocating it.
There are similar, legal but intense, interest group activities that have almost reached the level of fervour of groups such as PETA and the NRA. in the United Kingdom, The Automobile Association has tussled with the Pedestrians’ Association (now ‘Living Streets’) on road safety issues since 1929. In the US, the Tobacco Institute has had a long-standing battle with Action on Smoking and Health over tobacco legislation.
The much more disturbing aspects of interest groups have generally arisen from within corporate interest groups or political operators. One of the largest cases lead to the Tobacco Master Settlement Agreement between the Attorneys General of 46 states and the four largest US tobacco companies, who agreed to pay $206 billion over the first twenty-five years of the agreement. At the seedier level, Jack Abramoff was involved in the Indian lobbying scandal, which involved corrupt and fraudulent lobbying in relation to Native American gambling enterprises. He and his cronies pretended to be lobbying for the rights of the tribes while pocketing large amounts of the money themselves and attempting to bribe officials and politicians.
Bending the rules
There are also borderline political interest groups that masquerade as commercial entities but that are more realistically operating on the fringes of the interest group community while avoiding the regulations that apply to them. Fox News is one such entity. It is owned and operated by individuals with a strong political agenda, much like many news groups in history, but it has employees and on screen “celebrities” who run their own Political Action Committees and activities and actively promote them on air under the guise of objectively reporting or commenting on genuine news items. Fox News has probably created and promoted more “fake news” than any organization outside of the official military disinformation and wartime propaganda operations. The largest broadcaster with an opposing point of view, MSNBC, does not condone and has not been found perpetrating, such activities.
The money angle
Opensecrets.org has an extensive database covering the money aspects of interest groups. They list: the total amounts contributed by an itnerest group and who they contributed to; the top contributors in that group; and the top recipients from that industry. We’ve condensed some of the information, which is available in raw data from the Federal Election Commission (FEC), into the table below.
| Interest Group |
Top Contributor (2009-10) |
Top Lobbying Client (2010) |
Top Recipient (2009-10) |
| Abortion Policy/Pro-Life |
Susan B. Anthony $30,091 |
Right To Life $142,306 |
Smith, Chris (R-NJ) $14,190 |
| Abortion Policy/Pro-Choice |
NARAL Pro-Choice America $142,805 |
Planned Parenthood $216,233 |
Coakley, Martha (D-MA) $35,758 |
| Abortion Policy/Pro-Choice |
MGM Mirage $390,500 |
Harrah’s Entertainment $905,515 |
Reid, Harry (D-NV) $189,900 |
| Commercial Banks |
American Bankers Association $1,828,605 |
American Bankers Association $1,990,000 |
Gillibrand, Kirsten (D-NY) $218,600 |
| Computers/Internet |
Microsoft $1,257,729 |
IBM $1,810,000 |
Schumer, Charles E (D-NY) $196,384 |
| Gun Rights |
NRA $524,760 |
NRA $615,000 |
Toomey, Pat (R-PA) $25,885 |
| Gun Control |
Many small organizations |
Mayors Against Illegal Guns $50,000 |
Gillibrand, Kirsten (D-NY) $3,300 |
| Education |
Harvard University $338,803 |
State University of New York $480,000 |
Crist, Charlie (I-FL) $138,769 |
| Health Professionals |
National Community Pharmacists Association $1,520,383 |
American Medical Assn $6,360,000 |
Crist, Charlie (I-FL) $593,476 |
| Insurance |
New York Life Insurance $1,470,310 |
Blue Cross/Blue Shield $3,187,721 |
Portman, Rob (R-OH) $388,882 |
| Lawyers and Law Firms |
American Assn for Justice $1,897,700 |
American Assn for Justice %1,050,000 |
Reid, Harry (D-NV) $2,466,583 |
| Oil and Gas |
Koch Industries $724,300 |
Conoco Philips $6,408,978 |
Lincoln, Blanche (D-AR) $329,650 |
| Pharmaceuticals |
Pfizer $998,363 |
Pharmaceutical Rsrch & Mfrs of America $7,010,000 |
Burr, Richard (R-NC) $218,619 |
| Telephone Utilities |
AT&T $2,735,995 |
AT&T $5,930,381 |
Boucher, Rick (D-VA) $75,900 |
| Tobacco |
Atria Group $753,600 |
Atria Group $3,110,000 |
Burr, Richard (R-NC) $79,657 |
| TV/Movies |
Comcast $2,089,202 |
National Cable & Telecommunications Assn. $3,920,000 |
Schumer, Charles E (D-NY) $329,800 |
What’s next?
In the next article in this series we’ll look at Political Action Committees (PACs).
Related Articles: Introduction
 Many people turn to homeopathic remedies to try and reduce the effects of colds. Nasal gels and swabs that contained zinc were available over the counter until The FDA requested manufacturers to stop selling them in June 2009, amid concerns about their safety. There were reports of anosmia – loss of the sense of smell. The manufacturers complied, but orally administered products remain on the market as there is no evidence of a similar problem after using them.
Physicians at the University of California at San Diego Nasal Dysfunction Clinic noticed reports of anosmia from people who had used nasal zinc sprays or gels. Dr. Terence Davidson, Director of the clinic, then lead a study1 of the potential problem. He describes how – “In my practice, we started seeing people using the zinc nasal gel. They squirted it in, took a deep sniff and then had an incredibly intense burning sensation that lasted for several hours. When these people recovered, they found they had no sense of smell.”
