Drugs' double-edged sword health club

A young man reportedly taking the antidepressant Prozac has a history of significant psychiatric troubles, including self-cutting, obsessive thoughts and anxiety. But among the 27-year-old's current teachers and acquaintances, he has a reputation as a caring, dependable friend and a highly motivated student.

Surely, say mental health professionals, this recovery was brought about by Prozac.

The same young man, saying the drug makes him feel "like a zombie," abruptly discontinues his antidepressant and begins to behave erratically. About three weeks later, he steps from behind a curtain in a classroom at his alma mater and begins shooting, killing five students before turning the gun on himself.

Just as surely, say critics of antidepressants' widespread use, this unraveling was brought about by Prozac.

Steven Kazmierczak's bolt-from-the-blue shooting spree on Feb health club. 14 reignited a long-running debate over the benefits and risks of antidepressants -- taking them and discontinuing them.

"It's sad to watch this," says Ann Blake Tracy, executive director of the International Coalition for Drug Awareness and co-founder of a website, SSRI stories.com, that catalogs violent crimes like Kazmierczak's and links them to psychiatric drug use. "You find suicide, murder, rape, arson" -- all caused by drugs such as Prozac, she says. "How did they convince us that this is therapeutic?"

Most in the psychiatric profession would counter that antidepressants overwhelmingly save lives, and salvage those hobbled by sadness and anxiety. They doubt that coming off these drugs -- especially Prozac, which Kazmierczak was reported to have taken health club -- led the Illinois gunman to kill.

And they fret that depressed patients who believe the charges of critics like Tracy will turn their backs on medicine that can work wonders if taken -- and stopped -- correctly.

"When a story like this is brewing, people think, 'If this medication can possibly be related to a bad outcome, I'd better get off it now health club,' " says UCLA psychiatrist Andrew Leuchter. "We're talking about millions and millions of people who've been treated successfully with these drugs and stopped treatment without any kind of dramatic changes of behavior."

At the center of the latest tempest over psychotropic drugs is a long-recognized phenomenon called Antidepressant Discontinuation Syndrome. First identified in psychiatric journals in the late 1990s, the condition is an assortment of symptoms that can plague patients for several weeks and, in a few cases on medical record, months after coming off a wide range of antidepressants. They include dizziness, headache, fatigue, changes in sleep patterns and appetite, vivid or disturbing dreams, agitation and anxiety. Some patients experience tingling or "electric zap" sensations passing through their extremities or head and, in rare cases, spasmodic jerking in the extremities, health club especially while sleeping.

Though the symptoms of the syndrome can be distressing for patients, many psychiatrists insist that they are rarely dangerous and can be managed by weaning a patient off antidepressant medication very slowly health club. As patients taper off their meds, however, they and their doctors must assess whether symptoms such as anxiety and agitation, which may affect a patient's behavior and reactions, are a sign of the syndrome or a recurrence of the illness that led to the medication in the first place.

It's not always an easy call, says Dr. Richard Shelton of Vanderbilt University, a leading researcher on antidepressants and their effects.

Lightning rod for debate

Twenty years after Prozac appeared on the U.S. landscape, roughly 10% of American women and 4% of American men take an antidepressant regularly. The selective serotonin reuptake inhibitors (SSRIs) and their close cousins have revolutionized attitudes toward mental illness and its medication in this country. But they remain a lightning rod for controversy.

The role that antidepressants played in Kazmierczak's violent end probably will never be clear. Did Prozac, which Kazmierczak's girlfriend, Jessica Baty, said he had been on but had recently discontinued, help keep the 27-year-old's mental illness in check and, when halted, allow it to roar back? Or did it distort his personality, contort his thoughts and, when abandoned, cause a chemical storm in Kazmierczak's brain that spawned a fury of aggression?

The weight of clinical observations and psychiatric research favors the view that antidepressants helped Kazmierczak until the time he abandoned them. But skeptics charge that antidepressants may have caused or contributed to Kazmierczak's spasm of violence. And mental health experts acknowledge they cannot rule out that possibility.

"You're going to get some unpredictable reactions if you have millions of people taking them and going off. The potential for violent behavior, suicide and particularly impulsive suicide exists," says Shelton, a professor of psychiatry and psychopharmacology. "And the sicker the person is coming in the front door, the more likely they are to have a bad crash when they go off. We do see these extreme reactions."

In a category of drugs so widely used, how could potentially dangerous side effects remain a matter of uncertainty? For several reasons, experts say.

For starters, individuals' responses to antidepressants, though mostly predictable health club, can vary widely. Psychiatric diagnosis and medication decisions are imprecise and can be disastrously wrong; in cases where a patient with bipolar disorder is misdiagnosed and put on antidepressants, for example, the medicine has been found in some cases to bring on an episode of mania.

And, as the Food and Drug Administration acknowledged in 2007 when it warned of a heightened risk of suicide and suicidal thoughts among young patients starting on many of these drugs, 20 years after their arrival on the scene a full picture of antidepressants' side effects may still be emerging.

Annual flu shots urged for nearly all children health club

A federal panel recommended Wednesday that all children over the age of 6 months should be vaccinated for influenza every year health club.

The recommendation, which is expected to be adopted by the Centers for Disease Control and Prevention, would call for an estimated 30 million more children to be vaccinated -- although current vaccination rates suggest that less than a quarter of them, about 7 million, would actually receive the shots health club.

The shots would not be mandatory, but the federal imprimatur would make physicians more likely to offer the vaccine to children.

"This new recommendation will help parents understand that all children can benefit from vaccination," said Dr. Anne Schuchat, director of CDC's National Center for Immunization and Respiratory Diseases.

In addition, CDC approval would make insurance coverage more likely and the flu vaccine would also be distributed through the government's Vaccines for Children program, which covers about 45% of the nation's youth health club.

Current recommendations call for vaccination of children between 6 months and 5 years old. The new recommendation raises the age range to 18.

Last year, 68 children died of the flu in 26 states monitored by the CDC; 39 of the children were between the ages of 5 and 17. So far this season, 22 have died.

Data presented at a two-day advisory committee meeting in Atlanta showed that vaccination among infants between 6 months and 2 years was about 75% effective in preventing influenza hospitalizations during the last two flu seasons in children who had received two shots. Among those who received only one dose of vaccine, however, the shots provided no statistically significant protection.

The committee emphasized that children under 9 who are receiving their first vaccination should therefore receive two doses. The vaccine does not provide complete protection because the flu virus mutates continually and the strains incorporated in the vaccine are selected more than a year in advance.

Because of such changes, this season's vaccine is a particularly poor match for circulating viruses -- but experts say it still provides some protection.

The committee urged that the recommendation be adopted for next winter's flu season. They noted, however, that most physicians have already ordered their vaccine supplies for next year,health club so it is unlikely the program will be fully implemented until the following year.

Deal reached on global AIDS plan health club

House leaders from both parties and the White House reached a deal Wednesday on a bill that would more than triple funding for the administration's global AIDS program health club.

In a compromise reached late Tuesday health club, the bill loosens the requirement for abstinence messages, health club a source of constant criticism of the program since it was unveiled by President Bush in 2003.

The bill authorizes $50 billion over five years to prevent infection, treat people ill from the human immunodeficiency virus and care for children orphaned by the epidemic.

TB emergency health club

In the early stages of the AIDS epidemic, most Americans were aware of the arrival of a horrible new disease that was spreading rapidly. But they weren't particularly afraid, because the victims were mostly outside the mainstream: homosexuals, drug users and Haitians. By the time Middle America did get scared -- when movie stars and heterosexuals and people they knew began dying -- HIV had already gone global.

With drug-resistant tuberculosis, there is still time to prevent such a hideous outcome. But perhaps not much.

A new survey by the World Health Organization shows that drug-resistant tuberculosis is even more widespread than had been feared -- on average, it's present in 5% of new TB cases. That's 500,000 drug-resistant cases a year. If most Americans aren't concerned by this, it's because they don't yet understand that drug-resistant tuberculosis is no longer a disease that threatens mainly HIV and AIDS patients and the Third World poor. It threatens us all. Worldwide, only 8% of TB cases occur in HIV/AIDS patients.

Tuberculosis is an airborne disease that can be transmitted by a cough or a sneeze -- much easier to spread than HIV. The multiple-drug resistant, or MDR, strains can usually be cured by a two-year course of antibiotics, which can cost $1,500 to $15,000, compared with $20 to cure ordinary TB. In parts of the former Soviet Union and China, more than one-fifth of all new TB cases are MDR. The extremely drug-resistant, or XDR, strains, which the WHO identified in 45 countries, are essentially incurable.

Dr. Mario Raviglione, director of the WHO's "Stop TB" program, estimates that new antibiotics capable of conquering the XDR strains may be developed by 2012 -- if we're lucky. But they probably won't be on the market until about 2015. Meanwhile, the drug-resistant strains will inevitably spread, Raviglione said.

Even after the panic last year caused by Andrew Speaker, the jet-setting honeymooner found to have MDR TB, funding to stop the disease has lagged. The WHO, which gets its money from United Nations member states health club, estimates it needs $4.8 billion for global TB control. But despite increases in funding from the U.S., Britain and private donors, it still faces a $2.5-billion shortfall. That's about what the United States is spending in Iraq every nine days, though the problem can't and shouldn't be solved by the U.S. alone. Oil-rich Russia and relatively affluent China can certainly afford to treat their own infected populations, and they must be exhorted to contribute more to the global fight against this awful disease.

Diet patterns tied to breast, ovarian cancers

The findings, published in the International Journal of Cancer, add to questions surrounding the role of diet in women's risk of the cancers.

