Silver Buzz Cafe

Metals In Our Diet - A Mixed Blessing

metals I came across a graphic that attempts to show the amounts of metals that an average American consumes in a lifetime. It wasn’t that helpful, but the figures were interesting, particularly as we know that some metals are essential, while others, such as lead and mercury, are extremely harmful.

A shortage of essential metals in our diets can cause all kinds of problems in the body and brain, so we decided to take a look at the issues involved. Some of the results are surprising and others are disturbing. Metals aren’t the only problem, of course. Many compounds are far more dangerous when they enter the food chain. The ecology is still trying to recover from the effects of the use of DDT as an insecticide in the middle of the twentieth century, for instance. It almost wiped out the bald eagle in the contiguous United States, for instance.

Metals in our diet
The table below show the average amount of various metals eaten during the lifetime of an American who lives to an average age of 77.8 years. We aren’t, of course, suggesting that any one would eat the animals we’ve listed to illustrate the equivalent weights, but it should give you a rough idea of the amounts involved.

Amounts of Metals Eaten
Metal	Weight (Pounds)	Weight (Ounces)	Equivalent To
Phosphorus	18347		One African elephant, 3 giraffes and a jaguar
Aluminum	3474		3 giraffes
Copper	1389		1 giraffe and a jaguar
Lead	904		2 gorillas
Zinc	769		1 gorilla, 1 jaguar and a grey wolf
Chromium	289		1 jaguar, 1 goat and a rabbit
Nickel	129		1 sheep and a rabbit
Tin	33		5 rabbits
Antimony	16		2 rabbits and a guinea pig
Uranium	13		2 rabbits
Silver	3.48		1 guinea pig and 2 hamsters
Platinum	1.59		1 hamster
Iron	0.62	9.98
Germanium	0.35	5.64
Gallium	0.18	2.82
Gold	0.17	2.71
Rhodium	0.14	2.26
Indium	0.11	1.81

Known effects of the metals in our diet
Some of these metals are essential to the functioning of the human body, but most of them have no known function and they, or their compounds or salts, may be toxic or carcinogenic. Here’s a short summary of what we know about them:

Aluminum (Al): Has no known function in the body. Excessive amounts can lead to neurotoxicity, contact dermatitis, digestive disorders and vomiting.
Antimony (Sb): Has no known function in the body. Causes headache, dizziness, and depression in small doses. Larger doses cause frequent and violent vomiting, leading to death in a few days.
Chromium (Cr): Some forms in trace amounts influence sugar and lipid metabolism in humans. Its deficiency is suspected to cause a disease called chromium deficiency. Other forms are very toxic. Its use in food supplements is controversial. Some people are allergic to it in dust form.
Copper (Cu): Essential in all plants and animals. Copper is distributed widely in the body and occurs in liver, muscle and bone. Some people with a genetic defect can suffer from cirrhosis as a result of drinking water boiled in copper. Excessive amounts of copper salts are toxic.
Gallium (Ga): While not considered toxic, the data about gallium are inconclusive. Some sources suggest that it may cause dermatitis from prolonged exposure. It acts in a similar manner to iron in the body and is being considered for some kinds of medical treatment, such as fighting bacterial infections in people with cystic fibrosis.
Germanium (Ge): Has no known function in the body. The FDA has concluded that germanium, when used as a nutritional supplement, “presents potential human health hazard”.
Gold (Au): Has no known function in the body. Injectable gold has been proven to help to reduce the pain and swelling of rheumatoid arthritis and tuberculosis. Pure forms can be used in food, but it probably has no effect and is excreted.
Indium (In): Has no known function in the body. Pure indium in metal form is generally considered non-toxic. However, some indium compounds are toxic and others are known carcinogens.
Iron (Fe): Iron is a necessary trace element used by almost all living organisms. It plays a vital role in transporting oxygen through the blood system. A deficiency of iron leads to anemia and lethargy. Iron distribution is heavily regulated in mammals, partly because iron has a high potential for biological toxicity. It can provide food for microorganisms, encouraging bacterial infections.
Lead (Pb): Has no known function in the body. Lead is extremely toxic. It is a poisonous metal that can damage nervous connections (especially in young children) and cause blood and brain disorders.
Nickel (Ni): Nickel plays numerous roles in the biology of microorganisms and plants and a minor role in the human body. However, some people are allergic to the metal in powder form and many of its compounds are toxic or carcinogenic.
Phosphorus (P): Phosphorus is a key element in all known forms of life. Inorganic phosphorus plays a major role in biological molecules such as DNA and RNA. Living cells also use phosphate to transport cellular energy in the form of adenosine triphosphate (ATP). However, organic compounds of phosphorus form a wide class of materials, some of which are extremely toxic, leading to their use as pesticides and nerve warfare agents. Chronic white phosphorus poisoning leads to “phossy jaw“.
Platinum (Pt): Has no known function in the body. According to the Centers for Disease Control and Prevention (CDC), short-term exposure to platinum salts “may cause irritation of the eyes, nose, and throat” and long-term exposure “may cause both respiratory and skin allergies.” Certain platinum complexes are used in chemotherapy and show good anti-tumor activity for some tumors.
Rhodium (Rh): As a noble metal, rhodium is inert and it plays no biological role in humans. If used in elemental form rather than as compounds, the metal is harmless. However, chemical complexes of rhodium can be lethal and rhodium compounds can strongly stain human skin.
Silver (Ag): Plays no known natural biological role in humans, and the possible health effects of silver are a disputed subject. Silver itself is not toxic but most silver salts are, and some may be carcinogenic. Silver ions and silver compounds show a toxic effect on some bacteria, viruses, algae and fungi, but without the high toxicity to humans that are normally associated with lead and mercury. It is increasingly being used in nanoparticle form to create antibacterial surfaces.
Tin (Sn): Plays no known natural biological role in humans, and the possible health effects of tin are disputed. Tin in metallic form is not toxic but most tin salts are. Nausea, vomiting and diarrhea have been reported after ingesting canned food containing 200 mg/kg of tin.
Uranium (U): Has no known function in the body. Uranium is radioactive and toxic. Normal functioning of the kidney, brain, liver, heart, and other systems can be affected by uranium exposure. Prolonged exposure can be carcinogenic.
Zinc (Zn): An essential mineral of exceptional biologic and public health importance. Zinc deficiency affects about two billion people in the developing world and is associated with many diseases. Zinc deficiency in children causes delayed sexual maturation, diarrhea, growth retardation, infection susceptibility, and contributes to the death of about 800,000 children worldwide per year. Consumption of excess zinc can cause ataxia, copper deficiency and lethargy.

Moderation in all things…
So, next time you look a that bottle of vitamin or mineral supplements, take a good look at the label. There’s no reason whatsoever to be taking more than the recommended daily average dosage of any metal. As we’ve seen above, none of them are beneficial if taken to excess and some are downright harmful.

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Everyone's Guide to Medical Equipment - Part 10 - Tomography & MRI

slbread We started this series by looking at the equipment that you would expect to find in a doctor’s bag or a clinic. We then looked at the laboratory equipment that’s used, generally behind the scenes, to analyze blood and other samples. Medical monitors are used to track a patient’s vital life signs, either for routine, preventive screening, or while a patient is experiencing a problem, or undergoing treatment. Modern diagnostic equipment plays a very large part in narrowing down the possibilities when a patient shows signs of a disease, often being able to pinpoint problems, such as cancerous tumors, extremely accurately.

In this article we’ll look at a technique, tomography, that advanced scanning equipment uses to produce and process data into two or three-dimensional images that are easier for a human to interpret. We’ll also look at one of the better known techniques that has become increasingly useful as a result of higher precision instruments and better, faster tomography algorithms – Magnetic Resonance Imaging (MRI).

Tomography
Tomography is an imaging technique that uses a wave of energy to take images of a section, generally a slice, of an object that are then combined into two or three-dimensional images. Imagine a standard loaf of bread, straight out of the oven. If I slice it into thin sections, separate them and then hand them to you in sequence (from one end to the other) it’s easy to reassemble them into the shape of the original loaf. If I shuffle them before giving them to you it’s still quite easy to reassemble them accurately, because there are irregularities in the shape of the outline of a slice and the imperfections (such as air bubbles) within the loaf. It doesn’t really matter if the slices are of the same thickness, or whether I decide to cut the loaf into irregular chunks. Just like a jigsaw puzzle, it’s almost always possible to fit the pieces together properly.

Tomography uses exactly the same principle. An X-ray machine, or some other kind of scanning equipment, is moved along part, or all, of the body or head, taking images of a slice of the subject. The images are captured electronically and then the computer uses an algorithm to align the slices. The final image is then presented to the diagnostician in two or three-dimensional form. Color or brightness may be used to enhance the image to highlight key structures, such as bones, and anomalies, such as suspected tumors or foreign objects. The computer can combine data from adjacent slices to create two-dimensional slices through the object oriented differently than the originals, or to create full three-dimensional images that can be rotated or manipulated to create multiple visualizations. Some viewing systems can even produce stereoscopic (full 3D) images or videos.

The term “computed tomography” is most often applied to techniques that start with X-ray images, but the tomography technique is used in a wide variety of other equipment, including Magnetic Resonance Imaging (MRI) and non-medical fields, such as Nuclear Magnetic Resonance Imaging (NMRI) and seismology. The images below show a typical MRI scanner, images of slices of a subject’s head and the images that the computer software has combined into a more usable view.

MRI Equipment and Tomograms

MRI Scanner¹	Tomogram Slices	Full Head Visualization

Magnetic Resonance Imaging (MRI)
“Magnetic resonance imaging was developed from knowledge gained in the study of nuclear magnetic resonance in atoms. In its early years the technique was referred to as nuclear magnetic resonance imaging (NMRI). However, as the word nuclear was associated in the public mind with ionizing radiation exposure it is generally now referred to simply as MRI. Scientists still use the term NMRI when discussing non-medical devices operating on the same principles. The term magnetic resonance tomography (MRT) is also sometimes used.” – Wikipedia.org

Nuclear Magnetic Resonance (NMR) is a property that magnetic nuclei exhibit in a steady magnetic field when electromagnetic (EM) pulses are applied. The nuclei absorb energy from the EM pulses and then transmit it back out at a specific resonance frequency that is directly proportional to the strength of the applied magnetic field.

In layman’s terms – if you place an object in a steady magnetic field and then direct pulses of electromagnetic energy into it, the nuclei of all of the atoms in it “wobble” at a particular frequency and orientation to the pulses. The frequencies and orientations differ according to the type of atom that the nucleus is a part of, so you can differentiate between substances. The effect can be directly measured and turned into data that can be processed to form images.

The steady magnetic field aligns all of the nuclei in the same direction. The pulses then cause the nuclei to momentarily change their alignment, an effect that can be detected and measured extremely accurately. The pulses are usually applied perpendicularly to the original field, to produce maximum effect. Once the fields are removed, everything returns to its original state. The behavior of the atoms, relative to one another, is unchanged, so there is no known affect at the molecular and thus the cell, tissue, organ and organism level. X-rays, on the other hand, can cause damage to cells, tissues and organs, particularly at higher powers, or after longer exposure to them.

So, there is no nuclear material or atomic radiation involved in nuclear magnetic resonance or the MRI equipment that uses the effect. The term refers to the behavior of the nuclei in the object being examined. MRI equipment is very expensive, mainly due to the cost of the powerful magnets and electromagnets involved. There is a lot of research into producing more powerful magnetic materials and the use of superconducting materials. The magnet assembly is so massive that it’s much easier to move the patient through the magnets than vice versa. The strong magnetic fields also pose some other problems. Areas of the body that contain pacemakers or metallic implants, must not be scanned. The magnetic fields may move them and the electromagnetic pulses may cause electric currents to flow in them, causing overheating or damage to the electronics.