Dr. Davidson also said – “Most of us take our sense of smell for granted. But, people need to take a moment to realize how important smell is. It helps us avoid dangers when we smell smoke or gas or rotten, spoiled food and it brings us incredible pleasure — think about the smell of our homes, loved ones, food, coffee. In fact, 90 percent of our appreciation for food comes from our sense of smell.”
Lingering doubts
Some of the people affected by the zinc-induced anosmia filed lawsuits against the manufacturers of these products. However, as there have been no randomized, controlled clinical trials that conclude a loss of smell is one of the possible outcomes from using these products, it has been hard to prove cause-and-effect. In fact, the manufacturers of nasal products that use zinc have claimed that as common colds are a known cause of anosmia, there is no clear link between use of their products and the condition. However, other experts have speculated that the effect, if real, may well have been found if the products had been subjected to standard FDA trials.
Statistical evidence
Dr. Davidson and his colleague, Dr. Wendy Smith, applied the “Bradford Hill Criteria” to 25 patients they had seen for the sudden loss of smell after using a zinc gel product. The criteria were developed in 1965 by a statistician who wanted to establish a causal link between tobacco smoking and lung cancer. The nine key criteria necessary to find a causal link include:
- Strength of the association
- Consistency
- Specificity
- Timing
- Dose-response
|
- Biological plausibility
- Biological coherence
- Experimental evidence
- Experimental analogy
|
The researchers applied the criteria to suspected zinc-induced anosmia and conclusively showed that nasal zinc was the cause of the subsequent loss of smell. The patients seen by the researchers had a permanent loss of smell, but Dr. Davidson said there may be people who have had lesser degrees of damage from these products as well. The researchers also concluded that the efficacy of these products in reducing cold symptoms is “questionable”.
1 “The Bradford Hill Criteria and Zinc-Induced Anosmia: A Causality Analysis” – Terence M. Davidson; Wendy M. Smith – Archives of Otolaryngology – Vol. 136 No. 7, pp. 645-748, July 2010 – Arch Otolaryngol Head Neck Surg. 2010;136(7):673-676.
Related articles:
 A study conducted in 13 US states in 2008 forced the closure of one in eight public pools for public health and safety code violations. Approximately 13,500 of the 112,000 pools inspected were found to be in serious violation of health and safety codes and were immediately closed down. Last week the Centers for Disease Control and Prevention (CDC) released a report that estimates the cost of waterborne infections to the United States health care system at around $539 million a year.
The three most common waterborne diseases are Legionnaire’s disease, cryptosporidiosis and giardiasis. All of them can be easily avoided for relatively minor costs. The CDC looked at a database of health care claims submitted between 2004 and 2007 and concluded that the average cost of treating one patient hospitalized because of them worked out at:
- Legionnaire’s disease – over $34,000
- Cryptosporidiosis – over $21,000
- Giardiasis – around $9,000
People commonly associate waterborne diseases with diarrhea, which is annoying but easily dealt with. However, these illnesses can also cause rashes, eye and ear infections and serious neurological and respiratory problems, some of which can be fatal. The CDC recommends – “public education campaigns, appropriate maintenance of building water systems, and regular inspection of pools and other recreational water facilities.”
As we’ve noted in previous articles, it’s particularly important to protect yourself when traveling abroad, particularly to warmer and underdeveloped countries. Even developing countries can have their problems in this respect. We have always carried water filtration tablets and now use a UV water purifier when traveling to those countries. We’ve seen conference halls half empty on the second day and fellow travelers with bloated eyes or severe dehydration as a result of unsafe water. It’s worth checking out the water cleansing gadgets in the Travel Boutique in the Silver Buzz Cafe Store.
Related articles: Traveling As A Senior – Part 2
 SmithKline Beecham introduced Avandia, a type of diabetes drug known as insulin sensitizers in 1996. They launched an aggressive $34 million “Ask Your Doctor” advertising campaign and in its first full year on the market, Avandia reached $647 million in sales. In 2006, Avandia generated $2.1 billion in revenue for GlaxoSmithKline. Based on the number of prescriptions dispensed, it had a larger market share than Actos, the other major drug in its class, known as glitazones. However, sales dipped the next year, after a study suggested that Avandia carries a risk that Actos does not: a small but significant capacity to trigger heart attacks or strokes. Even so, nearly four million prescriptions were filled last year for various forms of Avandia.
The drug is clearly not without risks. Glaxo reportedly agreed to pay $460 million last week to settle about 10,000 of the 13,000 Avandia lawsuits that it faces. A new, large-scale study is finally under way to determine the benefits and risks, but last Wednesday a majority of experts on a Food and Drug Administration (FDA) panel voted to keep Avandia on the market, despite the evidence of risk. The panel voted 20-12 to recommend keeping the controversial treatment on the market but 17 voted in favor of stricter warning labels or restrictions on its sale. One member abstained from voting. No member voted to take the current warning label off the box. A majority of panel members thought that analyses of previous studies showed that the drug was linked to significant heart risk in diabetes patients and that its market competitor, Actos, has been shown to be a stronger alternative. So, why is it still on the market?
Big Pharma Coverup
SmithKline Beecham was obviously aware that there were problems with Avandia, because they secretly began a study in late 1999 to find out if Avandia was safer for the heart than a competing drug, Takeda’s Actos. Avandia’s success was crucial to SmithKline, which had almost no new drugs coming to market. The study’s results were potentially disastrous. Avandia was no better than Actos at controlling diabetes and there were clear signs that it was riskier to the heart.
