Drug Prices Are Spiking

Drug costs are rising, but in the opaque world of health care pricing, figuring out what's driving the increase has become difficult—if not impossible.

Nonetheless, pharmacists want Congress to try. Vexed by triple- or quadruple-digit percent increases in drug costs, the National Community Pharmacists Association is asking lawmakers to hold a hearing to find out why.

The problem, the group says, is that pharmacists are getting gouged. Pharmacists trying to get their hands on generic drugs such as Pravastatin, a drug for patients with high cholesterol, or the antibiotic Doxycycline faced price spikes upwards of 1,000 percent in 2013, according to a survey by the group.

Some 77 percent of pharmacists surveyed by the association said in the last six months of 2013 they experienced 26 or more instances of a large upswing in the acquisition price of a generic drug.

 

An additional 84 percent said the price fluctuations impeded their ability to provide care and remain in business, as some community pharmacies could not fill prescriptions that would result in losses and some patients declined medication that would have emptied their wallets.

The findings are consistent with reports nationwide that generic-drug prices are experiencing bank-breaking price increases. Health care and pharmaceutical consulting firm Pembroke Consulting, for instance, found that within the last year, more than a dozen drugs hit prices 10 times their standard rate. NCPA wants Congress to hold a hearing to find out what's driving the price points and whether anything can be done by the feds to stop the trend.

But one primary-care doctor, David Belk, says he's suspicious that the fault lies with drug companies. The San Francisco-based blogger has observed price jumps in single doses of medication, where one size dosage of a drug was very expensive and the other dosages of that same drug were at a more reasonable cost.

Belk took a clip of the Costco website after he saw the generic drug Irbesartan, a medication for high blood pressure, hit nearly $300 for a 90-day supply of the 150 mg tablet. Yet for the 90-day supply of the 300 mg tablet, consumers paid only $30.

"If you ask the pharmaceutical company, they'll say 'Oh, we had a shortage,' " Belk said, "which makes no sense because they were making other milligrams. By the time the pharmacy has figured out the price spiked, it's dropped back down again."

That trend, Belk said, leaves pharmacies hanging out to dry with the extra cost.

"Most doctors are prescribing on the basis of the last drug rep they went to lunch with," he said. "I think you would fix a lot of it if everyone had to advertise their price."

While Belk proposes to turn patients into educated consumers by creating transparency about prescription drug costs at the doctor's office, the problem remains that pharmacists can't place their finger on why generic drugs seem to cost more than they used to--or at least, experience extreme price variations throughout the year.

To continue reading this article visit http://www.nationaljournal.com/health-care/drug-costs-are-spiking-and-it-s-not-clear-why-20140131

Benefits of a Single-Payer Healthcare System

Oncologists have a "moral and ethical obligation" to their patients to advocate for a single-payer universal health insurance program, according to two oncologists who stated their case in an editorial.

A single-payer system would simplify healthcare delivery for patients and providers without sacrificing quality of care, said Ray Derasga, MD, and Lawrence Einhorn, MD, in an editorial published online in the Journal of Oncology Practice, a journal of the American Society of Clinical Oncology.

The switch to such a national system would face huge and innumerable challenges, but gradual implementation, perhaps even on a state-by-state basis, would reduce the administrative burdens, they wrote.

"Because the [Affordable Care Act or ACA] will fail to remedy the problems of the uninsured, the underinsured, rising costs, and growing corporate control over care giving, we cannot in good conscience stand by and remain silent," said Derasga, a retired oncologist in Chicago, and Einhorn, of Indiana University in Indianapolis.

"Life is short, especially for some patients with cancer; they need help now."

Making Their Case

Derasga and Einhorn state their case for a single-payer system by delineating problems that such a system could address:

• Reduced administrative costs, which currently account for almost a third of healthcare expenditures
• Eliminating many bankruptcies attributable to healthcare costs, which accounted for more than 60% of family bankruptcies identified in a 2009 report
• Improved health, as indicated by evidence that being uninsured increases the mortality hazard by 40%
• Building on an existing structure, noting that about 60% of all healthcare in the U.S. is publicly funded
• Implementation of proven cost-containment strategies, which are absent from the ACA
• Improving quality of care and outcomes by increasing access to care
• Reverse the trend toward for-profit, investor-owned healthcare plans
• Preserve physician's income potential, as judged by experience with the Canadian healthcare system

The authors devoted special attention to the cost of drugs and devices. They cited a study showing that pharmaceutical companies charge 50% more in the U.S. than in Europe for the same drugs. Much of the difference can be traced to large outlays for marketing and for a 20% profit margin, they said. By comparison, research and development (R&D) accounts for about 13% of drug costs.