The benefits from using the MRI technique are enormous, as seeing inside the body is one of the most important diagnostic techniques available to many fields of medical science, particularly for distinguishing pathologic tissue (such as a brain tumor) from normal tissue. The visualizations obtained from MRI equipment are also extremely valuable in planning treatments and surgery and in evaluating their effects.

What’s next?
In the next article in this series we’ll look at Positron Emission Tomography and other kinds of advanced medical diagnosis equipment.

¹ Source: Southwestern University, Georgetown, TX.

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Footnotes to Yesterday's Article

liar3 Yesterday we wrote about the Republican’s attempts to change history by trying to look like the fiscally responsible party. A couple of items came our way as a result of that article that we’d like to share with you.

It was interesting to hear yesterday that South Carolina Governor Mark Sanford (R) “has changed his mind and is now requesting his state’s share of a popular education grant authorized as part of last year’s federal stimulus.” Remember that Gov. Sanford was vehemently against the American Recovery and Reinvestment Act of 2009 (ARRA) and famously turned down a much-needed $700 million of the recovery money before his state’s Supreme Court over-ruled him. He was back in Washington on Thursday to request $300 million from the stimulus fund to keep the education system alive in his state. Like many other “fiscally conservative” politicians, Gov. Mark Sanford (R) is clearly a hypocrite.

Job loss rates
One of our readers (”Thank You” again) sent me this graphic, from the Bureau of Labor Statistics. It’s not certain that the Recovery Act money has caused all of the turnaround in job loss rates, but in the absence of any other major change in the factors affecting the economy, it must be a prime driver.

The total unemployment rate is still high, of course, but there are many background trends that aren’t helping the situation. Large companies are still offshoring jobs to save money. President Obama has included the following (paraphrased) provision in his budget for next year – “Strengthen international tax enforcement to combat offshore tax evasion, and reform the way income earned abroad is taxed to reduce incentives for moving jobs and profits offshore.”

The Republicans, of course, are against the idea as it can be talked down by using one of their standard talking points – “Raising taxes.” What do you want, people? Jobs for Americans, or better profits for your cronies in big business? They’ll answer “Both”, of course, but there’s no evidence that slashing taxes for big companies will cause them to create more jobs in America. It might have worked in the early twentieth century, when it was unprofitable or difficult to offshore most skilled jobs, but it won’t work now unless companies are forced to reverse the trend.

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Rewriting History - Why You Need To Hide Your Wallet

liar As the health care reform debate limps on, the Republicans are attempting, with some degree of success, to rewrite history and prepare the way for big businesses to drain your wallets, silently targeting seniors for an extra-special shakedown. Aware that some of the public still remembers that their party was in power in the eight years leading up to the financial meltdown they’re sending out an endless stream of messages about big, growing government, increasing taxes and a growing budget deficit.

All of this is connected with their attempt to get back into power, of course, but there are tactical goals too, namely protecting their buddies in Wall Street against new regulations. One of the more disturbing things about their game plan is that it relies on: straight, irrefutable, blatant lies; innuendo; and the distortion of facts. There’s no substance to their ideas and the lies seem to go unchallenged by most of the press.

Before we look at the proposals that Republicans are now putting on the table regarding health care reform and financial industry regulation, lets look at the background noise regarding the deficit and taxes.

The budget deficit
Republican claim: Obama is overspending and will run up a $1.6 billion deficit next year.
Fact: The Republicans last came to power with a government budge surplus of $236 billion. When they left power the deficit was $1.75 trillion! They also chose not to disclose the costs of the wars in Afghanistan and Iraq in their annual budgets. They also left a $16 trillion national debt, a $700 billion trade deficit, and an economy that was shrinking significantly.
Reality check: The deficit number is correct. However, President Obama was left with a $1.75 trillion deficit. He has to cover part of the $800 billion in Medicare prescription drug plan charges that the Republicans never funded, i.e. they committed to spending the money without finding a source for it. He has to cover a chunk of the $1 billion Wall Street bailout plan, put in place by the Republicans, and he also has to start paying for the Recovery Act, which he had to put in place because of the mess left by the Republicans. He also folded the cost of the two wars into his budget. So, it was going to be at least $1.6 trillion anyway, before he came into office. He’s also proposed cuts to the budget to help limit the increase, but they won’t start happening until we’re over the worst of the recession and people are back at work.

The truth about new taxes
Republican claim: U.S. Senate Republican Leader Mitch McConnell (R-KY) claimed earlier this week that the government will impose $400 million in new taxes on American citizens and small businesses next year.
Fact: The need to reduce the deficit, cover the above costs and start providing for health care will indeed require extra taxes.
Reality check: Here are the new taxes…

On people making more than $250,000:

$338 billion – Bush tax cuts expire and won’t be renewed
$179 billlion – eliminate itemized deduction
$118 billion – capital gains tax hike

On big (not small) businesses, particularly the petrochemical giants:

$17 billion – Reinstate Superfund taxes, i.e. make businesses pay for the environmental hazards they’ve created.
$24 billion – tax carried-interest as income, i.e. tax bonuses to partners managing financial funds.
$5 billion – codify “economic substance doctrine“, i./e. eliminate questionable tax shelters.
$61 billion – repeal LIFO, i.e. stop companies shuffling their inventory to minimize tax payments
$210 billion – international enforcement, reform deferral, other tax reform
$4 billion – information reporting for rental payments
$5.3 billion – excise tax on Gulf of Mexico oil and gas
$3.4 billion – repeal expensing of tangible drilling costs
$62 million – repeal deduction for tertiary injectants
$49 million – repeal passive loss exception for working interests in oil and natural gas properties
$13 billion – repeal manufacturing tax deduction for oil and natural gas companies
$1 billion – increase to 7 years geological and geophysical amortization period for independent producers
$882 million – eliminate advance earned income tax credit

It’s true that rich people will pay more taxes, reverting to the levels they were at during the Clinton administration. However, the above taxes, totaling $989 billion, are spread over 10 years, i.e. they amount to about $90 billion a year. Senator Mitch McConnell appears to have conjured the $400 billion figure out of thin air, i.e., he lied. It’s also worth noting that: “In its 2009 report, Citizens for Responsibility and Ethics in Washington (CREW) named McConnell one of the 15 most corrupt members of Congress, stating that ‘Sen. McConnell’s ethics issues stem primarily from (1) earmarks he inserted into legislation for clients of his former chief of staff in exchange for campaign contributions and (2) the misuse of his nonprofit McConnell Center for Political Leadership at the University of Louisville.’ McConnell was also included in the group’s report in 2007 and 2008.” – Wikipedia.org. Could it be that he’s simply lining up ammunition for his cronies in the financial industry? Having reduced the value of your assets by about 40% in the past few years, they’re now after an even bigger slice of the contents of your wallet.

The Republican health care reform roadmap
Republican claim: They have a new roadmap that will save Medicare and provide everyone with better health care plans.
Fact: The roadmap does next to nothing for consumers and bolsters health insurance companies.
Reality check:The new roadmap is a really bad joke. Here are its main effects (abstracted from Politifact):

It decreases the number of uninsured by only a small amount, about 3 million (out of nearly 50 million).
It will not serve to reduce the deficit (even though healthcare spending is a growing reason for the deficit).
It does prop up Medicare/Medicaid, but only by assuming that people can obtain the same insurance for substantially less, which isn’t possible. Seniors will be particularly hard hit.
It will not prevent insurers from dropping sick people from policies.
It will not prevent insurers from refusing to cover those with pre-existing conditions.
It will reduce consumer protections on health insurance, such as limiting higher premiums for seniors.
It will continue the excessive Medicare Advantage subsidy.
It will not offer a public option or create new insurance exchanges.
It will put limits on malpractice awards and make it harder to win them (but will not curb large malpractice insurance premiums, and will under-compensate people who have been harmed).
It will reduce regulation of the health insurance industry (through the so-called cross-state purchase option), allowing them to run their empires out of states with the weakest consumer protection laws.
It will probably reduce the level of available insurance benefits in small businesses.

So, the proposed roadmap protects and strengthens the health insurance industry and does next to nothing for consumers. Many more will go bankrupt. Everyone on Medicare/Medicaid will receive less care, if they can find an insurer, and seniors will be particularly hard hit. The proposed roadmap has started to attract adverse attention, particularly regarding its core proposal – to give people vouchers to buy insurance from private insurers, rather than via Medicare/Medicaid. Unfortunately, the vouchers wouldn’t even cover the cost of any equivalent insurance policy premium that’s available today, let alone in future years, as the insurers hike prices uncontrollably.

This proposal is so clearly ridiculous that the senior Republicans who supported the roadmap on the day that it was handed to President Obama are now backpedaling and claiming that it’s just one input to a plan they’ll formulate later. The question is – how much later? People are dying because of these clowns (see “A Grim Reminder” in the right hand sidebar).

The fight against regulation of the financial industry
Republican claim: The Democratic majority are ruining America, ruining capitalism, so stand up for yourselves.
Fact: The Republican’s lack of regulation of Wall Street led to the greatest financial meltdown since the Great Depression.
Reality check: Wall Street showers both parties with campaign funds, a total of $42 million to lawmakers, mostly to members of the House and Senate banking committees and House and Senate leaders between November 2008 and November 2009. The Democratic candidates received well over $88 million and Republicans got over $67 million during the 2008 elections. It’s all for the good of the public, of course, not to fight off regulation of the financial industry. Sure!

Wall Street executives and lobbyists have been swarming all over Washington and the White House in recent months, as new regulations are being debated to curb the excesses that lead to the great meltdown. It’s over year since it started, but there have been no laws passed to prevent it from happening again. They’ve gone right back to their former mode of business, even dishing out monstrous bonuses with money received from the bailout that taxpayers are being asked to fork out. That’s adding insult to injury.

You’d think that the Republicans would want to keep a low profile on this one, but they kicked off the debate by having House Republican leaders meet with more than 100 lobbyists at the Capitol Visitors Center on December 8, 2009 to co-ordinate plans to fight back against the planned overhaul of financial regulatory legislation. House Minority Leader John Boehner (R-OH), Minority Whip Eric Cantor (R-VA) and Reps. Kevin McCarthy (R-CA), Scott Garrett (R-NJ) and Jeb Hensarling (R-TX) sat down with their masters to receive their orders. A lobbyist whoa attended the meeting said afterwards – “The message was [House Financial Services Chairman Barney] Frank and the Democratic majority are ruining America, ruining capitalism, so stand up for yourselves. They said, ‘Look, you all oppose this bill, but only a few of you have come out publicly.’”

The message has been banged out repeatedly over the past few months, with supporters carrying on about their Federal Reserve Bank conspiracy theories to further fuel the flames that could lead to congressional control of our currency – something that both the politicians and large companies would love. With the recent ruling that allows companies to spend unlimited amounts on their own campaign advertising, it’s pretty clear where things are headed. Can anybody come up with a sensible argument for allowing the people who got us into the current recession have even greater control over the country’s destiny? I can’t think of one.

Late breaking news: Rep. Barney Franks, Chairman of the House Financial Services Committee, announced today that discussions with the Republicans on financial industry reforms have stalled. What a surprise!