A company document estimated the lost sales that would result if Avandia’s cardiovascular safety risk became public at $600 million from 2002 to 2004 alone. So, the company decided not to publish the results and spent the next 11 years trying to cover them up. They failed to submit them to federal drug regulators, as is required by law in most cases.
Then, in May 2007, a cardiologist at the Cleveland Clinic used data that the company was forced by a lawsuit to post on its own Web site. Soon afterwards, GlaxoSmithKline officials conceded that they had known of the drug’s potential heart attack risks since at least 2005. It’s now known that they were lying even then, as they had clearly known of the problem since 1999.
This isn’t the first time that the company has hidden adverse drug trial results. GlaxoSmithKline was found in 2004 to have hidden data that showed that its antidepressant, Paxil, led children and teenagers to have more suicidal thoughts and behaviors. The company later settled a lawsuit by agreeing to publicly post data from all of its trials.
In fact, the problem is so widespread that, in 2007, Congress mandated such disclosures. But the postings are often little more than cryptic references hidden in other material, so the problem remains. GlaxoSmithKline has also been widely criticized by medical leaders for not using all of the adverse cases, including omitting data from at least a dozen cases where users of Avandia suffered serious heart problems.
With Avandia, GlaxoSmithKline has done more than hide trial data. An FDA reviewer who closely examined a landmark Avandia clinical trial called “Record,” found at least a dozen instances in which patients taking Avandia suffered serious heart problems that were not counted in the trial’s tally of adverse events, mistakes that further obscured Avandia’s heart risks.
Suspicious FDA Activity
Recently released documents show that Dr. John Jenkins, director of the agency’s office of new drugs, who has argued internally that Avandia should remain on the market, briefed the drug company extensively on the agency’s internal debate on Avandia. That is something that should never happen. A top company official wrote this in an e-mail message after he spoke with Dr. Jenkins – “It is clear the office of new drugs is trying to find minimal language that will satisfy the office of drug safety.”
Dr. Rosemary Johann-Liang, a former supervisor in the drug safety office who left the FDA after she was disciplined for recommending that Avandia’s heart warnings be strengthened, said in a deposition referencing Dr. Jenkins’ conversations with GlaxoSmithKline – “This should not happen, and the fact that these kind of things happen, I mean, I think people have to make a determination about the leadership at the FDA.”
The company also conducted trials comparing Avandia with glyburide, a cheaper and older diabetes medicine. An internal memo said – “These put Avandia in quite a negative light when folks look at the response of the RSG monotherapy arm. It is a difficult story to tell and we would hope that these do not see the light of day.”
What happens next?
There will almost certainly be changes to the labeling of Avandia and physicians may be more wary about prescribing it. However, until the results of a more extensive study are available, the drug will remain on the market. There have been calls for an overhaul of the FDA and this case demonstrates that it’s clearly warranted. Until that happens, we must be very wary about taking any new drug that we are prescribed without a full and frank discussion of the potential risks. The companies making them can’t be trusted and the regulators, much like the ones who failed to prevent the BP oil spill disaster, are asleep at the switch and possibly corrupt.
Related articles: Controversy Rages Over Safety Of Diabetes Drug Avandia – Silver Buzz cafe – 2/10/2010.
 Sarah Palin has repeatedly lied about the government’s intent to set up “death panels“, regurgitating her claims again last week. She also cited the United Kingdom (UK) as a place where shadowy bureaucrats get to decide whether a sick person lives or dies. These ideas are, of course, a figment of Ms. Palin’s strange delusions. In the United States your health insurer (if you have one) decides whether or not you get life-saving treatment. If you don’t have health insurance, you’ll die. Take a look at “A Grim Reminder” at the top right of this page.
In the UK there is indeed an expert team of doctors that decides whether or not a new drug or treatment should be paid for by the National Health Service. The team does not get involved in individual cases. It would be hard to control costs and fraud if practitioners and patients could demand any kind of treatment, proven or not, so it makes sense to have experts decide how best to deploy taxpayers’ money.
The Worldwide Palliative Care Alliance (WPCA) estimates that while more than 100 million people need hospice care annually, fewer than 8% of them actually receive it. The Economist magazine recently commissioned the Singaporean Lien Foundation to study and rank end of life care services in forty countries. Mr. Poh Wah Lee, Chief Executive Officer of the Lien Foundation said – “To highlight this gap and advocate for better care for the dying, the Lien Foundation commissioned the Index, which provides a global benchmark on the provision of end-of-life care.” Rather than look at “Quality of Life” they focused on “Quality of Death”. They produced an index that scores countries across four categories:
- Basic end-of-life healthcare environment.
- Availability of end-of-life care.
- Cost of end-of-life care.
- Quality of end-of-life care.
The United Kingdom scores best. Contrary to Ms. Palin’s accusations, it has led the way globally in terms of its hospice care network and statutory involvement in end-of-life care. Canada and the United States tie for the 9th position. The main reason for the low score that the US achieves is the financial burden of end-of-life care, which reflects the high overall cost of US healthcare. The US comes in at number 7 for Quality and number 8 for Availability of End-of-Life Care.
The study also notes that, while hospice care is available through public medical insurance in the United States, patients must relinquish curative treatments in order to be eligible for their hospice benefits. The United Kingdom and most other countries don’t impose that condition on terminally ill patients.
Some rich countries are surprisingly low in the rankings. They include Denmark (22nd), Italy (24th) and South Korea (32nd). In these cases the quality and availability of care is often poor and policy co-ordination is lacking. The bottom-ranked countries in the Quality of Death Index include developing countries, such as China, Brazil, India and Uganda.