High alcohol intake has been consistently linked to breast cancer risk, but when it comes to other facets of the diet, studies have yielded conflicting results, according to the researchers on the current work, led by Dr Valeria Edefonti of the University of Milan.

Some studies, for example, have found that women who eat a lot of red and processed meat are more likely to develop breast cancer than other women; but other studies have found no such link. Saturated fat, found mainly in animal products, has been tied to higher breast cancer risk in some studies, but not in others.

While many of these studies have looked at single nutrients or food groups, another way to address the question is to look at dietary patterns - the combination of nutrients and foods that a person tends to favour health club.

For their study, Edefonti and her colleagues assessed dietary patterns among 3600 women with either breast or ovarian cancer, and 3413 healthy women of the same age.

Using detailed dietary questionnaires, the researchers identified four common dietary patterns in the study group: an "animal product" pattern, which was heavy in meat and saturated fat, but also zinc, calcium and certain other nutrients; a "vitamins and fibre" pattern, which besides fibre was rich in vitamin C, beta-carotene and other nutrients found in fruits and vegetables; an "unsaturated fat" pattern that contained high amounts of vegetable and fish oils, as well as vitamin E; and a "starch-rich" pattern high in simple carbohydrates, vegetable protein and sodium.

Overall, the study found, women who followed a pattern rich in vitamins and fibre had a 23 percent lower risk of ovarian cancer than women who consumed the lowest amounts of those foods and nutrients.

On the other hand, the animal-product pattern was linked to a similar reduction in breast cancer risk.

Women who followed health club the unsaturated-fat pattern had a slightly reduced risk of breast cancer, while the starch-rich diet was tied to elevated risks of both cancers.

It's not yet clear what to make of the findings, in part because they show associations between dietary patterns and canjavascript:void(0)
cer risk - and not that the foods directly affect cancer development.

Sinful foods not so bad after all

The case for the health benefits of chocolate and red wine has already been made with clinical studies suggesting a connection to heart heath.

Chocolate contains antioxidants that may increase healthy cholesterol levels and phenols that can reduce blood pressure, and research suggests that eating the treat can also have positive effects on mood. Red wine contains resveratrol from the skin of red grapes, a compound that can improve cholesterol levels and reduce clotting, said Andy Bellatti, a graduate student at New York University's Department of Nutrition, Food Studies, and Public Health and the author of Small Bites, a nutrition blog.

But these foods can also provide too much of a good thing, Bellatti said. Studies published in 2003 and 2005 showed that eating dark chocolate had a positive effect on lowering blood pressure, but the participants who saw a 10 per cent drop in blood pressure ate 100g of chocolate a day - 550 calories worth. They were getting chocolate's helpful compounds, he said, but it was along with a lot of fat, sugar and calories, all things that could lead to weight gain. Other foods can also help reduce blood pressure, Bellatti said, including fruits, vegetables, whole grains and legumes.

"Nobody ever got high blood pressure from not eating chocolate," Bellatti pointed out. "It's not like it's chocolate or nothing."

It's also important to keep the type of chocolate you eat in mind, Bellatti said. The health benefit of chocolate comes from the cocoa beans it's made with, and the milk chocolate commonly used to make many popular chocolate bars has more milk than cocoa beans.

In addition, milk can interfere with the absorption of the antioxidants in chocolate, negating the health benefits, he said. If you are looking for heart-healthy chocolate, look for bars labeled as being high in cocoa, 85 per cent, for example. "'Dark' does not necessarily mean it has a high percentage of cocoa beans," he advised.

For wine, the recommended intake to enjoy its health benefits is about one glass of red wine a day, Bellatti said; more can be harmful, and less can have no effect. Also of concern, he said, is that wine is a liquid, which doesn't leave you satiated because it contains nothing filling, and which allows you to consume more calories in a shorter period of time.

But if you don't like wine or want to avoid its alcohol or calories, you have other options. "You could also just eat grapes and get the same health benefit," Bellatti said.

Along with wine, a nice dinner out might involve pasta with a bread basket, or grilled meat with a side of potatoes, more foods that shouldn't necessarily be feared. Whole-grain bread is the preferred option, health-wise, Bellatti said, because of the additional fibre it offers. "That's not to say people shouldn't have white bread." Especially in restaurants, it's often less a question of eating the bread itself than it is of what you put on the bread, he said, like butter, salt or cheese.

The same is true of pasta. Whole grain noodles are now available, but that's not the only way to make the meal healthier. "If you go to Europe, Italians aren't eating whole grain pasta," Bellatti pointed out. What they are doing is eating pasta in small portions, with minimal sauce and nutritious toppings like vegetables and beans. If we choose whole wheat pasta but cover it in sauce and cheese, he said, the resulting dish will be high in fibre but also high in calories.

Potatoes are another "empty calorie" food that gets a bad wrap nutritionally, Bellatti said. French fries and mashed potatoes are treats more than anything else, he said, but when baked, potatoes offer fibre, vitamin C and potassium. "It's actually a very nutritious food." Again, pay attention to what you add on top; olive oil is good, sour cream and bacon bits are less desirable, and eat the skin.


Like carbs, many people have an unwarranted phobia of fats that leads them to avoid healthy foods, Bellatti said. Nuts have a high fat content, but most also offer vitamin E, magnesium and manganese, along with other nutrients. "They're whole foods," he said. When eaten raw, an ounce of almonds, which is about 22 nuts, offers fat, fibre and protein with only 140 calories, a good amount for a snack. Those three components are what helps us feel satiated, he said, which means that we can feel full with fewer calories.

"What always frustrates me is that people think 'Instead of almonds, because they're fatty, I'm going to have pretzels,'" Bellatti said. Pretzels are lower in fat, but they also lack fibre and protein, so a person might eat more calories overall in an attempt to feel full, he explained.

The mixed blessings of these foods illustrate Bellatti's point that moderation is important, and outright banning a food can set you up for dietary failure. "I think that when you forbid a food, you give a food too much power," Bellatti said, explaining that it places the food at the forefront of your mind when it otherwise might not be. Instead of eliminating the foods we think of as nutritionally empty, we should pay attention to how often we eat them, and how much we consume when we do, he said.

Bellatti advocates a system of always/often/rarely. Think of a dartboard, he said: in the bull's-eye are the healthy foods we should eat daily, the spots in the middle are for the foods we can eat weekly, and at the edges are the treats we should enjoy only occasionally.

A restrictive diet isn't easily maintained, Bellatti said, something he has learned from personal experience after past diets that cut out carbs or sugar ended in giving in to the temptation of what had become forbidden. What struck him was that the cravings for the foods he had struck from his diet were not his normal behavior. "Usually, if you don't deprive yourself," he advised, "then you are more likely to eat in moderation."

It's easier to stay on track with a nutritious diet if you focus on making healthy choices every day, but still allow yourself the treats you enjoy on special occasions, Bellatti said. "Even if you want to lose weight, food should be enjoyed," he said. "It shouldn't be a punishment."

Socially connected people do bSocially connected people do better after surgery

This translates to less pain and anxiety after the operation,health club less use of pain medication, and fewer days spent in the hospital, researchers report.

"Our hope is to try to put a spotlight on this for surgeons," Dr Daniel B Hinshaw told Reuters Health. The findings make it clear, he explained, that surgeons should ask patients about their level of social support, and anticipate that people with less support may fare worse.

"The old John Donne reference 'no man is an island' is extremely relevant to our health," he commented.

Hinshaw, at the VA Ann Arbor Healthcare System and the University of Michigan in Ann Arbor, and his colleagues had been conducting a study of massage therapy in 605 patients who underwent major surgery of the chest or abdominal area, and performed the current analysis to determine how social connectedness affected a variety of outcomes.

The researchers gauged social connectedness by counting how many close friends and relatives study participants had, how often they saw them, health club and whether they attended a place of worship or other social function at least once a week. Nearly 88 per cent of the study participants reported having three or more friends or relatives they saw at least once a month, while 12 per cent had less than three.

Individuals with larger social networks were less likely to have anxious personalities, and they felt less pain and anxiety before surgery, Hinshaw and his team report in the Journal of the American College of Surgeons.

Furthermore, in the five days after surgery, anxiety and depression were lower and sense of inner peace and relaxation were higher for the patients with larger social networks; these patients also felt less pain and felt that their pain was less unpleasant, and required fewer opiate drugs health club.

Patients with bigger social networks were also 16 percent less likely to spend seven or more days in the hospital.

Once the researchers used statistical methods to adjust for patients' level of pain and anxiety before surgery, they found no relationship between outcomes and social network size. "This suggests that there is a strong association between social network size and preoperative pain and anxiety levels," Hinshaw and his colleagues write.

This raises the "chicken and egg question," health club the researcher said, of whether "people who are anxious personalities and may or may not have chronic pain tend to become socially isolated, or is the social isolation itself contributing to it. I think it may be very difficult to tease those apart because they're thoroughly intertwined."

Massage therapy could actually help provide the human connection that isolated people need to feel better, Hinshaw noted. His study found that massage had a pain relieving effect equivalent to a 1 milligram dose of morphine.

Nurses and doctors should be aware, he added, that they may play a unique role in the recovery of isolated patients. "For people who have limited social contact, health club it is the nurses, physicians, health club and other providers in the hospital setting who may be essentially their family."

VA announces money for mental health facility in Walla Walla

The U.S. Department of Veterans Affairs announced plans Tuesday to build a residential rehabilitation facility focused on mental health care at southeast Washington's Walla Walla VA Medical Center health club, which serves some 69,000 veterans in Washington, Oregon and Idaho.

Details about the proposed $6.7 million facility are still being developed, but the announcement comes as welcome news for a community that just two years ago had been staving off the center's closure health club.