The need for fact checking
It may be time to have a professional, real-time fact checker follow every senior Republican around, making them pause at the end of each statement, just as they would if a translator were necessary, for instant verification or refutation of what they’d just said. Even better, do the fact checking before allowing the statements on air, replacing most of them with a standard “Politician X made a statement about Y this morning, but independent fact checking showed that it was 100% false, so we are not airing/repeating it.” Is that censorship? What about freedom of speech? People can say what they like, but the rest of us don’t have to repeat, broadcast or listen to it, particularly when it’s a pack of lies. We could do the same for Democrats too, but most of the problems seem to lie with the Republicans and some Independents right now.

We all know that this won’t happen, so it’s even more important for the independent press to maintain its vigilance and for individuals to check multiple sources. You can avoid a lot of the lying by simply not watching or reading anything owned by Rupert Murdoch (check the reviews), for instance, unless you’re verifying statements that somebody else says were made there. Meanwhile, when it comes to new ways to spend our tax Dollars, check the figures that the independent Congressional Budget Office (CBO) produces rather than anything manufactured by either side of an argument.

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Brain Scanning Technique Offers New Hope For Vegetative Patients

fmriimage Some patients in a low awareness state, commonly referred to as a “vegetative” state, have been proven to be able to communicate by activating areas of the brain that can be monitored in real-time using an advanced scanning technique called functional magnetic resonance imaging (fMRI) which shows brain activity in real time. A study¹ published on February 3, 2010 by scientists from the United Kingdom Medical Research Council (MRC), the Wolfson Brain Imaging Centre in Cambridge, UK and a Belgian team at the University of Liege describes the scanning technique and positive results with four of twenty three patients who had been diagnosed as being in a persistent vegetative state (PVS).

Patients who are in PVS are awake, not in a coma, but they seem to have no awareness because of severe brain damage. As they can’t communicate using conventional means, it’s very hard to establish their exact condition. The scientists monitored brain activity in real time and asked patients and healthy volunteers to imagine playing tennis. For each of the volunteers this stimulated activity in the pre-motor cortex, part of the brain which deals with movement. They also monitored activity when the volunteers were asked to use their spatial skills by thinking about roaming the streets. The scientists then asked the volunteers a series of questions that required “Yes” or “No” answers, instructing them to think of playing tennis if they wanted to respond “Yes” or roaming the streets to mean “No”. The researchers established that the volunteers’ responses could be detected accurately. The patterns detected when they were simply asked to think “Yes” or “No” were too complex to allow clearcut differentiation.

They then used the same technique with a Belgian man who had been injured in a traffic accident seven years ago. They asked him a series of questions. The patient responded accurately to five out of six autobiographical questions, such as confirming that his father’s name was Alexander, that the scientists asked him. Dr Adrian Owen, from the MRC in Cambridge, UK, a co-author of the report said – “We were astonished when we saw the results of the patient’s scan and that he was able to correctly answer the questions that were asked by simply changing his thoughts.” This could be a breakthrough in treating patients in this state. “You could ask if patients were in pain and if so prescribe painkillers and you could go on to ask them about their emotional state.”, he said.

Potential ethical issues
There are almost a thousand PVS patients in Britain who are kept alive by doctors in the hope they may one day regain consciousness.The new discovery raises many ethical issues. As an example, it is lawful to allow patients in a permanent vegetative state in the United Kingdom to die by withdrawing all treatment. However, if a patient showed that they could consistently respond to questions it would not be legal, even if they made it clear that they would prefer that course of action. Physicians have also been able to use other techniques to determine that some patients in a low awareness state are able to communicate, so the ethical problem isn’t new. However, the new technique seems to be much more conclusive than previous ones.

Helen Gill-Thwaites, a consultant in low awareness state at the Royal Hospital for Neuro-disability in London, welcomed the new research, but she also cautioned that it was still early days for this kind of research. She said that – “It’s very useful if you have a scan which can show some activity but you need a detailed sensory assessment as well. A lot of patients are slipping through the net and this adds another layer to ensure patients are assessed correctly.” She said that the hospital had conducted a study of 60 patients admitted with a diagnosis of PVS and researchers concluded that 43% of them were able to communicate.

Opinions on how to treat PVS patients vary widely across the medical, religious, political and legal communities:

Dr. Jacob Appel, an expert in medical ethics at the Mount Sinai Hospital in New York, said that doctors should help end the lives of people trapped in their bodies, if they think that is what they want. He said -”I think a compelling case can be made that doctors have an ethical obligation to assist such patients by removing treatment. I suspect that, if such individuals are indeed trapped in their bodies, they may be living in great torment and will request to have their care terminated or even active euthanasia.”
Professor Geraint Rees, Director of the Institute of Cognitive Neuroscience at University College London, said: “As a clinician, it would be important to satisfy oneself that the individual that you are communicating with is competent to make those decisions.”
Dr Peter Saunders, Director of the Care Not Killing Alliance, which opposes euthanasia, believes that the breakthrough will be unlikely to alter contentious guidelines on assisted suicide, as patients in vegetative states are not likely to be considered to have sufficient mental capacity to make life-or-death decisions.
A spokesperson at the British Medical Association said that it is unlikely that many medics would consider the results of a brain scan experiment as sufficient evidence of mental capacity.
The late Pope, John Paul II, said that it is “morally obligatory” to provide nutrition and hydration to patients in a vegetative state.
Terry Schiavo, a Florida woman who was artificially kept alive for 15 years after having been diagnosed with a profound brain injury, was at the center of a seven-year legal battle involving Congress, the U.S. Supreme Court and even President George W. Bush before a judge granted her husband the right to allow her to die in 2005.

It is very likely that the new technique will be further refined, possibly even opening the ability for a PVS patient to communicate with a sufficiently rich vocabulary as to leave no doubt as to their capabilities. Many patients with other disabling conditions, such as motor neuron disease, which Stephen Hawking, the renowned Nobel prize-winning physicist, has survived with for decades, communicate with the aid of a computer and a voice synthesis device. If that ability can be achieved for PVS patients the ethical debate will become very interesting indeed.

¹ “Willful Modulation of Brain Activity in Disorders of Consciousness” – Martin M. Monti, Ph.D., Audrey Vanhaudenhuyse, M.Sc., Martin R. Coleman, Ph.D., Melanie Boly, M.D., John D. Pickard, F.R.C.S., F.Med.Sci., Luaba Tshibanda, M.D., Adrian M. Owen, Ph.D., and Steven Laureys, M.D., Ph.D. – New England Journal of Medicine – February 3, 2010 – 10.1056/NEJMoa0905370.

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1 in 5 Nursing Homes Get Poor Ratings From Medicare

Medicare started releasing star ratings for the nation’s nursing homes in late 2008. They derive the ratings from complaint investigations, standard inspections and other data. There are around 15,700 nursing homes in the United States, caring for over 1.5 million people. Just over 5% of over 65s live in nursing homes and twice as many others are admitted for short periods in a given year.

The Medicare rating system awards nursing homes one to five stars. The latest report rates one in five facilities in the one or two star (i.e. “poor”) category. It’s worth noting that even a one star facility meets minimum Medicare requirements. However, the fact that more than a quarter of a million patients are living in the lower grade facilities, most of which are for-profit organizations, is a cause for concern. The problem is widespread, with every state having homes with low ratings from one year to the next. Here are some of the main findings and facts:

More than 200,000 onsite reviews are used in the health inspection scoring nationally.
Over 12 million assessments of the conditions of nursing home residents were taken into account.
The lowest-rated nursing homes had an average of 14 deficiencies per facility, which can include quality-of-life measures and safety violations.
Many of the facilities with low ratings are the only ones for miles around.
There have been some improvements within the past year, including a reduction in the number of one-star homes and increased vigilance among providers in the use of restraints (to stop people falling out of bed).

The rating system
The CMS Nursing Home Compare web site now uses a quality rating system that gives each nursing home a rating of 1 to 5 stars. Nursing homes with 5 stars are considered to have much above average quality and those with 1 star are considered to have quality much below average. There is an overall 5-star rating for each nursing home plus a separate rating for each of the following three sources of information:

Health Inspections – This uses information from the last 3 years of onsite inspections, including both standard surveys and any complaint surveys. The most recent survey findings are weighted more than the prior two years.
Staffing – This considers the average number of hours of care provided to each resident each day by nursing staff. It takes into consideration the differences in the level of need of care of residents in different nursing homes. A nursing home with residents who had more severe needs should have more nursing staff than a nursing home where the resident needs were not as high.
Quality Measures (QMs) – This takes into account 10 different physical and clinical measures for nursing home residents, such as the prevalence of pressure sores or changes to resident’s mobility. The QMs offer information about how well nursing homes are caring for their residents’ physical and clinical needs.

Taking advantage of the rating system
The Nursing Home Compare tool has detailed information about every Medicare and Medicaid-certified nursing home in the country, making it a valuable resource for patients, caregivers and family members. The online tool allows you to:

Find Nursing Homes in your area: You can search by name, city, county, state, or ZIP code.
Make quality comparisons: You can compare the quality of the nursing Homes you’re considering using the quality ratings and measures, health inspection results, nursing home staff data and fire safety inspection results.

You should look closely at the reasons for a particular facility not receiving more stars as they may not be relevant to a particular patient’s needs, particularly for short term stays. If you can, you, or somebody you trust, should visit the nursing homes being considered. The web site provides a handy nursing home checklist and other resources.

You should also talk to your doctor or other healthcare practitioner about potential nursing home choices. You can also contact the Long-Term Ombudsman or State Survey Agency if you have any concerns before you make a decision. We’ve added links that will help you find the above resources to the Useful Sites page.

Don’t forget that you or your family member may also have other long-term care choices, such as community-based services, home care, or assisted living.

Related articles:

Nursing Home Quality – an independent data source.
Alternatives to Nursing Homes
More Like Home
Home, But Not Alone

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Auto Safety Features For Senior Drivers

MrMagoo One day last week we set off for San Francisco in the pouring rain. We have to drive a winding, single lane road to reach the nearest freeway. A few hundred yards from home we came up behind a senior lady driving at 35 MPH in a zone with a 55 MPH limit. This road is deadly. It’s nicknamed “Blood Alley” by the locals for good cause. Governor Schwarzenegger passed emergency legislation in 2009 to accelerate a central barrier and road widening scheme that Caltrans had sat on for years. Unfortunately, it took a spate of five deaths in a few weeks to spur action. It’s a road where a momentary loss of attention can put you into a head on collision with a large semi.

The lady in question wasn’t just driving slowly, she was weaving from side to side. At first we thought she was drunk and we were about to call the CHP when we realized that she was putting on her makeup. She had no idea we were behind her, as she’d swiveled the rear view mirror towards her to get a better view of herself. Honking the horn did no good, but we were able to pass her safely on the two-lane stretch a few miles from home. It was raining, slippery and she was on a very dangerous road – paying no attention to her driving. She had no lights on either, which is illegal in California in the rain and doubly illegal on a stretch of roads where headlight use is mandatory. It was an accident waiting to happen.

Yesterday, I was in town and I saw another senior doing a K-turn in the parking lot behind a store. That’s fine, except that he was turning around in order to drive the wrong way out of the lot! I don’t know why, unless he was afraid of getting lost in the back allies and felt safer heading straight out onto Main Street. Maybe the slant on the parking spaces and the big arrows on the ground should have been a clue. Anyway, that was only a part of the problem. He reversed into a neighbor’s fence post, pushing it out of line and putting a large dent in his rear bumper. Shortly afterwards, two seniors reversed into each other outside of the grocery store, which is why I was glad to get home and was prompted to write this article. One of the drivers was on a handheld cellphone, which is illegal while driving in California.

