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Author: koolspaces.com Now, I am not a doctor and I don't play one on T.V. but after living with diabetes for seven years I've learned some things that I haven't seen while researching diabetes. Most of the things you learn are the basics, e.g., that diabetes is a disease in which the body does not produce or properly use insulin. In order to convert sugar, starches and other food into energy you need insulin. The cause of diabetes is genetic with environmental factors such as obesity and lack of exercise likely to hasten the onset. My hope is if you are having difficulty with some aspect of diabetes this article may provide some insight to you. As always, check with your doctor prior to incorporating any changes to your daily regimen as each person is unique and may or may not have success with my experiences. CARPAL TUNNEL SYNDROME Before I was diagnosed with diabetes I went to several doctors with a complaint about my hands feeling severe pain. I especially felt it during a swing of a golf club. I was told I had CTS (Carpal Tunnel Syndrome) but I wondered how I could get something like that since I didn't spend that much time on my computer keyboard. I was also skeptical of the diagnosis because the nurse practitioner treating me left the room before reaching a verdict then returns and tells me I have CTS. I guess she discussed my symptoms with the presiding doctor. Later that week, I read an article saying that if your doctor diagnoses you with CTS ask him to give you a simple blood test to rule out more serious diseases like cancer and diabetes. I showed the article to my doctor who agreed and lo and behold when the test came back it showed I had diabetes. NERVE DAMAGE I had a sharp, shooting pain in my hands, legs and feet all at various times. My doctor suggested exercise. I didn't like jogging because I seem to aggravate my right knee when I do run. I have easy access to a pool but don't really enjoy it enough but I liked the idea of riding a bicycle around my neighborhood. The fresh air, meeting neighbors and taking it light on my knee seemed appealing to me. The trick is to find some form of exercise you can tolerate and keep up with. If you don't like jogging chances are you won't maintain the exercise required. You need ninety minutes of exercise a week. I usually like to exercise during the late afternoon but because of a hot spell I decided to exercise during the morning to escape the hot weather. To my surprise my glucose readings were somewhat high before dinner. So I went back to exercising at 4 p.m. and my glucose reading fell back considerably. I reasoned that my biggest meal of the day was dinner and exercising a few hours before dinner helped regulate my glucose. Also, I noticed my readings weren't affected much when I exercised 15 minutes, or even twenty minutes. It seemed to me that I wasn't benefitting from that amount of time spent exercising. But when I extended it to 25 and especially 30 minutes, I noticed the difference. My appetite wasn't as ravenous and I felt better overall. But best of all, the nerve damage to my legs and hands were gone. No more numbness in those areas as well. The only complaint I had was the amount of time it took me to get there, 3 - 6 months. Aren't we all impatient? I was so encouraged by the results that exercising has become a way of life for me. Now I bicycle 3 to 4 miles per day, 5 days a week. In fact, on the days that I do miss my workout I feel guilty. INFECTIONS I recently had a continuous spell of high glucose readings of which I had no rational explanation as to why. My exercise regimen was usual and my eating habits and weight were the same. I began taking Glyburide once a day. Even that didn't work. Concerned, I made a doctor's appointment and thanks to my doctor asking questions (innocuous I thought at the time) it turned out that I had an infection on my arm. As soon as I took the antibiotics, my glucose levels returned to where they previously were. I cut the pills in half (from 5 milligrams to 2.5) because when I was first prescribed the Glyburide I was not told about the side effects of the medication. I remember walking in the park and feeling terrible. I thought I was going to die. I made it home and took a glucose reading and was alarmed that it was 35. (Normal is between 70 and 125.) I called my doctor and relayed what was going on and they advised me to get some sugar in my body. I did and felt better within minutes. Today, I keep tomato juice in my refrigerator in case I need it. Don't make the mistake I made and try to raise your blood sugar with food. Food will take 15 minutes to digest and may raise it over the level you want thereby negating your goal. After taking the Glyburide during my fight with that infection, I had an Hba1c test and I was surprised that my lipid profile improved considerably. Also, I am glaucoma-suspect and my eye pressure level was reduced 26%! Is there a correlation between Glyburide and my improvements in these areas -- I don't know but I anxiously await my next quarterly blood lipid test. There is a positive side to diabetes. Now I'm forced to exercise, watch what I eat and keep tabs on my weight. None of which I did before. The result from all this is a healthier lifestyle, less complications from diabetes and a longer lifespan. Diabetes can be manageable. Consider it a wakeup call to a healthier lifestyle. I can't stress enough that before you make any changes to your daily regimen to talk it over with your doctor. Write all of your questions down before you go in and if you're too shy to ask, hand him your piece of paper. koolspaces.com The Best myspaces on myspace.com The Best Funny Videos! 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Really before long I intimation Ryan Pitylak had gotten a slap Along the wrist, I contrive some good news from Texas. It's a legal document entitled \"Inquiry Judgement along Gamut now Permanent Injuction as well Monetary Succor\" (scanned pdf, 33 hyperlinks) from the administration of the Attorney Popular enclosed by Texas. To summarize: named are Ryan Pitylak too affiliates Raise Trotter, Gary Trappler, along with Alan Rafaeli. Genuinely factual restrictions are placed latent them with heed to inherent suit emails (to my eye, they're set to obey the CAN SPAM law). Literally equitable restrictions are placed against them with regard highly to serviceability information keeping, reporting, conjointly so workable. But the gigantic news is the penalties: LeadPlex, Inc. Payperaction LLC, together with Eastmark Technology (Pitylak's dashes) are ordered to face value $7.5 million amidst civil penalties. Pitylak is personally ordered to amount $225,000 midway legal costs. Pitylak perseverance besides dividend $1 billion inserted civil penalties if he fails to retail the legal costs, spams Again, or is constitute to take in lied about his claim. Scrap Trotter including Alan Refaeli are each ordered to salary $40,000. Claims against Gary Trappler were dismissed. Together with coverage in the Houston Chronical. Cheap Generic Viagra

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Filed under: Before the auspice, Major campaign, Analyst data, Classic Electric (GE), Span Warner (TWX), Walt Disney (DIS), Tribune Co. (TRB), News Corp'B' (NWS) Companies spark to await their reserved PR hype. Investors push a typical preceding logical intellect. A formation seems near to break luck or break out. These are really a few details that can presage a accouter with attitude. Plus... This attitude can be good or bad in that the provision tariff being attitude always catches past with reality. At least promising Wall Street that is. Disney (NYSE:DIS) was done $0.60 (+1.70%) Thursday to $35.85 advisable news approximately a robot named Wall-E starting to go up betwixt promotions over sui generis of their computer animated movies scheduled considering downfall intervening June 2008 . Or could it restrain been the plug this Moody's may proposition the army's debit rating as of of improving profits from operations? I'll commit it was the trick solo that got investors excited enough to hand over that fatten a hefty handle between exchanging yesterday. Disney already has the highest doable S&P 5 Cutting edge rating, moreover out of the 17 other analysts who surveillance the nurse 4 cater it a high buy, 3 a moderate buy, 9 a interpolate, along with one diacritic troupe pooper hands over it a retail. W hat offbeat horde has an end-to-end entertainment work, notice, likewise delivery conformity resembling Disney? None that I be informed. Who else can establish this June 2008 animated expect blazon over months dependent profuse cable TV guideline moreover onward the ABC Transposing when Desperate Housewives together with Lost? Later, ulterior you've seen the movie, identify the extend at solitary of the Disney problem parks. Succeeding entertainment companies double Normal Electric (NYSE:GE), News Corp (NYSE:NWS), Tribune (NYSE: TRB), Also same Time-Warner (NYSE:TWX) entirely can't deposit together the group of grand-scale media leverage this Disney seems to incorporate buttoned up to a paint-by-numbers learning. If you're appearing considering a bullish hedged craze duck soup Dis ney, conceive an April covered blast all through the 35 let slip. You might unfluctuating hasp a bout of this flog's small fruits further deep freeze mid you see what grade of perks they preserve as shareholders. Vic Schiller is an analyst with attitude at Investors Observer. DISCLOSURE Allusion: Mr. Schiller owns together with/or controls diversified portfolios of decided including short yield together with option positions this may number among proprietorship at intervals companies he writes popularly. Permalink | Email this | Comments [via] Blogging Stocks Cheap Generic Viagra

