Growing Up

More Harm from Sodas

Metabolic syndrome is characterized by increases in waist circumference, blood pressure, serum triglycerides and blood glucose as well as aberrations in cholesterol levels. It is being diagnosed and recognized with increasing frequency.

There is now more data from the recently released July 31 issue of Circulation suggesting that consumption of at least one soda per day is associated with a higher risk of metabolic syndrome in middle-aged adults.

Data was obtained from over 6,000 person-observations from the Framingham Heart Study to determine the effect of soft drink consumption on the development of metabolic syndrome.

Individuals who drank one or more soft drinks per day had a 48 percent increased risk of having metabolic syndrome compared to those who drank less than one soda per day. The study showed no difference in whether they drank diet or regular sodas.

This observational data is now causing the authors to question whether public health policies to limit the rising consumption of soft drinks in the community need to be implemented.

Sure let’s just have the government get involved in our dietary consumption as well. I am sure this will solve the problem.

Resident Work Hours

As some readers may or may not know, medical school training programs have dramatically changed over the past 5-10 years related to resident work hours. All programs have limitations on how much and how often residents can work and be on-call.

According to a recent article in the July 23 issue of the Archives of Internal Medicine, most internal medicine faculty members believe that decreased resident duty-hours have had adverse effects on both residents and faculty.

The study from the Mayo Clinic College of Medicine in Rochester, Minn. surveyed 111 key clinical faculty from 39 internal medicine residency programs and came up with these conclusions.

Although 50 percent of the faculty believed that decreased duty-hours had improved the residents' well-being, strong majorities agreed that it had compromised the residents' continuity of care (87 percent), physician-patient relationships (75 percent), education (66 percent) and professionalism (73 percent).

Many of them also agreed that the reduced workload for residents had increased their own workload (47 percent), and decreased their satisfaction with teaching (56 percent), decreased their ability to develop relationships with residents (40 percent), and decreased their overall career satisfaction (31 percent).

Faculty burnout could lead to further problems in getting quality instructors to teach the residents as they train.

Once again, more studies will be done.

Primary Care Physicians

The nation is beginning to recognize its increasing need for primary care physicians and less sub specialists. Patients typically have more than just one medical problem like hypertension, diabetes and heart disease.

Walking through every office door in primary care medicine is an everyday adventure and can be as simple as a sore throat or as complex and serious as cancer and heart disease.

Patients may be depressed, attacked by a dog, hung-over or having problems with their spouse marriage or mother-in-law.

This all translates into a growing need for family physicians who can address the whole patient, within the context of the family, religious beliefs, and their support systems that help or undermine the patient's health.

Primary care physicians can integrate the care of these patients far better than any other provider and decrease cost and redundancy of tests.

There are more than 100 papers cited that support the need for primary care physicians and if the United States is to improve health care quality and outcomes, we need to encourage more students to choose these fields compared to specialty fields.

Other studies show areas with an overabundance of sub specialists have higher costs and lower quality of care because the care becomes increasingly fragmented and routine preventative steps are often missed.

With the aging population, the system must change. Incentives that encourage more medical students to choose primary care needs to be incorporated into the programs.

William Osler, a family physician, said “Listen to your patients. They're telling you what's wrong with them.” We need primary care doctors to take this advice to heart!

New Gene Variant Found in Restless Leg Syndrome

In the July 18 issue of the New England Journal of Medicine, researchers have identified a gene variant strongly associated with restless leg syndrome and also periodic limb movement disorder of sleep.

The researchers studied 306 Icelandic patients with objectively documented evidence of the disorder and 15,633 controls. I guess sleep is something fairly important to Icelanders as there is probably not much else to do.

The investigators found a highly significant association between restless legs syndrome and a common gene variant on chromosome 6p21.2. This was also replicated in an American sample. Persons with the gene variant were 50 percent more likely to have one of the two disorders.

This study may offer some hope in finding the underlying cause leading to better and more effective therapies. There are a few drugs available now that does improve the symptoms, but no cure as of yet.