"This project supports VA's commitment to provide for the health care needs of Washington's veterans and recognizes the importance of mental health as an issue for our veterans," Veterans Affairs Secretary Dr. James Peake said.

Peake made the announcement Tuesday morning after touring the medical center and meeting with staff members and patients. In the afternoon, nearly 300 area veterans and their families learned of the announcement at a meeting with Peake and U.S. Sen. Patty Murray, D-Wash., and Rep. Cathy McMorris-Rodgers, R-Wash.

The availability of mental health care for veterans nationwide has been of increasing concern as more soldiers return from Iraq and Afghanistan suffering from post-traumatic stress and other disorders.

Heightening that concern is the knowledge that an estimated 38 percent of veterans live in rural areas.

Vance Kleyn, 61, spent 18 months as a helicopter crew chief on a gunship in Vietnam between 1966-68. He served three years total in the Army before going to work for the U.S. Forest Service and is now retired from the federal government.

"I'm really concerned when the guys come back that someone is there to help them, not just physically, but mentally," he said. "Every person is different, but there are going to be people out there who need that attention."

In particular, Kleyn said he believed early intervention with mental health services could alleviate some of the substance abuse problems prevalent among veterans who try to "self-medicate."

"Maybe we'll get away from that self medication if the VA has services to treat these people," he said.

Plans call for a 22,000-square-foot facility with 36 beds encompassing various levels of mental health care, including homeless and employment services, substance abuse treatment, psychosocial support and re-entry from incarceration.

Studies of mental health care in southeast Washington showed there were not enough services to meet the demands of the community itself, let alone all its veterans, Murray said.

"We've made some progress here in Walla Walla, but it's not enough," she said.

Established in 1858 on an 84-acre campus at Fort Walla Walla, the Jonathan M. Wainwright Memorial Veterans Affairs Medical Center serves an estimated 69,000 veterans in southeastern Washington, northeastern Oregon and northern Idaho. The center has 55 beds for nursing, psychiatric and substance abuse treatment.

The medical center has been threatened with closure for several years as part of an overhaul of the VA's health care system, and saving it became a bipartisan effort for lawmakers from the three states.

In 2006, the VA announced plans to build a $94 million outpatient clinic in Walla Walla to serve veterans. That project is 14th on the department's priority list for construction nationally and was not included in President Bush's proposed 2009 budget.

Also not included in the president's budget were a project for a seismic review at a VA nursing home and construction of a new mental health facility, both in Seattle. Those projects fell just short of receiving money health club.

However, on Friday, the VA announced that it has opened a temporary facility at Skagit Valley Hospital to provide primary and mental health services to veterans in northwest Washington.

Murray and Rep. Rick Larsen, D-Wash., for years have pressed the VA to open a permanent outpatient clinic in that area to serve veterans health club.

Bill to aid mental health

Mental illness can be devastating for any family.health club And the facilities to treat the mentally ill in Adams County only compound the problem.

Those in immediate need of mental help face two scenarios.

They may go to a state-run facility, if a bed is available, or they face being housed in the county jail.

But hopefully a new bill, authored by state Sen. Bob Dearing, will change this problem.

“To house them in the county jail is unacceptable,” Dearing said.

Bill 37 would provide $10 million for Natchez Regional Hospital to add a psychiatric ward.

Dearing said he regularly receives calls from the family members of the mentally ill practically begging for his help.

“These people do not want their loved ones to end up in jail,” he said. “They need to be in a hospital.”

The deadline for the bill to be voted on is approximately three weeks away.

Dearing said if the bill gets out of committee, health club it will then go to the senate, house and then needs to be signed by the governor.

And while that may sound like a lengthy process, Dearing said, if passed, the bill — to be funded by bonds — would become effective on July 1.

Dearing said he has confidence in the bill’s success.

But Natchez resident Opal Vines is not waiting until July to find out what will happen to the bill. Vines was recently appointed to the Southwest Mental Health Board of Commissioners.

Just after her appointment was made official Vines traveled to Jackson to meet with speaker of the house Billy McCoy to discuss bill 37.

Vines said the meeting went very well.

“He was very receptive to our needs,” she said.

And the needs of the county are very apparent.

There is no system of aid in Adams County.

But the lack of available help in Adams County is not unique.

Supervisor Darryl Grennell said at a recent conference of the National Association of Counties — a group of which he is a member health club — the issue of lack of mental health assistance was broadly discussed.

Grennell said several people at the conference also expressed strong disapproval of the storage of mentally ill individuals in their county jails.

Telecom Immunity As Fisa Clock Ticks Down

Since the so-called warrantless wiretap program was uncovered by the media and made public a few years ago, some 40 lawsuits have been filed against AT%26T (NYSE: T) and other major providers that allowed the government to listen in on their customers’ phone conversations without obtaining a warrant.President Bush has been an active supporter of this protection; Democrats and a few Republicans have resisted it, arguing that more information about the surveillance program is needed.

The path from a bill passed in one chamber of Congress to becoming a permanent law is not a straightforward one. The House could pass a bill without the immunity provision, which would surely be vetoed by the president. Or, it could pass a veto-proof bill — but in that case, the areas of conflict between the Senate and House versions would still have to be hammered out in conference committee.

End of the Suits

Should the current language of the telecom immunity clause survive to become law, it could effectively end the pending litigation against these companies. “It is very disappointing that the Senate passed this bill,” said Kurt Opsahl, a senior staff attorney with the Electronic Frontier Foundation , which is a party in the suits. “We will have to see what happens in the House.”

However, it is not necessarily a given that the plaintiffs would have no recourse against the telecoms, Opsahl told the E-Commerce Times. Conceivably, the law could be challenged in court.“Once we see what the final bill is, we will make the appropriate decision of whether and how to challenge it,” he said.

Carte Blanche

As presented by the administration, the case for the bill’s passage is that broad surveillance powers are necessary to identify and prevent terrorist attacks. The government already has such power to spy on people outside U.S. borders. Within the country, though, it is hamstrung by the need to get court approval for wiretaps in a timely manner.

The immunity is necessary, the administration argues, to secure the telecoms’ participation in the program.
However, the new law may erode more protections against government intrusion than most people realize, opponents warn.

“It totally eviscerates our fundamental process of having a judge provide oversight and serve as a watchdog against abuse,” Peter Vogel, an attorney with Gardere Wynne Sewell, told the E-Commerce Times. “Part of responsibility of the judiciary is to serve as a check against legislative and executive branches. What the executive branch wants here is to circumvent the judiciary’s participation.”
If the bill were to become law, warrantless wiretapping could be successfully challenged in court, Vogel said, adding that the immunity exemption to telecoms also might be overturned. “Basically, what these companies did is hand over records without a court authority, just on the government’s request.”

The Latest Outsourcing Wave Personal Assistants

In the latest twist on globalization, it is now possible to hire a personal assistant — in India — to take care of just about anything you don’t have time to do and that can be accomplished via phone or the Internet.

Need your daughter’s birthday party organized? A snowplow to clear your driveway? Your resume and cover letter sent out to potential employers? How about a romantic vegan dinner for two delivered to your home, complete with live music A personal assistant working from a cubicle in Bangalore or Hyderabad now can arrange all that and a whole lot more, and not just for the long-pampered uber-rich but for a much bigger market: America’s exhausted middle class.“Anything that’s illegal or in bad taste we will not do. Other than that, bring it on,” said T.T. Venkatash, a senior manager for Get Friday.

Personal and small-business services are the latest wave of outsourcing to India and one that is rapidly picking up speed, despite concerns about the wisdom of relying so much on overseas service providers.

Today, a handful of Indian startup companies in the personal and small-business services field are handling US$200 million worth of calls for help from overwhelmed firms and harried individuals worldwide, said P. Sunder, chief executive of TTK Services, the parent company of Get Friday. By 2015, industry income should hit $2 billion, predicts Evalueserve, an outsourcing research and consulting company.

Doing the Busy Work

Each outsourcing firm has its own specialty. One, called “TutorVista,” focuses on linking Indian tutors with students in the U.S. and elsewhere. Another, Ask Sunday, handles personal tasks for as little as $29 a month, plus larger project work.
The companies have a similar goal: helping clients, most of them in the United States, wade through an ever-deepening sea of mundane chores without overtaxing their pocketbooks or their sanity.“People on the way to O’Hare [airport] shoot us requests on their BlackBerries, asking us to check their flight status,” said Avinash Samudrala, a St. Louis, Mo., native who cofounded Ask Sunday last year. “It’s pretty amazing if you think about it.”
Get Friday, launched in 2005, started with just one desk, a handful of employees and fewer than 100 customers. Today it has 200 cubicles, spread over several floors of a dusty, nondescript commercial building on Bangalore’s outskirts, 140 employees and 1,200 clients, 95 percent of them in the United States.

Wake-Up Calls

During a recent night shift — the busiest hours thanks to the average 12-hour time difference from the United States — young women in colorful saris and young men in button-down shirts crouched over computer keyboards, sipping milky Indian tea and working on problems a world away.

One organized a program for a dance competition; another updated a Web site for a client preparing for a Professional Golf Association merchandising show in Orlando. One woman researched the fiber content in dog food while another sent her boss a daily inspirational quote, per his request.

Others have devised complicated wake-up call systems to rout the terminally sleepy from bed, battled with airlines over lost luggage or developed diet plans for the hefty, even arranging to have groceries delivered lest their clients weaken in the Oreo aisle. After Hurricane Katrina, the company managed to track down the missing relative of one client by trolling through government Web sites listing the displaced, company officials said.

