Are Health Savings Accounts - HSAs - Right for You? The Rules. The Truth.

Increasingly more Americans are being offered health savings accounts (HSAs) either from their employers or when choosing individual insurance plans.

What are they?

What are their advantages?

What are their disadvantages? (There is no free lunch after all).

Definition - Health Savings Accounts were enacted under President George W. Bush and allow individuals to save money tax-free for medical expenses. Unlike previous medical savings accounts, money not used within a particular year can be rolled over. In other words, the "use it or lose it" problem no longer applies.

HSA funds can be invested like retirement accounts into various mutual funds, bonds, savings accounts and those earnings are tax-free.

When the funds are spent on appropropiate medical expenses as defined by the IRS, the transaction is also tax-free.

In other words, HSAs are the only financial vehicle that essentially never gets taxed when done correctly. Set aside money tax-free (like your 401k), invest (if you want to) and earnings are tax-free, and finally spend money tax-free on medical expenses. You aren't obligated to use HSA funds to pay for medical expenses if you have other dollars available. In fact, after age 65, you can take out the money from the HSA, pay some taxes like your 401k, and voila use it like your other retirement accounts. There are NO income restrictions on who can get a HSA.

Sound too good to be true? Is it right for you? Depends.

The catch are at least a couple, not major, but you must know.

First to have a HSA it needs to be paired with a high deductible insurance plan. Unlike health insurance policies that you may have had in the past, you now have to pay a deductible before the insurance policy kicks in. Very similar to your auto insurance policy. Consequently, doctor office visits won't be the small copay, but potentially a hundred or two hundred dollars. The same may apply to prescription drug coverage.

Despite a higher cost when you use healthcare services, you still may have more take home pay. A high deductible insurance plan typically has lower monthly premiums. If you set aside money for your HSA you have less taxable income. Just be prepared for a little sticker shock. Of course, you can use the money you set aside in the HSA to pay for these expenses.

The second, which is far more important, is will you know when to seek medical care and when to safely skip? Unlike your car which many of us will defer repairs for damages in fender benders, will you know when you must spend money?

Research already shows that patients often skip important needed preventive care, medications, and doctor visits when copays go up. Should you pay for the colonoscopy, which is easily a few hundred dollars, to screen for colon cancer at age 50 even if you feel perfectly well and have no family history (Yes). Finding cancer early is far less expensive than waiting and needing abdominal surgery as well as chemotherapy, which costs tens of thousands of dollars and not only drains whatever other savings you have, but will be unlikely to extend your life. If only you had done the right thing.

HSAs favor those who will be proactive in taking care of themselves and knowing when to go seek medical care, when to invest money to stay healthy, and not "wing" it. Perhaps it isn't surprising then that doctors and accountants are people most commonly enrolled in HSAs. The former know when to get medical care and when to safely skip. The latter know all about the major tax savings as well as the ability to use a HSA as a retirement account.

For the rest of us, this is why I wrote my book - Stay Healthy, Live Longer, Spend Wisely - Making Intelligent Choices in America's Healthcare System - which gives you all the information you need to know to use the HSA wisely.

• How to make the most out of your office visit (after all each visit will cost more).
• The truth about prescription drugs (is the marketing really worth the hype?)
• What tests you must have to stay healthy and well (saving money by being uninformed will cost more in the end don't be ignorant).
• Assembling the right team of doctors.
• How to pick a health insurance plan and hospital.
• Websites that are free and excellent references (far better than simply Googling).
• Body scans, herbal dietary supplements (buyer beware).
• Much more and all for less than a price of a copay or a date to the movies! Your health is worth far more. What you don't know might kill you sooner!
  

Are HSAs good for you? As a doctor and someone who studied accounting at business school, I would have no problem enrolling. If I wasn't a doctor, I would always have some uncertainty about whether I was doing the right thing.

No need to worry, my book is written in an easy to read language that anyone can pick up. It's an insider guide just for you and your friends who will now have the knowledge I give my loved ones all the time.