Gila Monster Spit may Help Diabetes

Even though the Gila monster looks horrible and is typically less than friendly, its spit has medical use.

A new drug derived from Gila monster saliva appears to help people with type 2 diabetes and may be a welcome alternative when other commonly used drugs have failed to work.

The new drug, called exenatide, (byetta) does not appear to cause weight gain like many of the other commonly used drugs.

It is sometimes called the "non-insulin" insulin as it is an injection.

Exenatide also appears to help preserve insulin-producing cells in the pancreas according to researchers at the Joslin Diabetes Clinic in Boston.

Even though it is available we do not want to hear about any missing Gila monster pets.

Decisions and Cost

Physicians of all kinds make clinical decisions based on financial realities. Examples include:
• The uninsured patient in need of a gallbladder surgery and is denied by one surgeon because of having no insurance but referred to another.
• Suggesting a cheaper but more invasive surgery to an uninsured patient.
• Closing your office lab because it wasn’t making any money, even though the lab made life a lot easier for patients.
• Or a pediatrician who stops doing vaccinations in the office because payers barely reimburse for the supplies, let alone all the associated administrative work.
• Choosing generic drugs over brand name
• Bartering medical care for services

What are you supposed to do when you’re losing money on procedures and services? Many physicians have to answer this question when they continue to offer labs, vaccinations and other procedures in the office that insurance companies do not reimburse.

Should convenience for the patient be a motivating factor or should you eliminate those services and refer the patient to another facility to have them done?

When the costs are borne by the patient, it should be part of good medical care for the doctor to discuss the financial impact with patients.

If an uninsured patient or one with a high deductible needs a procedure, the physician’s job is to lay out all the options and allow the patient to make the best informed decision. This may sometimes be that patients choose not to proceed with a certain course of action because of financial concerns. Physicians should not make clinical decisions or financial decisions without the patients input and direction.

Many tests and procedures are not emergent and just because patients want them doesn’t mean they are necessary especially if the patient cannot afford them.

I believe it is wrong for a doctor to assume that a patient would want a more expensive or less expensive treatment strictly on the basis of costs. They need information to make these decisions

Physicians have the ability to offer or not offer services based on financial as well as other factors. Patients need to be informed about where they can receive these services, but physicians are not obligated to provide money losing services.

Patients who need procedures and are uninsured may have a ready fund of cash or relatives willing to pitch in. They might be able to make monthly payments. By discussing financial concerns, physicians may help patients find solutions.

As with most businesses, you sometimes take a loss in certain areas to make it up in others. Physicians are no different, but there is a limit on how much you can lose in certain contexts.

I think most physicians believe that refusing to do anything except that for which you are specifically paid is bad business and ethically inappropriate.

Healthcare is getting tougher for everyone and the financial concerns have to play a more important role and be included in the decision making process. Patients are ultimately responsible for their healthcare and need to be the final decision-maker.

E-Prescribing

Physicians wrote 1.6 billion prescriptions in 2004 and that accounts for more than five prescriptions for every person alive in the USA.

This accounts for a lot of time-consuming phone calls and faxes between the pharmacies and a doctor’s office.

Based on recent statistics, half of these drug orders require at least one communication between the prescriber and the pharmacy and many times more than one. Questions about restrictive insurance formularies, nonexistent dosage forms, and indecipherable handwriting, among others, all spur conversations for which physicians or their staff has little, if any, time.

The common problems bogging down the system is:
• Telephone tag
• Hide-and-seek charts
• The disappearing act where physicians often leave the exam room to write a prescription which closes a window of opportunity to explain the medication.
• Keeping up with the e-Joneses where small practices cannot afford computerization and E-prescribing. Crack the code of poor handwriting and indecipherable scribbles
• Who’s on first? Patients have an obligation to read all materials doctors or pharmacists hand out regarding a prescribed medicine, and to call in if a drug does not seem to work, makes symptoms worse, or causes unpleasant side effects. Patients also need to arrange for periodic rechecks.

