Sunday, April 26, 2009

Swine Flu – What You Must Know

Swine flu is a respiratory virus which is caused by influenza A that occurs in pigs. Typically the virus would spread from pig to pig and at times would move from pig to humans, usually due to direct contact with the animals. The virus usually is not able to transmit effectively among people and would not infect beyond three individuals.

Since late March and early April of 2009, a particular strain of swine flu influenza A (H1N1) has been identified first in Texas and Southern California which appears to spread more efficiently among people. The Centers for Disease Control (CDC) is tracking the number of cases in the United States as well as various other health agencies like the World Health Organization (WHO). Although the cases in the US have been mild without any reported deaths at this time, in Mexico, already about 1800 cases have been confirmed with nearly 90 deaths, mostly in young healthy individuals.

It appears to be spreading by the respiratory route, that is from exposure to infected respiratory droplets from coughing and sneezing.

Since the 1918 Spanish flu pandemic which killed millions of individuals, mainly young and healthy, scientists are always concerned that the next flu outbreak is the next big one. It is currently too early to tell. As of now there is no vaccine for the swine flu. There are steps you can take to prevent it.

What You Must Do
Recommendations from the CDC are common sense and apply not only to preventing the flu but also the common cold. These include:

Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
Avoid touching your eyes, nose or mouth. Germs spread this way.
Try to avoid close contact with sick people.
If you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them. What is the best way to keep from spreading the virus through coughing or sneezing?

Although it is unlikely that one can find the past year’s influenza vaccine available, getting vaccinated probably won’t help protect against the swine flu.

Ideally, the best prevention is to avoid individuals who are ill. Facemasks may be helpful if needed to care for someone ill. A N95 disposable respirator is a better option than a facemask. More important tips on caring for an ill person from the CDC.

Watch Out for Symptoms
Symptoms of the swine flu are similar to that of the human flu, influenza, which occurs seasonally in the winter.

Sudden onset of high fever, shakes, chills.
Muscle aches
Dry cough
Low back pain

Unlike the common cold where symptoms build up gradually, patients with the flu always seem to remember what they were doing when they were overcome by symptoms. “Doctor, I was fine until about 4pm when all of a sudden I felt muscle aches all over.”

If you have symptoms of the flu, it is important to contact your doctor right away, ideally within 2 days of onset. There are prescription medications that can be helpful, but must be taken within 2 days of symptoms.

Don’t Believe the Myths
You don’t need to worry about eating pork or pork related products. It doesn’t spread by food.

Stay Informed and Educated
Learn more from the ongoing investigation from the CDC.

Friday, April 17, 2009

Generic Lipitor - Not Yet. Other Excellent and Less Pricey Alternatives

On a recent radio ad for LIPITOR, Pfizer's best selling cholesterol lowering medication, the announcer states two interesting points.
  • There is no generic LIPITOR.
  • Your doctor may ask you to switch to a less pricey alternative, but if everything is working fine with LIPITOR, why would you switch?
Indeed, why would you switch?

For a full court press, at the LIPITOR website, they've dedicated an entire section on questions you should ask your doctor as well as other things you should consider.

Now I'm all in favor of empowering individuals with information, so the wise patient needs to be a wee bit skeptical when a pharmaceutical company appears to be providing "helpful" information that promotes their product.

Let's look at each point objectively.
  • LIPITOR is the #1 prescribed branded medication in the world. -- True. Number one doesn't mean it is the best. Note that the recalled VIOXX anti-inflammatory and its related CELEBREX competitor were pulled of the shelves because of research that suggested increased heart attacks compared to other less pricey alternatives, NAPROSYN. CELEXBREX was the number one prescribed anti-inflammatory on the market at the time.
  • LIPITOR is FDA-approved to significantly reduce the risk of: Heart attack, Stroke, Certain kinds of heart surgeries, Chest pain. -- True. Other cholesterol lowering medications are also approved for the same indications.
  • LIPITOR is one of the most widely studied medicines in the world—with more than 15 years of research.-- True. Incidentially there are other cholesterol lowering medications that have been around for even longer.
  • If you switch, you may not get the same cholesterol-lowering results you get with LIPITOR. LIPITOR is proven to lower LDL ("bad" cholesterol)- 76 to 115 points, or 39%-60% (average effect depending on dose). The cholesterol level you've achieved could change. -- True. This part is a little trickier. LIPITOR is one of the most potent cholesterol lowering medications in the family of medications called STATINS. The one that lowers the most at this time is called CRESTOR (and obviously it isn't generic either). But does lower LDL (bad) cholesterol mean better outcomes, that is less likelihood of heart attack and stroke? It depends. The cholesterol lowering medication VYTORIN, which contains two cholesterol lowering medication - ZOCOR and ZETIA, actually lowered LDL cholesterol better than ZOCOR alone, yet the study which looked at how much the carotid artery (neck artery) blockage decreased showed little to no change. So lower doesn't necessarily mean better, even though intuitively we want to believe it to be the case.
Indeed the four questions that Pfizer has you ask your doctor or pharmacist really hinge on the last point.
  • No generic LIPITOR. This means, you will pay more until LIPITOR goes generic.
  • Is generic ZOCOR proven to lower cholesterol as well as LIPITOR. No, ZOCOR, also known as SIMVASTATIN, isn't as potent. But don't get fooled, the real question is if I reach my LDL (bad) cholesterol goal with ZOCOR or LIPITOR, is one far better than the other in protecting my heart?
  • If I switch could the cholesterol level I've achieved change? Yes it can. But better question, is it possible to achieve the same change with a different medication?
  • If I switch could my body respond differently? Yes, but is it also possible that it might not?