The Economist Intelligence Unit has analyzed the Index results in a white paper1. Their key findings include:
- Combating perceptions of death, and cultural taboos, is crucial to improving hospice care.
- Debates about euthanasia are largely inconsequential as they only affect a tiny proportion of the population, but they have lead to positive changes in the availability of hospice services in some countries, such as Australia.
- Availability of pain control drugs is fundamental to quality of end-of-life care. This is a big problem in the underdeveloped countries.
- Training in end of life care issues needs improvement in almost all of the countries in the study.
The world’s population of people over the age of 65 will soon outnumber children under the age of five. By 2050, about one-in-five Americans will be over the age of 65, with about 5% percent reaching 85 and older (up from 2% today). More than 75% of those receiving such care in the US die in their own homes. By increasing the proportion of community and homecare options, hospice care, which is available as a Medicare benefit, can reduce the costs associated with hospital stays and emergency admissions. Over 40% of people over 65 who die in the United States take advantage of Medicare hospice benefits, some of which also extend to their families and loved ones. However, as the study shows, there is huge room for improvement.
1 Quality of Death Index
 Key GOP leaders bowed to pressure from the ultra-conservative Club for Growth this week and pledged to work to repeal the recent health care reform bills. If you look at the list of benefits that click in this year alone, it’s hard to understand why anyone would want to repeal them.
The Republicans have shown a stark lack of concern for the health and wellbeing of their fellow Americans in the past few months. They blocked the payment of unemployment benefits to people who have been out of work for long periods (mainly as a result of the GOP’s lack of control of Wall Street). House Minority Leader John Boehner (R – OH) infamously likened the recession to being an ant-sized problem. The GOP unanimously opposed the new financial regulatory bill, choosing to support the interests of big business, rather than their electorate. The Republicans even blocked additional benefits for homeless veterans and their families. Rep. Joe Barton (R – TX) apologized to BP after they volunteered to put $20 billion into an escrow fund to help cover the costs of the environmental crime they’ve committed in the Gulf of Mexico. Republican National Committee Chairman Michael Steele deluded that the war in Afghanistan “was of Obama’s choosing” this week, ignoring the fact that it was a Republican President, George W. Bush, who ordered it started soon after the 9/11 attack.
Until recently I’ve tended to look carefully at the GOP’s arguments, most of which turned out to be distortions and lies during the health care reform debate, and try to find the positives. It hasn’t been easy. After turning a trillion Dollar surplus into a multi-trillion Dollar deficit and leaving our economy in shreds, plus causing an almost worldwide recession, the GOP suddenly found fiscal conservatism to be an absolute criterion against which every proposal made by the Democratic majority and the White House has to be judged. However, that’s typical political hypocrisy. The roots of the behavior outlined above go deeper.
Is it just greed and corruption?
It would be easy to simply attribute the GOP’s stance to a need to re-establish its position after its huge losses in 2008 to greed and corruption. They have done everything that they can to support the big businesses that line their campaign coffers and wine and dine them under the guise of lobbying. While they were supposed to be working on bi-partisan reform of Wall Street they secretly held a campaign fund raising meeting with executives from the major financial institutions. Soon after being caught leaving with their swag bags, they brazenly announced that they would protect Wall Street to the fullest extent possible. After succeeding in watering down the bill, they almost unanimously voted against it.
To be fair, the Democratic leader of the committee that worked to produce the bill has also taken a lot of money from the financial industry, but he voted for it. Was he instrumental in watering down its provisions? We’ll never know, as the Republicans insisted that all of the last minute negotiations be conducted behind closed doors.
Or a mental illness?
The more that I think about what we’re seeing from the GOP leadership and the Tea Party in general, the more I’m convinced that we’re looking at a group of people who are mentally ill. Let’s look at a few conditions that may apply here (all definitions are from Wikipedia):
- Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a “loss of contact with reality”. People suffering from psychosis are said to be psychotic.
- Psychopathy is a personality disorder characterized by an abnormal lack of empathy combined with strongly amoral conduct, masked by an ability to appear outwardly normal. Although the term has been widely replaced by the term ” antisocial/dissocial personality disorder”, [noted criminal psychologist] Robert Hare describes psychopaths as “intraspecies predators” that “use charisma, manipulation, intimidation, sexual intercourse and violence” to control others and to satisfy their own needs.
- Antisocial Personality Disorder (ASPD or APD) is defined by the American Psychiatric Association’s Diagnostic and Statistical Manual as “…a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood.”
You can draw your own conclusions.
 It is known that healthy aging is influenced by our environment, lifestyle and family history. Many scientists have been searching for genes that appear to be linked to diseases, especially cancer, that reduce our lifespan. Drs. Paola Sebastiani, Professor of Biostatistics at the Boston University (BU) School of Public Health and Thomas Perls, Associate Professor of Medicine at the BU School of Medicine and a geriatrician at Boston Medical Center, led a team that focused on genetic sequences that appear to be unique to people with exceptional longevity.
The researchers studied the DNA of 1,055 centenarians and 1,267 controls. Centenarians are important in studies of aging because they tend not to get many of the associated diseases until they are well into their mid-90s. The researchers then focused on unique sequences of DNA from inside or between genes that are called single-nucleotide polymorphisms (SNPs). They also looked for groups of SNPs that appeared to be related to exceptional longevity or particular age-related diseases.
Study findings
The researchers found that:
- By focusing on 150 of the SNPs, the team found that they could predict exceptional longevity (living to the late-90s or more) with 77 per cent accuracy in a separate, independent group of centenarians and controls.