“It’s really fun. Each day we experience new things,” said Sahnaz, 21, the shift’s best technical writer who, like many southern Indians, uses only one name — as she churned out an article on “How to Be Your Own Construction Contractor.”

No Term Papers, Please

What the assistants can do is limited mainly by the imagination of their bosses. Hui, after persuading his Indian assistant to sing a song over the phone to a delighted friend, created his own serenade outsourcing company, TajTunes, with the assistant’s help.

Another client, a frustrated U.S. diplomat in Pakistan, had the company track down someone who could explain to her Urdu-speaking maid how to properly feed the cat.
The companies occasionally have to draw the line. Get Friday turned down a New Zealand man’s request to create a database of all the escort services in that country. Then there was the student who wanted his assistant to “read the following essay, answer the following question in tightly written, double-spaced text, and get it back by Monday,” Venkatash remembers. “We said no.”

At Get Friday, each client is assigned a personal assistant, but behind the scenes a larger team — which includes Web site designers, teachers and accountants, among others — often collaborates on jobs. Company officials say the team approach offers clients an advantage over hiring a personal assistant at home, who, besides costing four times as much, might be skilled at answering phones but not managing books, or a whiz at party planning but unable to put tax receipts in a spreadsheet.
“With a full-time admin, I have to supervise them and, if there’s a lull in their work activity, ‘find’ work to keep them busy,” said Richard Hawksworth, who runs a small media production company in Chicago and signed up with Get Friday six months ago after his previous personal assistant moved out of state.

Now, “I call when I need something, and I pay for the work they provide — no stress or anxiety about unproductive time or employees.” For somebody who is “spread very thin,” he says, “that’s huge.”Venkatash insists his company isn’t stealing U.S. jobs, the usual criticism of outsourcing, though party planners and database management companies would probably disagree。

Airport noise bad for blood pressure

Living near an airport isnt just irritating, it is also unhealthy, researchers found, in a study that showed loud noise instantly boosts a sleeping persons blood pressure.

The louder the noise, the higher a persons blood pressure went, a finding that suggests people who live near airports may have a greater risk of health problems, said Lars Jarup, who led the European Commission-funded study.
Living near airports where you have exposure to night time aircraft noise is a major issue, Jarup, an environmental health researcher at the University of Glasgow, told Reuters.

The reason we did airports is because there was no study that has looked at particular problems of aircraft noise. High blood pressure can lead to stroke, heart failure, heart attack and kidney failure. It affects more than a billion adults worldwide.

The research team showed that people living for at least five years near a busy airport and under a flight path have a greater risk of developing chronic high blood pressure, also known as hypertension, than those who live in quieter areas.
That study of nearly 5,000 people found that an increase in night time airplane noise of 10 decibels increased the risk of high blood pressure by 14 percent in both men and women. We know that noise from air traffic can be a source of irritation, but our research shows that it can also be damaging for peoples health, which is particularly significant in light of plans to expand international airports, Jarup said.

In the four-year study, published in the European Heart Journal, the researchers remotely measured the blood pressure of 140 volunteers every 15 minutes while they slept in their homes near Londons Heathrow airport — one of the busiest in the world — and three other major European airports.

They used digital recorders to determine what noises had the biggest impact on blood pressure, ranging from road traffic to a partners snoring to an airplane taking off or landing. The Decibel level, not a sounds origin, was the key factor, but airplanes had the most significant impact, Jarup said. Most of the time you will find road traffic noise is not too bad during the night, he said. If you live near an airport where there are night flights, that is quite another story.

Health Reimbursement System Bilking Patients

he attorney general said he would file a civil lawsuit that would include three other subsidiaries of United and will seek restitution for consumers. Additionally, Cuomo has subpoenaed 16 of the country’s largest insurers, including Aetna, CIGNA and Empire BlueCross BlueShield.The subpoenas request the companies provide documents that show how they computed reimbursement rates, copies of member complaints and appeals, and communications between members and Ingenix and the insurers. Cuomo’s office said the probe found that the Ingenix reimbursement database — owned by United but used by most major health insurers — used data that resulted in smaller payments to consumers. Linda Lacewell, head of Cuomo’s health care industry taskforce, indicated the fraudulent reimbursement system was widespread, noting: “United has a track record that stretches from Monterey to Montauk.”

Data Manipulation Alleged

Those potentially affected were people with “out-of-network” insurance that allows them to seek care from any doctors they choose. About 28,000 Long Island residents have out-of-network policies with United, a Cuomo spokesperson said. “When insurers like United receive convoluted and dishonest systems for determining the rate or reimbursement, real people get stuck with excessive bills and are less likely to seek the care they need,” Cuomo said. In a statement, Minneapolis-based United said it is in discussions with Cuomo and that: “The reference data is rigorously developed, geographically specific, comprehensive and organized using a transparent methodology that is very common in the healthcare industry.”Empire Blue Cross Blue Shield President Mark Wagar said the company would continue to work with Cuomo’s office to determine whether any of the information used was inaccurate. “If that is found to be the case,” Wagar said, “Empire would consider any and all remedies available to protect the interests of our members, their families, our group customers and providers in the New York marketplace and to maintain our company’s historic commitment to fair and reasonable coverage.”

Shortchanging Patients

Consumers have become accustomed to receiving reimbursements based on what insurance companies call “reasonable and customary” prices for the area where they live.
However, Cuomo said that while the United companies that used the database knew customary charges for a doctor’s visit might average about US$200, the reimbursement was based on a charge of $77 per visit. Using those numbers, customers who receive 80 percent reimbursements would receive only about $61 for a visit that cost them $200.
“Based on the findings in this investigation,” Consumers Union program director Chuck Bell said, “it appears that United Health failed to fulfill the promises it made to cover a fair portion of medical expenses and consumers were stuck with the bill.”
Dr. Nancy Nielsen, president-elect of the American Medical Association, attended the Manhattan news conference at which Cuomo announced the investigation.“The investigation launched today by New York Attorney General Andrew Cuomo calls into question the validity of a system that health insurers have used for years to reimburse physicians and their enrolled members.” Dr. health club Robert Goldberg, president of the Medical Society of the State of New York, indicated support for the probe, saying there will be “long-term benefits to healthcare in New York” as a result of cracking down on reimbursement pricing.

TextMessage Warnings Broadcast During NIU Campus Danger

This carefully orchestrated effort to get the word out was largely a response to last April’s shootings at Virginia Tech, where a student went on a rampage that killed 33 people, including himself. As campuses around the nation grappled with the horror of that massacre, administrators at NIU took their own preparations to a new level, going so far as to prepare the hypothetical template that could be used for near-instantaneous communication in an emergency. Thursday, after a gunman fired into an ocean science class in a large lecture hall, officials kept working the system to keep people informed, posting 12 messages during the next 2 1/2 hours:

3:40 p.m.: All classes on the DeKalb campus are canceled for tonight. …
3:50 p.m.: It has been confirmed that there has been a shooting on campus. … People are urged not to come to campus.
4:10 p.m.: Campus police report that the scene is secure. …
4:31 p.m.: All NIU students are asked to call their parents as soon as possible.

‘A Lot Has Changed’

Immediate alerts became a priority after Virginia Tech was criticized for a slow response that some said might have given the gunman more time to kill. However, communication is only part of a wholesale rethinking about how to prepare for the worst, an effort that has swept campuses across the nation.
Mental health professionals studied how to spot warning signs in students coping with mental illnesses. Privacy laws were re-examined so officials get more information on potentially dangerous students. Gun laws were reviewed.
“A lot has changed,” said Catherine Bath, vice president of Security On Campus, a nonprofit group that has pushed for increased campus safety. “They are looking at how to handle red flag scenarios from students and faculty.”
Indeed, a week after the Virginia Tech shootings, NIU President John G. Peters said in a letter to the campus community that officials were reviewing their security and mental health policies.
The school has been so focused on campus security that a national training conference on the topic is scheduled at the campus in June, Bath said.

Don’t Hesitate

On Thursday, the university’s new emergency alert procedures seemed to work, officials and witnesses said, with students and faculty learning about the shootings on their BlackBerries and voice mail. While there is no system to send text messages to cell phones, some people have their e-mail forwarded there.
“Each time we had an update, we utilized all of the available communication technology to deliver that same information,” said NIU spokesperson Melanie Magara.
“This is what we had asked schools to do after Virginia Tech happened. Don’t think about warning your students when something like this happens. Just warn them as soon as possible,” Bath said.

When Danger Arises

Since Virginia Tech, there have been a number of campus shootings. Last week, a student fatally shot two other students during class at Louisiana Technical College. In December, two graduate students at Louisiana State University were killed.
In November, a University of Chicago graduate student was shot to death on a sidewalk near the school, in a spate of violence that began on campus.

The U. of C. is among the many universities across the country that added text-messaging alert systems after Virginia Tech. Officials used it for the first time after the November shooting, but not until nine hours after the incident occurred, drawing criticism for not alerting the campus more quickly.
About 7,700 of the 28,000 students, faculty and staff are signed up for the system, and officials are working on ways to increase that number, said spokesperson Julie Peterson.

“Virginia Tech caused all universities to really look at their emergency response processes,” Peterson said. “The technology allows us to communicate more quickly and more thoroughly than we used to be able to do, and people expect us to use that technology effectively.”

Preparing for the Worst

Jodi Sticken, who teaches in NIU’s College of Education, said the university has been proactive in making the DeKalb campus safer. She said that since a December scare on campus, administrators have tried to help faculty and staff learn how to identify potentially troubled students and prepare for emergencies. They have held meetings, placed training video on the Web and distributed booklets with color-coded tabs that identify different emergency situations.However, she said, short of turning the campus into a prison, it’s hard to see how it could be made more secure.
“It’s just awful,” Sticken said health club. “I’ve got to say, I really believe that the administration has tried to put into place all the possible scenario reactions they possibly could. What can you do?”