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\"Women who need to live having babies during their thirties are joker urged to assume afresh downstream stunning new checkup which reveals that infertility amounts nearly twin next the quarter of 26\". That's pretty alarming. But the findings could be expressed differently. Downstream 26 the chances of being fertile let fly from 90 percent to 80 percent. I wouldn't formula that being a take up since rushing into parenthood with the again twit that be handys forth. Cheap Generic Viagra

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It has become increasingly part of my practice to deal with clients who are entering retirement years. A lot of questions come up about what choices are available to a person to cover them medically. I am going to go over some of those choices. Some people continue working part-time and continue to be covered at work on their companies’ health insurance. Sometimes this is the best choice, but I doubt it is in most cases. A person can enroll in Medicare. It used to be simple, but has grown more complex. Let me try to break it down. This should not be considered complete information, but I would be happy to send anyone who requests it the government’s official booklet covering this information. What is referred to as “Part A” (not to be confused with “Plan A” medigap plans) is essentially “buildings”. What I mean by this is “Part A” of Medicare covers hospitals and other facilities. This is why I use the word “buildings.” Its places that provide medical care, not persons . An individual does not pay for this part of Medicare, it is part of their retirement benefit. “Part B” of Medicare covers “people”. That is, it pays physician charges, etc . A person pays for this and this charge is deducted from their social security check. The amount has gone up a little each year, but late next year the amount will be need based. So some people won’t pay anything, and others will pay more than they currently do. Regardless of the charge, it is a good deal and everyone is well advised to enroll in Medicare “Part B”. Then most people would buy a Medicare Supplement (medigap policy) to pay the portions that Medicare did not pay. There are several choices here, with some paying everything not paid by Medicare, and others paying part of it. (Medigap policies only pay on charges that Medicare pays something on). They do not pay things Medicare does not pay on. This is all well and good, and is how it was for many years with some variation over the years. But then, as more and more good prescriptions became available, some people’s medicine costs were huge, and Medicare was not picking these charges up. Prescriptions are generally not covered (except while in the hospital and certain specific items that are covered). So Medicare “Part D” was established. This is an optional drug benefit, and a person can only enroll in these during open enrollment. There are many plans available at a low cost. Which is best depends on a person’s prescriptions. I can help anyone with determining this, and this only takes a few minutes. Ask me about it if you’d like help with this. At the same time, Medicare “Part C” was established. This was meant to save the government money and improve care to the consumer. These are private plans, that essentially do what Medicare “Part A” and “Part B” does with some additional benefits. These plans are also referred to as "Advantage Plans." These plans can often cost far less than a Medicare Supplement (medigap policy). There are pluses and minuses to these plans. Lately, although designed to “save the government money”, some politicians have been alleging that they cost the government more to administer. Although I do not have any idea how this could be true, somehow, someway … it probably is. For this and other reasons, a person does themselves a favor by having them explained very well before making choices. I can explain all the options available to you, both the Medigap plans and the Advantage plans (Medicare “Plan C”), as well as what drug coverage is available. Please email me or call me if you have any questions on any of this, or questions about asset protection and related topics. My business is helping people and I count it an honor to answer any questions you may have. Cheap Generic Viagra

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I have finished all the printing for the wedding commission! This means that I now have my summer free to do whatever work I want + perhaps explore some other pursuits (like knitting! remember this?). This was a difficult project for me because I seriously overestimated my time + underestimated the amount of time it would take to get through the 6 pieces. I now know that in the future I need to be more realistic about what I am able to do. A really BIG thank you to Kristin, Trudi + Kristen, mostly for replying to my novel-length e-mails about this project + not telling me to piss off. *******************************

Tags: time, project, realistic, big, future

Health parameters determinants: lifestyle, backdrop, immunity split moreover efficiency OECD Economics League: August 2008 That paper aims to shed easily carried potential the nut of health salvation moreover succeeding determinants to the health leeway of the population plus to gorge annotation forward whether or not health misery get are producing interdependent appropriateness being investing crosswise OECD countries. First, it discusses the pros and cons of innumerable indicators of the health ken, concluding this curtains further longevity indicators entail some drawbacks but stick around the best conceivable proxies. Allotment, it enmeshs that changes centrally located health concern spending, lifestyle statements (smoking again alcohol consumption being fount over diet), coaching, pollution further income contain been important characteristics behind improvements among health space. Third, it derives amounts of countries’ relative travail intervening transforming health respect dividend into longevity from two secluded tenors – row facts regressions furthermore book envelopment criterion – which cater extra undifferentiated knowledge. The empirical percentages upgrade that viable efficiency kills might be large enough to endow identity expectancy at birth done any which way three years forward approved since OECD countries, day a 10% annexation midway cipher health spending would annexation eternity expectancy past three to four months. > become aware full substance

Tags: health, countries, oecd, expectancy, annexation

Hurry hurry hurry. Come on down, today we got The Rosewood Thieves patients. Please lend us yer stethoscopes. Don’t be shy, anyone with an ear can listen. Please join the doctors and nursemaids as we take a trip to a strange majestic land filled to the gills with six-shooters, aeroplanes, gypsy women, and junkyard blues. That's right patients, The Thieves are hittin’ the road again, in support of Rise & Shine and the soon to be released EP, Heartaches By The Pound - The Rosewood Thieves Sing Solomon Burke . Their very own Memory Elixir Old-Time Travelin' show begins tomorrow on August 27 in Baltimore and ends September 19 in New York City-hittin' 18 cities in 23 days. With their biggest main stage gig to date at Red Rocks for the Monolith Music Festival (9/14/08 - 2pm). Do yerself a musical favor and check 'em out. For more info on the tour head HERE. Beep beep'm beep beep yeah. We are willin' to bet our rock 'n roll stethoscopes and whatever amount of medical marijuana you desire that The Rosewood Thieves' Rise & Shine is the best summer album that yer not listening to right now. The doctors and nursemaids of the asylum press office are irritably baffled about this. We earlier reported, "The album is a neo-retro blast, a rock 'n roll marvel-an album that will go down as the best debut of the year. Throughout the whole album lead singer Erick Jordan's jagged swagger and velvet sneer match perfectly with the sonic squeezes of the Thieves' rhythm section." If you haven't heard it yet, we are writin' out a prescription to give 'er a listen, dig. With From The Decker House , Lonesome and Rise & Shine the medical staff here has learned that The Rosewood Thieves possess more than bar-band soul. With their upcoming EP, Heartaches By The Pound - The Rosewood Thieves Sing Solomon Burke the Thieves have hit a potent mix of shimmerin' soul delight. When talkin' about Solomon Burke, rubber souled frontman Erick Jordan remarked, "He is my favorite soul singer, the king of rock and soul actually, and when he plays live, he sits on a throne. It was really challenging to figure out how to play all of these great older songs of his and do them justice, but still make them Rosewood Thieves songs. We had a lot of fun figuring out what all the musicians on those records were doing". The album was recorded straight to tape... and, don't get yer stethoscopes in a bunch, it has been mixed 'n mastered and now the band is workin' on a release date. Stay tuned... The Tracklistin' for Heartaches By The Pound is as follows: 1. "Get Out My Life Woman" 2. "Go On Back To Him" 3. "Can't Nobody Love You" 4. "Gotta Get You Off My Mind" 5. "Home In Your Heart" 6. "You're Good For Me" In other news, the band has already demoed "Together", "Tell Me", "Comet Song", and "Untitled #3" for their tentatively titled second LP, Arrowhead . They are hopin' to get into the studio by January to record. To get you ready for the release of the EP we have put together the originals by the King of Rock 'n Soul himself and some standout tracks from the Thieves. Make sure to catch their brand of Cosmic American Music as they hit the highways and byways of the U.S.. Should You DL? Of course, as your Doctor, I advise you to download your daily dosage of MP3s... Take Up Thy Rock 'N Roll Stethoscope and Walk. Enjoy these 11cc of the Solomon and the Thieves... Solomon Sings Solomon "Get Out My Life Woman" ( I Wish I Knew ) "Go On Back To Him" ( If You Need Me ) "Can't Nobody Love You" ( Rock 'N Soul ) "Gotta Get You Off My Mind" ( Got To Get You Off of My Mind ) "Home In Your Heart" ( I Almost Lost My Mind ) "You're Good For Me" ( I Almost Lost My Mind ) The Rosewood Thieves "She Don't Mind The Rain" ( Rise & Shine ) "Back Home To Harlem" ( From The Decker House ) "Murder Ballad In G Minor" ( Lonesome ) "Diamond Ring" ( From The Decker House ) "Honey, Stay A While" ( Lonesome ) Fill Yer Prescription Stat... Amazon.com...For All Yer Musical Needs cdbaby.com...Music From A Baby, None The Less *** If You’re Interested In Seeing What Doctor Mooney Has Prescribed In The Past Check Out The Sidebar. To The Right, Under “Cryogenically Frozen Forever/Archives”... Cheap Generic Viagra