Modern auto safety features
There isn’t much that the auto makers could have done to help the idiot lady doing her makeup instead of focusing on her driving – or is there? Here’s a list of interesting features (excluding seat belts and air bags, which are mandatory) that you can find on many new cars and some older ones. Many of them might seem like frills to Nascar-style drivers, but all of them make driving safer for seniors and their fellow motorists:

Handsfree cellphone hookups: Some of these are actual docks, but by far the most convenient are the ones that use the Bluetooth wireless communications protocol to connect a regular cellphone to the car’s controls, microphone and speakers. Many systems permit voice dialing, while others use controls on the steering wheel.
Voice actuated controls: The system will recognize a wide range of spoken commands that allow the driver to control the radio, air conditioning, navigation system and some other devices that may be safely adjusted while driving.
Satellite navigation system: It may have a touch screen, joystick-like controls, voice control, or a combination of them. You not only won’t get lost, you’ll have ample warning when it’s time to change lanes to exit the freeway, or to negotiate complex interchanges. Some of them have real-time traffic flow, accident and adverse weather warnings and the ability to route you around the problem if you decide not to wait for it to go away. A good navigation system can take a lot of stress out of driving.
Onstar, AcuraLink or other safety/concierge service: These systems allow two-way communication between the car and a human or computer concierge. They can alert emergency services in the event of a medical emergency or if the airbags deploy, provide directions and tell you when maintenance is required.
Flexible maintenance schedules: Cars used to have set periods or mileage requirements for the myriad kinds of maintenance that they require. Some now let the onboard computer decide when oil changes and other services are needed. We tend to get forgetful as we get older. These systems will help make sure that your car stays in optimal condition. Say goodbye to burning transmission smells, boiling radiators, ineffective A/C or empty windshield washer bottles.
Parking sensors: Once a boon for comedians, they’re becoming smarter than the old “cat’s whiskers” and can alert you to things that you might not otherwise see, such as a toddler behind you in the parking lot. Others will assist with parallel parking – some even doing most of the work for you.
Self-dimming/dipping rear-view mirror: These rear view mirrors dip or dim automatically to avoid dazzling the driver when some yahoo in a jacked up monster truck is behind you with his fog lights on. They cut dazzle when you’re on crowded freeways too.
Rear view cameras: These may be black and white or color and are even better than parking sensors when you’re reversing. I actually did spot a toddle behind me as I started backing out of a parking spot and stopped in time. His mother was angry at me for some reason, until I pointed out that it wasn’t my fault that her three year old was loose in the busiest parking lot in town and was unharmed because I wasn’t driving a clunker. It might have saved the fence and three rear bumpers in the incidents I mentioned above.
Blind spot elimination: These may use sensors that alert the driver to nearby vehicles, or actual cameras that display an image of the areas in the blind spots.
Lane departure sensors: These systems track the lane markings and sound a warning, or vibrate something, if the car starts to wander over the lines. This system might have alerted our senior lady friend if she’d had one in her car. Some systems are smart enough to keep the car in lane by steering the car, but they aren’t sold in the United States because the lane markings are of such variable quality here. I drove one for miles on the freeway around London, England a couple of years ago and it worked perfectly.
Driver alertness sensors: These systems continually check the driver’s eyes or head position and sound an alert if there are signs of drowsiness.
Collision mitigation/avoidance radar: This system detects hazards ahead of the car and alerts the driver, usually while applying the brakes. My car flashes and sounds alarms and actually tightens the seat belts just in case the problem is unavoidable, e.g. if there’s an object, such as a lost wheel from an oncoming vehicle, rolling straight at you.
Adaptive cruise control: This system couples the radar with the car’s regular cruise control, allowing you to set a speed that the car will maintain unless there’s a vehicle ahead of you. It then slows down or speeds up to match the speed of that vehicle, but without exceeding the speed you’ve set. This truly is an amazing system. It’s been invaluable around here in the Tule fogs that we experience and it takes a huge amount of the stress out of driving on the freeway in the rain or snow. It’s slowed the car down for me before I spotted a coyote running out into my path from the fields alongside the road (why do they do that?) and a deer that leapt out from behind an oncoming semi. It once applied the brakes just in time to avoid a crazy driver who joined the freeway traffic and crossed four lanes at almost 100 MPH before slamming into a car moving into the commuter pool lane. I missed him by about a foot. I’d been concentrating on moving into the lane on my left safely. He came from the right.
Night vision: These systems either have thermal sensors that can detect animals and people at night, use night vision cameras or illuminate the road far ahead with infrared beams that are invisible to oncoming traffic, but that illuminate objects in your path when seen through an appropriate camera.
Heads-up displays: These systems project information, such as vehicle speed, fuel remaining and directions onto the windshield in a position that the driver can see without looking down or sideways.
Memorized seat, pedal(s), steering column and mirror positions: The car’s computer system remembers each driver’s preferred settings, making sure that the driver is sitting comfortably, can reach all controls easily and has optimum all-round visibility.
Keyless entry systems: These won’t help you avoid accidents, but they will make sure that you don’t lock yourself out of the car by leaving the key in the trunk or passenger compartment. There’s generally a valet key that will allow the car to be driven, but that won’t allow access to the trunk and locked compartments in the cabin.
Heated side mirrors: The mirrors clear quickly if they are wet or iced over.
Ventilated, heated/cooled seats: A comfortable driver is probably a better driver.
Smart climate control: Allows the driver and passengers to set their own airflow and temperature preferences. On some systems the car knows where the sun is and can change the flow of air accordingly.
Run-flat tires: This kind of tire is very expensive, but the car won’t slew if a tire is punctured and the car can be driven at reasonable speeds for up to fifty miles. This is a huge benefit on narrow roads and freeways, as you can drive to a safe location before calling for a tow. I’ve had two tires go flat in the past couple of years and both times I was close enough to an Acura dealer to simply drive there and get them to replace the tire. One of these tires saved my life may years ago on a narrow country road in England.
Automatic tire pressure monitoring: Your tires are essential to steering, stopping and accelerating. If they are under or over-inflated you will lower gas mileage and run the danger of burst or less effective tires.
Smart all-wheel drive: These systems keep the car glued to the road in almost all conditions, making almost every journey safer, no matter what the weather and road conditions. The best ones vary the individual wheel speeds according to the steering wheel position, direction of travel and road conditions.
Swiveling head lights: One or both of the main headlights swivel(s) as you turn corners. This provides extra lighting as you enter and exit a corner.
Self retracting rear head restraints and sunscreens: These retract when the car is about to reverse, giving the driver better visibility.
Steering wheel “paddle” gear shifters: Some people hate them, I love them. They’re a boon at times when you want to be smarter than the automatic transmission computer at low speed in mud, or at high speed if you want to push the car to its safe limits on winding roads.
Ground illumination: lights that shine on the ground when the doors are opened, making it easier to see uneven ground or other obstacles.
Delayed light extinguishing: The headlights stay on long enough for you to move onto safe footing before they finally turn off.
Homelink garage and security door opener: Program all of your remote door openers into the car so you won’t have remotes flying about if you have to stop suddenly. Some can be voice activated.
Quick lock/release baby seat anchor points: For when the kids dump the grandkids on you. No more wrestling with seats, straps etc. Click it in. Press the lever and lift it out. Don’t forget the baby.

I’m sure that the above list isn’t extensive and I don’t think you’ll find all of them on a single model of car (our Acuras have most of them), but I think that almost all of them will become standard in the near future. Please let us know of ones that we’ve missed or ones that you’d like to see made available.

Some people may be daunted by all of this high technology stuff. Verna fell into that category, but once she found that most of it takes care of itself she settled down to focus on her driving. Properly implemented, the technology makes journeys safer, less stressful and far less tiring. I’m not sure that I’m looking forward to the day when all cars are computer driven and the driver can sleep through the journey, or watch a 3D video, but when I think about that senior lady the other day, maybe it would be a good insurance option – the “I promise not to touch the car’s controls” discount.

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The Antidepressant Controversy

(cc) optiknerve-gr

A recent article¹ in Newsweek drew attention to a controversial series of studies that casts doubt on the general efficacy of popular antidepressant drugs, many of which are based on compounds called Selective Serotonin Reuptake Inhibitors (SSRIs), tricyclics and MAO inhibitors. The number of Americans taking antidepressants doubled in a decade, from 13.3 million in 1996 to 27 million in 2005. At least 32 million will have the disease at some point in their life and many of the 57 percent who receive treatment seem to be helped by antidepressant medication.

The controversy started in 1998 when a study², by psychology researchers Irving Kirsch and Guy Sapirstein of the University of Connecticut, examined 38 manufacturer-sponsored studies involving just over 3,000 depressed patients. Their basic findings agreed with scores of other trials that showed that antidepressants seem to work. Then they went further than other studies and compared the results obtained with the antidepressants with those where patients were given placebos – dummy pills that generally have no active ingredients. They found that patients who were given a placebo improved about 75 percent as much as those on the antidepressant drugs. The obvious conclusion is that three quarters of the benefit from antidepressants may just be a placebo effect.

Were the original studies scientifically sound?
The situation is slightly complicated by an effect that can occur if a test subject discovers, or deduces, that they really are using some kind of drug, rather than a placebo. Some of the drugs have side effects and if a patient recognizes them they may become more confident that the pill is actually working, boosting the results slightly more than if they suspect that they are on a placebo. Psychologists have long known that making a change to a person’s environment (in response to a complaint about a problem) usually makes the person feel better because something (even if actually made things worse) was being done. It’s known as the Hawthorne effect. So, studies that changed the kind of antidepressant and that showed that each change was improving matters, may simply have been exhibiting the Hawthorne effect. Unfortunately, nobody had used placebos after using a real antidepressant to see if the results were the same as switching to another type. Some of the tests used mildly active ingredients, which might alter the digestion, or produce other noticeable symptoms, without significantly changing the overall findings.

Physicians and researchers who had seen what they believed to be real improvements as a result of prescribing antidepressants were skeptical about the results. Kirsch and Sapirstein were encouraged to go back and take a look at all of the results of the trials sent to the Food and Drug Administration (FDA), many of which had never been disclosed. They did, publishing an updated result in 2002. The results showed that the placebos were about 82% as effective as the real drugs. In other words, their original findings (75% effectiveness) were reinforced.

Researchers also found that increasing the dosage of particular drugs didn’t improve outcomes. They also looked at the effect of other medications, such as tranquilizers, sedatives and other preventive substances. Once again, these medications produced much the same effect as the placebos, casting further doubt on the unique abilities of the antidepressants. A separate meta-analysis³, in 2001, of data submitted to the Dutch authorities, reached virtually identical conclusions to the other meta-analysis.

Round 2 – Could the meta-analyses be flawed?
Other researchers were quick to point out the fact that meta-analyses are only as good as the studies they are based on and may exclude useful or undiscovered facts. As such, they are subject to change as more studies are conducted. Critics also raised questions about the relatively small proportion of available studies included in the meta-analyses and various technical details of the statistical techniques that were used. However, it soon became apparent that many other similar studies, based on different data sets and using diverse statistical analysis techniques, produced results that were in broad agreement with the original meta-analysis. One of them showed that the benefits of antidepressants over placebos were even more pronounced in studies of the long term effectiveness of a treatment. Only one in six patients had better outcomes with the antidepressants than with placebos.