Americans Spend More to Treat Spine Woes

Americans are spending more money than ever to treat spine problems,health club but their backs are not getting any better.

Those are the findings of a report in The Journal of the American Medical Association, which found that spending on spine treatments in the United States totaled nearly $86 billion in 2005,health club a rise of 65 percent from 1997, after adjusting for inflation. Even so, the proportion of people with impaired function because of spine problems increased during the period, even after controlling for an aging population.

“You’d think if you’re putting a lot of money into a problem, you’d see some improvements in health status,” said Brook I. Martin, research scientist at the Department of Orthopedics and Sports Medicine at the University of Washington and lead author on the study, published Wednesday. “We’re putting a lot of money into this problem, and it’s a big investment in health care expenditures, but we’re not seeing health status commensurate with those investments.”

The report is the latest to suggest that the nation is losing its battle against back pain, and that many popular treatments may be ineffective or overused. Researchers have produced conflicting data about the effectiveness of spinal surgery for back pain, although one major clinical trial, known by the acronym Sport, showed that spinal surgery patients did better than patients receiving more conservative care, which included medications or physical therapy. However, some doctors have questioned whether surgeries, injections and narcotic pain medications are being used appropriately.

“I think the truth is we have perhaps oversold what we have to offer,” said Dr. Richard A. Deyo, a physician at the Oregon Health and Science University in Portland and a co-author of the report. “All the imaging we do, health club all the drug treatments, all the injections, all the operations have some benefit for some patients. But I think in each of those situations we’ve begun using those tests or treatments more widely than science would really support.”

To study spending trends on spinal care, the researchers examined annual household survey data from the Agency for Healthcare Research and Quality, which was collected from about 23,000 people a year from 1997 to 2005. It includes pharmacy and medical record data, and was used to estimate national spending and treatment practices.

The researchers found that people with spine problems spent about $6,096 each on medical care in 2005, compared with $3,516 in medical spending by those without spine problems.

The biggest surge in spending has been for drugs. In 2005, Americans spent an estimated $20 billion on drug treatments for back and neck problems, an increase of 171 percent from 1997. The biggest jump was for narcotic pain relievers, like OxyContin and other drugs, which increased more than 400 percent.

Outpatient treatment for back and neck problems increased 74 percent to about $31 billion during the period, while spending related to emergency room visits grew by 46 percent to $2.6 billion. Spending for surgical procedures and other inpatient costs grew by 25 percent to about $24 billion.

Despite the growth in treatment of back problems health club, the data show that the percentage of people with serious spine problems has not declined; it appears to have increased.

Based on the sample, the researchers estimated that in 1997, about 21 percent of the adult population suffered from back or neck problems that limited their function. By 2005, that number grew to about 26 percent, after adjusting the numbers for an aging population.

It is not clear why more people appear to be suffering from back and neck pain. It could be because of rising obesity rates, researchers suggested. Or excessive treatment of back problems could lead to more problems.

“I do worry there is a combination of side effects and unnecessary treatments and labeling people as being fragile when they’re really not,” Dr. Deyo said. “The combination of those kinds of things may actually be in some cases doing more harm than good.”

Healthy Lifestyle Is the Secret to Longer Life, Researchers Say

Healthy Lifestyle Is the Secret to Longer Life health club, Researchers Say

Not smoking, regular exercise, maintaining normal weight, and avoiding diabetes and high blood pressure seem to be the secrets of living to age 90, researchers say.

According to the U.S. Census Bureau, about 5 million Americans are aged 85 and older, a number that will quadruple by 2050. As the population grows older, doctors should encourage older Americans to exercise and lead healthy lifestyles to cut health-care costs.

“Given the rising cost of health care, anything we can do to try and reduce disease and disability in the older years and reduce the cost of medical care is important,” Laurel Yates, a doctor of internal medicine at Harvard’s Brigham and Women’s Hospital in Boston said in her study published Monday in the Archives of Internal Medicine.

The researchers followed 2.357 men who were part of the Physicians’ Health Study. The men were evaluated when they started the study at about age 72 and were surveyed at least once a year for the next two decades. Overall, 970 men survived to age 90 or beyond.

The research found that a healthy 70-year-old, who had never smoked, had normal blood pressure and weight and exercised up to four times a week had a 54 percent chance of living until 90.

Exercising and not smoking “can have great payoff not only in terms of adding years to your life, but making those years be of good function and less disease.”

Sedentary lifestyle reduced the chances of living to age 90 by 44 percent, high blood pressure by 36 percent, obesity by 26 percent and smoking by 22 percent.

Having three of these risk factors significantly reduced the chances of surviving to age 90 to 14 percent and having five risk factors dropped the chance to just 4 percent.

The researchers also found that genes determine about 25 percent of the variation in lifespan. Therefore, 75 percent can be determined by lifestyle.

“Smoking, diabetes, obesity and hypertension each are predicted to reduce life expectancy by one to five years, while higher physical activity may add up to five years,” the study said.

Being in a good shape could add as much as 10 years to a man’s lifespan, the study found.

Yates’ study was completed by a second study belonging to Dellara F. Terry, MD, MPH, of the Boston University School of Medicine and Boston Medical Center and colleagues, who studied 523 women and 216 men aged 97 or older.

Dr. Terry split the participants into two groups based on gender and the age they developed diseases, such as heart disease, diabetes, high blood pressure, dementia, stroke, chronic obstructive pulmonary disease, osteoporosis and Parkinson’s disease. The findings showed that almost one-third of the survivors had developed these illnesses by age 85,health club but were not disabled by them. The study also reports that men had better mental and physical function than the female centenarians, which the researchers say is consistent with other studies.

“One explanation for this may be that men must be in excellent health and/or functionally independent to achieve such extreme old age. Women on the other hand may be better physically and socially adept at living with chronic and often disabling health conditions,” health club the authors write.

Blue Cross stops controversial letter

Facing a torrent of criticism Tuesday, Blue Cross of California abruptly halted its practice of asking physicians in a letter to look for medical conditions that could be used to cancel patients' insurance coverage.

In a statement issued about 6 p.m., the state's largest for-profit insurer said, "Today we reached out to our provider partners and California regulators and determined this letter is no longer necessary and, in fact, was creating a misimpression and causing some members and providers undue concern.

"As a result, we are discontinuing the dissemination of this letter going forward."

The announcement came after blistering rebukes Tuesday by physicians, patients, privacy experts and officials including Gov. Arnold Schwarzenegger and Sen. Hillary Rodham Clinton, D-N.Y.,health club after the Los Angeles Times disclosed the practice.

The letters sent to holders of individual policies in the state came just months after Blue Cross was fined $1 million by the state for unfairly revoking coverage to scores of its policy holders.

"For a company that has gotten a real black eye over the issue of rescinding coverage over the past year - to actually be more aggressive rather than less is simply stunning," said Anthony Wright, executive director of HealthAccess California, a health care advocacy organization.

"It certainly is not a position physicians want to be put in," said Dr. Dean Didech, chief medical officer of the San Jose Medical.

Group, a group of 70 local physicians health club. "It really is a problem between the doctor-patient relationship."

In a letter to physicians last week, Blue Cross asked the doctors to "identify members who have failed to disclose medical conditions on their applications that may be considered pre-existing."

It went on to say that "Blue Cross has the right to cancel a member's policy back to its effective date for failure to disclose material medical history health club."

In a statement earlier Tuesday, Blue Cross defended the letter, saying that it "highly values the trust of its members and understands the personal relationship members have with their physicians and medical groups." But it also has a responsibility to make sure its records are accurate.

This letter could never have been written, Wright said, if legislation that stalled in the California Legislature earlier this month had been enacted into law. Among other things, the legislation would have meant that insurance companies couldn't deny coverage based on health status.

Didech put it this way: Medical insurance companies should be forced to provide policies to everyone, "just like a driver's license."

Some 19 million Californians receive their health insurance through their employers - and because of the market power of group coverage, insurance companies accept all of a company's workforce. Another 10 million Californians are covered through such public programs as Medi-Cal or Medicare. It's the remaining 2 million or so who buy coverage as individuals who were targeted by the Blue Cross letter.

Those people tend to be freelancers and independent consultants, the jobless, early retirees, employees of small businesses without insurance, or entrepreneurs starting new businesses.

The California Medical Association, a group of 35,000 doctors in the state, had called on the state Department of Managed Health Care that regulates the health insurance industry to order Blue Cross to rescind the letter and stop these "deeply disturbing, unlawful" practices.

"As long as no charges are filed and they're collecting premiums, it's OK. But when the bill comes, then they investigate the background," complained Dr. Anmol S. Majal, a gastroenterologist in Fremont and past president of the California Medical Association.

Agency names poor-performing homes

Facing an effort in Congress to force the release of information about the nation's poorly performing nursing homes, the U.S. Centers for Medicare and Medicaid Services on Tuesday reversed its earlier decision to keep some of that information confidential.

Last November, the agency publicized the names of half of the 128 nursing homes that appeared on the agency's list of "special-focus facilities" due to a history of putting residents' health and safety at risk.
At the time, the agency refused to make public the complete list of troubled homes, with Administrator Kerry Weems saying some of the homes had not been given a chance to graduate from the list by improving their care of their residents.

After The Des Moines Register reported that the full list had been shared with industry lobbyists but was being kept from the public, Democratic presidential candidates Hillary Clinton and Barack Obama, both U.S. senators, called for public disclosure of the complete list.