The Department of Veterans Affairs gets a 40% discount on medication by buying in bulk. Medicare is legally forbidden to negotiate drug prices.

"Lower drug prices would not jeopardize drug innovation," Derasga and Einhorn stated. "Most true innovations in therapeutics (as opposed to me-too drugs that are slightly different versions of existing drugs) stem from publicly financed research."

The issue of drug pricing is especially relevant to oncology, they added, where the median cost of a new drug has risen to $10,000 a month since 2010.

The authors called on ASCO to lead the way in advocating for a single-payer system, which would orient healthcare "toward care giving, not toward maximizing investors' profits."

ASCO has taken no position on a single-payer or other type of healthcare system, said ASCO chief executive officer Allen Lichter, MD.

"We have long advocated that every American deserves to have insurance coverage," Lichter told MedPage Today. "We have advocated that those patients who receive a new cancer diagnosis and don't have insurance should be placed into Medicare because facing a cancer diagnosis without insurance lowers your risk of survival, as Dr. Derasga and Dr. Einhorn pointed out in their paper."

To continue reading this pro

Antibiotic Resistance Caused by Our Dinner

WASHINGTON — The Food and Drug Administration on Wednesday put in place a major new policy to phase out the indiscriminate use of antibiotics in cows, pigs and chickens raised for meat, a practice that experts say has endangered human health by fueling the growing epidemic of antibiotic resistance.

Enlarge This Image

Brian C. Frank for The New York Times

Pigs on a farm near Ralston, Iowa, where animals received antibiotics in their feed. Dark spots on their backs mean they are ready for market.

This is the agency’s first serious attempt in decades to curb what experts have long regarded as the systematic overuse of antibiotics in healthy farm animals, with the drugs typically added directly into their feed and water. The waning effectiveness of antibiotics — wonder drugs of the 20th century — has become a looming threat to public health. At least two million Americans fall sick every year and about 23,000 die from antibiotic-resistant infections.

“This is the first significant step in dealing with this important public health concern in 20 years,” said David Kessler, a former F.D.A. commissioner who has been critical of the agency’s track record on antibiotics. “No one should underestimate how big a lift this has been in changing widespread and long entrenched industry practices.”

The change, which is to take effect over the next three years, will effectively make it illegal for farmers and ranchers to use antibiotics to make animals grow bigger. The producers had found that feeding low doses of antibiotics to animals throughout their lives led them to grow plumper and larger. Scientists still debate why. Food producers will also have to get a prescription from a veterinarian to use the drugs to prevent disease in their animals.

Federal officials said the new policy would improve health in the United States by tightening the use of classes of antibiotics that save human lives, including penicillin, azithromycin and tetracycline. Food producers said they would abide by the new rules, but some public health advocates voiced concerns that loopholes could render the new policy toothless.

Health officials have warned since the 1970s that overuse of antibiotics in animals was leading to the development of infections resistant to treatment in humans. For years, modest efforts by federal officials to reduce the use of antibiotics in animals were thwarted by the powerful food industry and its substantial lobbying power in Congress. Pressure for federal action has mounted as the effectiveness of drugs important for human health has declined, and deaths from bugs resistant to antibiotics have soared.

Under the new policy, the agency is asking drug makers to change the labels that detail how a drug can be used so they would bar farmers from using the medicines to promote growth.

To continue reading this article visit http://www.nytimes.com/2013/12/12/health/fda-to-phase-out-use-of-some-antibiotics-in-animals-raised-for-meat.html?pagewanted=all

Funny Picture To Get Me Through the Cold Weather in Ohio

Watch out for black ice! 

Could Drug Shortages Really Affect You?

In a new survey that interviewed pharmacy directors, the responses revealed that drug shortages could potentially be a huge problem for patients. According to the directors, when drug shortages occurred at their respective facilities, patient safety and care were negatively affected. Based on the findings, the researchers believe that more might need to be done to prevent drug shortages.

"This survey is the first that we are aware of to describe the effects that drug shortages have on patient complaints," said Despina Kotis, PharmD, director of pharmacy at Northwestern Memorial HealthCare and co-author of the article. "It clearly shows that patients are aware these shortages are happening and they are upset that their care is being adversely affected by them."