Pfizer is doing what most pharmaceutical companies do when their product will soon lose its patent and become generic. They are trying to increase loyalty to their brand, even though LIPITOR is the dominant cholesterol lowering medication in the market.

Want reasonable alternatives and analysis that is objective? Consumer Reports has a free drug report which is fantastic. Here's what they say:

Taking the evidence for effectiveness, safety, and cost into account, we have chosen four statins as Consumer Reports Best Buy Drugs:

* Generic lovastatin and pravastatin — if you need to lower "bad" (LDL) cholesterol by less than 30%
* Generic simvastatin (20mg or 40 mg) — if you need 30% or greater LDL reduction and/or have heart disease or diabetes, or if you have had a heart attack or have acute coronary syndrome and your LDL level is not highly elevated.
* Atorvastatin (Lipitor) (40mg or 80mg) — if you have had a heart attack or have acute coronary syndrome and your LDL is highly elevated; use for two years and then reconfirm need or switch to generic simvastatin. Generic pravastatin and simvastatin became available in 2006. The price of these two medicines will decline in 2007, creating a significant savings opportunity compared to brand-name statins.

There you go. This is the nuance that is heart of a candid conversation between you and your doctor. Pfizer wants you to think the LIPITOR is the only cholesterol medication for you. Medicine is never quite that black and white. Smart patients will realize that there is always a deeper story and shouldn't get fooled by 30 second sound bites. Consumer Reports does say LIPITOR is a good choice for certain conditions. Note however they also say that generic SIMVASTATIN is also for patient who has had a heart attack or acute coronary syndrome, just like LIPITOR.

So why is Pfizer pushing now? Well if you check the FDA website on medications and when they lose their patent, LIPITOR 10 mg will no longer have protection in September 2009, this year!

So if it is too expensive to continue with LIPITOR, don't worry that you aren't getting the right care. Do some research by going to the Consumer Reports website. Ask more questions than the spoonfed ones by Pfizer. It is possible that you do need LIPITOR. It is also a very good chance you don't and others will do the job just fine at keeping you healthy and perhaps saving you money so you never have to choose between your health and all of the other important things you need to take care of.

Monday, April 13, 2009

Improving Healthcare System Won't Save Money

While healthcare reform is gaining momentum (and rightly so), plenty of experts believe that improving the healthcare system will save money.

Don't believe it.

A recent USA Today piece titled, "Do smokers cost society money" suggests that smoking and dying earlier saves the healthcare system and other benefit programs. It may be that healthier individuals living longer, and consequently having the opportunity to have more chronic illnesses like diabetes and cancer, cost more.

From the article -
  • Smoking takes years off your life and adds dollars to the cost of health care. Yet nonsmokers cost society money, too — by living longer.
  • smokers die some 10 years earlier than nonsmokers, according to the CDC, and those premature deaths provide a savings to Medicare, Social Security, private pensions and other programs.
  • A Dutch study published last year in the Public Library of Science Medicine journal said that health care costs for smokers were about $326,000 from age 20 on, compared to about $417,000 for thin and healthy people. The reason: The thin, healthy people lived much longer.
This is something I've always thought was a possibility. It makes some intuitive sense. Back in the 1950s, if a man died of a heart attack that would be the only cost to the healthcare system. Now as people live longer as we know better on what we must do to stay healthy and well, then they have more opportunities to not only become ill, but also injured, as well as need surgery for joint replacements, etc.

The additional wrinkle is that even the smoker now is likely to survive what was a fatal heart attack a generation ago, presumably quit smoking and also develop illnesses that can't be current, but controlled with a dizzying array of medications.

Why is this important? Healthcare reformers keep talking about cost savings to the system which isn't likely. Instead of claiming huge savings, we should be talking on how better to shift costs from expensive medical expenses like emergency room care and hospitalization for an uninsured patient with a heart attack to providing affordable health insurnace to the person to completely avoid the heart attack.