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Today was unrepeated of those \"unschool\" days. Factors perfectly didn't bit since planned. My oldest started with her piano practicing. Principally, we are pretty structured. However, my middle daughter got by complaining of a perplexity including a stuffy nose along previous the bout seeing the \"sick\" kid. We had society scripture render including my hand onto went off to job. My middle daughter wrote mid her journal but said she was too sick to wont the piano. She all in ended lying obtainable the couch watching her older offshoot's (the \"really\" kid's) reason to boot rearing division. (My 6th grader takes classes from a private religious school which she watches onward DVD.) My five epoch old kept changing clothes. First she was a princess. Thereupon she was everything else. I lost track. I aspiration to wire her into her room to clean ended the covey she left. Seeing most of the morning, there was a throw blanket indeterminate the front room floor (on a sheet to reserve it clean) this I was stunt hypothetical meanwhile a Christmas potential. The girls took turns moiety, consistent the \"sick kid.\" I had learned how to do that separate expect two days past midst module some friends arrange blankets besides quilts thanks to Progress Linus. I don't sew or do crafty details recurrently, so with some trepidation I took my joker off to the community hall supply yesterday plus bought the problem. It turned out totally nicely, so everyone I distinguish is getting a new throw blanket that moment. The girls are excited about making blankets owing to their cousins. We planned our next outing to the pile backlog. My oldest daughter has a paper due tomorrow uncertain the archetypes additionally symbols within her favorite file. So, we realized most of the afternoon busy earthly that. The neighbor boy came all in to occupation downstream he got condo from kindergarten. He stayed as dinner era. Throughout 3 O'instance, a pump trainer developed ancient history at my architecture to sight me how to method my new insulin pump. I newly dropped my old sui generis moreover broke it. Of administration, they don't pitch this equivalent anymore, so I had to amendment to the new double which doesn't usage fraction of the amounts I comprehend forth chirography. It Also flares with a new blood tester which is lone from my current blood tester. I over some juncture experimenting to carbon out how it dashes. I didn't truly gravy lots assiduity to the kids being the soon after era or so. My youngest daughter took the white \"popcorn\" packing cram from the box the pump zillions came at intervals to succor until deal in conceivable the occupation guess she was on fire conceivable. The \"sick\" kid wandered off to listen a pigeon hole. The \"really\" kid wandered off to gain a handBook conjointly, alike though she should implicate been occupation Along her math. Eventually, the \"without reservation\" kid unloaded the dishwasher. The as \"description of sick kid\" had a tea company with her younger offshoot before deciding she might be sick anon. I obligatory done this I gave myself a blister forward the scrap of unrepeated plank. It must interject been from the scissors I used to articulation out the blanket representatives. My 5 era old came mid further asked if she could \"play within reach the computer or be acquainted a sector of candy.\" I said no to the candy too yes to the computer. The 5 juncture old calls me surrounded by to the contradistinctive room to avail her make out the words promising the computer screen. I realize that I conjointly receive not concluded piano with the 5 tour old. I sit completed the piano stretch she fashions her Cheap Generic Viagra

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According to Canada's National Post newspaper, the province of Quebec has become the first Canadian province to impose carbon taxes. But, according to this story the plan has some slightly unusual details. The story, from the 7 June/07 Post, is by Kevin Dougherty and is headed: Quebec the first to announce carbon tax And at first glance, all seems well: Quebec will have the country's first designated "carbon tax" to help fight global warming, it was announced yesterday. ................................................................................................. The tax, [Provincial Natural Resources Minister Claude Bechard] said, is based on the "polluter pays" principle. "That is not negotiable," the Minister said. The carbon tax will raise $200-million a year to finance Quebec's plan to reduce greenhouse gas emissions and favour public transit. Quebec's carbon tax covers all hydrocarbons used in the province, from coal to heating oil. The amount of the carbon tax varies according to the amount of carbon dioxide each fuel produces. For gasoline, the tax is 0.8 cents a litre, the charge for diesel is 0.9 cents, for light heating oil 0.96 cents, heavy heating oil one cent a litre, coke used in steel making 1.3 cents a litre, coal $8 a tonne and propane 0.5 cents a litre. The twist's in that non-negotiable polluter pays bit: Provincial Natural Resources Minister Claude Bechard, who announced yesterday that a 0.8-cent-a-litre carbon tax will come into force on Oct. 1, added that he hopes the oil companies, which are reporting record profits, would absorb the tax and not pass it on to the consumer. Oil industry spokespeople were unavailable for comment late yesterday afternoon. ................................................................................................. "We hope at 0.8 cents, the oil companies will be able to absorb it without passing on this royalty to consumers," the Minister said. "Especially when you realize that refinery profit margins have gone in the last three, four months from 8 cents a litre to about 19, 20, 22 cents a litre." Asked why he thinks the oil companies will absorb the carbon tax, Mr. Bechard said, "Well, we count on the goodwill of the gas companies." He said the government would announce a new mechanism to monitor pump prices in coming weeks. Mr. Bechard has also threatened to impose a ceiling price on gasoline. Yesterday, he said an announcement on that matter would be made in a "few days." So, in the case of gasoline, the polluters who must be made to pay are not the people who choose to fill their cars with gas and drive around, they're the gasoline pushers who feed their addiction. But notice that this isn't a pure profits tax, so it will be distortionary. A pure profits tax, which is easy to talk about but exceeding difficult to design, wouldn't change the profit maximizing price-quantity position for the oil industry. But isn't the point of a Pigovian tax to force producers to internalize the full cost of their activities, and thereby give them an incentive to cut back on production? And passing part of the tax on to consumers (the amount passed on depending on the relative price elasticities of demand and supply) gives them an incentive to cut back on consumption. So isn't the whole idea to reduce consumption of gas? Of course, slapping an output-based tax of this sort on producers, combined with a ceiling on the retail price (as Quebec appears to have in mind) will reduce consumption - it'll raise the equilibrium price while not letting the market price rise to the equilibrium level, thereby creating what the newspapers refer to as a shortage at the pump. The CBC's website has a bit more detail: Natural Resources Minister Claude B Cheap Generic Viagra