For this research article, the team from Northwestern Medicine and MedAssets set out to examine the relationship between drug shortages and patient outcomes. The team distributed the survey to pharmacy directors that worked at many different health care settings. The survey collected data on patient complaints related to drug shortages, any adverse outcomes, medication errors, patient outcomes, demographics and institutional costs.

The team found that nearly half of the responses they received revealed that adverse events occurred when there were drug shortages. In some of the situations, patients ended up dying due to the lack of medications. The researchers were able to tie medication errors, increased institutional costs, cancelled care and delayed treatment to poor patient outcomes.

The researchers also calculated that almost 10 percent of the adverse events was related to patients who needed to be readmitted due to drug shortages. 38 percent of the responses revealed that they received at least one complaint about drug shortages at their facilities and roughly 20 percent of that rate had received more than 10 complaints.

To continue reading this article visit http://www.counselheal.com/articles/8220/20140109/11-30am-drug-shortages-will-affect-patient-care.htm

Flu Season Epidemic

It's January and we are in the peak of the flu season. The video below discusses some symptoms, treatment and ways to prevent the flu. 

Anti Vaccine Movement

Measles outbreaks (purple) worldwide and whooping cough (green) in the U.S., thanks in part to the anti-vaccination movement. (Council on Foreign Relations)

Aaron Carroll today offers a graphic depiction of the toll of the anti-vaccination movement. (H/t: Kevin Drum.) It comes from a Council on Foreign Relations interactive map of "vaccine-preventable outbreaks" worldwide 2008-2014.

A couple of manifestations stand out. One is the prevalence of measles in Europe -- especially Britain -- and the U.S. Measles is endemic in the underdeveloped world because of the unavailability of the MMR (measles, mumps and rubella) vaccine.

But in the developed world it's an artifact of the anti-vaccination movement, which has associated the vaccine with autism. That connection, promoted by the discredited British physician Andrew Wakefield and the starlet Jenny McCarthy, has been thoroughly debunked. But its effects live on, as the map shows.

Vaccine panic also plays a role in the shocking incidence in the U.S. of whooping cough, also beatable by a common vaccine. Researchers have pointed to the effect of "non-medical exemptions" from legally required whooping cough immunizations -- those premised on personal beliefs rather than medical reasons -- as a factor in a 2010 outbreak of whooping coughin California.

Full coverage: Obamacare rolls out

These manifestations underscore the folly and irresponsibility of giving credence to anti-vaccination  fanatics, as Katie Couric did on her network daytime TV show in December. We examined the ethics of that ratings stunt here and here.

Among other worthwhile examinations of the impact of the anti-vaxxers, see this piece about growing up unvaccinated in Great Britain in the 1970s, and this disturbing piece by Julia Ioffe about her battle with whooping cough, a disease no American should have.

The lesson of all this is that vaccination is not an individual choice to be made by a parent for his or her own offspring. It's a public health issue, because the diseases contracted by unvaccinated children are a threat to the community. That's what public health is all about, and an overly tolerant approach to non-medical exemptions -- and publicity given to anti-vaccination charlatans like Wakefield and McCarthy by heedless promoters like, sadly, Katie Couric, affect us all.

http://www.latimes.com/business/hiltzik/la-fi-mh-antivaccination-movement-20140120,0,5576371.story#ixzz2rF6h0k9Q

Flu Season Predictions

Jeffrey Shaman, an environmental health scientist at Columbia University, hopes that he and his colleagues will someday change the nightly news. “The way you get pollution reports and pollen counts on the local weather report, you could also have a flu forecast on there,” said Dr. Shaman.

Each year, the flu season arrives like clockwork. But once it strikes, it can unfold in surprising ways. In 2012, for example, it arrived in November, four weeks ahead of the typical flu season. Some years it can be especially brutal, and in others, very mild. Infection rates may start climbing in some parts of the United States when they are already falling in others.

Scientists like Dr. Shaman are reducing this uncertainty with computer models that make predictions about flu seasons in the United States. Last year, Dr. Shaman and his colleagues carried out their first flu forecasts in real time. They are now making predictions about the current outbreak, and this week they set up a website where you can see their predictions for yourself.