So go ahead and save some money on healthcare, but make the right choices, be informed, be educated, and be empowered. Save money and stay healthy.

Alternative Medicines Not Helpful

A recent article by the Associated Press noted that over the past decade federal researchers have invested $2.5 billion in trying to determine if alternative medicines or therapies are helpful.
The answer is essentially no. Were studies flawed in their design? Were politics involved (yes, even in academic research centers where science is practiced daily)?

Until researchers can clarify which alternative therapies are worthwhile, it might be best at this time, both to your health and your wallet, to hold off on purchasing any alternative therapies unless okay with your doctor or pharmacist. Federal law at this time gives alternative medicines a free pass. They are not as tightly regulated as over the counter medications or prescription medications. This is the reason each alternative medicine has the disclaimer we all know about, "This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease".

More about dietary supplements and the FDA's role are found here.

The entire Associated Press article follows:

By MARILYNN MARCHIONE, AP Medical Writer – Wed Jun 10, 5:02 pm ET

BETHESDA, Md. – Ten years ago the government set out to test herbal and other alternative health remedies to find the ones that work. After spending $2.5 billion, the disappointing answer seems to be that almost none of them do.

Echinacea for colds. Ginkgo biloba for memory. Glucosamine and chondroitin for arthritis. Black cohosh for menopausal hot flashes. Saw palmetto for prostate problems. Shark cartilage for cancer. All proved no better than dummy pills in big studies funded by the National Center for Complementary and Alternative Medicine. The lone exception: ginger capsules may help chemotherapy nausea.

As for therapies, acupuncture has been shown to help certain conditions, and yoga, massage, meditation and other relaxation methods may relieve symptoms like pain, anxiety and fatigue.
However, the government also is funding studies of purported energy fields, distance healing and other approaches that have little if any biological plausibility or scientific evidence.

Taxpayers are bankrolling studies of whether pressing various spots on your head can help with weight loss, whether brain waves emitted from a special "master" can help break cocaine addiction, and whether wearing magnets can help the painful wrist problem, carpal tunnel syndrome.

The acupressure weight-loss technique won a $2 million grant even though a small trial of it on 60 people found no statistically significant benefit — only an encouraging trend that could have occurred by chance. The researcher says the pilot study was just to see if the technique was feasible.

"You expect scientific thinking" at a federal science agency, said R. Barker Bausell, author of "Snake Oil Science" and a research methods expert at the University of Maryland, one of the agency's top-funded research sites. "It's become politically correct to investigate nonsense."
Many scientists say that unconventional treatments hold promise and deserve serious study, but
that the federal center needs to be more skeptical and selective.

"There's not all the money in the world and you have to choose" what most deserves tax support, said Barrie Cassileth, integrative medicine chief at Memorial Sloan-Kettering Cancer Center in New York.

"Many of the studies that have been funded I would not have funded because they seem irrational and foolish — studies on distant healing by prayer and energy healing, studies that are based on precepts and ideas that are contrary to what is known in terms of human physiology and disease," she said.

In an interview last year, shortly after becoming the federal center's new director, Dr. Josephine Briggs said it had a strong research record, and praised the many "big name" scientists who had sought its grants. She conceded there were no big wins from its first decade, other than a study that found acupuncture helped knee arthritis. That finding was called into question when a later, larger study found that sham treatment worked just as well.

"The initial studies were driven by some very strong enthusiasms, and now we're learning about how to layer evidence" and to do more basic science before testing a particular supplement in a large trial, said Briggs, who trained at Ivy League schools and has a respected scientific career.
"There are a lot of negative studies in conventional medicine," and the government's outlay is small compared to drug company spending, she added.

However, critics say that unlike private companies that face bottom-line pressure to abandon a drug that flops, the federal center is reluctant to admit a supplement may lack merit — despite a strategic plan pledging not to equivocate in the face of negative findings.