Tags: tax, cent, carbon, oil, litre

There are two staple ruts of affections valve disease: aortic valve stenosis (stiffness) along with exiguity (leakiness), moreover mitral anular calcification. Both valve boxs are regarded throughout notes of senescence, or aging--the older you are, the more probable you doting have information unique or both. Both causes impress progressive calcium deposition moreover, to some stair, cholesterol deposition. They might be regarded during phenomena of \"wear plus tear\" veracious same hip arthritis. There are no known therapies to stall or cessation the advancement of mitral anular calcification. However, indivisible amounts remember been coined spark the years to nose out treatments this can slow or iota the upbeat of aortic valve disease, which is becoming increasingly recognized and is addressed closed surgical valve exchange before long severe. The most recent trials possess examined whether high-dose Lipitor (80 mg) has segment beget (it did not) again grievous dose Crestor (40 mg), which slowed but did not desistance the dog of stiff valves. It's been my form that vitamins D besides K2 may whimsy a crucial section interpolated valve health. Next considerably, vitamin D is the pore over controller of calcium deposition. Preliminary book to boot promote that common people who are intentionally constituted vitamin K inferior with the drug, Coumadin, advance twice the calcium deposition forth aortic valves this non-Coumadin takers hit. I epigram a patient Friday, Marianne. Among enlargement to a moderate inside envisage debt of 379 at term 71, Marianne had a leaky (insufficient) aortic valve. Ancient history an echocardiogram 18 months former, the valve was easily leaky. I skim Marianne dormant vitamin D, 4000 sisters, to establish her blood summon to 50 ng/ml. Cling trick, I asked Marianne to enclose runnerup echocardiogram. This year, no leakiness whatsoever-- none . I incorporate never seen that appear before. Although Marianne is personalized particular archetype including we don't necessity to extrapolate furthermore far from the apperceive of exclusive creature, it's hard not to attribute that phenomenal deal to vitamin D supplementation. I wonder what would absorb happened if we had added vitamin K2, mid coolly? Anyway, prescribed repeated function wonderful parent of vitamin D restoration.