- 45 per cent of the oldest centenarians (110 years old or more), had the highest proportion of longevity- linked SNPs.
- They also found that, in 90 per cent of the centenarians, there were strong links between 19 clusters of SNPs, which they termed “genetic signatures”, and the prevalence and onset of age-related diseases like dementia, high blood pressure and cardiovascular disease.
- These 19 genetic signatures predicted longevity more strongly than the absence of disease-related variants.
- Although these genetic signatures had varying predictive value, they may help identify key subgroups of healthy aging.
- Regardless of how many disease-related variants each centenarian had compared to the control group, they made little difference to the predictive value of the longevity-linked SNPs. This suggests that having longevity genes had a stronger influence on how long they lived than the absence of disease-related variants.
The scientists hope that their findings will be useful for developing better prevention and screening tools and personalized medicine. However, they cautioned that the confirmation that genes play such a strong part in exceptional longevity does not mean lifestyle factors, such as following a healthy diet and exercising, are ineffective. They still play an important role in helping humans live to a healthy old age.
The researchers believe that the method that they used to arrive at the 150 SNPs for their model could also be applied to other complex genetic traits, such as Alzheimer’s and Parkinson’s, diabetes and cardiovascular diseases.
Observations
The discovery that having the right longevity genes is more important than not having the disease-related genes is very significant. The authors noted that if their findings are confirmed by others – “Predicting disease risk using disease-associated variants may be inaccurate and potentially misleading, without more information about other genetic variants that could attenuate such risk.”
They also noted that exceptional longevity may be – “The result of an enrichment of longevity-associated variants that counter the effect of disease-associated variants and contribute to the compression of morbidity and/or disability towards the end of these very long lives.”
They recommended further studies to help us better understand how and why these variants, both individually and together, influence exceptional longevity.
1 “Genetic Signatures of Exceptional Longevity in Humans.” – Paola Sebastiani, Nadia Solovieff, Annibale Puca, Stephen W. Hartley, Efthymia Melista, Stacy Andersen, Daniel A. Dworkis, Jemma B. Wilk, Richard H. Myers, Martin H. Steinberg, Monty Montano, Clinton T. Baldwin, and Thomas T. Perls – Science, Published online 1 July 2010 – DOI: 10.1126/science.1190532
 The health care reform legislation signed into law on March 23 does not prohibit the health insurance industry from discriminating against the sick until the beginning of 2014. However, as of Thursday July 1, 2010, U.S. citizens who have been uninsured for six months because of pre-existing conditions will be eligible to apply for a new Department of Health and Human Services (HHS) program called the Pre-existing Condition Insurance Plan (PCIP).
Coverage could start as soon as August in the 21 states where the federal government is administering the program itself. Twenty-nine other state governments and the District of Columbia will run the plan themselves. This site will tell you who is running PCIP in your state. HHS estimates that the program could cover around 350,000 (just under 9%) of the four million people uninsured due to pre-existing conditions up until 2014, when private insurers can no longer deny them coverage.
Thursday’s rollout, which was timed to coincide with the beginning of state fiscal years, also introduces a new website – www.healthcare.gov. It provides information on how eligible people can apply for the new program. Jay Angoff, Director of HHS’s Office of Consumer Information and Insurance Oversight said – “The Pre-Existing Condition Insurance Plan is designed to address these [current] challenges by offering comprehensive coverage at a reasonable cost. We modeled the program on the highly successful Children’s Health Insurance Program, also known as CHIP, so states would have maximum flexibility to meet the needs of their citizens.”
Some states already offer similar coverage, but they often exclude some, more expensive, conditions. The PCIP is designed to be more comprehensive and affordable, with average monthly premiums ranging $140 to $900. Congress initially allocated $5 billion for the new program, allowing it to cover 200,000 people. Without that cap, the program could potentially expand to cover 700,000 people, at a cost of $15 billion. Congress can extend the program to cover more people, if necessary, but the allocation should be enough to cover the estimated total of 350,000 that will need it, as only 200,000 should need it at any particular time.
 Almost every country in the world has an aging population, with the greatest changes happening in the less-developed countries. It is estimated that by 2050 about 80% of the expected 2 billion people aged 60 years or over will live in low or middle income countries. The World Health Organization (WHO) has launched the Global Network of Age-friendly Cities as part of its broad response to the rapid ageing of populations. The Network aims to help cities create urban environments that allow older people to remain active and to be healthy participants in society. It recognizes the positive contribution of older people and is designed to support active and healthy aging.
Dr John Beard, Director of the Department of Ageing and Life Course at WHO said – “Older people are a vital, and often overlooked, resource for families and for society. Their contribution will only be fully realised if they maintain their health and if the barriers that prevent them engaging in family and community life are broken down”.
In 2006, the WHO Age-friendly Cities initiative stated by identifying the key elements of the urban environment that support active and healthy ageing. They conducted research in 33 cities that highlighted:
- The importance of seniors’ access to public transport, outdoor spaces and buildings.
- The need to foster the facilities and networks that:
- Allow seniors to be active participants in society.
- Help seniors overcome ageism
- Provide seniors with greater opportunities for civic participation and employment.
- The need for appropriate housing, community support and health services.
The Global Network builds on these principles but also requires participating cities to commence an ongoing process of assessment and implementation. Network members are committed to taking active steps to creating a better environment for their older residents.