Echinacea is an example. After a large study by a top virologist found it didn't help colds, its fans said the wrong one of the plant's nine species had been tested. Federal officials agreed that more research was needed, even though they had approved the type used in the study.

"There's been a deliberate policy of never saying something doesn't work. It's as though you can only speak in one direction," and say a different version or dose might give different results, said Dr. Stephen Barrett, a retired physician who runs Quackwatch, a web site on medical scams.

Critics also say the federal center's research agenda is shaped by an advisory board loaded with alternative medicine practitioners. They account for at least nine of the board's 18 members, as required by its government charter. Many studies they approve for funding are done by alternative therapy providers; grants have gone to board members, too.

"It's the fox guarding the chicken coop," said Dr. Joseph Jacobs, who headed the Office of Alternative Medicine, a smaller federal agency that preceded the center's creation. "This is not science, it's ideology on the part of the advocates."

Briggs defended their involvement.

"If you're going to do a study on acupuncture, you're going to need acupuncture expertise," she said. These therapists "are very much believers in what they do," not unlike gastroenterologists doing a study of colonoscopy, and good study design can guard against bias, she said.

The center was handed a flawed mission, many scientists say.

Congress created it after several powerful members claimed health benefits from their own use of alternative medicine and persuaded others that this enormously popular field needed more study. The new center was given $50 million in 1999 (its budget was $122 million last year) and ordered to research unconventional therapies and nostrums that Americans were using to see which ones had merit.

That is opposite how other National Institutes of Health agencies work, where scientific evidence or at least plausibility is required to justify studies, and treatments go into wide use after there is evidence they work — not before.

"There's very little basic science behind these things. Most of it begins with a tradition, or personal testimony and people's beliefs, even as a fad. And then pressure comes: 'It's being popular, it's being used, it should be studied.' It turns things upside down," said Dr. Edward Campion, a senior editor who reviews alternative medicine research submitted to the New England Journal of Medicine.

That reasoning was used to justify the $2 million weight-loss study, approved in 2007. It will test Tapas acupressure, devised by Tapas Fleming, a California acupuncturist. Use of her trademarked method requires employing people she certifies, and the study needs eight.
It involves pressing on specific points on the face and head — the inner corners of the eyes are two — while focusing on a problem. Dr. Charles Elder, a Kaiser Permanente physician who runs an herbal and ayurvedic medicine clinic in Portland, Ore., is testing whether it can prevent dieters from regaining lost weight.

Say a person comes home and is tempted by Twinkies on the table. The solution: Start acupressure "and say something like 'I have an uncontrollable Twinkie urge,'" Elder said. Then focus on an opposite thought, like "I'm in control of my eating."

In Chinese medicine, the pressure is said to release natural energy in a place in the body "responsible for transforming animal desire into higher thoughts," Elder said.

In a federally funded pilot study, 30 dieters who were taught acupressure regained only half a pound six months later, compared with over three pounds for a comparison group of 30 others. However, the study widely missed a key scientific standard for showing that results were not a statistical fluke.

The pilot trial was just to see if the technique was feasible, Elder said. The results were good enough for the federal center to grant $2.1 million for a bigger study in 500 people that is under way now.

Alternative medicine research also is complicated by the subjective nature of many of the things being studied. Pain, memory, cravings, anxiety and fatigue are symptoms that people tolerate and experience in widely different ways.

Take a question like, "Does yoga work for back pain?" said Margaret Chesney, a psychologist who is associate director of the federally funded Center for Integrative Medicine at the University of Maryland.

"What kind of yoga? What kind of back pain?" And what does it mean to "work" — to help someone avoid surgery, hold a job or need less medication?

Some things — the body meridians that acupuncturists say they follow, or energy forces that healers say they manipulate — cannot be measured, and many scientists question their existence.

Studying herbals is tough because they are not standardized as prescription drugs are required to be. One brand might contain a plant's flowers, another its seeds and another, stems and leaves, in varying amounts.