Antidepressant use continues to grow
Given the above evidence, obtained from multiple studies and using a variety of different techniques, but all showing that antidepressants are, at best, only partially effective, you’d expect usage to reduce, or stay constant, rather than to keep increasing. That might be true if only the scientific facts were involved. The Big Pharmas have developed a $6 billion market for antidepressants in the United States alone. They point at the estimated $10 billion per year (in addition to the cost of the drugs) that depression costs industry and the nation. They have no interest whatsoever in educating physicians to use antidepressants more selectively, primarily on severe cases. Their marketing machines are geared up to find even more uses for a drug once it has been approved by the FDA, as there are fewer hurdles once the basic safety and side effects of a drug have been established.

Herbal alternatives
Given the size of the problem, it’s not surprising that alternative treatments have been explored. Treatments that use herbal alternatives, such as St. John’s Wort, which has the active ingredient hypericum, have shown that it is at least as good as conventional antidepressants in mild to average cases, but it may be significantly worse in severe cases. Some other herbal treatments, such as Kava Kava, have been shown to have unacceptable side effects in some patients. Others, such as Bach-Flower remedies, have been shown to have no better an effect than a placebo.

Conclusions
It’s clear that the widespread and growing use of antidepressants isn’t scientifically or medically justified for any other purpose than treating people with above average to severe depression. However, the Big Pharmas’ marketing machines are exploiting a lucrative market and the only thing that will stop them is better education within the medical community. A part of the problem is that is difficult for a physician to accurately assess the degree of depression and the avenues of treatment without involving a specialized psychiatrist, whose skills are in short supply. Hopefully, advanced imaging and other techniques for studying the brain may cast more light on the causes of depression and lead to the development of more effective treatments.

Cautionary Note: If you are taking an antidepressant you may want to discuss the situation with your physician. It might be possible to reduce the strength or frequency of use of a medication without adverse affects. However, you should never reduce or increase dosages, change, or stop taking medications without prior consultation.

¹ “The Depressing News About Antidepressants.” – Sharon Begley – Newsweek – Published Jan 29, 2010 from the magazine issue dated Feb 8, 2010.
² “Listening to Prozac but Hearing Placebo: A Meta-Analysis of Antidepressant Medication.” – Irving Kirsch. & Guy Sapirstein – Prevention & Treatment, a publication of the American Psychological Association – Vol 1(2), Jun 1998, ArtID 2a.
³ “Short-term efficacy of tricyclic antidepressants revisited: a meta-analytic study.” – Jitschak G. Storosum, André J.A. Elferink, Barbara J. van Zwieten, Wim van den Brink, Berthold P.R. Gersons, Roel van Strik, André W. Broekmans – European Neuropsychopharmacology – Volume 11, Issue 2, Pages 173-180 – April 2001.

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Fake Drug Scams Proliferate Online

viagra When we wrote an article on “The Best Ways to Save Money On Prescription Medicine” last October, we pointed out the dangers that counterfeit drugs pose. A study of the rapidly growing problem of counterfeit drugs being sold over the Internet shows the scale of the problem. Counterfeit drug sales have almost doubled in the last five years, and will hit $75 billion in 2010, according to one estimate. Seizures of fake drugs in Europe quadrupled between 2005 and 2007. In the United States the number of investigations undertaken by the Food and Drug Administration (FDA) increased by a factor of eight between 2000 and 2006.

The author of the study, Dr. Graham Jackson, Consultant Cardiologist at Guy’s & St. Thomas Hospitals in the United Kingdom (speaking about fake Viagra) said – “The first danger is people don’t know what’s in it. Some are just talcum powder or brick dust, while some have a bit of Viagra or Cialis and some chemicals that have nothing to do with it. One batch actually contained amphetamine, which is an addictive drug. Tablets are made shiny with road paint or shoe polish. The content of the medication could be anything.”

The risks
Fake Viagra and similar drugs for treating male impotence are a major part of the problem. The study cited an incident in Singapore in 2008, where four men died after ingesting counterfeit impotence drugs that had been contaminated with an agent used to lower blood sugar levels. The purity, quality and main content of a fake drug can all pose a problem. Some of the fake impotence drugs do actually contain phosphodiesterase type 5 inhibitors (PDE5), the main ingredient in Viagra, as well as vardenafil (Levitra) and tadalafil (Cialis). However, men with underlying cardiac problems are at great risk if they take PDE5 without prior medical consultation.

The fake drug problem isn’t just limited to impotency treatments. The study also cites cases where two pregnant women died after they were given injections of a counterfeit iron preparation for anemia, and 51 children died in Bangladesh of kidney failure after taking paracetamol syrup that was contaminated with an antifreeze chemical.

At best, the victims may be wasting their money, but, at worst, they may die from poisoning, cardiac arrest, or as a result of not receiving the correct dosage of a necessary medicine. Dr. Margaret E. Wierman, Professor of Medicine at the University of Colorado Denver and Chief of Endocrinology at the Denver VA Medical Center, who was not involved with the study, said – “You may be wasting your money or you may actually be hurting yourself.”

Avoiding the risk
Clearly, you can avoid the direct risk by not purchasing drugs over the Internet. However, that’s too simplistic a solution. Reputable online drug sites, such as Drugstore.com and the ones owned by the large pharmacy and health care chains, sell the same drugs online that you would obtain at a hospital pharmacy. Drugstore.com, which is owned by Amazon.com, ships orders over $25 for free and their pricing is competitive. Walmart, CVS and Target all charge less for online purchases than in-store. Make sure that any online prescription drug site you use is licensed as a “Verified Internet Pharmacy Practice Site” (VIPPS). They’ll display the VIPPS logo on their site. More importantly, as a counterfeiter could also copy and display their logo, you can check the validity of web sites at the VIPPS site.

If you search for a prescription drug online and find a site that heavily features it, the odds are very high that you’ve found one selling counterfeit drugs. You should never buy drugs from a site that isn’t run by a nationally known company. There are many other ways to save money on prescription drugs, as shown in our October, 2009 article on the subject (see below).

References:
¹ “Faking it: the dangers of counterfeit medicine on the internet.” – International Journal of Clinical Practice, Volume 63, Issue 2 – G. Jackson – February 2009, Pages: 181-181.

Special Note: It should be noted that the International Journal of Clinical Practice has multiple ties to pharmaceutical companies, including Pfizer, which makes Viagra. However, there is no reason to doubt the accuracy of the cases mentioned in Dr. Jackson’s review article. It covered more than fifty studies published between 1995 and 2009 and was conducted by British, Swedish and American researchers.

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Everyone's Guide to Medical Equipment - Part 9 - Diagnostic Equipment

labequipment In this series we’ve looked at the basic equipment that every physician or clinic will have, ranging from the clinical thermometer to stethoscopes. We’ve also looked at medical monitors, such as the electrocardiograph and laboratory equipment used for blood and other tests. Today we’re going to start looking at the very sophisticated diagnostic equipment that can take still or moving images of your body and brain.

Photography became more useful in the 1820s with the invention of photochemistry. The main uses of photography in medicine in the early years revolved around teaching and for recording details of autopsies. It is still used for those purposes, especially in fields such as surgery and dentistry. However, almost any professional grade camera, often used with macro (close-up) lenses and special lighting, can be used for medical photography, so we’ll move on to more modern imaging techniques.

Modern imaging techniques
The development of modern imaging machines can be traced back to the discovery and exploitation of X-rays, so we’ll start there. We’ll be covering a whole range of medical imaging techniques in this set of articles on medical diagnostic equipment, including:

Computed tomography: A method of imaging a single plane, or slice, of an object resulting in a tomogram. The image may be produced from several other images, or the slices may be combined to give a three-dimensional view of an object.
Elastography: A non-invasive method in which stiffness or strain images of soft tissue are used to detect or classify anomalies.
Electrical impedance tomography (EIT): An image of the conductivity or permittivity of part of the body is computed from surface electrical measurements.
Electron microscopy: Electrons are used as the source of illumination for a microscope which can magnify small details as many as 2,000,000 times.
Laser ophthalmoscopy: A confocal laser scanning technique used for examination of the retina or cornea of the human eye.
Magnetic Resonance Imaging (MRI): A tomography technique that uses powerful magnets to polarise and excite hydrogen nuclei (single protons) in the water molecules in human tissue. This produces a detectable signal which can be exactly located in space, resulting in high resolution images of the body.
Nuclear imaging: This technique uses certain properties of isotopes and the energetic particles emitted from radioactive material to diagnose conditions. We’ll take a close look at gamma cameras and Positron Emission Tomography (PET).
Optoacoustic imaging: An imaging technology based on the photoacoustic effect. It can be used for obtaining images of structures in turbid environments, such as the stomach. The technique combines the accuracy of spectroscopy with the depth resolution of ultrasound.
Photoacoustic imaging: Low power laser pulses are directed into the tissues to be examined. Some of the delivered energy will be absorbed and converted into heat, leading to minute and temporary expansion material in the area, which itself results in faint ultrasonic emissions. The generated ultrasonic waves are detected by transducers and are used to form images.
Radiography: The use of a beam of X-rays to produce a static or moving image of an area of the body.
Thermography: The use of special cameras to detect radiation in the infrared range of the electromagnetic spectrum and produce images of that radiation, called thermograms.
Ultrasound: The use of high frequency, broadband, sound waves that are reflected by tissue to varying degrees to produce 2D or 3D images.

Radiography
“Radiography started in 1895 with the discovery of X-rays (later also called Röntgen rays after the man who first described their properties in rigorous detail), a type of electromagnetic radiation. Soon these found various applications, from helping to find shoes that fit, to the more lasting medical uses. X-rays were put to diagnostic use very early, before the dangers of ionising radiation were discovered. The predominant test is still the X-ray (the word X-ray is often used for both the test and the actual film or digital image). X-rays are the second most commonly used medical tests, after laboratory tests. This application is known as diagnostic radiography. Since the body is made up of various substances with differing densities, X-rays can be used to reveal the internal structure of the body on film by highlighting these differences using attenuation, or the absorption of X-ray photons by the denser substances (like calcium-rich bones).” – Wikipedia.org.

Projection radiography involves exposing an object to X-rays or other high-energy forms of electromagnetic radiation and capturing the resulting remnant beam (or “shadow”) as an image. The “shadow” can be converted to light using a fluorescent screen, which is then captured on photographic film. It can also be captured by a phosphor screen to be “read” later by a laser, or it may directly activate a matrix of detectors -similar to a very large version of the ones used in a digital camera. It can be used to look at bones and soft tissue. Specialized X-ray machines are used for dental examinations and mammography.

Projection Radiography

Fluoroscopy is a term invented by Thomas Edison to describe the fluorescence he saw while looking at a glowing plate bombarded with X-rays. The technique provides moving projection radiographs of lower quality than projection radiography. Fluoroscopy is mainly performed to view movement or to guide a medical intervention, such as angioplasty, pacemaker insertion, or joint repair/replacement. Angiography is the use of fluoroscopy to view the cardiovascular system. An iodine-based contrast is injected into the bloodstream and watched as it travels around. Fluoroscopy can also be used to examine the digestive system using a substance (such as barium sulfate) which is opaque to X-rays, introduced into the digestive system.

Fluoroscopy

What’s next?
In the next article in this series we’ll look at computed tomography, a technique that can be applied to many of the diagnostic technologies listed above, and an application of it in Magnetic Resonance Imagery (MRI).