Things that would help everyone are knowing what your patients are taking. There should be a hard-and-fast policy that patients bring their actual medication bottles with them for an exam, or at least a detailed list of all current drugs. Patients see many doctors on average and may have changes made that the primary physician is unaware of.

It is the patient’s responsibility to track their use of the medication and to allow the lead time necessary for a refill authorization. Poor planning on the patient’s part should not create an emergency on the office or pharmacy.

Charging for prescription refills is becoming more common and necessary to offset the huge cost of employee time and paperwork that is now required.

Technology, specifically, e-prescribing is a software application for physicians to send prescriptions straight to a pharmacy. E-prescribing offers a higher quality of patient care, fewer troublesome prescriptions for the pharmacist to process, and peace of mind for you that you’ve done your job to the best of your ability. But not everyone accepts them and not all states play by the same rules making it a hassle at times. It is also an added expense for offices and another software application to manage.

E-prescribing helps eliminate the handwriting worries and minimizes dosing errors. It should save paper as well as phone calls and faxes.

As with all technologies, there are up-sides and down-sides and each has to be weighed appropriately for the offices.

Statins may have link to cancer

A very recent analysis released is questioning a link between the use of cholesterol lowering drugs called “statins” and the increased risk of cancer.

The initial analysis suggests that the cardiovascular benefits of achieved levels of LDL cholesterol might be offset by an increased risk of cancer. In the analysis of patients enrolled, investigators observed a "significant and linear relationship" between achieved LDL levels and the risk of new cancer cases.

There have been numerous studies previously showing the reduction in cardiovascular risk using these drugs, but this new observation will raise some concern on the aggressiveness of treatment in patients.

This analysis was really focused on trying to enhance our understanding of the risk side of the statins but it has now produced a provocative and interesting result that raises a lot of new questions. Researchers are warning everyone not to jump to conclusions and certainly not to stop taking the medication until further analysis and studies can be completed.

Investigators continue to study the effect of drug dosage on liver and muscle toxicity but will now have to add another potential outcome indicator in the studies.

It is interesting historically that physicians in the pre-statin era monitored cholesterol levels and knew there was a correlation with falling levels and the later finding of cancer. We seem to have forgotten some of these clinical pearls and now rely more and more on studies which later turn out to only be partially true.

Others are rationalizing that the use of statins are causing people to live longer and that is why we are discovering more cancer. This may or may not be the case.

Once again, the jury is out. Moderation seems to be the key. No overly-aggressive attempts to alter what the body is doing naturally seems to be the prudent strategy for most patients!

Heavy Traffic = Heavy Calcification

A new and recent study from Germany has shown, for the first time that living near very busy roads is associated with coronary atherosclerosis. This is published in the journal Circulation.

The study purports to show a relationship between particulate matter and the proximity to roads in relation to cardiovascular events.

The study of 4494 adults, age 45 to 74 years, is part of the Heinz Nixdorf Recall Study that is being conducted in three large, adjacent cities in the industrialized Ruhr area of Germany. Home address was used to estimate each person's exposure to urban air pollution. Participants were interviewed about risk factors such as diabetes and smoking underwent extensive clinical examinations, and had their coronary artery calcification (CAC) measured by electron-beam computed tomography (EBCT).

The researchers found that the closer the participant lived to heavy traffic, the higher the CAC.

The fact that they showed a positive exposure-response relationship for increasing traffic exposure that persisted even after multivariable adjustment "strengthens our findings," the researchers say.

The study was adjusted for city, area of residence, age, sex, education, smoking, environmental tobacco smoke, physical inactivity, waist-to-hip ratio, diabetes, blood pressure, and lipids. They did not mention significant family history which would be very important.

Hoffman and colleagues said their results concur with those from a recent study conducted in Los Angeles, which showed an increase in carotid artery thickness in patients exposed to similar particulate matter.