WHO issued invitations to join the Network last December and it has been swamped by responses. Their press release says that – “Many individual cities, both large and small have formally applied to join the Network. WHO has also established formal agreements with the French government, the Irish Ageing Well Network and the Slovenian Network of Age-friendly Cities to develop affiliated national programmes. The China National Committee on Ageing has also indicated interest in developing a national programme, and 5 Canadian Provinces are running complementary initiatives.”
New York was the first city to formally join the network and New York Mayor Michael Bloomberg will be presented with the first certificate of membership today.
 Telephones are essential, especially for seniors. They provide a lifeline in terms of emergency and they help us keep in touch with relatives and friends. They can also be used for an Internet connection, which has become an essential part of modern life for those who have taken the plunge and learned how to use it. However, unlike the old days, there is a huge, sometimes bewildering and often unnecessary range of services available via that thin connection that comes into our homes. There are also alternatives.
The first thing to do is to take a close look at your monthly phone bill, or bills. Most of us have a landline and a cellphone. There’s still no completely reliable replacement for a landline in times of emergency, or whenever there’s a power cut. If you receive phone service via your cable TV provider there’s a very high probability that your phone won’t work if the power goes off. Conventional landline phones receive enough power over the telephone lines to establish a connection and allow you to make and receive calls. Unfortunately, once a cable box is switched off, or the power goes out, you lose both your TV signal and your phone connection.
A cellphone will only work for as long as it maintains its charge. If your power is out, your cellphone will eventually become useless, usually in a matter of hours if you make too many calls. If you decide to turn off your landline connection and rely on your cellphone you should buy an attachment that can use a standard battery to run or charge your cellphone. They’re usually available for around $20, but availability and effectiveness depends on your cellphone model. You also have to be methodical about maintaining a supply of fresh batteries, so that you can cope with a prolonged power outage. We have several Uninterruptible Power Supplies (UPS), one dedicated to keeping our network and iPhones alive, but we have the batteries for really long power outages, which occur at least once a year out here in the Boonies.
Eliminating unnecessary services
It’s in the telephone company’s interest to sell you as many services as they can. They can do this in multiple and subtle ways, such as offering you a cheaper rate if you add other services. They will almost all try to do this at any time that you contact them with a question on your bill or a service problem. Do you really need the ability to do three-way calling to international destinations, or nine voicemail boxes? Look in your phone book or the company’s online site to see which services you really need. We were getting nuisance calls from someone who mistakenly thought he was calling someone he knew, so we paid for specific line blocking. The nuisance caller got other people to connect him, so we eventually changed our number, which the provider did for free in the circumstances. Then we were able to drop the additional service, which cost $6.99 a month.
Once you’ve decided which ones you need, see if there is a package that only includes those features. If you only need CallerID it’s probably cheaper to drop all of the others. Here are some frequently offered, but infrequently used or avoidable offerings:
- Voicemail: many phones now handle this with a built-in memory card. They’re worth the cost. We’ll cover alternatives later in this article.
- 3-way calling: use online conferencing (see below), or make two calls.
- Busy number redialing: set an alarm and call 15 minutes later.
- Call return: look at the CallerID, write it down, then dial it. Most phones will call back to a number on the CallerID anyway.
- Customized ringing: many phones have this ability built in. Our cordless phones also show a picture of the caller if we’ve uploaded it to the phone.
- Speed Calling: buy a phone with multiple memories for frequently called contacts.
If you’re lucky, you’ll be able to change your features online. If not, you’ll have to endure the sales pitch and questions that you’ll get when you try to turn the feature off, but you’ll save money after the next bill.
Know the difference between local, regional, long distance and international call plans
When the government split Ma Bell up they promised that the ensuing competition would lower rates, improve service and lead to the introduction of new services. They were partially right, but there has been a lot of consolidation in the industry and there has also been a huge opportunity for scammers to take advantage of the confusion that still prevails. The simplest course is to let your main landline provider charge you on an as-used basis. However, if you do that, you’ll be paying maximum, sometimes outrageous, rates, especially for long distance and international calls. It’s worth knowing how the tariffs work. They’re based on the regulatory divisions within the telecommunications business, which are currently:
- Local Call Area: usually covers calls within an area code, such as 408, but in sparsely populated areas, an area code may be split into lists of Central Office numbers, such as 1234, 1235, 1236 and 1237, e.g. a call between any number starting 408-1234 and any of the other three will be regarded as a “local area call”. The formal name for this division is Local Access and Transport Area, or LATA.
- Local long distance: calls within the customer’s LATA but outside of their local calling area. Using the previous example, a call from a number starting with 408-1234 to one starting with 408-6789 would be a local long distance call.
- Long distance: two classes of call that are not local area calls:
- Inter-LATA intrastate: covers calls between different area codes in the same state.
- Interstate long distance: technically known as inter-LATA interstate long distance, these are calls between sites in different US states.
- International: covers calls to another country.
Your main (LATA) phone company provides the wires or fiber optic cable that connects you to their network and local area calls. You can have accounts with other companies for one or more of the other kinds of call. In most cases the LATA will also provide the best rates for local long distance calls. However, if the other number is managed by a much larger company they may be able to provide you with cheaper rates than your local company. The same applies with inter-LATA intrastate.
You’ll almost always receive cheaper interstate long distance from a specialized long distance company, such as AT&T or Sprint, or a consolidator, such as Pioneer, that buys spare capacity from the big guys. Likewise, the international carriers, such as AT&T and British Telecom, and a whole host of consolidators, are your best conventional bet for international calling.