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High Blood Pressure Linked To Dementia

Alzheimer’s disease and other forms of dementia affect about one in eight people aged 65 or older. While age appears to be the most important factor, scientists have noted that some of the same triggers for heart diseases, such as diabetes, high blood pressure and obesity, also seem to increase the risk of dementia. The prevalent view was that the link was with “vascular dementia,” the memory problems usually linked to small strokes, and not with classic Alzheimer’s disease.

Specialists now realize that a large proportion of patients have a mix of the two dementias. Hypertension (blood pressure readings of 140 over 90 or higher) weakens arteries and it also seems to spur Alzheimer’s disease-like processes. The evidence linking high blood pressure to dementia is now strong enough to persuade the National Institutes of Health to conduct a major study to see if aggressive treatment, which would push patients’ blood pressure lower than currently recommended, better protects not just their hearts but their brains. The study will involve thousands of people.

What the studies have shown so far
In recent research studies, scientists scanned people’s brains to show that hypertension fuels a kind of scarring linked to later development of Alzheimer’s disease and other dementias, often decades before memory problems will appear. The main suspect is scarring known as white matter lesions. The white matter is a system of axons, or nerve fibers, that allow brain cells to communicate with each other. Even slightly elevated blood pressure can damage the tiny blood vessels that feed white matter, interrupting those signals.

A study¹ published last month describes Magnetic Resonance Imaging (MRI) scans that showed women 65 and older with high blood pressure had significantly more white matter lesions in their brains eight years later. The study covered 1,403 women who were enrolled in a memory subset of the Women’s Health Initiative tracking postmenopausal health. The study showed that higher blood pressure led to a higher volume of white matter damage.

A similar study², at Johns Hopkins University, tracked 983 people for more than 15 years, starting in middle age. It found that the longer people spent with uncontrolled high blood pressure, the more white matter damage they accumulated. The researchers noted a significant change with each 20-point jump in too-high systolic pressure (the top number in a blood-pressure reading, such as 140 over 90).

As always in medical research, the picture isn’t 100% clear. Some studies have found that hypertension treatment lowered the dementia risk, while others haven’t. It is clear that hypertension alone doesn’t doom someone to dementia as they age. Far more people, nearly one in three U.S. adults, have hypertension, against one in eight who suffer from dementia. Likewise, some other dementia-preventing efforts, such as targeting the sticky amyloid plaques in Alzheimer’s patients brains, haven’t worked so far.

The new NIH study
The NIH’s SPRINT study will soon begin enrolling 7,500 hypertension patients age 55 and older around the country. They will try to determine whether or not aggressive treatment to lower systolic blood pressure below 120 (considered normal) will prove healthier than today’s guidelines that urge getting it below 140, or 130 for diabetics.

Their main focus will be on heart and kidney health, but all participants will also be screened for dementia. A subset will undergo repeated cognitive testing and MRI scans to tell if lowering blood pressure also slows or prevents dementia. They will also determine if older patients can tolerate larger blood pressure drops without adverse side effects, such as falls.

The upside
Dr. Walter Koroshetz, Deputy Director of NIH’s National Institute of Neurological Disorders and Stroke, said – “If you look … for things that we can prevent that lead to cognitive decline in the elderly, hypertension is at the top of the list.” Hypertension control has little downside as it is also a leading cause of heart attacks, strokes and kidney failure. If the researchers are right, controlling blood pressure early and consistently might dramatically reduce a major cause of dementia. Doctor William Thies of the Alzheimer’s Association says – “With dementia rising fast as the population grays, even a small effect from better blood pressure control could have a big public health impact.”

Related articles

References:
¹ “Relationship of Hypertension, Blood Pressure, and Blood Pressure Control With White Matter Abnormalities in the Women’s Health Initiative Memory Study (WHIMS)—MRI Trial” – Lewis H. Kuller, Karen L. Margolis, Sarah A. Gaussoin, Nick R. Bryan, Diana Kerwin, Marian Limacher, Sylvia Wassertheil-Smoller, Jeff Williamson, Jennifer G. Robinson – The Journal of Clinical Hypertension – December 2009.
² “Higher Systolic Blood Pressure Is Associated With Increased Water Diffusivity in Normal-Appearing White Matter” – Alasdair M. J. MacLullich, Karen J. Ferguson, Louise M. Reid, Ian J. Deary, John M. Starr, Jonathan R. Seckl, Mark E. Bastin, and Joanna M. Wardlaw – Stroke – Dec 2009; 40: 3869 – 3871.

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Patients Who Delay Treatment Pay More

Researchers at Brown University and Providence (Rhode Island) VA Medical Center, led by Dr. Amal Trivedi, conducted a study¹ between 2001 and 2006 that looked at the effect of increased Medicare copayments. It involved nearly 900,000 Medicaid beneficiaries enrolled in 36 Medicare managed-care plans. In half of the plans, mean copayments for ambulatory care were almost doubled for both primary care (from $7.38 to $14.38) and specialty care (from $12.66 to $22.05). In the other half, copayments didn’t change over the study period. They were pegged at $8.33 for primary care and $11.38 for specialty care.

The researchers found that in the year after the increase in copayments, for every 100 beneficiaries in the plans where copayments increased, there were almost 20 fewer outpatient visits, but 2.2 more hospital admissions and 13.4 more inpatient days than those in plans where copayments stayed the same.

The causes of the problem
The system of copayments and other out-of-pocket costs started back in the 1960s. The thinking was that imposing some modest costs would deter patients from using services unnecessarily. By the 1990s, copayments, deductibles and other forms of cost-sharing became standard on most health plans. Rising costs then forced many public and private insurers to shift a greater share of the costs to patients. Copayments and deductibles for many employer-based and Medicaid plans have also increased over time. Just 0.3% of Medicare enrollees had plans requiring a copayment of more than $15 for a primary care visit in 1999, but that proportion had jumped to 24 percent by 2003.

However, the new study shows that the reasoning behind these payments may be faulty. The authors note that – “Increasing the patient’s share of the cost … may not reduce (or may even increase) total health care spending and may result in worse health outcomes.”

A number of other factors have also contributed to the problem:

The current economic downturn has made seniors particularly vulnerable. They tend to have fixed incomes and to rely on investment income that has dropped sharply after the Wall Street collapse.
Seniors tend to suffer from chronic conditions that require regular medical care. With reduced income they can afford fewer visits to medical facilities.
The increased popularity of Medicare Advantage plans, which are run by private companies and often offer perks such as cash back and free gym memberships. Unfortunately, they also often require copayments for doctor visits.

What can seniors do?
The most important thing for seniors to do in order to minimize their medical expenses is to fully understand the Medicare options available to them. Medicare Advantage plans that offer zero premiums and other benefits may look good at first, but many plans require copayments that can increase over time. That in turn, can worsen a patient’s health, leading to increased costs later.

Seniors should take advantage of independent programs that offer free counseling about health insurance options. Most states run a State Health Insurance Counseling and Assistance Program (SHIP). The advisors can give unbiased advice because they are working for you, not an insurance company, where the employees are earning commission. You can find the SHIP resources in your state on this Medicare page. We’ve also added it to our Useful Sites list for future reference.

You can also take some easy steps to help maintain your health and reduce the need to use expensive services. Good nutrition, exercise (such as walking and resistance training) and socializing can all improve a senior’s health. Check out the Nutrition and Senior Health tags (in the left hand sidebar) to find related articles.

¹ “Increased Ambulatory Care Copayments and Hospitalizations among the Elderly.” – Trivedi AN, Moloo H, Mor V. – New England Journal of Medicine – 362:320, January 28, 2010.

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Virtual Colonoscopy May Be A Good Solution For Some Seniors

drsnake A study¹ by researchers at the University of Wisconsin School of Medicine and Public Health has found that individuals in the 65-79 year old age range who are at average risk of developing colorectal cancer (CRC) are good candidates for screening using Computed Tomographic Colonography (CTC), also known as virtual colonoscopy. CRC is the third most frequently diagnosed cancer and the second leading cause of cancer death in men and women in the United States, claiming nearly 50,000 people each year.

The technique produces low referral for colonoscopy rates that are similar to other screening exams now covered by Medicare. The big advantage of CTC over conventional optical colonoscopy is that there are far fewer safety concerns (such as the risk of perforations) when dealing with older, frailer patients. It has the additional benefit that it does not result in unreasonable levels of additional testing as a result of other indicators. The main disadvantage of CTC is that a radiologist cannot take tissue samples (biopsy) or remove polyps during the procedure.

CTC employs X-ray and virtual reality computer technology to produce a three-dimensional visualization that permits a thorough and minimally invasive evaluation of the entire colon and rectum. The study found that CTC is now just about as accurate at diagnosing problems in senior patients as it is with younger ones. The 15.3% referral rate to optical colonoscopy is actually slightly lower than other Medicare covered CRC screening exams, such as flexible sigmoidoscopy.

David H. Kim, MD, Associate Professor of Radiology, University of Wisconsin School of Medicine and Public Health, and principal investigator of the study said – “There have been questions raised that factors such as the referral rate and extracolonic work up rates would be too high in an older population for CTC to be a cost-effective, frontline CRC screening exam. Our results suggest otherwise and that these rates remain in a reasonable range.”

The American Cancer Society (ACS) estimates that more widespread screening could save 20,000 CRC-related deaths each year. Unfortunately, the the cost, inconvenience, and safety concerns associated with current screening exams mean that most of the over-50s who should be screened for the disease are not being tested. Dr. Kim commented that – “This study shows that CTC is a viable screening exam in all age groups. We are hopeful, now that the remaining questions regarding older patients have been answered, [that] patients will have wider access to the CTC, more will be screened for colorectal cancer, and more lives can be saved as a result.”

The Centers for Medicare and Medicaid Services (CMS) came in for widespread expert criticism last May when it issued a ruling, summarized in a note on its web site, that said – “We have determined that there is insufficient evidence on the test characteristics and performance of screening CT colonography in Medicare-aged individuals, and that the evidence is not sufficient to conclude that screening CT colonography improves health benefits for asymptomatic, average-risk Medicare beneficiaries.” Maybe, in the light of this scientific study, they’ll reconsider that decision. Incidentally, we’ll be covering all of the above techniques as a part of our series on medical equipment.

¹ “Rectal Cancer: Comparison of Accuracy of Local-Regional Staging with Two- and Three-dimensional Preoperative 3-T MR Imaging” – Honsoul Kim, Joon Seok Lim, Jin Young Choi, Jaeseok Park, Yong Eun Chung, Myeong-Jin Kim, EunHee Choi, Nam Kyu Kim, and Ki Whang Kim. – Radiology – February 2010 254:485-492; doi:10.1148/radiol.09090587.

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Resistance Training May Be Good For Your Brain

A study conducted by the Centre for Hip Health and Mobility at Vancouver Coastal Health (VCH) and the University of British Columbia (UBC) found that weight-bearing (resistance) exercises may help minimize both cognitive decline and impaired mobility in seniors. That, in turn, may help people live better and longer.

The study, led by Dr. Teresa Liu-Ambrose, an Assistant Professor in the UBC Faculty of Medicine and a researcher at the UBC Brain Research CentreCentre is one of the first controlled trials of progressively intensive resistance training in senior women. Liu-Ambrose is one of the few researchers in Canada investigating the role of targeted resistance training in promoting mobility and cognitive skills in seniors.

The researchers found that 12 months of once or twice-weekly resistance training improved the cognitive abilities necessary for independent living (known as “executive cognitive function”) in senior women between the ages of 65 and 75. Dr. Liu-Ambrose said – “We were able to demonstrate that simple training with weights that seniors can easily handle improved ability to make accurate decisions quickly. Additionally, we found that the exercises led to increased walking speed, a predictor of considerable reduction in mortality.”