Whether information like this should be incorporated into planning and zoning regulations remains up in the air.

Out of GAs

A man was driving down the road and ran out of gas. Just at that moment, a bee flew in his window.

The bee said, "What seems to be the problem?"

"I'm out of gas," the man replied.

The bee told the man to wait right there and flew away. Minutes later, the man watched as an entire swarm of bees flew to his car and into his gas tank. After a few minutes, the bees flew out.
"Try it now," said one bee.

The man turned the ignition key and the car started right up. "Wow!" the man exclaimed, "what did you put in my gas tank"?

The bee answered,













(I see you smiling)

New Recommendations for Women

The American Heart Association’s 2007 update of its Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women is shown in the picture.

Lifestyle recommendations apply to virtually all women as this is a disease many times of lifestyle management or mismanagement along with uncontrollable genetic factors.

The updated guidelines propose three levels of risk:

“High-risk” women have established coronary heart disease (CHD), cerebrovascular disease, abdominal aortic aneurysm, end-stage or chronic renal disease, or diabetes mellitus.

“At-risk” women have family history, subclinical markers of disease such as coronary calcification, and two new things: low exercise tolerance and failure of heart rate to return rapidly to normal after exercise testing.

“Optimal-risk” women have a Framingham score <10%,>

Women are counseled not to smoke and to avoid environmental tobacco-smoke exposure.

Women are given recommendations for physical activity a minimum of 30 minutes of exercise at a level of moderate intensity, e.g., brisk walking, most—and preferably all—days of the wee and an addition, in the current update, is the prescription of a higher dose of physical activity (60-90 minutes, daily if possible) for women who are trying to lose weight or sustain weight loss.

The dietary guidelines proposed for all women continues to be a variety of fruits and vegetables but several recommendations have been added including fish (oily fish in particular) twice weekly, and limiting alcohol to one drink and sodium to <2.3>

Folic acid, which had been recommended for high-risk women with elevated levels of homocysteine, should not be used for primary or secondary CVD prevention at all according to the new recommendations.

And the tentative recommendation is against antioxidant supplementation (e.g., vitamin C or E) for CVD prevention. Withholding hormone therapy for CVD prevention continues to be upheld in the current recommendations.

Autism Trial

The debate on Autism and its links to vaccines has raged for years and just recently, the British doctor who sparked the scare that the MMR vaccine was linked to autism faced a hearing into charges of professional misconduct during his research.

The General Medical Council hearing, expected to last 15 weeks, revolves around the research published in the Lancet medical journal in 1998.

This claim led to fierce worldwide debate among researchers and caused a decline in MMR vaccinations leading to increased disease and some deaths.

The scientific evidence suggests that vaccines are not linked to autism but a vocal group of people remain unconvinced.

The council will not look into the scientific claims but whether Wakefield and two colleagues -- John Walker-Smith and Simon Murch -- violated a number of ethical practices during the study involving young children.

The council said it would also look into charges Dr. Wakefield was involved in and paid for advising lawyers representing children claiming to have suffered harm due to the MMR vaccine.

Dr. Wakefield also faces a charge that he acted unethically by taking blood from children at a birthday party after offering them money and without proper ethical approval.

Dr. Wakefield now works in the United States and said in a recent interview with the Observer newspaper he plans to defend himself vigorously.

"My concern is that it's biologically plausible that the MMR vaccine causes or contributes to the disease in many children, and that nothing in the science so far dissuades me from the continued need to pursue that question," Dr. Wakefield said.

The jury is still out!

HPV and throat cancer

The New England Journal of Medicine recently published a new study and found a link between HPV infection and oropharyngeal cancer.

The results were consistent regardless of tobacco or alcohol use, which are known risk factors for this type of cancer.

The authors go further by saying this study “provides a rationale for HPV vaccination in both boys and girls—since oropharyngeal cancers occur in men and women.”

The study revealed that people who have had more than five oral-sex partners in their lifetime are 250% more likely to have throat cancer than those who do not.