Their interest is greater than curiosity. Hospitals and public health workers could someday use flu forecasts to prepare their vaccine supplies and hospital beds. The advanced warning would be useful not only for the regular seasonal flu, but also for so-called pandemics, when a new strain sweeps across the country and causes higher rates of disease and death.

“In the event of a pandemic, this could become a more important issue,” said Matthew S. Biggerstaff, an epidemiologist at the Centers for Disease Control and Prevention in Atlanta. “We could understand how much lead time we had before a pandemic might peak, and it could help us get resources to the places that are going to need them.”

The spread of the flu is difficult to predict because it depends on many interconnected factors — how fast the virus replicates in people, for example, how well their immune systems wipe it out, and how easily the virus travels from one person to another. Despite decades of research on the flu, scientists are still deciphering some of the most important factors. Dr. Shaman and his colleagues, for example, have found that the drier the air is, the easier it is for viruses to spread from person to person.

Scientists are now using that understanding to make forecasts. To build computer models for predicting the flu, Dr. Shaman and his colleagues have gotten inspiration from meteorologists, whose embrace of mathematical tools has greatly improved their forecasting ability. “They really have the same problems for predicting the weather that we have for predicting influenza,” Dr. Shaman said.

To continue reading this article visit http://www.nytimes.com/2014/01/16/science/this-weeks-forecast-what-flu-season-may-look-like.html?_r=0

Should I be Taking Vitamins?

Multivitamins and other supplements are not all-purpose elixirs of health: Most studies suggest they don't play a big role in preventing chronic illnesses or extending lives. One recent medical journal editorial called them a flat out waste of money for most consumers. But even the doctors who wrote that editorial, in the Annals of Internal Medicine, said there are exceptions.

What might those be? Experts differ. Below is a rundown on some of the vitamins and minerals that mainstream physicians and dietitians commonly recommend for specific groups.

Here's an important rule of thumb: Treat any supplement like a drug, which has possible benefits but also possible risks, especially if you take too much. Check with your doctor before using it, and always let health professionals know what you are taking.

Folic acid for women of childbearing age

Public health agencies, including the Centers for Disease Control and Prevention, recommend that all women capable of becoming pregnant get 400 micrograms a day of folic acid, from either supplements or fortified foods, such as breads, cereals and pastas. "The reason is that at least half the pregnancies in the United States are unplanned," and folic acid prevents some serious birth defects, including spina bifida, says Edward McCabe, medical director of the March of Dimes. A supplement is a sure way to get it, he says, but "some women feel strongly they can get it from food, and if they really monitor it, that's fine." Some breakfast cereals have the full recommended amount in each serving.

Prenatal vitamins for pregnant women

These contain at least 600 micrograms of folic acid, plus higher levels of iron than typically found in multivitamins, McCabe says. But, he says, the vitamins are not a substitute for good nutrition: "It's extremely important for pregnant women to eat a well-balanced diet."

B-12 supplements for vegans and other groups

Vitamin B-12, which is essential to nerves and blood cells, is found almost exclusively in animal foods – meat, seafood, eggs and milk. So vegans get virtually none in their diets, and some vegetarians may run short, too, if they don't take a supplement or eat fortified foods (including many breakfast cereals, soy milks and nutritional yeast). "Vegans must find a source of vitamin B-12 to be healthy," says Marion Nestle, a professor of nutrition at New York University. Though there's some B-12 in certain seaweeds, they are not a reliable source, according to the Vegan Society and the Vegetarian Resource Group, two educational groups. B-12 supplements also are commonly recommended for people who have gastrointestinal disorders or have undergone weight-loss surgery. That's because their digestive tracts may not adequately absorb the nutrient.

To continue reading this article visit http://www.usatoday.com/story/news/nation/2014/01/18/vitamin-supplement-recommendations/4310573/

Teen Drug Abuse More of a Problem Than Ever

When most people think of addiction, they visualize a derelict on a street corner or in a back alley, homeless and wasting away from a nasty and illegal drug habit. In truth, an addict could be the teen next door, a co-worker, the man or woman in the pew next to you at church, an athlete recovering from an injury, or even your doctor. Prescription drug abuse is epidemic, killing thousands of Americans every year

An estimated 4 million Americans over the age of 12 use prescription pain relievers, sedatives and stimulants for "nonmedical" reasons every month. Living in a society increasingly striving for "political correctness," we now call prescription drug addiction a "dependence."