There are 150 makers of black cohosh "and probably no two are exactly the same, and probably some people are putting sawdust in capsules and selling it," said Norman Farnsworth, a federally funded herbal medicine researcher at the University of Illinois at Chicago.

Even after a careful study, "you know one thing more precise and firm about what that agent did in that population with that outcome measurement, but you don't necessarily know the whole gamut of its effectiveness," as the echinacea study showed, Briggs said.

The center posts information on supplements and treatments on its Web site, and has a phone line for the public to ask questions — even when the answer is that not enough is known to rule in or rule out benefit or harm.

"I hope we are building knowledge and at least an informed consumer," Briggs said.

Federal agency: http://www.nccam.nih.gov

Hydroxycut Dietary Supplement Not Safe? FDA Warning

You may have seen the ads for Hydroxycut dietary supplement touted to help you lose weight. Just the other day, the Food and Drug Administration (FDA) warned consumers to stop taking the product immediately.




Liver injury and one death occurred at dosages recommended by the manufacturer.

The manufacturer has agreed to recall many of its products.

A different question is are dietary supplements safe? It depends. What perhaps is more concerning is how little legal authority FDA has in regulating herbal or dietary supplements. From their website:

How Are Supplements Regulated?

You should know the following if you are considering using a dietary supplement.

* Federal law requires that every dietary supplement be labeled as such, either with the term "dietary supplement" or with a term that substitutes a description of the product's dietary ingredient(s) for the word "dietary" (e.g., "herbal supplement" or "calcium supplement").
* Federal law does not require dietary supplements to be proven safe to FDA's satisfaction before they are marketed.
* For most claims made in the labeling of dietary supplements, the law does not require the manufacturer or seller to prove to FDA's satisfaction that the claim is accurate or truthful before it appears on the product.
* In general, FDA's role with a dietary supplement product begins after the product enters the marketplace. That is usually the agency's first opportunity to take action against a product that presents a significant or unreasonable risk of illness or injury, or that is otherwise adulterated or misbranded.
* Dietary supplement advertising, including ads broadcast on radio and television, falls under the jurisdiction of the Federal Trade Commission.
* Once a dietary supplement is on the market, FDA has certain safety monitoring responsibilities. These include monitoring mandatory reporting of serious adverse events by dietary supplement firms and voluntary adverse event reporting by consumers and health care professionals. As its resources permit, FDA also reviews product labels and other product information, such as package inserts, accompanying literature, and Internet promotion.
* Dietary supplement firms must report to FDA any serious adverse events that are reported to them by consumers or health care professionals.
* Dietary supplement manufacturers do not have to get the agency's approval before producing or selling these products.
* It is not legal to market a dietary supplement product as a treatment or cure for a specific disease, or to alleviate the symptoms of a disease.
* There are limitations to FDA oversight of claims in dietary supplement labeling. For example, FDA reviews substantiation for claims as resources permit.

Troubling, isn't it?

FDA has valuable information about dietary supplements that everyone should find helpful. Like many things if it sounds too good to be true, it is!

Book Review - Medical Myths That Can Kill You: And the 101 Truths That Will Save, Extend, and Improve Your Life

As a practicing family doctor and author of Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America's Healthcare System, I am a strong believer in empowering and educating patients so that they can make the right decisions to get the most out of life. As the only doctor in my family I don't think it is fair that only the people I know or care for are privy to the truth about staying healthy, so I looked forward to reading Medical Myths That Can Kill You: And the 101 Truths That Will Save, Extend, and Improve Your Life, by Dr. Nancy Snyderman, chief medical correspondent for NBC News, which has a similar same perspective.

Overall, the book was a mixed blessing. It has interesting factoids, ideas we should all take to heart, but at times is misleading. As a consumer and a patient, I thought the truths and news you can use pieces were interesting. As a primary care doctor and patient advocate, however, I felt that many parts of the book were misleading. Perhaps one of the faults is it tries to be too ambitious and attempts to cover too many topics, which often are not in depth enough to be of much value.