The researchers believe oral sex transmits human papillomavirus (HPV) similar to the one implicated in the majority of cervical cancers.

With more and more teenagers having oral sex, the incidence of this type of cancer will probably increase.

Many of the teenagers I talk with do not even consider oral sex “sex” and further education needs to be provided on these new concerns.

Will there be a PSA replacement?

In the recent Urology Journal, an experimental blood test is shown to detect prostate cancer so accurately that it may replace the PSA level as the preferred screening tool for the disease.

Researchers at Johns Hopkins University in Baltimore discovered an early prostate cancer antigen (EPCA-2) that functions as a biomarker and was shown to identify 78% of men who had prostate cancer with currently normal PSA levels <2.5 ng/mL

This biomarker would be more specific and a better early indicator if future studies validate these results. Medicare and insurance carriers will be waiting to pay for this test until the sensitivity and specificity have shown it to be an adequate screening tool.

Patients may ask for the test and pay for it out of pocket, but it will be expensive for a while. Whether the cost benefit ratio is beneficial has yet to be proved.

CRABBY OLD MAN

A friend passed this on to me and I thought it was worth a quick read and posting.

When an old man died in the geriatric ward of a small hospital near Tampa, Florida, it was believed that he had nothing left of any value.

Later, when the nurses were going through his meager possessions, they found this poem. Its quality and content so impressed the staff that Copies were made and distributed to every nurse in the hospital.

One nurse took her copy to Missouri. The old man's sole bequest to
Posterity has since appeared in the Christmas edition of the News
Magazine of the St. Louis Association for Mental Health. A slide
Presentation has also been made based on his simple, but eloquent, Poem.

And this little old man, with nothing left to give to the world, is Now the author of this "anonymous" poem winging across the Internet.

Crabby Old Man

What do you see nurses? ......What do you see?
What are you thinking......when you're looking at me?
A crabby old man, ..not very wise,
Uncertain of habit ........with faraway eyes?

Who dribbles his food.......and makes no reply.
When you say in a loud voice....."I do wish you'd try!"
Who seems not to notice .....the things that you do.
And forever is losing .............. A sock or shoe?

Who, resisting or not...........lets you do as you will,
With bathing and feeding ...... The long day to fill?
Is that what you're thinking?.....Is that what you see?
Then open your eyes, nurse......you're not looking at me.

I'll tell you who I am ......... As I sit here so still,
As I do at your bidding, .....as I eat at your will.
I'm a small child of Ten.......with a father and mother,
Brothers and sisters .........who love one another

A young boy of Sixteen ........with wings on his feet
Dreaming that soon now. ..........a lover he'll meet.
A groom soon at Twenty .........my heart gives a leap.
Remembering, the vows........that I promised to keep.

At Twenty-Five, now .......... I have young of my own.
Who need me to guide . And a secure happy home.
A man of Thirty ......... My young now grown fast,
Bound to each other ........ With ties that should last.

At Forty, my young sons ....have grown and are gone,
But my woman's beside me........to see I don't mourn.
At Fifty, once more, .......... Babies play 'round my knee,
Again, we know children ......... My loved one and me.

Dark days are upon me .......... My wife is now dead.
I look at the future ...........I shudder with dread.
For my young are all rearing .young of their own.
And I think of the years...... And the love that I've known.

I'm now an old man.........and nature is cruel.
Tis jest to make old age .......look like a fool.
The body, it crumbles..........grace and vigor, depart.
There is now a stone........where I once had a heart.

But inside this old carcass ...... A young guy still dwells,
And now and again ........my battered heart swells.
I remember the joys.............. I remember the pain.
And I'm loving and living.............life over again.

I think of the years ....all too few......gone too fast.
And accept the stark fact........that nothing can last.
So open your eyes, people .........open and see.
Not a crabby old man. Look closer...see........ME!!