In reality, this "dependence" is simply part of different phases and definitions of drug abuse." For example, drug abuse is merely the inappropriate use of a controlled substance. Chronic drug abuse is a sustained use over a long period, when the user can't "live without" the medication. Binge usage is an occasional or recreational use of a drug. Dependency is a physiological phenomenon, and we're all susceptible. When the body becomes accustomed to the presence of a substance, the body itself can become addicted. Finally, addiction is a mental dependency (with or without physiological dependence). Usually there's an underlying mental health issue.

Whatever we call it, prescription drug abuse is on the rise, and it kills. Opioid use alone has gone up from 76 million prescriptions in 1991 to 219 million in 2011. Opioid deaths have increased more than 400 percent from 1999 to 2010. Oddly enough, traffic-related deaths have been decreasing since 1980.

Instead of changing how we label addiction, a better approach might be to take a close look at who is addicted - or dependent - on prescription drugs. Prescription drug abuse isn't particular about its victims.

NOTHING NEW

Prescription drug abuse isn't new; it's just getting worse. The Rolling Stones made reference to prescription drug abuse in the song "Mother's Little Helper," recorded nearly 50 years ago. The opening verse laments:


To continue reading this article visit http://www.chicagotribune.com/health/sns-201401140000--tms--premhnstr--k-g20140115-20140115,0,5997658.story

New Dosing of Acetaminophen (APAP or Tylenol) in Prescription Medications

FDA recommends health care professionals discontinue prescribing and dispensing prescription combination drug products with more than 325 mg of acetaminophen to protect consumers

[1/14/2014] FDA is recommending health care professionals discontinue prescribing and dispensing prescription combination drug products that contain more than 325 milligrams (mg) of acetaminophen per tablet, capsule, or other dosage unit. There are no available data to show that taking more than 325 mg of acetaminophen per dosage unit provides additional benefit that outweighs the added risks for liver injury. Further, limiting the amount of acetaminophen per dosage unit will reduce the risk of severe liver injury from inadvertent acetaminophen overdose, which can lead to liver failure, liver transplant, and death.

We recommend that health care providers consider prescribing combination drug products that contain 325 mg or less of acetaminophen. We also recommend that when a pharmacist receives a prescription for a combination product with more than 325 mg of acetaminophen per dosage unit that they contact the prescriber to discuss a product with a lower dose of acetaminophen. A two tablet or two capsule dose may still be prescribed, if appropriate. In that case, the total dose of acetaminophen would be 650 mg (the amount in two 325 mg dosage units). When making individual dosing determinations, health care providers should always consider the amounts of both the acetaminophen and the opioid components in the prescription combination drug product.

In January 2011 we asked manufacturers of prescription combination drug products containing acetaminophen to limit the amount of acetaminophen to no more than 325 mg in each tablet or capsule by January 14, 2014. We requested this action to protect consumers from the risk of severe liver damage which can result from taking too much acetaminophen. This category of prescription drugs combines acetaminophen with another ingredient intended to treat pain (most often an opioid), and these products are commonly prescribed to consumers for pain, such as pain from acute injuries, post-operative pain, or pain following dental procedures.

More than half of manufacturers have voluntarily complied with our request. However, some prescription combination drug products containing more than 325 mg of acetaminophen per dosage unit remain available.

In the near future we intend to institute proceedings to withdraw approval of prescription combination drug products containing more than 325 mg of acetaminophen per dosage unit that remain on the market.

Cases of severe liver injury with acetaminophen have occurred in patients who:

• took more than the prescribed dose of an acetaminophen-containing product in a 24-hour period;
• took more than one acetaminophen-containing product at the same time; or
• drank alcohol while taking acetaminophen products.

Inadvertent overdose from prescription combination drugs containing acetaminophen accounts for nearly half of all cases of acetaminophen-related liver failure in the United States, some of which result in liver transplant or death.

Acetaminophen is also widely used as an over-the-counter (OTC) pain and fever medication, and is often combined with other ingredients, such as cough and cold ingredients. We will address OTC acetaminophen products in another regulatory action. Many consumers are often unaware that many products (both prescription and OTC) contain acetaminophen, making it easy to accidentally take too much.

http://www.fda.gov/Drugs/DrugSafety/ucm381644.htm

Bed Bugs--What Do I Do If I Get Them?