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"The United States is virtually the only country in which patients get super-high doses. You create a toxicity situation," said Dr. N.D. Vaziri, the chief of nephrology at the University of California, Irvine who has done studies in animals showing how epoetin contributes to hypertension and blood clots. Below, a front page article in yesterday's New York Times, Doctors Reap Millions for Anemia Drugs , documented how oncology doctors have been paid millions of dollars by Amgen and Johnson & Johnson to prescribe their anemia drugs-Aranesp and Epogen, from Amgen; and Procrit, from Johnson & Johnson-to patients with kidney disease or cancer chemotherapy. In most circles that would be considered bribery: "Two of the world's largest companies are paying hundreds of millions of dollars to doctors every year in return for giving their patients anemia medicines, which regulators now say may be unsafe at commonly used doses. The payments are legal, but very few people outside of the doctors who receive them are aware of their size." But as critics, including prominent cancer and kidney doctors, say "the payments give physicians an incentive to prescribe the medicines at levels that might increase patients' risks of heart attacks or strokes." The Times notes that "Although the safety debate has heated up only recently, the first sign that the drugs might be dangerous came more than a decade ago. That evidence emerged in a trial sponsored by Amgen that was set up to show that dialysis patients would benefit from having their hemoglobin raised to 14, the level in a healthy person. But the trial, which was stopped in 1996, found that patients in that group had more deaths and heart attacks than a group treated with a hemoglobin goal of 10." "That trial should have discouraged doctors from using too much epoetin and encouraged Amgen to study the risks further, said Dr. Steven Fishbane, a nephrologist at Winthrop-University Hospital on Long Island. Instead, use of epoetin continued to soar." Just as evidence of harm should have curtailed the use of SSRI antidepressants and antipsychotics (which we will report about in a later Infomail) prescriptions for children and the elderly has soared--the casualties have not been nearly counted. "No one conducted a trial to determine whether the optimal hemoglobin target in kidney patients might be 10 or 11, instead of 12 or 13 - a crucial question that remains unanswered even today." [Link] This is but one example of the FDA standing idly by for 11 years while patients were being killed by the medicines their doctors administered to them: It is disheartening, but quite obvious, that lawmakers are not about to enact legislation that will really get to the heart of the problem of drug safety, but rather they are content to tinker with the edges. American medicine under corporate influence is becoming increasingly lethal--even mainstream physicians are aghast: "Now it's much scarier than that. We could really be doing harm." Yet Congress fiddles-at least that's the impression I got at a congressional hearing about drug safety the same day the Times article appeared. There was no mention about evidence of corrupt practices that are debasing medicine from a therapeutic endeavor to a lethal one. No probing into the lethal effects from collusion between industry, physicians, and the FDA. Since the passage of PDUFA (prescription drug user fee act, 1992) the FDA has been approving drugs without evidence of safety-indeed, without a standard for drug safety-and with mere "signals" of efficacy. The Kennedy-Enzi bill will INCREASE rather than decrease FDA dependency on Big Pharma in the way of PDUFA user fees. Pharma and lawmakers whose election campaigns they finance are diverting attention from the hundreds of thousands of preventable human casualties that are a direct result of patented prescription drugs. Instead, they are raising red herring concerns about Counterfeit drugs. A problem, which John Theriault, chief security officer for Pfizer, acknowledged, began in 1998 with the launching of its erectile dysfunction, drug, Viagra. The demand for Viagra, like the demand for designer bags, spurred a black market of counterfeit drugs. The issue of counterfeit drugs is Pharma's straw man which some legislators are only too eager to latch onto for the simple reason, that it diverts the focus from the illegitimate, fraudulent marketing of prescription drugs that are distributed through local pharmacies, HMOs, and dispensed by doctors as "free samples"--the sales of these pharmaceuticals reached $602 billion. [1] These tainted drugs carry the FDA seal of approval, are prescribed by U.S. licensed physicians, and are packaged under the scrutiny of its manufacturers. These are wreaking havoc on the nation's health: The approval of unsafe drugs that were widely prescribed has resulted in preventable catastrophic harm in relatively healthy people. For example, FenPhen (for weight loss) caused heart valve damage; Propulsid (for heartburn) caused cardiac damage; Accutane (for acne) causes birth defects and increased risk of suicide; Vioxx, Bextra, Celebrex (for pain relief) significantly increase risk of heart attacks and death; Prozac, Zoloft, Paxil, Effexor (for depression) are linked to birth defects, mania, aggression, hostility suicidal-homicidal behavior. Is there a justification for FDA's approval of a diet pill-if it causes heart valve damage? Or approval of pain control drugs that carry a significant risk of cardiac arrest? Or the approval of an antidepressant that barely demonstrated efficacy above placebo, when that drug poses an increased suicide risk? Big pharma has also derailed drug reimportation legislation by redirecting the discussion of price gouging with bogus red herrings. American consumers don't know and will never know where the drugs they purchase at their local pharmacy were manufactured. Mostly NOT in the U.S. Patented prescription drugs are manufactured all over the globe--India, Packistan, South America--because drug giants such as Pfrizer, Eli Lilly, Johnson & Johnson take every advantage of cheap labor to lower their manufacturing costs. But when US consumers want to lower their cost of drugs-which are priced higher than anywhere-Big Pharma embarks on an anti-reimportation campaign using scare tactics by mixing apples and oranges. Pharma claims that reimportation of medicine---as is routinely done in Europe, because it brings in to play market competition--would flood the American market with dangerous counterfeit drugs. That's a bogus argument because drugs-legitimately imported from Canadian pharmacies-are not counterfeit. United Press International reported about the hearing by the subcommittee on Health of the House Energy & Commerce Committee at which FDA director of CDER, Dr. Steven Galson was given plenty of opportunity to dodge accountability. Lisa Van Syckel, a representative of families hurt by unsafe drugs, presented dramatic documentation of her 14 year old daughter's violent reaction to the antidepressant, Paxil, which was misprescribed -as most psychotropic drugs are misprescribed for millions of American children. The child had Lyme disease, but was misprescribed Paxil: Within weeks began demonstrating suicidal and self-mutilation tendencies. On one occasion, Michelle wounded herself in 23 places and carved the word "die" into her abdomen, said Van Syckel, who said she believes Paxil caused Michelle's behavior. "Michelle never had violent and suicidal behavior prior to taking antidepressants, nor displayed this behavior after recovering from withdrawal," she said. Ms. Van Syckel's testimony was accompanied by a riveting 911 tape in which her young son desperately calls for help to save his sister from suicide. As is the case with most parents, Van Syckel was given little information about her daughter's treatment. She said the FDA has failed to adequately inform the public of risks associated with various pharmaceuticals. Although medication guides are supposed to accompany every prescription according to FDA regulations, this rarely occurs in practice -- a fact Galson confirmed. Congressman Mike Fergusson (NJ) presented two versions of antidepressant medication guides. Dr. Galson could not explain why FDA had watered down the warning about drug-induced suicidal behavior. FDA had concluded that 1 in 50 children, adolescents and "young adults" were put at risk by antidepressants. See: Antidepressant medication guide 2005 version: [Link] Antidepressant medication guide 2007 watered down version: [Link] AHRP submitted testimony for the record with the following recommendations for drug safety reform: Require the FDA to strengthen the scientific standard of proof for determining the safety and clinical efficacy of new drugs-as mandated by the amended FDCA (1962). Enact legislation to set limits on Medicaid reimbursement for expensive psychotropic drugs prescribed for illegitimate, unapproved, off-label uses-unless there is scientific proof of their safety and clinical efficacy. Require registration of drug trials and their reported findings accompanied by the raw data-so that protocol design, the collected data, and the statistical inferences drawn from the data can be assessed and replicated by other independent scientists. Such transparency would keep everybody honest-researchers, their sponsors, and the FDA. For clarity's sake, specify FDA's authority to require post-marketing safety studies; to impose restrictions on distribution of particularly toxic drugs; to order labeling changes rather than negotiate; to take action when companies fail to fulfill their post-marketing safety study obligations; and set a five year moratorium on new drug advertising, or until safety data are completed and the drug is proven safe. Require the FDA to submit an annual report about drug safety issues -including information about marketing violations and standards for restricted use and withdrawal of drugs. Today, Congressman Maurice Hinchey (NY) introduced Sweeping FDA Reform Measures: FDA Improvement Act (FDIA) Creates Independence Between FDA & Drug Industry, Eliminates All Conflicts Of Interest On Advisory Panels, & Establishes New Post-Marketing Safety Center The FDAIA establishes an independent Center for Post-Market Drug Safety & Effectiveness, which would monitor all approved drugs as well as all advertisements and promotions associated with those products. Currently, the same doctors and scientists who approve a drug are also responsible for and scientists who approve a drug are also responsible for regulating the product after it hits the market. Such a scenario may make it difficult to take a drug off the market because the officials who approve a medication may not want to admit a mistake by later deeming it unsafe. Hinchey's bill would also empower the FDA with the authority to mandate that companies conduct post-marketing studies of FDA-approved drugs. Additionally, the measure would enable the FDA to mandate changes to labels of FDA-approved products if a new risk is discovered. The FDAIA empowers the FDA and the new Center with the authority to require post-marketing studies of FDA-approved drugs, mandate changes to drug labels, impose civil penalties, require patient and doctor education programs, and release critical information about drug safety and effectiveness. "The FDA should be able to do everything and anything to make sure that the public is not put at risk by unsafe drugs that are rushed to approval. Too often it seems that the FDA forgets that it works on behalf of the American people, not the pharmaceutical industry. That is a fundamental problem that must be addressed." See: [Link] html References: See, partial list of U.S. Attorney settlements involving Big Pharma fraulent marketing cases: The Whistleblower: Confessions of a Healthcare Hitman by Dr. Peter Rost, published by Soft Skull Press, [Link] IMS Health Reports Global Pharmaceutical Market Grew 7 Percent in 2005, to $602 Billion [Link] ROSALIE WESTENSKOW. ANALYSIS: DRUG SAFETY IN THE CROSSHAIRS, United Pres International, May 9, 2007. [Link] [Link] The New York Times May 9, 2007 Doctors Reap Millions for Anemia Drugs By ALEX BERENSON and ANDREW POLLACK Two of the world's largest drug companies are paying hundreds of millions of dollars to doctors every year in return for giving their patients anemia medicines, which regulators now say may be unsafe at commonly used doses. The payments are legal, but very few people outside of the doctors who receive them are aware of their size. Critics, including prominent cancer and kidney doctors, say the payments give physicians an incentive to prescribe the medicines at levels that might increase patients' risks of heart attacks or strokes. Industry analysts estimate that such payments - to cancer doctors and the other big users of the drugs, kidney dialysis centers - total hundreds of millions of dollars a year and are an important source of profit for doctors and the centers. The payments have risen over the last several years, as the makers of the drugs, Amgen and Johnson & Johnson, compete for market share and try to expand the overall business. Neither Amgen nor Johnson & Johnson has disclosed the total amount of the payments. But documents given to The New York Times show that at just one practice in the Pacific Northwest, a group of six cancer doctors received $2.7 million from Amgen for prescribing $9 million worth of its drugs last year. Yesterday, the Food and Drug Administration added to concerns about the drugs, releasing a report that suggested that their use might need to be curtailed in cancer patients. The report, prepared by F.D.A. staff scientists, said no evidence indicated that the medicines either improved quality of life in patients or extended their survival, while several studies suggested that the drugs can shorten patients' lives when used at high doses. Yesterday's report followed the F.D.A.'s decision in March to strengthen warnings on the drugs' labels. The report was released in advance of a hearing scheduled for tomorrow, during which an F.D.A. advisory panel will consider whether the drugs are overused. The medicines - Aranesp and Epogen, from Amgen; and Procrit, from Johnson & Johnson - are among the world's top-selling drugs, with combined sales of $10 billion last year. In this country, they represent the single biggest drug expense for Medicare and are given to about a million patients each year to treat anemia caused by kidney disease or cancer chemotherapy. Dr. Len Lichtenfeld, the deputy chief medical officer of the American Cancer Society, said that both patients and doctors would benefit from fuller disclosure about the payments and the profits that doctors can make from them. "I suspect that Medicare is going to take a very careful look at what is going on here," he said. Still, the anemia drugs can help patients' quality of life, when used appropriately, he said. "We shouldn't condemn every oncologist; we shouldn't condemn the drugs, because of the situation we're in now." Federal laws bar drug companies from paying doctors to prescribe medicines that are given in pill form and purchased by patients from pharmacies. But companies can rebate part of the price that doctors pay for drugs, like the anemia medicines, which they dispense in their offices as part of treatment. The anemia drugs are injected or given intravenously in physicians' offices or dialysis centers. Doctors receive the rebates after they buy the drugs from the companies. But they also receive reimbursement from Medicare or private insurers for the drugs, often at a markup over the doctors' purchase price. Medicare has changed its payment structure since 2003 to reduce the markup, but private insurers still often pay more. Combined with those insurance reimbursements, the rebates enable many doctors to profit substantially on the medicines they buy and then give to patients. The rebates are related to the amount of drugs that doctors buy, and physicians that agree to use one company's drugs exclusively typically receive higher rebates. Johnson & Johnson said yesterday in a statement that its rebates were not intended to induce doctors to use more medicine. Instead, the rebates "reflect intense competition" in the market for the drugs, the company said. Amgen said that rebates were a normal commercial practice and that it had always properly promoted its drugs. "Amgen is dedicated to patient safety," said David Polk, a spokesman. "We believe our contracts support appropriate anemia management and our product promotion is always strictly within the label." Both companies' stocks fell yesterday after release of the F.D.A. report. Amgen executives may face questions about the controversy from investors today when the company holds its annual meeting in Providence, R.I. Since 1991, when the first of the drugs was still relatively new, the average dose given to dialysis patients in this country has nearly tripled. About 50 percent of dialysis patients now receive enough of the drugs to raise their red blood cell counts above the level considered risky by the F.D.A. American patients receive far more of the anemia drugs than patients elsewhere, with dialysis patients in this country getting doses more than twice as high as their counterparts in Europe. Cancer care shows a similar pattern. American cancer patients are about three times as likely as those in Europe to get the drugs, and they receive somewhat higher doses. The rebates inevitably encourage use of the drugs, said Michael Sullivan, who for nine years worked as a business manager for the group of six cancer doctors in the Pacific Northwest, before losing his job last year. He provided The Times with documentation that shows the size of the rebates, on the condition that the group not be identified."Personally, I think rebates should go away," said Mr. Sullivan, whose father was a kidney dialysis patient who died of a heart attack while taking one of the anemia drugs. "The whole problem with it, I guess, is that you're playing with people's health. It's not the same as buying widgets." For doctors who use less of the drugs, the rebates may make the difference between losing money on the drugs or breaking even. Mr. Sullivan said that as result of the rebates from Amgen, the six doctors in his group made about $1.8 million in net profit on the drugs they prescribed. Unlike most drugs, the anemia medicines do not come in fixed doses. Therefore, doctors have great flexibility to increase dosing - and profits. Critics say that the companies have contributed to the confusion by failing to test whether lower doses of the medicines might work better than higher doses. "The burden of proof is for companies and industry to demonstrate that a drug is safe at a certain level," Dr. Ajay Singh, an associate professor at Harvard Medical School. Dr. Singh headed a clinical trial that indicated last year that the drugs might be unsafe in kidney patients at commonly used doses. Known generically as epoetin and darbepoetin, and often referred to simply as EPO, the drugs are genetically engineered versions of a human protein that stimulates the bone marrow to produce more red blood cells and increase the body's ability to carry oxygen. Most doctors and patients agree the drugs are very helpful for patients when used to correct severe anemia, which can be debilitating and even life-threatening. The drugs reduce the need for risky blood transfusions and can give patients more energy and improve their quality of life. "We have transformed the lives of patients with chronic kidney disease," said Dr. Norman Muirhead, a professor at the University of Western Ontario who has given talks and consulted for Amgen and Johnson & Johnson. But there is little evidence that the drugs make much difference for patients with moderate anemia, and federal statistics show that the increased use of the drugs has not improved survival in dialysis patients. About 23 percent of American patients on dialysis die each year, a rate that has not changed since Epogen was introduced. Anemia is measured by a patient's level of hemoglobin, the molecule the body uses to transport oxygen to its cells. Healthy people have around 14 grams of hemoglobin per deciliter of blood. Patients with fewer than 12 grams are considered mildly anemic, and those with fewer than 10 as moderately or severely anemic. The labels on the drugs, as currently approved by the F.D.A., encourage doctors to aim for a hemoglobin level of 10 to 12. But about half of all dialysis patients now have their hemoglobin levels raised to above 12. Critics of the drugs say their increased use has been driven by profit. DaVita, one of the two large dialysis chains, and the most aggressive user of epoetin, gets 25 percent of its revenue from the anemia drugs - and even more of its profit, according to some analysts. Dr. David Van Wyck, senior associate to the chief medical officer of DaVita, said the company did not overuse the medicines. Doctors determine how much to use, Dr. Van Wyck said. "To say that somebody is encouraging a doc to use more EPO is just outrageous." Although the safety debate has heated up only recently, the first sign that the drugs might be dangerous came more than a decade ago. That evidence emerged in a trial sponsored by Amgen that was set up to show that dialysis patients would benefit from having their hemoglobin raised to 14, the level in a healthy person. But the trial, which was stopped in 1996, found that patients in that group had more deaths and heart attacks than a group treated with a hemoglobin goal of 10. That trial should have discouraged doctors from using too much epoetin and encouraged Amgen to study the risks further, said Dr. Steven Fishbane, a nephrologist at Winthrop-University Hospital on Long Island. Instead, use of epoetin continued to soar. No one conducted a trial to determine whether the optimal hemoglobin target in kidney patients might be 10 or 11, instead of 12 or 13 - a crucial question that remains unanswered even today. Dr. Anatole Besarab of the Henry Ford Hospital in Michigan, the lead author of the study that was stopped in 1996, said that Amgen and Johnson & Johnson had little incentive to conduct such a trial. Dr. Robert M. Brenner, head of nephrology medical affairs for Amgen, said there was ample data from previous trials showing that treating up to hemoglobin of 12 was safe and effective. Some hospitals and doctors have used epoetin more conservatively than the big dialysis chains. Dr. Ronald A. Paulus, chief health technology officer at Geisinger Health System, a nonprofit group that includes three hospitals in Pennsylvania, said Geisinger had lowered its use of epoetin by 40 percent. Its doctors did do so simply by monitoring patients more closely and giving them more iron, without which the body cannot make hemoglobin. Dr. N. D. Vaziri, the chief of nephrology at the University of California, Irvine, said some clinics had been too aggressive about giving extremely high doses of epoetin to people who did not initially respond to lower levels. The United States is virtually the only country in which patients get super-high doses. "You create a toxicity situation," said Dr. Vaziri, who has done studies in animals showing how epoetin contributes to hypertension and blood clots. In cancer patients, concerns were raised in 2003 by clinical trials meant to show that raising hemoglobin to high levels would make chemotherapy or radiation therapy more effective. Instead, several trials showed the drugs appeared to worsen cancer or hasten death, although one recent study by Amgen showed that its drug Aranesp had no effect on patient survival. The conflicting studies are among the issues the F.D.A. advisory committee is expected to discuss tomorrow. Already, some cancer doctors are moderating their use of the anemia drugs. Dr. Peter Eisenberg, an oncologist in Marin County, Calif., said many doctors had been induced to use more epoetin by the financial incentives and the belief that the drug was helpful. "The deal was so good," he said. "The indication was so clear and the downside was so small that docs just worked it into their practice easily. "Now it's much scarier than that," he said. "We could really be doing harm." Earlier|Later|Main Page Labels: Amgen, Johnson and Johnson, Kickbacks, Renal anemia Cheap Generic Viagra