Remember this poem when you next meet an older person who you
might brush aside without looking at the young soul within.....we will all, one day, be there, too!

Spirituality and Health

A new study published in the Archives of Internal Medicine has been cited in a number of papers, magazines and news articles. It surveyed physicians on their view of science and spirituality.

The results were not too surprising for most readers. A majority of physicians (56 percent) believe religion and spirituality have much or very much influence on the health of patients. Only 6 percent believe some type of deity intervenes to change “hard” medical outcomes.

The basic outcome is that most physicians believe that spirituality helps patients cope with their diseases and underlying diagnoses. It also helps families cope with the situation as well.

New Hiding Place

A reminder recently went out to police departments, but it may also be something for parents to be aware of.

Police recently arrested a female in possession of cocaine and after a more thorough search at the station; they located a small section (4cm x 2.5cm x 1cm) in the sole of her Nike Shox brand shoe. The section has a removable red spongy plug with a Nike symbol upon it and if absent, could house a range of drugs.

For parents with any suspicion of drug use in your kids, this may be another place to check. We have personally had drug abusing patients hide drugs from their spouse in their shoes.

Who is being tortured?

There is a new controversy that has been escalating over the past several months and more states are getting involved. The question may become “who is really being unduly punished, the criminal or the family?”

The controversy is over imposing the death penalty in states that utilize lethal injection as the primary method. Most of these states require a physician to minimally monitor vital signs through the process, but the American Medical Association's (AMA) code of ethics insists that it is unethical for a physician to participate in an execution even though they take no active stance on abortion, partial birth abortion, etc.

This has caused many states to stay executions because they cannot get physicians to participate in fear of sanctions by their states licensing boards.

Examples of a few cases are:

In North Carolina, Allen Holman admits he murdered his estranged wife after he chased her down at high speeds and rammed her car from behind, then gunned her down in a convenience store parking lot in front of a police officer. He dropped his appeals, fired his lawyers, and has repeatedly asked the state to impose his death sentence.

The State’s medical board says it will discipline any doctor who participates calling physician participation in executions unethical.

In Missouri state officials sent letters last year (and got no volunteers) to 298 certified anesthesiologists, asking for technical oversight at the execution of death row inmate Michael Taylor. He kidnapped, raped and murdered a 15 year old after abducting her while waiting for the school bus. Taylor’s execution was stayed.

In California last year, a federal judge ordered that anesthesiologists be present at the execution of Michael Morales, an inmate convicted of raping and killing a 17-year-old girl. In this case, two doctors volunteered, but later backed out because of possible sanctions. Morales' execution was also stayed and the death penalty is still under review in California.

In some states, doctors can face legal action if they participate. There are private and political groups on both sides fighting for and against the issue. Even though the AMA code of ethics has no legal binding, many physician organizations and state boards adhere to the guidelines.
North Carolina has now halted 5 executions since they stated earlier this year that they would discipline any physician who participated.

Legal questions arise because medical boards are appointed state agencies and not law-making bodies and executions are not illegal. Therefore, just like abortions, physician participation is consistent with the current law. Another argument is that there are no other legal activities State Boards prohibit a physician from participating in making this an apparent “double standard”.

The Department of Corrections in North Carolina is currently suing the North Carolina Medical Board and wants the judge to prohibit the agency from disciplining doctors over this issue. In Oklahoma and Georgia, they have proactively passed laws to protect physicians over this issue. Other states are also considering legislation to protect physicians before there is an issue.

Budget Decorating

Here is an idea that we may be able to use to help cut costs on a remodeling project.

Grove City Pennsylvania Medical Center enlisted the services of eleven Grove City college sophomore women to help give their emergency room a makeover. After some planning and idea sessions, these women helped give an overnight facelift to the department.

Just like the show “Design on a Dime,” they stripped and painted the hospital’s waiting room on a single Saturday night in April.