Scabies, more commonly known as bed bugs, can be a nasty problem that many people across the world face. In third world countries it is a life long struggle, that is often lost, to rid oneself of scabies. I have spent time in Honduras treating patients and bedbugs was one of the most common conditions seen. Life long scars are often present and bedbug are not picky--they infest infants to the elderly

Here in developed nations, we are not immune to scabies. Infestations break out quickly, and often spread even quicker. Scabies is often confused with lice, but unlike lice, these critters burrow under your skin and form tunnels. The symptoms associated with scabies are due to an allergic reaction to the bugs.

Common symptoms of bed bugs are:

• Severe itching and rash 
• Burrow tracks often in straight lines 

Most Affected Areas:

• Hands
• Feet
• Wrists
• Elbows
• Buttocks
• Groin
• Face (if severe enough) 

Treatment:

• There is no over the counter treatment for scabies! You must go to the doctor
• Permethrin: This is a cream that is prescribed by your doctor that you apply all over your body before bed and wash off in the morning for 7-14 days
• Ivermectin: This is a pill prescribed your doctor that if taken once can kill the bugs on and in your body
• IT IS VERY IMPORTANT THAT EVERYONE IN YOUR HOME BE TREATED EVEN IF THEY DO NOT HAVE SYMPTOMS

Prevention of Re-occurrence:

• Anything that fits in a washer should be washing in HOT water (blankets, sheets, clothing, etc.)
• Anything that cannot be washed should be sealed in garbage bags and placed in a secluded area such as a garage or basement for TWO WEEKS 

Over The Counter Medication Use In Mothers is Mirrored in Children

A variety of over-the-counter medications are available for pain, including the popular use of acetaminophen (Tylenol). But overuse of these products can be harmful.

Therefore, it is important that parents teach their children when it is and is not appropriate to use these medications.

A recent study found that mothers' use of medications appears to be related to their children's use of these products. The more often mothers use over-the-counter pain medications, the more often their children appear to use them as well — regardless of their pain levels.

The study, led by Janne Fangel Jensen, MD, of the Department of Public Health at the University of Copehagen in Denmark, looked at whether children's use of over-the-counter pain medications was related to their mothers' use of similar products.

The researchers conducted surveys involving 131 children, aged 6 to 11, and their mothers.

The families came from two different parts of Denmark — one rural and one urban.

The researchers interviewed the children in person and gave questionnaires to the mothers to learn about the participants' health, pain experiences and use of medication.

In analyzing their results, the researchers took into account differences between the participants' socioeconomic conditions and health.

The researchers found that mothers who frequently used over-the-counter pain medications (at least once a month), especially acetaminophen, were more likely to have children who frequently used these medications.

To continue reading this article visit http://www.dailyrx.com/children-use-over-counter-pain-meds-more-often-if-their-mothers-do

Weight Loss Product Dangers

With the New Year, many of us have made New Years resolutions. The most common resolution is to lose weight or get in shape. While the healthiest way to do this is through a healthy diet and increased exercise, many Americans do not want to put the time and effort into that or they simply do not have the time. They often turn to quick fixes such as weight loss pills, wraps and injections. While they often claim to help you lose weight quickly, they can be very dangerous. The only FDA approved over the counter weight loss supplement is Alli, which has many unpleasant side effects. These other supplements often have more dangerous effects, and the results you see are temporary. Watch the video below from YouTube to learn more about the dangers of weight loss supplements. 

Healthcare Spending on the Decline

America continued to curb its spending on health care for the fourth year in a row.

Spending on health care grew by only 3.7% in 2012, continuing a streak of the slowest growth rates on record, according to data released Monday by the Centers for Medicare and Medicaid Services.

The report looked at all spending on health care services, including doctors, drugs, hospitals and nursing homes, and research nationwide. It also breaks down who is doing the spending: consumers, Medicaid, Medicare and insurers.

Spending remained restrained due to the weak economy. People continued to pull back on medical care amid a continued weak job market and providers sought to keep prices in check. The Affordable Care Act had minimal impact, as many of the health reform's major provisions had yet to kick in.

The White House quickly jumped on the report saying that health reform has helped stop the trend of skyrocketing health care costs by stressing efficiency improvements. It specifically cited the act's contribution to lowering Medicare spending by penalizing hospitals with high readmission rates as an example.

Experts agreed, saying that providers began making changes in anticipation of required reforms.

"Every hospital executive has started the process of holding costs down," said Larry Levitt, senior vice president at the Kaiser Family Foundation.