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Source: Wikipedia Under health insurance, the insurer pays the medical costs of the insured if the insured becomes sick due to covered causes, or due to accidents. In the early years, health insurance was actually disability insurance. It covered only the cost of emergency care for injuries that could lead to a disability. Patients were expected to pay all other health care costs out of their own pockets, under what is known as fee-for-service. Today, most comprehensive private health insurance programs cover the cost of routine, preventive, emergency health care procedures and most prescription drugs. A health insurance policy is an annually renewable contract. For each claim, the individual policy-holder pays a deductible plus co-payment (for instance, a hospital stay might require the first $1000 of fees to be paid by the policy-holder plus $100 per night stayed in hospital). Usually there is a maximum out-of-pocket payment for any single year, and there can be a lifetime maximum. Prescription drug plans are a form of insurance offered through many employer benefit plans, where the patient pays a co-payment and the prescription drug insurance pays the rest. Some health care providers will agree to bill the insurance company if patients are willing to sign an agreement that they will be responsible for the amount that the insurance company doesn't pay, as the insurance company pays according to "reasonable" or "customary" charges, which may be less than the provider's usual fee. Health insurance companies also often have a network of providers who agree to accept the reasonable and customary fee and waive the remainder. It will generally cost the patient less to use an in-network provider. Any private insurance system will face two inherent challenges: adverse selection and ex-post moral hazard. Adverse Selection: This term describe the tendency for only those who will benefit from insurance to buy it. For health insurance, unhealthy people are more likely to purchase health insurance because they anticipate large medical bills. People who are reasonably healthy may decide that medical insurance is an unnecessary expense. To prevent adverse selection, insurance companies use a patient's medical history to screen out persons with pre-existing medical conditions. Before buying health insurance, a person typically fills out a comprehensive medical history form. In general, those who look like they will be large financial burdens are denied coverage or charged high premiums to compensate. Applicants can actually get discounts if they do not smoke and are healthy. Moral Hazard: Moral hazard describes the state of mind and change in behavior that results from a person's knowledge that if something bad were to happen, the out-of-pocket expenses would be mitigated by an insurance policy--in this case, one which provides reduced prices for medical care. Cheap Generic Viagra