The healthcare system will still cost employers and the government a lot of money. We as a nation shouldn't expect savings from requiring doctors and hospitals to have electronic medical records (which is the right thing to do) or other touted improvements despite what the experts tell us. The irony and curse of our healthcare system is if we are as good at preventing premature death, by definition we are extending life and the likelihood of more healthcare costs for individuals saved. Can't argue with more time with family and friends.

So be cynical about stories that fixing the healthcare system will save money. It won't. What is far more important is given the amount of money we spend can we ensure it is wisely spent so all of us have the potential to live productive healthy lives?

Monday, April 6, 2009

Why You Should Support an Individual Mandate for Health Insurance

A recent article from the Associated Press, "Insurers offer to stop charging sick people more" is welcome news for everyone. To accomplish the goal, however, it is important to understand why the insurance industry is asking that everyone be required to purchase health insurance also known as an individual mandate.

Without an individual mandate, people who don't need medical care and view themselves as healthy won't participate. As a result, the costs for those buying health insurance is higher for two reasons. First, those who want health insurance are often those who need medical care. Since their costs are often higher than the insurance premiums they pay, these additional costs must be borne by someone else (that would be those paying for health insurance but not requiring medical services). Second, if those healthy non-participants do require medical care, like emergency room services, because they don't have insurance and usually cannot afford the costs, hospitals and doctors don't just absorb this free care, they also pass it on to those with insurance.

Understandably there will be complaints from many who don't wish to be mandated to purchase health insurance, however, for the insurance mechanism to work properly, like Medicare and Social Security, it requires participation by all to work. As a result, those individuals with pre-existing conditions who are currently offered unaffordable coverage may in the future get their own insurance plan.

Although the theory of insurance makes sense, time will tell whether insurers do what they are supposed to do, make insurance affordable when everyone pays into the system.

The complete article follows:

Insurers offer to stop charging sick people more
By RICARDO ALONSO-ZALDIVAR, Associated Press Writer Ricardo Alonso-zaldivar, Associated Press Writer Tue Mar 24, 7:08 pm ET

WASHINGTON – The health insurance industry offered Tuesday for the first time to curb its controversial practice of charging higher premiums to people with a history of medical problems. The offer from America's Health Insurance Plans and the Blue Cross and Blue Shield Association is a potentially significant shift in the debate over reforming the nation's health care system to rein in costs and cover an estimated 48 million uninsured people. It was contained in a letter to key senators.

In the letter, the two insurance industry groups said their members are willing to "phase out the practice of varying premiums based on health status in the individual market" if all Americans are required to get coverage. Although the letter left open some loopholes, it was still seen as a major development.

"The offer here is to transition away from risk rating, which is one of the things that makes life hell for real people," said health economist Len Nichols of the New America Foundation public policy center. "They have never in their history offered to give up risk rating."

"This letter demonstrates that insurance companies are open to major insurance reform, and are even willing to accept broad consumer protections," said Sen. Jeff Bingaman, D-N.M., a moderate who could help bridge differences on a health care overhaul. "It represents a major shift from where the industry was in the 1990s during the last major health care debate."

Insurers are trying to head off the creation of a government insurance plan that would compete with them, something that liberals and many Democrats are pressing for. To try to win political support, the industry has already made a number of concessions. Last year, for example, insurers offered to end the practice of denying coverage to sick people. They also said they would support a national goal of restraining cost increases.

The latest offer goes beyond that.

Insurance companies now charge very high premiums to people who are trying to purchase coverage as individuals and have a history of medical problems, such as diabetes or skin cancer. Even if such a person is offered coverage, that individual is often unable to afford the high premiums. About 7 percent of Americans buy their coverage as individuals, while more than 60 percent have job-based insurance.

"When you have everyone in the system, and you can bring (financial) assistance to working families, then you can move away from health status rating," said Karen Ignagni, president of America's Health Insurance Plans, the leading trade group.

The companies left themselves several outs, however. The letter said they would still charge different premiums based on such factors as age, place of residence, family size and benefits package.

"If the goal is to make health care affordable, this concession does not go far enough," said Richard Kirsch, campaign manager for Health Care for America Now. "It still allows insurers to charge much more if you are old." His group, backed by unions and liberals, is trying to build support for sweeping health care changes.

Importantly, insurers did not extend to small businesses their offer to stop charging the sick higher premiums. Small employers who offer coverage can see their premiums zoom up from one year to the next, even if just one worker or family member gets seriously ill.

Ignagni said the industry is working on separate proposals for that problem.

"We are in the process of talking with small-business folks across the country," she said. "We are well on the way to proposing a series of strategies that could be implemented for them."


On the Net:

America's Health Insurance Plans:

Blue Cross and Blue Shield Association:


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