Resistance training can also reduce the risk of falls
Although previous studies have shown that aerobic exercise training, such as walking or swimming, enhances brain and cognitive function, seniors with limited mobility can’t benefit from this type of exercise. The impact of resistance training, which is an alternative type of exercise for seniors with limited mobility, on cognitive function has received little investigation until now. Cognitive decline among seniors is a key risk factor for falls, so strategies to prevent cognitive decline are essential to improving the quality of life for older British Columbians and to save the Canadian health care system millions in associated costs. Dr. Heather McKay, Centre Director and Professor in the UBC Faculty of Medicine said – “Dr. Liu-Ambrose’s research provides a clear illustration of relatively simple interventions with a profound and immediate impact on the mobility and quality of life of older adults.”

The same findings and techniques could be applied here in the United States too, of course. Approximately 30 per cent of British Columbian seniors experience a fall each year and fall-related hip fractures account for more than 4,000 injures each year, costing the Canadian health care system around $75 Million a year. The corresponding statistics from the National Centers for Disease Control and Prevention on serious falls in the United States are worrying:

One of every three people 65 years and older falls each year.
Five times more older adults are hospitalized for fall-related injuries than they are for injuries from other causes.
20-30% of those who fall suffer moderate to severe injuries that reduce mobility and independence and increase the risk of premature death.

What is resistance training?
“Resistance training is a form of strength training in which each effort is performed against a specific opposing force generated by resistance (i.e. resistance to being pushed, squeezed, stretched or bent). Resistance exercise is used to develop the strength and size of skeletal muscles. Research shows that regular resistance training will strengthen and tone muscles and increase bone mass.” – Wikipedia.org. The new study provides further evidence that resistance training is particularly beneficial to seniors, improving mobility and possibly boosting cognitive skills.

As always, check with your physician before changing or starting an exercise regime. The doses of resistance training used in the study meet the recommended criteria provided in the 2008 Physical Activity Guidelines for seniors. You should also check out the physical therapy aids and Wii exercise games in the Silver Buzz Cafe store.

¹ “Resistance Training and Executive Functions: A 12-Month Randomized Controlled Trial” – Teresa Liu-Ambrose; Lindsay S. Nagamatsu; Peter Graf; B. Lynn Beattie; Maureen C. Ashe and Todd C. Handy. – Archives of Internal Medicine, Jan 2010; 170: 170 – 178.

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Tylenol Maker Forgets Its Own Lesson

tylenol Johnson & Johnson (J&J) the maker of Tylenol, Motrin, Rolaids, Benadryl and St. Joseph’s brand aspirin, announced a recall of some batches of these and other of its products on January 15, citing complaints of an “unusual moldy, musty or mildew-like” odor. The cause of the problem is known and it is not believed to pose a major hazard. However, tainted batches can cause what J&J termed “non-serious stomach complaints”, including diarrhea, nausea, stomach pain and vomiting.

The contamination appears to have come from a chemical called “2,4,6-tribromoanisole (TBA),” a fungicide that is applied to the wooden pallets that are used to transport and store packaging materials. The Food and Drug Administration (FDA) said that the pallets were traced to a plant in Puerto Rico. The agency is looking into whether any other drugmakers also used pallets from this plant to transport their products. It is not yet clear as to whether or not it changed the chemical composition of the drugs.

Slow response to the problem
It’s obviously not good that this occurred, but at least the problem was tracked down, something that is becoming increasingly important as more drugs are manufactured and packaged overseas before being sold in the United States. The main issue is what happened after J&J became aware of the problem. Problems were first reported with some Tylenol products in early 2008. It took until September, 2008 to find the source of the problem and issue a product recall for five lots of “Tylenol Arthritis Pain 100 count with the EZ-open cap”.

That was when McNeil-PPC, the J&J division involved, reported the issue to the FDA. On Dec. 18, 2009, McNeil expanded the recall to include all available product lots. They further expanded the list of products¹ on January 15, 2010, almost two years after the initial problems were reported.

The FDA steps in
McNeil’s tardiness prompted the FDA to issue a warning letter, saying the company has 15 days to report back on its efforts to address the problem and prevent future violations. A warning letter is more than a courtesy, or a slap on the wrist, it can be followed up with actions that can seriously impact a product and company. The agency warned Johnson & Johnson that “failure to correct these violations may result in legal action, including seizure and injunction.” It also said that the FDA may “withhold approval of requests for export certificates or approval of pending new drug applications” that list one of the company’s facilities as a manufacturer until the violations are resolved.

What J&J forgot
Besides being tardy in reporting and resolving the problem, J&J has tarnished the admirable reputation it earned for rapidly exposing and correcting a similar problem many years ago. Back in 1982, when seven people died as a result of poison being introduced into Tylenol packages, the company reacted immediately. It withdrew all Tylenol products from shelves, informed the public of the problem, apologized and listed the steps being taken to find the source of the problem and prevent it from happening again. The episode is a classic case study in how to deal with a product disaster. Tylenol’s market share plummeted from 35% to 8% immediately after the scare, but it rebounded within a year.

Is it an isolated case?
It’s sad that, just over 25 years later, the same company became aware of a potentially serious problem with some of its products, but chose to minimize knowledge of it, to the extent that the FDA has had to issue a formal warning. Was the reaction to the latest incident a bad call by senior management, or is it a sign that similar cover-ups may be going undetected across the industry? The Big Pharmas are very different today than they were back in 1982. They are no longer the innovative, science-based companies that we knew then, but giant marketing machines, intent on making huge profits at almost any cost. The FDA has every reason to be concerned. We should be too.

¹ The recalled products are: extra strength Tylenol; extra strength Tylenol rapid release gelcaps; extra strength Tylenol PM geltabs; Motrin caplets; extra strength Rolaids fresh mint tablets; St. Joseph Aspirin chewable orange tablets; Benedryl allergy ultratab tablets; junior strength Motrin and children’s Tylenol grape meltaway tablets. You can check the exact products and lot numbers here or by calling 1-888-222-6036.

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New Rules For HMOs in California

dmhc California’s Department of Managed Health Care (DMHC) issued several new regulations on January 5 that affect Health Maintenance Organizations (HMOs). About three in five Californians receive their health care via HMOs. The rules range from new time standards for services to the provision of medically necessary prescription drugs. The rules were authorized by a 2002 state law but have been delayed by years of bureaucratic wrangling.

A 2009 survey by Merritt Hawkins & Associates, a physician recruiting firm, found that the delay to see a doctor in San Diego is 24 days on average, and 59 days in Los Angeles. The new rules specify that HMO patients be seen by a general practitioner within 10 business days of requesting an appointment and a specialist within two weeks. There are also limits on the time that a doctor can take to respond to a call.

The DMHC will rely heavily on consumer complaints that may lead to an audit of a plan’s records and, if warranted, a fine. A DHMC statement said – “While these regulations set time standards, it also provides doctors flexibility in scheduling appointments, as long as doing so would not adversely affect the patient’s condition.”

New DMHC rules relating to HMOs
The new rules, which will be phased in over the next year, fall into two groups – practitioner response times and prescription drug coverage:

HMO patients must be seen by a general practitioner or mental health care provider within 10 business days of requesting a non-urgent appointment and a specialist within 15 days.
Doctors must return a patient’s call for treatment within 30 minutes and they, or an alternative, must be available 24 hours a day.
People with urgent needs must be seen within 48 hours, unless prior authorization is needed, in which case the limit is 96 hours.

Health plans must cover any drug considered medically necessary, even if it is not on the plan’s approved medication list. Disputes over medical necessity will be decided by an independent medical review board.
Health plans must list all drug exclusions and limitations on their Web sites and in evidence-of-coverage handouts.
Patient co-payment amounts must be approved by DMHC in advance and they may not exceed 50% of an HMO’s cost for medications. They are never allowed to exceed the retail price.
HMOs must seek prior approval from state DMHC to limit access to prescription drugs, instead of deciding coverage on a case-by-case basis and forcing patients to appeal.
HMOs may now deny coverage for prescription drugs prescribed for cosmetic reasons or for non-medical conditions, including hair growth, athletic or sexual performance and weight loss, except in the case of morbid obesity.
Health plans are allowed to require that patients first try less expensive, or over-the-counter, alternatives to a drug. If such a treatment is not effective, the regulations mandate coverage of the more expensive medication.

The bad news
There are some fears that the new rules may result in higher premium fees if, as expected, HMOs have to hire more doctors or incur other costs to meet the time demands. There could be even higher demand if Congress extends insurance to 30 million more Americans. Cindy Ehnes, Director of the DMHC, called the new requirements a “major leap forward” in care, but acknowledged a shortage of general practitioners may make it difficult to put the plan in place. She noted that the department may grant exemptions to the standards in areas where the shortage is particularly acute.

Although the new rules don’t cover Preferred Provider Organizations (PPOs), patients on their plans may experience longer delays than at present if providers decide to deal with HMO patients first.

As always when prescription drug prices are involved, there are fears that the drug companies will artificially hike prices of the cheaper drugs, which patients must be offered first, in order to maintain current profit levels. However, patients who buy drugs that are not medically necessary will now pay full price

California is the first state to impose these kinds of rules and other states will probably follow. However, many will face the same kind of wrangling with the drug companies (spread over eight years) that California endured.

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Everyone's Guide to Medical Equipment - Part 8 - More Laboratory Equipment

labequipment So far in this series we’ve looked at the equipment that you could expect to find in your physician’s bag and office and the medical monitors that you’re most likely to encounter in clinics and hospitals. Some of them are simply measuring instruments, adapted to work safely in a clinical environment. Others are complex, often computer driven, pieces of electromechanical machinery.

In the previous article we started looking at what happens after you hand over those samples for analysis, or have blood drawn. We covered blood tests and the equipment, such as clinical chemical, electrolyte and blood gas analyzers, used to perform the analysis. Today we’ll look at the tests that are performed on bodily wastes (urine and solids) and the equipment involved.