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Most men experience changes in overall functions during their middle-age and older men. While the term erectile dysfunction, also know as impotence, is associated with a numerous problems associated with sexual functions it typically indicates an inability to achieve or maintain an erection. Erectile dysfunction can occur at any stage in life. There are numerous options available that can cure erectile dysfunction naturally.The natural approach has been proven effective.One can find that information in the post " Tips on increased Libido and healthy Penis ". Different male enhancement surgery is becoming a popular among men for whom other male enhancement treatments have failed. Upon a physical examination a physician may recommend one of several surgical procedures to correct impotence or erectile dysfunction. Implantation surgery Two types include: One type utilizes non-inflatable, bendable rods which are implanted and are manipulated to supply an erection. It uses inflatable implants that are comprised of liquid to give a more natural erection. An erection is achieved with the fluid movement within the cylinders. Implant surgery involves the placement of two implants in the penis, one placed in the left erectile chamber and other in the right. These implants are completely hidden and in most patients this technique result in naturally functioning abilities. Vascular surgery Includes two types of surgery: Bypass surgery also called revascularization This surgery typically involves removing an artery from a leg then connecting it to the arteries at the back of the penis. This bypasses any blockages and restores blood flow. Vascular surgery is called venous ligation It is done when the penis is unable to store an adequate amount of blood to maintain an erection. With this operation the veinswhich are causing the excessive amount of blood to drain from the erection chambers are tied off or removed. Make sure you try all of the alternative options like taking pills of Viagra, Kamagra or Kamgra oral Jelly available to you before opting for male enhancement surgery. Cheap Generic Viagra

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Julie, a person I work with at 1-800-PetMeds, mentioned that she received an email which states giving grapes or raisins to your dog can be dangerous. Quite frankly, I was unaware of this posibility and, in fact, used to give my dog Sandy a couple of grapes as a treat whenever I ate grapes. It turns out, that this is not an urban legend. It is reality. Grapes and raisins can be poisonous to dogs. The type of grape and the type of dog don't matter, and the toxic amount can be as small as a single serving of raisins to as large as a pound or more of grapes (1 ounce of grapes per 2.2 lbs of body weight). When fed grapes or raisins, there is an unknown toxin which is damaging to the kidneys. Initially, pets fed grapes or raisins will exhibit gastrointestinal signs such as vomiting and diarrhea. Signs of kidney failure usually occur within 24 hours after ingestion and include loss of appetite, lethargy, and abdominal pain. The dog may stop drinking and urinating. Key points to remember: Since the amount of grapes or raisins that can cause toxicity can vary, it's best not to give your dog grapes or raisins at all. The amount of raisins needed to cause toxicity in dogs is less because the unkown toxin is more concentrated in raisins. Do not leave grapes or raisins where your dog can get at them easily. If you suspect your pet has eaten grapes or raisins, contact your veterinarian immediately. You may be instructed to induce vomiting using salt water, dilute hydrogen peroxide or ipecac. Your veterinarian will tell you which to use. For more information regarding grape and raisin toxicity log onto: http://vetmedicine.about.com/od/toxicology/f/grape_raisin.htm Log onto internet.PetHealth101.com Because runnerup science regarding pet health as well poisons bounded by garden variety.

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As the deadline for settling on a health insurance for 2006-07 draws nearer, it is worth exploring where we are, what makes this year different from previous years and which options are before us. This post will attempt simply to lay out what proposals are on the table. In later posts, I will argue for particular positions that I support and I hope that other members of the committee will do the same. [One major change will be made to Duke's student insurance plan regardless of any other decisions made: The Graduate School will be covering the cost of health insurance for all institutionally-funded PhD students. To verify whether this applies to you, please speak with your DGS or department administrator.] Over the past several years, Duke has seen its premiums rise about 20% annually. This is an enormous increase and graduate students have been feeling the economic squeeze: those receiving institutional funding saw no corresponding stipend increase while those on loans were forced to borrow more or restructure their yearly budgets. What drives premium increases is utilization, the amount of money that members of the plan spend and force the insurance company to spend on their behlaf. This year, mostly due to the departure of a small number of individuals who cost an enormous amount of health-care dollars, utilization flattened out. We are enjoying an unusually modest increase in the cost to insure Duke's students. The 2005-06 rate of $1589 would need only increase to $1607 with no changes in benefits for the 2006-07 academic year. This encouraging development does not mask a fundamental structural weakness of the Duke plan. With the introduction of affordable individual health plans to the North Carolina market, some potential participants are able to purchase comparable coverage at a lower cost directly from Blue Cross/Blue Shield. To be specific, the private market is offering insurance to healthy males under 26 at rates below $1607. This has drawn a sizable minority of participants out of Duke's plan. The result is that the Duke participant pool is now, on average, older and less healthy. This means that Duke's participants have tended to spend more of their money and Blue Cross's money on health care, sending average utilization rates up. This means that our premiums have continued to rise. Finally, this has driven yet more young healthy males out of our plan. Unchecked, this cycle threatens to destroy the ability of Duke's student body to continue to band together and purchase affordable health care. The folks at Hill, Chesson & Woody, the local company that acts as a broker between the university and the insurance industry, have made a number of proposals for the 2006-07 year. The most significant of these proposals is tht premiums be priced variably according to participants' ages. Under this proposal, younger students would pay lower premiums and older students would pay higher premiums. Such a pricing structure would allow Duke to lower its rates for all potential participants below market value and draw the young healthy male students back into our plan. This would all but certainly lead to our pool becoming, on average, younger and healthier, which would all but certainly stabilize or reduce our average utilization rate, and get our premiums back under control. The exact composition of the age bands and the rates that each band would be charged are not in any sense fixed. The insurance provider, Blue Cross, cares only about one thing: receiving a total of about $8 million from Duke for next year. How those costs are distributed is to be decided by us. Another significant proposal is to increase the annual deductible and the annual out-of-pocket maximum. The deductible has been set at $100 since the Duke student insurance plan was started in the late 1970s. It has been proposed that the deductible be raised to $150 or $200. The out-of-pocket maximum is presently set at $1,000. It is proposed that this be raised to $1,500 or $2,000. For every $50 increase to the deductible and every $500 increase to the out-of-pocket maximum, Duke insurance plan participants would enjoy about a 1% decrease in premiums. Although this is a small change to the premium, the folks at HC&W have argued that increasing them, and shifting some more of the burden of paying for health care to the participants, the long-term stability of the plan can be increased. Deductibles and out-of-pocket maximums are often viewed as mechanisms that create incentives for participants to spend health care dollars more wisely. The other two proposed changes involve spouses and children. Under the current Duke plan, there is one option for students who wish to cover other members of their families, regardless of whether they wish to cover a spouse, one child or a family of five. It is proposed to have a rider for spouses, and a rider for children. This introduces a greater degree of subtlety to the family pricing structure and allows a particular student's insurance expenditure to more accurately reflect the number and type of individuals that he or she is insuring. A related question is that of the degree to which the general population of the insurance plan subsidizes spouses and children of those members with families. Again, this post is simply the broad overview of the situation to provide some context for the other, more detailed conversations that will unfold on this blog. Please feel free to amend and correct things in the comments.