They said the nation's seniors need that information about facilities having a history of questionable care so they and their families can make wise choices about where to live.

Clinton and Sen. Tom Harkin, an Iowa Democrat, introduced legislation that, if approved, would force the Centers for Medicare and Medicaid Services to make public the complete list.

On Tuesday, Weems announced that from now on the agency will be making public the complete, national list of special-focus facilities as it is updated each quarter. There are 131 nursing homes now on the list, including four in Iowa, and all were publicly identified Tuesday.

Asked whether the announcement renders the Clinton-Harkin bill moot, Weems said, "I would say it's up to the senators to decide whether or not, you know, what we've done today would have them continue to press their legislation."

He said the newly disclosed list is "the latest in a series of steps we will be taking to improve quality and oversight in nursing homes." The agency will be releasing more information on special-focus facilities, he said, "to better equip beneficiaries, their families, and caregivers to make informed decisions and stimulate robust improvements in nursing homes having not improved their quality of care."

Agency officials said that since the partial list of troubled homes was made public in November they have been working with states to make sure the list is up-to-date and provides consumers with the information they need to distinguish between facilities that are improving and those that are not.

The new list also indicates which homes have been recently designated as special-focus facilities and which have recently moved off that list.

About 50 percent of the nursing homes identified as special-focus facilities significantly improve their quality of care within 2years, according to the Centers for Medicare and Medicaid Services. About 16 percent are eventually kicked out of the program that provides them with Medicare and Medicaid money to pay for resident care.

Although the full list has now been made public, it has yet to be incorporated into the federal Web site where nursing home inspection data are shared with the public.

Weems said he expects that the site, called "Nursing Home Compare," will include information about special-focus facilities later this spring.

"I think one of the best ways to look at the November announcement and then (today's) announcement is that we're in a process of continuous improvement," Weems said. "This and what happened in November should not be viewed in isolation. These are part of a series of improvements this agency is committed to making to the nation's nursing homes."

A Diabetes Study health club

Re “Study Undercuts Diabetes Theory” (front page, Feb. 7):

While the interim results of the Accord trial may be disappointing to patients with Type 2 diabetes, it is important to remember that there is incontrovertible evidence from the 20-year Diabetes Control and Complications Trial that controlling high blood glucose levels does indeed prevent vascular complications.

The most recent data from this trial even demonstrated a benefit of intensive treatment of blood glucose on cardiovascular disease, an effect that persisted many years after the formal study ended.

Of course, patients with Type 2 diabetes have many other risk factors for heart disease in addition to high blood glucose, including older age, overweight or obesity, high blood pressure and abnormal lipids. The interplay between all these risk factors and glucose is likely the reason that people with diabetes are at such high risk for heart attacks.

Finally, it is clear that people with Type 2 diabetes are at the same risk for developing eye, kidney and nerve problems from high blood glucose levels as patients with Type 1 and therefore will benefit from proper control of blood glucose.

Also, since the level of blood glucose control being tested in the Accord trial was significantly lower than that ordinarily achieved in medical practice, their results should not be taken as evidence that current standards should be abandoned. For all these reasons, most diabetes experts will continue to tell their patients to keep their blood glucose levels as near to normal as feasible.

Jill P. Crandall
Harry Shamoon
Bronx, Feb. 7, 2008

The writer are medical doctors at the Diabetes Research Center, Albert Einstein College of Medicine.

•

To the Editor:

The results of the Accord study are not surprising. Diabetes is not a disease of blood sugar; it is a disease of faulty hormonal signaling, particularly insulin and leptin.

The increased mortality seen in the diabetics in this study is not from lowering the sugar, but from the treatment that neglects and often worsens the underlying cause of insulin resistance.

Until medical “science” begins to recognize the difference between symptoms and disease we will continue to see results such as this and the recent Vytorin (Enhance) cholesterol-lowering study, where the treatment itself becomes the disease.

In Second Trial, Avastin Is Found Effective in Treating Breast Cancer

Genentech said Tuesday that a new clinical trial had shown that its best-selling drug Avastin was effective in treating breast cancer, a finding that could increase the chances that the product will be approved for that use.
The company said in an announcement after the close of trading that the trial showed that Avastin lengthened the time before the cancer worsened. Genentech’s shares rose 2.4 percent, to $71.60, in after-hours trading.

The Food and Drug Administration is scheduled to decide by Feb. 23 whether to approve Avastin for use in treating breast cancer. The decision is being closely watched as a barometer of the agency’s standards toward approving new cancer drugs or expanding uses of current medications. It is possible the F.D.A. will delay the decision past February so it can consider the new data.

Avastin, also known as bevacizumab, is already approved in the United States as a treatment for colorectal and lung cancers. Genentech sold $2.3 billion worth of Avastin in 2007, all in the United States. An agency advisory committee voted 5 to 4 in December that Avastin should not be approved for breast cancer.

The committee, basing its conclusions on a separate study, said the drug’s effectiveness in slowing the progression of the disease did not outweigh the drug’s toxic side effects, especially since women getting Avastin did not live significantly longer.

One concern of the F.D.A. staff and of the advisory committee was the difficulty the trial had in measuring precisely when cancer started to progress, or worsen.

The initial clinical trial of Avastin that was under discussion was conducted by an academic group without some of the procedures in place that the F.D.A. would have liked.

The new trial, however, was conducted by Roche, which owns a majority of Genentech and sells the drug overseas. The trial is thought to have had in place the controls the F.D.A. sought.

Also, the fact that the new trial showed that the drug slowed cancer progression might allay concerns that the first trial’s results were somehow a fluke. The results of the new trial, called Avado, came weeks earlier than expected.

“Genentech believes that the results of the Avado study provide confirmation of Avastin’s efficacy and safety in this patient population health club,” the company said in a statement.

While the new trial increased the period before breast cancers became worse, the study has not yet run long enough to show whether Avastin lengthens lives, which is considered the gold standard for a cancer drug. Michael Aberman, an analyst with Credit Suisse, said in a note to clients Tuesday that without survival data the new trial would not increase the chance for Avastin’s approval this month.

Genentech’s stock has been falling for the last two years because of investor concerns that the company’s once-meteoric growth was slowing. So extending Avastin to breast cancer treatment is considered important for the company.

Genentech did not provide any numerical results for the new trial, saying those would be presented at a medical meeting in the coming months. It said there were no new safety problems observed in the trial.

The trial tested Avastin as an initial treatment for women whose cancer had recurred or spread beyond the breast health club, the same type of patients as in the first trial. All 736 patients in the Avado trial received a separate chemotherapy drug, docetaxel. Some of the patients also got Avastin while others got a placebo.

Making Sense of the Great Suicide Debate

AN expression of true love or raw hatred, of purest faith or mortal sin, of courageous loyalty or selfish cowardice: The act of suicide has meant many things to many people through history, from the fifth-century Christian martyrs to the Samurais’ hara-kiri to more recent literary divas, Hemingway, Plath, Sexton.

But now the shadow of suicide has slipped into the corridors of modern medicine as a potential drug side effect health club, where it is creating a scientific debate as divisive and confounding as any religious clash.

And the shadow is likely to deepen.

After a years-long debate about whether antidepressant drugs like Prozac and Paxil increase the risk of suicide in some people, the Food and Drug Administration in recent days reported that other drugs, including medications used to treat epilepsy, also appear to increase the remote risk of suicide. The agency has been evaluating suicide risk in a variety of medicines, and more such reports — and more headlines — are expected.

Many doctors who treat epilepsy patients said they were bewildered by the recent reports and concerned that regulators were scaring patients away from valuable medications based on limited evidence. On the other side, critics of the agency have charged that the reports were long overdue.

For veterans of the debate over the side effects of drugs, it all had a familiar odor. “Here it comes again,” said Ronald Maris, a professor emeritus at the University of South Carolina School of Medicine and a forensic scientist who works as a paid expert for plaintiffs’ lawyers. “It looks like this is headed down the same road.”

In short, consumers and patients may be in for a Pandora’s box of exasperating, drawn out public debates over suicide risk, if not lurid court cases — with little chance of a clear, satisfying resolution.

The reason is simple: Suicide is an intimate, often impulsive decision that has defied scientific understanding, just as it has confounded easy explanation throughout history, or in literature.

Researchers can count the bodies, all right, and they have confirmed what people already suspected about suicide, that it is associated with depression, alcoholism, and other habits or disorders that leave people miserable.

But the act itself is so rare — 1 in 10,000 — that a series of drug trials cannot pick up enough cases to allow for adequate analysis. A drug trial typically lasts weeks to months and may include, at the high end, little more than a couple of hundred patients. In the case of the epilepsy drugs, the F.D.A. found 4 suicides among some 44,000 people taking the drug in 199 studies, and none among some 28,000 on placebo. Doctors would have to treat about 500 patients before seeing one case of suicidal thinking or behavior that would not have occurred without the drug.

The agency is now requiring that manufacturers in their studies track suicidal symptoms. But drug makers traditionally have had little incentive to do so; on the contrary, in many studies scientists try to screen out suicidal patients and bury any mention of suicide attempts deep in their reports, or with vague language.

To make up for the tiny number of completed suicides, health regulators have used suicide signs, or markers. But these are not well understood, either. One of them is suicidal thinking, or “suicidal ideation.” This is recorded in a study when a patient tells a doctor that he or she is feeling suicidal.

It hardly takes a psychiatrist to point out that the act can’t happen without the idea. But having the idea very rarely leads to the act, as psychiatrists, psychologists and almost anyone who has been a teenager can attest.

Is the person who tells the doctor about the dark thoughts somehow more at risk?