Urine analysis tests
The laboratory can measure many parameters using urinalysis techniques. Some are as simple as dipping a specially treated piece of filter paper, or spill, into the sample and recording the color that results. Others involve complex instruments, which we’ll cover below. The things that can be measured include:

Bilirubin: A pigment created by the breakdown of hemoglobin. The blood normally contains a small amount of bilirubin. An abnormally high level of blood bilirubin may result from: an increased rate of red blood cell destruction, liver damage (such as hepatitis and cirrhosis) and obstruction of the common bile duct as with gallstones. An increase in blood bilirubin results in jaundice.
Color and appearance: Anything abnormal may provide clues helping the diagnosis of an underlying problem.
Glucose: An indicator for diabetes mellitus. It should normally be absent (negative).
Hemoglobin: An iron-containing substance that helps transport oxygen around the body in the blood stream. The breaking open of red blood cells and some kinds of rupture or hemorrhage in the urinary system may cause hemoglobin to appear in urine.
Human chorionic gonadotrophin (hCG): Normally absent, this hormone appears in the urine of pregnant women.
Ketone bodies: When there is carbohydrate deprivation, such as starvation or high protein diets, the body relies increasingly on the metabolism of fats for energy. When the production of the intermediate products of fatty acid metabolism (collectively known as ketone bodies) exceeds the ability of the body to metabolize these compounds they accumulate in the blood and some end up in the urine (ketonuria). There should normally be none present in a sample from a healthy person. High triglyceride levels can be a cause for concern.
Leucocytes: See White Blood Cell Count.
Nitrites: The presence of nitrites generally indicates the presence of a bacteriological infection.
pH: A measure of the acidity or alkalinity of the urine. Pure water is said to be neutral, with a pH around 7. It is normally in the range 5 to 7 for human urine.
Proteins: These should normally be absent (negative). The detection of proteins in urine may indicate kidney infections, or it may be caused by other diseases that have secondarily affected the kidneys, such as diabetes mellitus, jaundice, or hyperthyroidism.
Red Blood Cell Count (RBC) or RBC number: The number of red blood cells per cubic millimeter of blood, typically around XXXX. High RBC numbers can result from: trauma; burns; pregnancy; anemia; gastrointestinal bleeding; Vitamin B12 or folate deficiency; bone marrow damage; chronic inflammation and other metabolic disorders. Low RBC numbers can be a sign of: dehydration; pulmonary or heart disease; polycythemia vera; renal problems; over-transfusion of whole blood or tissue hypoxia
Specific gravity: The weight of a substance relative to the weight of an equal volume of water. Water has a specific gravity of one. The specific gravity of your urine is measured by using a urinometer, an instrument very similar to ones used for measuring the specific gravity of beer and wine. Knowing the specific gravity of your urine is very important because the number indicates whether you are hydrated or dehydrated. If the specific gravity of your urine is under 1.007, you are hydrated. If your urine is above 1.010, you are dehydrated.
Urobilinogen: A colourless product formed in the intestines by bacterial action that breaks down bilirubin, which is itself a product of the breakdown of heme, found in hemoglobin, a principal component of red blood cells. Bilirubin is excreted in bile, and its levels are elevated in certain diseases. It is responsible for the yellow discoloration in jaundice and bruises.
White Blood Cell Count (WBC) or WBC number: The percentage and absolute number per litre of each white blood cell type. An elevated number of white blood cells is called leukocytosis. This can result from bacterial infections, inflammation, leukemia, trauma, intense exercise, or stress. A decreased WBC count is called leukopenia. It can result from many different situations, such as chemotherapy, radiation therapy, or diseases of the immune system. Pregnancy and smoking can cause an increased WBC. Many drugs raise or lower the count.

There are also tests that use microscopy to gather diagnostic information. There may be signs of excess red or white cells, distorted or damaged cells, crystalline deposits, or urinary casts – cylinders of protein that can indicate kidney disease.

Urinalysis equipment
The urinometer was mentioned in the description of tests. The medical laboratory will also have a urine chemistry analyzer. Reagent strips are dipped into each sample and then examined using a technique such as reflectance photometery, which measures the color intensity. The urine chemistry analyzer can perform tests relating to bilirubin, blood glucose, red and white blood cell counts, nitrite, pH, protein, specific gravity, and urobilinogen.

Urine Analysis Equipment

Urinometer	Urine Chemistry Analyzer

Faecal tests
Faecal (or fecal) tests fall into two main categories:

Faecal occult blood tests: These for hidden (occult) blood in the stool. Conventional faecal occult blood tests look for heme. Newer, modern tests look for globin.
Faecal fat tests: The fecal fat test measures the amount of fat in the stool and the percentage of dietary fat that is not taken in by the body.

“Fecal occult blood testing can provide clues to blood loss in the gastrointestinal tract, anywhere from the mouth to the colon. Positive tests warrant further investigation for peptic ulcers or a malignancy (such as colorectal cancer or gastric cancer). In the event of a positive faecal occult blood test, the next step is a detailed examination of the gastrointestinal tract, e.g. by sigmoidoscopy, colonoscopy, endoscopy, or a series of x-rays.” – Wikipedia.org.

Dietary fat (primarily triglycerides) is digested by enzymes into smaller molecules which can be absorbed through the wall of the small intestine and enter the circulation for metabolism and storage. As fat is a valuable nutrient, human faeces normally contain very little undigested fat. However, a number of diseases of the pancreas and gastrointestinal tract, such as chronic pancreatitis, cystic fibrosis and Shwachman-Diamond syndrome and celiac disease are characterized by fat malabsorption. Visible amounts of fat, in dyed specimens examined through a microscope, can indicate some degree of fat malabsorption. The fat content can be extracted with solvents and measured by turning it into soap.

Faecal testing equipment
Microscopy is very important in the detection of occult blood, cell structure problems and parasites. There are also specialized analyzers for detecting hemoglobin (occult blood) and fat in stools.

Faecal Testing Equipment

Clinical Microscope	Occult Hemoglobin Reagent/Analyzer

What’s next?
That’s it for the most important medical laboratory equipment. In the next article in this series we’ll look at diagnostic equipment. This category covers medical imaging machines, such as Computed Tomography (CT) and Positron Emission Tomography scanners (PET), ultrasound and Magnetic Resonance Imaging (MRI) machines and X-ray machines.

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Rep. Alan Grayson Starts a Fight Against Corpocracy

bribemoney Having anticipated Wednesday’s Supreme Court ruling that now allows corporations to spend as much of their funds as they wish on direct political campaigning, Rep. Alan Grayson (D-Fl) introduced five bills on Wednesday to try to limit what he calls “Corpocracy”. Grayson is worried that our democracy will be usurped by corporations, which can easily outspend unions, other special interest groups and individuals. He noted that Exxon’s annual profits alone exceed the total amount of money that all unions combined could spend on a campaign.

All of this presupposes that spending money on political campaigns actually works. Unfortunately, there is plenty of evidence that it does. Money that goes into campaign coffers certainly seems to influence politician’s voting, as we’ve seen over and over again in the health care reform debate. Negative advertisements, particularly, have changed the course of major elections. So, it appears that Rep. Grayson has legitimate concerns. It also assumes that all politicians want to be bought. The big smile on the face of House Minority Leader John Boehner (D-OH), as he lauded the Supreme Court decision, said it all – “I’m going to be rich, I’m going to be rich…” The Blue Dog Democrats, each a major recipient of corporate contributions, seemed pleased too.

Theres no doubt that the decision, based on the First Amendment to the constitution and included in the Bill of Rights, is valid – if you interpret the provisions on freedom on speech as applying to corporations as if they were individual citizens. Although a very early decision of the Court ruled that way, it doesn’t entirely make sense. If corporations are individuals, can they get legally married in church, or apply for Medicaid? Of course not, so something’s wrong with that argument and it should be re-examined. There was no chance of that happening during consideration of the campaign funding issue with a right wing dominated Supreme Court.

The proposed bills
Rep. Grayson has a knack for giving his bills catchy names. None of them are more than a few pages long. Here’s a summary:

The Business Should Mind Its Own Business Act (H.R. 4431): Implements a 500% excise tax on corporate contributions to political committees, and on corporate expenditures on political advocacy campaigns.
The Corporate Propaganda Sunshine Act (H.R. 4432): Requires publicly-traded companies to disclose in SEC filings money used for the purpose of influencing public opinion, rather than to promoting their products and services.
The Ending Corporate Collusion Act (H.R. 4433): Applies antitrust law to industry PACs.
The End Political Kickbacks Act (H.R. 4434): Prevents for-profit corporations that receive money from the government from making political contributions, and limits the amount that employees of those companies can contribute.
The Public Company Responsibility Act (H.R. 4435): Prevents companies making political contributions and expenditures from trading their stock on national exchanges.

Some of these (particularly H.R. 4431 and H.R. 4435) may not be viable, because they could be interpreted as Congress limiting free speech. However, H.R. 4432 might be OK and H.R. 4434 could be OK if it were proportionate to the public contribution versus the overall assets of the corporation. The third one, H.R. 4433, is badly needed, especially in reigning in the health insurance industry, which currently controls markets and prices by colluding behind closed doors. It will be very interesting to see if these bills actually get anywhere. The debate, if it happens, should be revealing.

Is there a real danger?
The more that we hear discussions of this ruling, the more disturbing it becomes. Nothing now stops a foreign power, such as China, or a Middle Eastern dictatorship, from setting up or buying a small company in the United States, then using it to funnel billions of Dollars into campaign funds and having their own local, state or congressional candidates elected. The foreign power could then change laws any way that they liked – making it illegal to produce armaments, shutting down our defense forces, or banning the extraction of U.S. oil reserves, for instance.

It might seem simple to change the law to stop this nightmare scenario from being legal, but how do you change the law if the lawmakers are owned by foreign powers? What if they set up a legitimate U.S. company with completely local, albeit mercenary, management and then top it up with funds by buying ten billion “Invisible widgets – Mk. 1″ from the company? What if the oil and mining companies directly control a majority in the House and Senate and they legalize unregulated exploitation of all national assets, including federal, state and private (your) land? All of those scenarios sounded ridiculous, until last Wednesday.

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Supreme Court Removes Controls on Corporate Funding of Political Campaigns

bribemoney One of the most obvious themes throughout the debate on health reform has been the effect of special interest funding on the voting behavior of our elected officials. Time and time again we’ve seen that our so-called representatives are actually working for the health sector, especially the health insurers and Big Pharma, rather than the people who voted them into office.

The right wing majority in the Supreme Court made the situation worse yesterday by rolling back the twenty year old ruling that said corporations can be prohibited from using money from their general treasuries to pay for their own campaign ads. They also struck down part of the bipartisan McCain-Feingold campaign finance bill that barred issue-based advertising paid for by unions and corporations in the closing days of election campaigns.

It leaves in place the ban on direct contributions to candidates from corporations and unions. It also doesn’t change the rules allowing corporations, unions and others to create Political Action Committees (PACs) that can contribute directly to candidates. PACs must be funded with voluntary contributions from members, employees and other individuals, not from corporate or union funds. “PACs account for less than thirty percent of total contributions in U.S. Congressional races, and considerably less in presidential races.” – Wikipedia.org.

Justice Anthony Kennedy, who presented the decision, wrote – “The government may regulate corporate political speech through disclaimer and disclosure requirements, but it may not suppress that speech altogether.” He and his right wing colleagues also reasoned that a central provision of the 2002 McCain-Feingold campaign finance act violated the First Amendment by restricting corporations from funding political messages in the run-up to elections. The liberal members of the Supreme Court called the majority opinion “a rejection of the common sense of the American people, who have…fought against the distinctive corrupting potential of corporate electioneering since the days of Theodore Roosevelt.”

The likely impact of the ruling
The effects of the ruling will almost certainly be felt very soon, so we can expect a barrage of additional advertising in the run up to the congressional elections this year. Unfortunately, as we’ve seen in the health reform debate, there appear to be no legal checks and balances on the accuracy of those ads. Special interest groups can tell blatant lies, or libel candidates, with little fear that anyone will have time or the money to outspend them and correct the facts. Unfortunately, uninformed, or misinformed, voters tend to make decisions using their emotions, which are easily influenced by skillful advertisers, rather than facts and logic.

The health reform debate has been largely driven by the health sector, but this year we can expect the unions, the National Rifle Association and rich, right wing groups to strongly push their interests and buy politicians in Washington to serve their needs. The only recourse for an individual American is to support as many special interests that address their needs and concerns as possible. Individual votes don’t count any more. We no longer have a democracy, especially with the Senate being so broken.

Is there an alternative?
Many countries, especially in Europe, choose to use government money to run political campaigns. The amounts that can be spent are strictly limited, though campaign advertisements may be run at discounted rates, the opposite of what happens over here. Can you imagine the right wing Fox “News” Channel giving preferential rates to a Democratic Party candidate? Rates are usually clamped in Europe during the run-ups to elections. Private contributions are generally made to parties, rather than individuals. The amount

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