Confused? Here’s a chart that shows the divisions. The terms that a particular phone company uses may differ (they love marketing names, such as Better-Cheaper-Local) but you should soon be able to work out what they’re really talking about.
Telephone Regulatory Divisions – An Example of the Different Service Divisions
|
The cellphone companies have a much simpler set of plans, in this respect. They generally only offer local, long distance and international plans. Most of them don’t even differentiate between local and long distance if you’re calling another of their subscribers. Do you remember MCI and their heavily advertised “Friends and Family” plan? They wanted more subscribers, but they also knew that they could offer lower rates if they didn’t have to pay another carrier, such as AT&T, to cover portions of the call. The cellphone companies are applying the same principle. Carriers charge one another a connection charge and for the traffic (voice minutes or data volume) that they handle for each call.
Incidentally, if you have an iPhone and you travel overseas, make sure that you switch on AT&T overseas service for both voice and data, or you may unable to make and receive calls overseas and you’ll also add unplanned expenses to your trip. You can do it online and you can switch it off when you come back.
Choose the best plan for your needs
Here’s how to look at ways to cut your bill for these services:
- Think who you call and how often. Look at several month’s bills for charges, especially the larger ones.
- Check your main (LATA) companies charges for each of the six classes of call we identified above. That’s what you’re trying to beat.
- If you’re paying for international calls and you never make them, have that plan eliminated.
- If you’re paying for interstate long distance and you don’t use it, have that plan eliminated. If it comes packaged with something else, ask how much it would cost for just the services you want. It’s never actually free, but they make it look so by betting that they’ll make money on the other services. You may be getting low cost interstate long distance calls, but be paying way over the odds for calls to a relative just twenty miles away, because you’re being ripped off on local long distance or intrastate inter-LATA calls.
- Check the online sites for the major long distance carriers. Check their rates against what you’re paying. They all offer interstate and intrastate inter-LATA services, but not in all areas. They often package these two kinds of long distance service into a competitively priced plan that will save you money over what your main (LATA) provider offers.
- Check the sites of the international carriers to see if they also offer interstate long distance in the United States. Most of them don’t handle intrastate inter-LATA calls.
- There are specialist companies that use some telphone tricks to provide cheal, legal international and long distance calling. They require you to call a special number before entering your account number and the number you want to call. They work by switching your call to equipment in another country, which then makes the call for you at low rates and then adds you to the call. It’s legal, but the call quality can be low.
- Think you’re worked out the best deal? Call your current provider(s) and see if they can beat it. If not, it’s time to start shopping the consolidator sites. We’re stuck with Frontier Communications as our LATA, but we get everything other than international from Pioneer Communications. Our telephone bills dropped by over 30% when we made the switch. However, international is another story, which we’re about to cover.
VoIP
If you have Internet service you can use Voice over Internet Protocol (VoIP) for free if you’re calling another computer and for a low rate if you call a regular phone or cellphone. The most popular service is Skype. The software is free. The call quality is good enough that you often see the news channels interviewing people using it, generally with a video connection. We’ve used it for years to call family members in the United Kingdom and New Zealand. You can also do three-way calling, online screen sharing and video calling. All you need is a headset and microphone or a webcam. They’re built in to many computers, including Macs. You can also use Skype on an iPhone or iPad if you have a WiFi Internet or 3G cellular connection.
You can also use your computer and applications software or online services to eliminate extra fax lines and voice mailbox charges from your LATA. Some services provide you with a single number for voicemail and faxes. You can call the voicemail number or have an email sent to your computer. Received faxes are turned into images that are forwarded to your regular email address.
There are also VoIP phone companies, such as Vonage, that provide a phone that connects to your regular phone line, but which is actually a modem that establishes a dialup connection to the Vonage equipment and thence to whomever you’re calling. That’s actually what’s happening if your cable provider also offers phone service, except that they’re using their cable rather than a phone line. However, most VoIP companies don’t replace your main (LATA) provider, they simply replace all of the other classes of service. You’ll also lose your phone service if the power goes down.
Multi-service Package Deals
The deregulation of the telecommunications carriers also started another turf war. The cable and satellite companies can now provide telephone and Internet services. The phone companies are starting to fight back by providing TV and movies to their broadband Internet customers. Don’t expect flawless, live HDTV over a dialup connection, but these services can be perfect for downloading movies to a Digital Video Recorder (DVR). Some companies, such as Dish, offer voice, Internet and satellite TV services as a package. As with the other carriers, make sure that you know exactly what you’re getting, especially with anything other than local calling, and remember that you’ll lose everything, including your phone, if the power goes out and you’re relying on an upscale cable TV box.
Beware the scammers
As always, you have to watch out for scammers. One of the worst kind will try to get you to unwittingly switch long distance services. They may ask you a couple of innocent sounding questions, then they’ll switch your long distance provider and earn a fee. It’s called slamming. As always, don’t respond to offers from companies you don’t know and trust. You should also be wary of services that charge a very low fee per minute, but have a flat-rate connection fee. Our LATA provider charges 11 cents per minute for calls to Europe. A competitor charges 1 cent per minute, but there’s a 99 cent setup fee per call, so you don’t start saving money until you make a call that lasts for more than nine minutes. If there’s one thing that we’ve learned when dealing with communications companies it’s that you always need to read the fine print.
After you’ve done your best
If you’re paying by the minute, use a timer to limit the number of minutes you use.