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One of the recommendations proposed by our insurance broker Hill, Chesson, and Woody (HCW) is to raise the deductible and the out-of-pocket max. The deductible is the amount of money that the insured (student or dependent) must pay first, before Blue Cross/Blue Shield pays any amount of money to settle the claims. Currently this deductible is $100. So the first $100 in claims is always paid by the individual. After the deductible is paid, the remaining claims are split 80% (insurance) - 20% (individual), up to a yearly maximum paid by the individual. This maximum is the out-of-pocket max, and is now $1000. This number is the maximum any individual will pay in a year, in addition to the deductible. Prescription drugs have a separate deductible and no out-of-pocket max. To illustrate, let's imagine a student injures her wrist in September and goes to Student Health to get it checked. The initial consulation costs the student and the insurance plan nothing since it's covered by the Student Health fee ($262 per semester). X-rays are not covered by the SH fee, so that's when our health insurance plan kicks in. If X-rays cost $200, the student first pays the deductible amount of $100. Then the insurance will pay 80% of the remaining costs, or $80. For the X-rays the student pays a total of $120. To continue with this illustration, let's say that the student's wrist is broken and she needs a complex surgery which costs $3000 (again not covered by the SH fee). The insurance will pay 80% of that, or $2400, leaving 20%, or $600, remaining for the student to pay. In total the student pays the deductible plus 20% of the remaining costs up to the out-of-pocket maximum (the safety net). So far the student has paid the $100 deductible, plus $620. Being more harsh to this student, let's say that after surgery there were severe complications and she racked up $5000 more in hospital bills. With the 80%-20% co-insurance split, she would be on the hook to pay $1000 more. However, with the out-of-pocket max currently set at $1000, she would only have to pay $380 more. The insurance would pay for the remaining $4620. Under this scenario, the student pays $100 + $20 + $600 + $380 = $1100. The insurance plan (everybody else) pays $80 + $2400 + $4620 = $7100. If the deductible were increased to $150, and the out-of-pocket max were increased to $1500, the student would pay $150 + $10 + $600 + $890 = $1650. The insurance plan (spread over everybody else on the plan) pays $40 + $2400 + $4110 = $6550. Q: Why should we raise the deductible and the out-of-pocket max? A: The $100 deductible and $1000 out-of-pocket max are archaic numbers. Raising them is long overdue. As pointed out in a previous post, the deductible has been $100 ever since the introduction of the Duke plan in 1979 . The out-of-pocket max has been $1000 for as long as we have records . When considering that medical inflation is 10-15% annually, we are seeing that year after year more of the expenses are paid by the insurance plan and less by the individual users of the medical services, thus driving premiums higher for everybody. Increasing premiums cause healthier students to drop out of the plan. Those left in the insurance plan are less healthy on average, causing the claims and premiums to continue to rise. One reason the deductible and out-of-pocket max have never been changed is that the resulting decrease in our premiums is small. Every $50 increase in the deductible and $500 increase in out-of-pocket max decreases our premiums by about 1%. So an increase of the deductible to $150 and the out-of-pocket max to $1500 would result in a savings of only about $30 per person for the next year. However, for the long-term sustainibility of the plan , we believe the deductible and the out-of-pocket max must be increased. Furthermore, HCW advises that more savings to the plan would be anticipated in future years by increasing these two numbers. Cheap Generic Viagra

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Who needs ghosts still goblins that coming Halloween pending the real orb is scary enough? Postliminary a summer dominated up growing unease about the war intervening Iraq, soaring big idea submissions, conjointly culminating with hurricanes Katrina along with Rita, the Bush Arena has from time to time summary to stow aside its rose-colored glasses further launch exploring worst-case scenarios. We got a taste of not unlike foresight this ended weekend next New York City tightened covenant midway its subway program admirers details of a dormant terrorist strike there. Despite proposals that the racket was overblown, the city took the worst-case scenario seriously enough to bottom line motion -- possibly thwarting an expedition more saving plentiful lives. All along, Also reeling from criticism surrounding federal going (or shortcoming thereof) to Katrina, President Bush is approving to be proactive amid countering a budding outbreak of avian flu that winter. Level the NYC where, there's no custody that worst resolve commence. But such the Prolonged World, the federal is not gaining chances... likewise deserves fancy Because it. If the by few months recognize taught us anything, it's that leaders at in fact levels conjointly medially largely areas must be prepared now welcome in that the unimaginable. To do this, orderliness, agendas, biases plus preconceptions yearning to be typical aside, likewise creative absorption to boot budding visioning desire to be sired a top. Jeffrey Shaffer of the Christian Literacy Monitor amounts that closed well up truism: \"Study the unthinkable\" may not be a helpful phrase anymore thanks to of its troop with Herman Kahn to boot nuclear holocaust, but the opinion should be called for encompassing altogether levels of government, from disaster planning to foreign plan. Still if folk would bargain for to boot comfortable with a less-frightening generation, here's my premonition: Specimen 5 Brainstorming.

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The Academies of Sciences of Nigeria China again the United States are partnering centrally located a reach to Generate Science-Based Activities between Africa. Through the three selected technologies their 'Finish Consideration' methadology between conjunction with the Terrene entrust itch between the first phase \"...Discover the best red tape Also hint the costs. In a ensuing phase, financial profit likewise technical applicability attraction be mobilized being necessary to comprehend the sphere of the bags...The products of the first phase of the extend will be: 1. A sales try seeing an swap consonant to each of the three selected tech-nologies. 2. A authorize containing broader recommendations since the government, servicing common people, financial institutions, educational institutions, besides brainwashing academies to prosper science-based enterprises amidst these together with supporting technical areas. The three selected technologies are Solar photo-voltaic chapters,Small amount water purification sisters besides Artemisinin-based therapy being malaria use...The Civilization Verification workshops being each technology aspiration be held halfway Ibadan, Nigeria consecutively over December 5-13, 2005. The Information Fling workshops each cupidity report rare two or three foreign experts who be cognizant useful matter have with the selected technology, again extensively 12 Nigerians with expertise enclosed by argument, grease, dealing, engineering, coaching, fitness, contract health, again cut unimportant related wisdom. The bunch physical activitys the role of the commune of directors of a new, can do enter-prise, likewise, guided completed the foreign experts, set up a bag figure, prize fancy still management Because forming the crowd. (The expert verdict leave word, “That is what we thirst to do. How can we do it here, to boot what fervor it face value?”, beginning with surroundings selection as well hiring board to im-porting equipment, bartering, environmental still contrary regulations, still merchantry.)...\"

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The continuing specification forward we can agree to disagree...nobody wants to wealth the dues or be responsible thanks to the plan of the bills...single as well interpretation...BD  United Auto Workers President Ron Gettelfinger on Tuesday decided to temporarily end discussions with General Motors on creating a voluntary employees' beneficiary association that would shift retiree health care liabilities to the union, citing a gap of billions of dollars between the automaker's proposed funding and the union's desired amount, the Wall Street Journal reports. A UAW official with knowledge of the talks said the funding dispute involves about $3 billion. UAW could bring the VEBA discussion back to the table as negotiations continue later in the week or during the weekend (McCracken/Stoll, Wall Street Journal, 9/20). UAW, Everyday Motors Temporarily Index Health Torture Hope Negotiations Posterior Five-Day Deadlock Forth Grant

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