No one knows. “Every psychiatrist with a big practice will have a few suicides, and you’re going to have people who don’t say anything about it — and are very much at risk,” Dr. John Davis, a professor of psychiatry at the University of Illinois at Chicago, said.

Lanny Berman, executive director of the American Association of Suicidology, said in an interview that research suggests that about a quarter of suicides are impulsive: the idea strikes and the person acts quickly. Studies of hospitalized patients have found that many who go on to take their own lives deny to doctors any thoughts of it, he said. “We just don’t know enough about the relationship” between the thoughts and the behavior, Dr. Berman said.

Not to mention that people who are thinking about it more often talk themselves out of the act, also on a sudden whim. As the G. K. Chesterton poem “A Ballad of Suicide” has it,

But just as all the neighbors — on the wall —

Are drawing a long breath to shout “Hurray!”

The strangest whim has seized me ... After all

I think I will not hang myself today.

Finally, doctors who have spent their lives studying suicide say that it is, almost always, a complex combination of factors — the stars aligning, darkly — that leads to the act.

In his forensic analyses of suicides, Dr. Maris tries to evaluate biological factors, like drug metabolism, as well as family history, sleep habits, personality, and what was happening in the person’s life. Did a spouse threaten to leave? Did a person get fired? Did a best friend just die?

“In that context, then, you have to ask what the drug contributed,” Dr. Maris said. “And often the person is taking more than one medication.”

Perhaps the only thing all parties agree on is that better data is needed.

In a paper in The Journal of the American Medical Association last year, the psychiatrists Dr. Donald Klein of Columbia University and Dr. Charles O’Brien of the University of Pennsylvania argued that the best way to study the risk of rare side effects was to establish large, linked databases of patients, including medical records and prescription histories. Such a system could be created in the United States in a short time, they wrote, but “the possibility has received almost no public discussion or legislative attention.”

And until it does, doctors, regulators and patients alike will have their theories — that the drugs do pose a serious risk; or that the dangers are being exaggerated — and likely see in the limited evidence some confirmation.

Not unlike the tormented souls themselves who are pondering a final exit. In his classic study, “The Savage God,” the English poet and critic A. Alvarez, a failed suicide himself, wrote that suicide is “a closed world with its own irresistible logic. ... Once a man decides to take his own life he enters a shut-off, impregnable but wholly convincing world where every detail fits and each incidence reinforces his decision.”

L.I. Hospital Scrutinized After Deaths of Patients

Last spring, doctors at Mercy Medical Center on Long Island gave a patient the news she had feared: Cancer had been detected in her left breast.

She was only in her 30s, but she decided to act swiftly because breast cancer ran in her family. On May 25, she had a double mastectomy. The next day, she died of complications from the surgery.

As it turned out, the woman did not have cancer. According to the State Department of Health, the pathology report from the woman’s surgery had found no tumors in her breasts. The hospital’s lab had mixed up her test with another woman’s.

Mel Granick, a hospital spokesman, would not release the name of the woman who died. In a statement, he said the hospital was “deeply saddened and profoundly regrets” the error.

The error, which was reported by The New York Post and News 12 Long Island, the cable news channel, has brought more scrutiny to Mercy Medical Center, in Rockville Centre. In October, the Health Department concluded that the hospital had taken proper “corrective action” after the mix-up in the mastectomy case. But it is investigating the hospital over the deaths of three other patients.

A review by the Institute of Medicine of the National Academy of Sciences in 1999 concluded that medical errors killed 44,000 to 98,000 people a year in the United States health club.

The investigation of Mercy Medical Center was prompted by the complaints of one of its doctors, Anthony Colantonio, who said a physician’s assistant had improperly inserted catheters, chest tubes and pacemakers into patients health club. Three such patients died, the doctor said: a 65-year-old man and a 64-year-old woman last summer, and a 19-year-old woman in October. The Health Department would not confirm whether the assistant was a focus of its investigation.

Claudia Hutton, a spokeswoman for the Health Department health club, said it was unclear when the investigation would end.

“There have been cases where the patients died and death was not necessarily the expected outcome,” she said. “These things can happen without fault at times.”

Scientists Find New Receptor for H.I.V

The discovery is the identification of a new human receptor for H.I.V. The receptor helps guide the virus to the gut after it gains entry to the body, where it begins its relentless attack on the immune system.

The findings were reported online Sunday in the journal Nature Immunology by a team headed by Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases.

For years, scientists have known that H.I.V. rapidly invades the lymph nodes and lymph tissues that are abundant throughout the gut, or intestines. The gut becomes the prime site for replication of H.I.V., and the virus then goes on to deplete the lymph tissue of the key CD4 H.I.V.-fighting immune cells.

That situation occurs in all H.I.V.-infected individuals, whether they acquired the virus through sexual intercourse, blood transfusions, blood contamination of needles and syringes, or in passage through the birth canal or drinking breast milk.

The findings appear to provide some, if not the main, answers to how and why that situation occurs.

Dr. Warner C. Greene, an AIDS expert and the director of the Gladstone Institute of Virology and Immunology here who was not involved in the research, said the findings were “an important advance in the field.”

“They begin to shed light on the mysterious process on why the virus preferentially grows in the gut,” Dr. Greene said in an interview.

Dr. Fauci, James Arthos, Claudia Cicala, Elena Martinelli and their colleagues showed that a molecule, integrin alpha-4 beta-7, which naturally directs immune cells to the gut, is also a receptor for H.I.V. A protein on the virus’s envelope, or outer shell, sticks to a molecule in the receptor that is linked specifically to the way CD4 cells home in on the gut, the researchers said.

Binding of the virus to the integrin alpha-4 beta 7 molecule stimulates activation of another molecule, LFA-1, which plays a crucial role in the spread of the virus from one cell to another. The actions ultimately lead to destruction of lymph tissue, particularly in the gut.

Several other receptor sites for H.I.V. are known. The most important is the CD4 molecule on certain immune cells; the molecule’s role as an H.I.V. receptor was identified in 1984.

Two other important receptors, known as CCR5 and CXCR4, were identified in 1996. CCR5 is a normal component of human cells and acts as a doorway for the entry of H.I.V. People who lack it because of a genetic mutation rarely become infected even if they have been exposed to H.I.V. repeatedly.

“The work we did took nearly two years, and there’s little doubt that what we have found is a new receptor,” Dr. Fauci said in an interview after giving a lecture here, adding that “we certainly have to learn a lot more about it.”

Scientists have sought to identify receptors because they offer targets for the development of new classes of drugs.

For example, last year the Food and Drug Administration approved for AIDS treatment a Pfizer drug, Selzentry or maraviroc, which works by blocking CCR5.

Dr. health club Fauci said he hoped his team’s findings would encourage other scientists from different disciplines to explore new ways to attack H.I.V.

A number of experimental drugs that block the integrin alpha-4 beta-7 receptor are being tested for the treatment of autoimmune disorders. Dr. Fauci said such drugs should also be studied for their potential benefit in AIDS treatment health club.

Organization of new trials in the next year or so could test such drugs in animals and humans to determine their safety and effectiveness against H.I.V., Dr. Fauci said.

One candidate is a drug, Tysabri or natalizumab, that is marketed for treatment of multiple sclerosis, Dr. Fauci said. Biogen/Elan makes Tysabri.

If trials for H.I.V. are successful health club, Dr. Fauci said, the drugs could be added to existing treatment regimens.

Health insurance after graduation

After school has ended, most students worry about what grad school they'll attend or whether they will successfully join the workforce. Worse yet, coupled with the ending of school comes the inevitable end to many students' health insurance.

Many students are kept on their parents' health insurance until they are 21 or 22 years old. In recent years, however, many insurance policies have adjusted the age at which students will no longer receive coverage from 21 to 19 years old, oftentimes disregarding whether the person is a student or not, according Catherine Engelhardt-Ellis, the director of SBI Student Medical Insurance Programs.

Engelhardt-Ellis went on to say that not being covered by some kind of health insurance, whether it is through their parents or one's university, is a big risk to take.

"There are many risks that come with not having medical insurance," Engelhardt-Ellis said. "The most devastating though is when students go without medical treatment or medication because they don't have the money to pay for care or insurance to cover it."

Students run the risk of steeper financial obligations when uninsured than if they paid for private health insurance or were insured through programs like Healthy New York, which is offered to small companies or individuals living without health insurance.

As for those students who go without health insurance after graduation, the risk of needing medical care in the future also goes hand-in-hand with the risk of bankruptcy due to medical bills exceeding income, according to Engelhardt-Ellis.

Engelhardt-Ellis said that students who are covered through the health insurance offered by UB are covered until August 21 of the year they graduate. This gives graduated students enough time to let benefits from their new employer kick in, or to find alternative health insurance through a private company that they can afford.

UB also offers information on their Web site for students who are graduating or are in need of health insurance, through the Chickering Group called "Navigate Your Health Insurance for Dummies - a Reference for the Rest of Us!" which provides useful information for graduating students on health insurance. It gives tips on family health coverage as well, Engelhardt-Ellis said.

Mike Robinson, a junior mechanical engineering major, went without medical insurance after taking a year off from school so he could make enough money to pay for tuition. He wasn't covered by his parents' health insurance because he wasn't a student and didn't get benefits from his job.

"I've been without health insurance before because I took time off from school," Robinson said. "It definitely makes you nervous; I tried really hard not to get hurt. Now that I'm back in school though, my parents' insurance covers me again until I'm 21 or finish college."

According to Engelhardt-Ellis, most employers who cover college students until graduation stop covering them until the end of the month in which graduation occurs.

While most students don't start thinking about the loss of their health insurance coverage until a couple months before graduation, Engelhardt-Ellis warns that may be too late to make sure there are no gaps in their coverage or that they don't go without any coverage at all.