 Both the United States and England were knocked out of the World [Soccer] Cup over the weekend. I don’t generally follow soccer as I was a rugby player in my youth. However, both of us like to walk, exercise (in the gym and with Wii Fit Plus), but I don’t think I’m up to rugby any more. A nice game of soccer with the grandkids is about it. Leaving aside the physical benefits of exercise, a new study shows that seniors are still capable of learning new skills – such as juggling, or knitting, which has seen a resurgence among the young in the UK, Australia and New Zealand, for some reason.
The researchers, led by Professor Dilip Jeste of the University of California, San Diego, studied 3000 San Diego residents, aged between 60 and 100. They used Magnetic Resonance Imaging (MRI) scans (which we wrote about in our series on medical equipment), to study the ability of their brains to generate neurones and synapses, which are critical to learning and memory capabilities. In addressing the Royal College of Psychiatrists‘ International Congress in Edinburgh, Scotland, Prof. Jeste said:
|
“The fact that older people are slower to respond than younger people is widely seen as a disadvantage. But that’s not always the case. The elderly brain is less dopamine-dependent, making people less impulsive and controlled by emotion. Older people are also less likely to respond thoughtlessly to negative emotional stimuli because their brains have slowed down compared to younger people. This, in fact is what we call wisdom.
Probably the most exciting breakthrough in the last decade has been the finding that neuroplasticity, the ability to generate neurones and synapses, continues throughout an individual’s life. MRI scans have also identified the four regions of the brain that contribute to wisdom…
… with older people demonstrating a higher level of activity between these regions than younger people.”
We know from structural MRIs that the brain’s hardware changes when people take up juggling. Within three months, studies show that there is a significant change in the structure of the brain in the region that involves perceptual anticipation.”
|
Prof. Jeste also said that older people should gain confidence from the knowledge that they can become sharper and develop new skills in older age. We may not be as good at playing soccer, or remembering where we put the car keys, but we can compensate for the loss of physical prowess and memory skills by developing greater wisdom. He believes that wisdom, which he characterizes as a uniquely human mix of intelligence and spirituality, may be hard-wired as an evolutionary tool to extend lifespan.
I can attest to that notion with a lesson that I learned when I was about 40. I was a very keen badminton and squash player back then, playing at least eight hours a week. A new couple joined our little group one evening and we played doubles. We lost. I played singles against the new guy. I lost. I was surprised, because he was in his 60s! It was only then that they told me he’d been a national team player. We played many games before I could eventually, sometimes, beat him. It wasn’t his speed, agility or strength. It was his experience. I’d run to intercept the shuttlecock and return it. He’d be right there, grinning at me. I benefited from his experience, which he used to coach me in the finer points of a game that requires very sharp and subtle skills. The more long-lasting effect was that he imparted some of his wisdom in response to discussions about my working life, which was in a totally different field from what his had been. We could stand back from the details and get to the crux of an issue. When I look back at it, we rarely discussed politics or religion and that, as my Dad often said, was probably a good thing.
So, heeding Prof. Jeste’s advice, I’m going to re-learn how to juggle and to knit fishing nets – both things that I could do standing on my head as a kid. I’m also going to buy a bicycle. Watch out neighbors – the “Blue Streak” is itching for a comeback. Perhaps I’d better check the health and personal liability insurance first. 
|
_small1.jpg){kind=link}
Political Influencers and Lobbyists – Part 3 – Lobbying
Most people are familiar with the concept of direct lobbying to the legislature. Lobbyists may also try to influence judicial opinion and outcomes by filing amicus curiae (“friend of the court”) briefs. This kind of brief is filed by people or groups who are not parties to a lawsuit. The briefs provide additional background on the matter being decided upon and are entered into the court records. Advocacy groups use them to share their expertise and promote their positions. Lobbyists may also approach lawyers to suggest expert witness candidates that will support their backer’s position.
The money angle
In 2009 there were 13,660 officially recognized lobbyists and the industry received a total of just under $3.5 billion from their clients. The tables below show the the Top 10 spenders on lobbying activities and the Top 10 lobbying firms, most of which are unknown outside of Washington.
The revolving door
If a group wants to quickly and effectively bring their position on an issue to the attention of lawmakers and the media it makes sense to hire an expert. Becoming a lobbyist can provide a steady source of income for retired executives and experts. However, there are some obvious dangers in this area. What if a lobbyist persuades congress to fund the building of a bridge, succeeds and then immediately joins the board of directors of the company awarded the construction contract? That’s fine, but it would be a different matter if all of the politicians who voted for it were given stock in the company. That’s corruption. However, what about a politician who used to head a committee overseeing the defense contracting industry leaving public office and then immediately joining one of those contractors and acting as a lobbyist for them?
That is the so-called “revolving door” and there is a large body of opinion that at an unhealthy relationship can develop between the private sector and government, based on the granting of reciprocated privileges to the detriment of the nation, so it is highly regulated. “Under current law, government officials who make contracting decisions must either wait a year before joining a military contractor or, if they want to switch immediately, must start in an affiliate or division unrelated to their government work. One big loophole is that these restrictions do not apply to many high-level policy makers…, who can join corporations or their boards without waiting.” – Wikipedia.
Vice President Dick Cheney had formerly been Chairman and CEO of Halliburton, a military contractor that was awarded huge, no-contest contracts in Iraq and Afghanistan after the Bush-Cheney administration started wars there. There is no evidence that VP Cheney was a part of the decision making process leading up to those awards and he was in such a high profile position that it would have been foolish of him to have exerted such influence. However, it’s a difficult area to police at lower levels in our political and administrative system.
What’s next?
In the next article in this series we’ll look at Political Action Committees (PACS).
Related articles: Series.