What's clear is that the slowdown in spending growth has benefited patients in recent years, sparing them from major increases in medical and premium costs. But looking at some of the underlying trends shows that growth varied widely depending on the service and payer.

To continue reading this article and to see what we spent more on in 2012 visit 

http://money.cnn.com/2014/01/06/news/economy/health-care-spending/

Hypothermia in the Elderly

All across America, the coldest temperatures seen in decades are knocking at our doors. Being from Ohio, I am use to snow and cold--but nothing like the -15 degrees I woke up to. We are currently at a Level 3 snow emergency, meaning only emergency vehicles and necessary workers are permitted on the roads. With weather such as this, frostbite and hypothermia are serious potential health problems that all of us can face, but the young and elderly are especially at risk.

Below is an article published by the National Institute of Health regarding hypothermia in Older Adults:

 

 

Hypothermia and older adults

Frigid weather can pose special risks to older adults. The National Institute on Aging (NIA), part of the National Institutes of Health, has some advice for helping older people avoid hypothermia — when the body gets too cold — during cold weather.

Hypothermia is generally defined as having a core body temperature of 95 degrees Fahrenheit or lower and can occur when the outside environment gets too cold or the body's heat production decreases. Older adults are especially vulnerable to hypothermia because their bodies’ response to cold can be diminished by underlying medical conditions such as diabetes and by use of some medicines, including over-the-counter cold remedies. Hypothermia can develop in older adults after relatively short exposure to cold weather or even a small drop in temperature.

Someone may suffer from hypothermia if he or she has been exposed to cool temperatures and shows one or more of the following signs: slowed or slurred speech; sleepiness or confusion; shivering or stiffness in the arms and legs; poor control over body movements; slow reactions, or a weak pulse.

Here are a few tips to help older people avoid hypothermia

• Make sure your home is warm enough. Set the thermostat to at least 68 to 70 degrees. Even mildly cool homes with temperatures from 60 to 65 degrees can lead to hypothermia in older people.
• To stay warm at home, wear long underwear under your clothes, along with socks and slippers. Use a blanket or afghan to keep your legs and shoulders warm and wear a hat or cap indoors.
• When going outside in the cold, it is important to wear a hat, scarf, and gloves or mittens to prevent loss of body heat through your head and hands. A hat is particularly important because a large portion of body heat can be lost through the head. Wear several layers of warm loose clothing to help trap warm air between the layers.
• Check with your doctor to see if any prescription or over-the-counter medications you are taking may increase your risk for hypothermia.

To continue reading this article visit http://www.nih.gov/news/health/jan2014/nia-06.htm

Are Vitamins a Waste of Money?

On Dec. 17, there was widespread coverage in the news media of an editorial that appeared in the Annals of Internal Medicine (Annals), under the title, "Enough is enough: stop wasting money on vitamin and mineral supplements."(1) The authors of the editorial concluded, "We believe that the case is closed -- supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful. These vitamins should not be used for chronic disease prevention. Enough is enough." However, the editorial appears to be biased and to lack scholarship, as it is based on selective reporting and a superficial analysis of the vast and complex body research on the health effects of nutritional supplements.

The editorial focused mainly on three studies published in that issue of the Annals. The first study found that supplementing with large doses of vitamins and minerals after a heart attack reduced the recurrence rate of cardiovascular events (such as heart attack, stroke, or heart surgery) by 11 percent, compared with a placebo. (2) However, because this reduction was not statistically significant, the editorial concluded (incorrectly) that the treatment was ineffective. The failure to demonstrate that an effect is statistically significant is not the same as demonstrating the absence of an effect. The correct conclusion is that the nutritional supplement reduced the number of cardiovascular events by 11 percent, but because this reduction was not statistically significant, we are less than 95 percent certain that the effect was real (as opposed to being due to chance).