Dr. Snyderman points out correctly multiple times that the path to good health is through prevention by adopting healthy habits, staying physically active, and maintaining a sensible weight. The structure of the book reflects this preventive focus and chooses to debunk many myths with these clever chapter titles - Annual Checkups Are Obsolete, Vaccinations Are Just For Kids, Doctor's Don't Play Favorites, Only Old People Get Heart Disease and Stroke, We're Losing the War on Cancer, Natural Means "Safe", and You Can Just Snap Out of Mental Illness. She tackles the truth about herbal and dietary supplements, the unproven value of full body scans, as well as the importance of vaccinations and preventive screening tests for cancer, heart disease, and diabetes.

Throughout the book there are plenty of truth tidbits including, "you cannot catch sexually transmitted diseases from toilet seats; you do not need to drink eight glasses of water every day", among many others and news you can use segments that will make some readers hopefully more aware of what is myth and what is fact. These small sidebars were very interesting. I think patients and consumers will find these factoids topics of conversation.

As a practicing doctor, however, there are many areas which are misleading and others that provide information too superficial to be of value. Dr. Snyderman is correct in one of her chapters that heart disease and stroke are the leading causes of death in this country. However, she uses two individuals, a twenty-six year old former beauty pageant winner, who suffered from a stroke, and a forty year old woman, who died suddenly from swimming, as reasons why we should be concerned. The problem is that these type of occurrences are extremely unlikely and rare for these age groups and gender. The typical cause of these problems, atherosclerosis, or hardening of the arteries didn't cause these cases. The former was most likely due to a heart wall septal defect or a blood clotting disorder, known as a hypercoagulable state. The latter was probably due to sudden cardiac death from a fatal arrhythmia, like ventricular fibrillation.

In the area of stroke, she talks about atrial fibrillation, a heart arrhythmia, as the leading cause of stroke. It is a cause, but this heart condition is typically found in patients over age 60 and far more common in people over 80 years old. She doesn't say that and one would naturally and wrongly assume based on the prior patient stories that it can happen at younger ages, which again is extremely unlikely.

Other areas that are covered superficially include when Dr. Snyderman discusses cancer and mental illness. She pushes for prevention as well as clarifies myths that still exist among the public. Unfortunately in the chapter on cancer, she also talks about various cancer treatments which isn't thorough enough and doesn't seem to fit in a book with this preventive theme. For the mental illness, one of the best written sections because of her personal experience, again the book is rather too ambitious and tries to cover anxiety, depression, and bipolar disorder and the various treatment options even as she admits that "it is impossible to go into as much detail as I would like to". Though she gives a website reference, perhaps it may have been better only to cover depression as she and her husband both had experienced it, and acknowledge the other conditions.

Overall, I wanted to like this book as I believe the intent of giving the public the facts about what they can do to stay healthy and well is vital. I think as a practicing doctor and insider, however, the book at times it is misleading, in some areas is too light in content and in others the information deviates from the book's intent of wellness and health promotion.

Chinese Herbal Supplements Not Safe

The FDA found that an erectile dysfunction herbal supplement had the active ingredient from the prescription medication Viagra. The herbal supplements is available under the names Super Shangai, Strong Testis, Shangai Ultra, Shangai Ultra X, Lady Shangai and Shangai Regular.

This unfortunately is not surprising. Due to loopholes in the current legislation, manufacturers of herbal and dietary supplements are not obligated to prove to FDA that their products are safe or effective. Manufacturers do not need to register with FDA that they will market a new product. Companies also must make sure that their marketing plans are not misleading. The laws that regulate herbal and dietary supplements is far different than those covering over-the-counter medications and prescription medications.

What does this mean to you? Be very careful when taking a herbal or dietary supplement as manufacturers are accountable to no one. Check with your doctor. Consider finding out more about potentially dangerous herbals at Consumer Reports, the Natural Standard database, and at Medline Plus.