This emergency room sees more than 14,600 patients per year and the waiting room takes a beating. This particular makeover incorporated elements from three design proposals the students presented to the management. They chose calming green hues to replace the outdated wallpaper and they removed cluttered bulletin boards. New lamps added homey lighting and the hospital re-covered its waiting-room chairs. Framed photographs shot by one of the sophomore volunteers now line the walls and all of this was done at a fraction of the cost of a professional designer.

We have lots of talented people in our community that I bet would help with projects such as these. Ideas like this could help with hospitals, community centers and other public funded buildings that need updated. The city county building could use a few new colors based on my last visit there.

Insurance Claim Humor

There are many examples of funny documentation errors in medical charts and I certainly have entered a few.

It is nice to know that nearly every profession has similar examples. Below are a few that were pulled from Insurance Claim Forms:

• 
  "I pulled into a lay-by with smoke coming from under the bonnet. I realized the car was on fire so took my dog and smothered it with a blanket."
• 
  "On approach to the traffic lights the car in front suddenly broke."


• 
  "I had been driving for 40 years when I fell asleep at the wheel and had an accident."


• 
  "I pulled away from the side of the road, glanced at my mother-in-law and headed over the embankment."


• 
  "The other car collided with mine without giving warning of its intention."


• 
  "I collided with a stationary truck coming the other way."


• 
  "In an attempt to kill a fly, I drove into a telephone pole."


• 
  "I had been shopping for plants all day and was on my way home. As I reached an intersection a hedge sprang up obscuring my vision and I did not see the other car."


• 
  "An invisible car came out of nowhere, struck my car and vanished."


• 
  "I was thrown from the car as it left the road. I was later found in a ditch by some stray cows."

Not sure what the result was on these claims, but it makes me feel better after reading them.

Grading the Media on Healthcare Reporting

Primary care physicians as well as most other physicians are constantly being questioned by patients about things they have seen, heard or read in the media. Many of us encourage our patients to research their diseases and bring us questions, but the media is sometimes very lax in their reporting accuracy.

Professor Gary Schwitzer who teaches Health Journalism at the University of Minnesota is taking a very proactive approach to combat this problem. His goals are to grade health stories on the ABCs:Accuracy, Balance, Completeness, support excellence in health journalism, and support consumers' informed decision-making.

His vehicle to accomplish this is FIMDM Health News Review, a website where the quality of major press articles and TV reports on clinical topics are reviewed and graded by medical experts and then given a rating of zero to five stars. Reports that fail to meet criteria like costs, potential benefits, risks, and outcomes will get dinged.

The website is very helpful and it makes sorting through some of the media claims much easier.
I would encourage everyone to bookmark the page and use it as a reference tool when evaluating what you see, read and hear.

COBRA benefits

Some patients have asked about COBRA which stands for the Consolidated Omnibus Budget Reconciliation Act of 1985. It is a law passed by the Congress that mandates an insurance program to give some employees the ability to continue health insurance coverage after leaving employment.

Employers qualify if they have 20 or more full time equivalent employees. Employees and their families can get COBRA benefits for some of the following reasons: (1) the death of the covered employee, (2) termination or a reduction in hours (which can be the result of resignation, discharge, layoff, strike or lockout, medical leave or simply a slowdown in business operations) that causes the worker to lose eligibility for coverage, (3) divorce, which normally terminates the ex-spouse's eligibility for benefits, or (4) a dependent child reaching the age at which he or she is no longer covered.

These are not hard and fast rules, but guidelines that may qualify a person for benefits.
COBRA does not require the employer to pay for the cost of providing continuation coverage and if a person wants to continue the coverage, they usually pay at their own expense.

There are exceptions to this and this can sometimes be a benefit as part of a golden parachute for corporate executives who get fired. An example according to the Wall Street Journal would be if Charles Schwab Corp. fires its CEO Charles Schwab, it would pay $32,561 for three years’ worth of healthcare and insurance. This I am sure would be a relief because with a net worth of $4.6 billion, Mr. Schwab couldn’t possible scrape together enough cash for a doctor visit.