The second study in the Annals found that daily use of a low-potency multivitamin (Centrum Silver) for an average of 8.5 years had no effect on cognitive function in elderly men participating in the large Physicians' Health Study II. (3) However, two other recent double-blind trials (which were not mentioned in the editorial) found positive effects of vitamins. In one of those studies, daily supplementation with 400 mcg of folic acid and 100 mcg of vitamin B12 significantly improved cognitive function in elderly men. (4) The other study showed that daily supplementation with 800 mcg of folic acid, 500 mcg of vitamin B12, and 20 mg of vitamin B6 slowed the rate of brain atrophy in elderly individuals suffering from mild cognitive impairment. (5) There are two potentially important differences between these positive studies and the negative study cited in the editorial. One difference is that the amount of vitamin B12 in Centrum Silver (25 mcg) is much lower than the amount used in the positive studies (100 and 500 mcg, respectively). Loss of cognitive function is a well-known effect of vitamin B12 deficiency. Although all of the study supplements provided more than the Recommended Dietary Allowance for vitamin B12 (2.4 mcg per day), recent research has shown that many elderly people need unusually large amounts of this vitamin (500 mcg per day or more in some cases) to achieve optimal vitamin B12 nutritional status. (6) The other difference is that several aluminum-containing artificial coloring agents are present in Centrum Silver (FD&C Blue 2 Aluminum Lake, FD&C Red 40 Aluminum Lake, and FD&C Yellow 6 Aluminum Lake), and these chemicals have the potential to adversely affect cognitive function. Artificial coloring agents are known to have negative effects on the behavior of children, (7) although these chemicals have not been well studied in adults. Moreover, there is evidence that long-term aluminum exposure can contribute to the development of Alzheimer's disease.(8) The ineffectiveness of a low-potency supplement that contains extraneous and potentially harmful additives does not negate the beneficial effects of higher-potency supplements reported in other trials.

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Rx Drug Abuse From Your Medicine Cabinet

Check out this clip from ABC world news. I have posted before about the dangers of prescription drug abuse and misuse. Prescription drugs are now killing more people than car accidents. This video mentions how this is a rising problem with our problem and how to properly dispose of expired or unused medications.

How Can You Save on Prescription Drugs? Ten Easy Ways

 

   

The world of prescription drugs is known for its cast of prancing seniors in scenic locales on commercials that air during the evening news. However, because drug prices are not fixed or regulated in the U.S., the reality is less road trip and more highway robbery. How can you find cheaper prescriptions? Here's a roadmap for medication discounts.

Use coupons
 Major discount stores and pharmacies spend a bundle on direct mail, fliers and coupons. They can be well worth your time to thumb through for prescription savings, but the Internet makes the search even easier. Websites and smartphone apps like goodrx.com compare drug prices at pharmacies near you. Other apps offering similar price comparison tools or discounts include: lowestmed.com, Prescription Saver (app available on iTunes) and OTC plus (also on iTunes). Also ask your pharmacist about pharmacy discount cards that can save you another 10 to 25 percent.

Try before you buy
 Asking your physician for a free sample of a new drug is a good way to save money, at least in the short term. Using a 10- or 14-day trial will help you decide if the prescription is right for you, and in the meantime you can shop for a discount on a longer-term supply. Drug manufacturers often offer 30-day free trials of medications through magazine coupons and online discounts.

Opt for generics
Nearly 80 percent of prescriptions filled in America are for generic drugs, according to the U.S. Food and Drug Administration. Choosing generic drugs can be another way to cut the cost of medications. Generics are the bio-equivalent of brand-name drugs, but cost 80 to 85 percent less – saving consumers about $3 billion every week in 2010, the FDA reports.
Even bigger savings may be ahead, as the 17-year patent on a number of popular drugs will expire in the next few years, including Nexium, Celebrex and others. Therefore, even if you haven't been able to find a generic alternative for your prescription in the past, there's a good chance you will soon.

Check out government programs
Many states offer drug assistance programs that help eligible seniors close the prescription coverage gaps of Medicare Part D as well as find treatments for patients of all ages. You can find a program near you at medicare.gov.

Consider Over the Counter Drugs
Your doctor might also recommend an over-the-counter alternative to a regular prescription. Just make sure to ask before he or she hands you the prescription.

Ask your doctor about pill splitting
 Ask your physician if your prescription is appropriate for pill splitting. Buying a higher dosage pill that can be spliced in half can save a substantial amount of money. Of course, some pills aren't suitable for splitting such as time-release or coated capsules. Splitting pills can be difficult, but many pharmacies sell handy devices that can cut pills of any shape in half.

Order by mail
 Purchasing longer-term supplies by mail can lower your costs, too. We're not talking about buying from shady fraudsters on the Internet, but drug fulfillment services that are accredited by the National Association of Boards of Pharmacy. These "Verified Internet Pharmacy Practice Sites" comply with licensing and inspection laws as well as patient privacy and quality assurance standards. Look for the VIPPS seal when shopping online.

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