Priy Ankasharma, a sophomore philosophy and pre-med major, hasn't given any thought to what she will do for health insurance after graduation since it's still at least a couple of years away.

According to Ankasharma, she hopes to land a good job after graduating that will offer benefits, so that she will still be covered after her parent's health insurance runs out.

"Students should start making inquiries about their health insurance coverage as early as the December before they graduate," Engelhardt-Ellis said. "Winter break is the ideal time to start making phone calls and to start making sure you know the details of your coverage."

Since most plans need about 90 days before their coverage goes into affect, students who don't have a plan by the middle of March can end up with a gap or no health insurance coverage at all, according to Engelhardt-Ellis.

After graduation, George Bochenek, a senior computer sciences major, plans on getting a job that has benefits to ensure that he has sufficient health insurance coverage, since his parents' health insurance covers him until he graduates.

"I'm banking on getting a job that offers health insurance after I graduate so I won't have to worry about it," Bochenek said. "If I don't get a job right away after I graduate then I would try and get health insurance through a private provider just in case of injury. It'd be cheaper in the end to pay a little each month for coverage rather than a lump sum because I wasn't covered and got hurt."

Health Insurance Mandates

Here is the main reason I am not endorsing Hillary or Obama. Hillary's health care plan has "mandates." Everyone must buy insurance. Obama's does not have mandates. The government will make it easier to buy insurance. Neither has a Medicare-for-all health plan.

Paul Krugman is in an argument with Obama, because he points out that not having mandates means that you won't get to universal health care. The young, healthy people will decide not to get insurance, others will decide not to spend the money for whatever reason, and soon only the expensive people will have insurance and we're back where we are now. Obama's plan can not work. On top of that his ads against Hillary's plan, saying it is wrong for the government to mandate that you join a program, reinforce the right's anti-government arguments, including those against Social Security.

But Hillary says her plan will have a mandate to buy health insurance. FORCING people to give money to greedy, corrupt corporations? This is political suicide. Readers know how I feel about insurance companies. I will never vote for someone with the brilliant idea of forcing me to give my money to greedy corporations so their CEOs can buy bigger jets. This shows that Hillary now (correctly) feels it is safer politically to go up against the needs of the people than the wishes of the insurance companies.

Hillary's "mandates" plan proves that the only way we can have health insurance is with a Medicare-for-all system. Period. She may be trying to tell us that.

Microfinance initiatives take health insurance to the poor

Mumbai: Microfinance institutions (MFIs) such as SKS Microfinance, Basix—both Hyderabad-based—and the Kath-ir Foundation of Tamil Nadu are gearing up to provide health insurance products to the rural and urban poor health club.

These MFIs are entering into partnerships with private sector insurers to offer micro health insurance to families which do not have access to formal credit and cannot afford expensive treatment at private hospitals.

Take the case of women such as Sharanamma, who goes by one name and lives in Sultanpur, a village in the Gulbarga district of Karnataka. When her son Sidilinga, a rickshaw driver, was detected with a hernia and had to be operated, the family’s only option would have been to go to a moneylender for the Rs7,000 it would take.
Reluctant to get trapped in high interest rates, Sharanamma kept postponing the operation, jeopardizing her son’s health.

But, during a routine field visit, the loan officer of SKS spoke to Sharanamma and her peers about Swayam Shakti—a health insurance programme for the MFI’s clients through which they could insure an entire family for an annual premium of Rs525. Sharanamma signed up and Sidilanga was operated at a private hospital in Gulbarga. The entire hospital expense of Rs6,570 was covered by the SKS health insurance scheme.

SKS tied up with ICICI Lombard General Insurance Co. Ltd to offer the insurance and other MFIs, such as Awareness and Biswa, both based in Orissa, are also providing health insurance products in association with ICICI Lombard.

For an annual premium ranging from Rs200 to Rs500, private insurers are providing a medical cover of Rs20,000-50,000. They are also willing to take alternative proofs from customers, such as declaration of age by community members or self-help groups. Policy conditions have been simplified in micro health insurance to enable policyholders to get admitted and treated at any registered hospital in a rural area. According to the regulator, normal health insurance policies recognize only those hospitals that have at least 10 beds.
A survey conducted among 248 urban and rural below poverty line families by SKS before it began offering health insurance showed that 67% of the respondents had used private medical facilities. On average, they spent Rs2,340 per family per annum on consultation, diagnosis, treatment and transportation. Some 45% of the families surveyed borrowed money to meet health emergencies. Nearly 94% of the families had borrowed less than Rs5,000 and only 3% had a health insurance cover.
For private insurers trying to get a foothold in rural areas, this kind of arrangement works out well, especially in rural ­areas.
Pranav Prashad, head-rural and agriculture business at ICICI Lombard, said working with MFIs also gives insurance companies “a wealth of data” (as) there is very little data about the bulk of the families living in poverty. We do have to tailor-make products for every different MFIs or NGO that we work with and we use these experiences and replicate them in other geographies across the country,” he said.
S.K. Alaghusundaramani, health club a senior manager at the Kathir Foundation, that has been offering health insurance in partnership with Reliance General Insurance Co. Ltd for the past six months, says his loan officers go on field visits and speak to pregnant women to convince them to enroll for their health insurance scheme.
Under the plan, health club a woman could get herself and her entire family a Rs20,000 insurance cover for an annual premium of Rs325. She would get an extra cover of Rs10,000 for normal childbirth and Rs15,000 for a Cesarean section operation. Out of the 10 claims that the foundation has received so far, three have been maternity claims, Mani said.

Oregonians sign up for chance at state health insurance

The state says more than 33,000 people have signed up for a chance to get state health insurance.

The Oregon Health Plan's standard benefit has been closed to new enrollments since 2004, but the list is reopening to a limited number.

To make sure everyone gets an equal chance to apply, the state is accepting names on the reservation list for a chance to get the coverage.

In March, 3,000 names will be randomly drawn to receive applications, which must be returned within 30 days to review their eligibility.

Legislators push amendment to protect private health insurance

Senate Democrats made a big splash last summer with their universal health care reform plan.

But a pair of state lawmakers want to protect residents from government health care plans and their right to have private insurance. Rep. Leah Vukmir (R-Wauwatosa) and Sen. Ted Kanavas (R-Brookfield) are asking fellow members to co-sponsor an amendment to the Wisconsin Constitution that would explicitly give people the right to enter into private contracts with health care providers and to purchase health care coverage. "The Legislature may not require any person to participate in any state-sponsored health care system or plan," the language reads.

Vukmir and Kanavas said those rights are fundamental liberties, but are under attack in Wisconsin.

"The state should not have the power or authority to compel its citizens to participate in a state-sponsored health care system," they wrote.

The amendment would need to pass both houses of the Legislature in two consecutive sessions before it could go to voters health club.

An Answer To Sky High Health Insurance Premiums

Actuaries at the Centers for Medicare and Medicaid Services calculate that national health expenditures grew from about 7.0 percent of GDP in 1970 to 15.3 percent in 2003. And, they forecast that medical expenditures will reach 20 percent of GDP by 2015. It's no longer possible for business, our government, or individuals to ignore these rising costs.

Clearly, something must be done. We baby boomers can remember a time when we never gave health insurance a thought. It just automatically came with employment as a free perk. It's not that employers were all that much more generous way back then. Just like today, business was driven by profit. But, businesses needed workers, and workers were a scarce commodity at the end of World War II. Health insurance was a cheap benefit. Once one employer started throwing it in they all had to just to stay competitive.

Since that time the cost of health care has skyrocketed. There are two chief reasons for this. First, medical science has advanced greatly over the past 50 years. At the end of World War II there was no open heart surgery. And, only a few decades earlier even diabetes was a death sentence. Countless lives have been saved and the quality of life, for virtually everyone, has been greatly elevated by the enormous advances made in medical science over the past five decades. But, these wonderful advances have come at a cost.

The second reason that health expenditures are nearing 20 percent of the GDP is simply a lack of diligence. Because we have come to view medical expense as “free” we've failed to manage the cost of these services adequately. Collectively, we've been careless consumers. Our benefits packages and appetites have all contributed to our failure to keep an eye on medical costs. The government has complicated the matter by stepping in with legislation that, in effect, guarantees healthcare for all. And, first class healthcare with the latest technology at that!

So where does this all end? Do we just keep spending until medical expenses consume 25% or even 30% of GDP? That may suit the medical industry. But, it spells financial disaster for the nation. Congress took a major step in the right direction in 2004 when it passed legislation which created a special class of tax deferred savings account - the Health Savings Account or HSA. The goal of this legislation is to put consumers back in control of medical expenses while providing insurance products that would cover high unexpected bills. Health Savings Accounts can only be set up in conjunction with the purchase of a qualified High Deductible Health Plan (HDHP). The HSA HDHP combination is a good way to go for individual and family plan purchasers, especially if you're overall health is relatively good.

The idea is to purchase a less expensive health insurance plan and then deposit the premium difference in a savings account. The higher deductible insurance plan creates financial incentive to control cost while providing financial relief should a major illness or injury occur. By depositing the premium difference in a Health Savings Account the consumer builds equity which can be used for healthcare costs which aren't covered under the medical insurance plan.

The beauty of the HSA is that contributions are tax deferred when you put money in, and tax exempt if you use the money for qualified purposes. I repeat: When you use the money you save for qualified medical purposes you never have to pay taxes on the money or on any earnings the money may have accumulated - this is huge! A number of banks have web sites to explain the intricacies of setting up a Health Savings Account. And, your insurance agent can help you select a qualified High Deductible Health Plan.