Source: Los Angeles Times

Why does there seem to be such a glut of research on the benefits or risks of wine, but not much out there for beer lovers? Do we need to know more?  Some suggest yes.

Greg Laden’s blog, called Greg Laden’s Blog, over in the ScienceBlogs collection got us thinking about the topic with Friday’s post: Does drinking beer increase your attractiveness … to mosquitoes? And the answer is yes.

He was referring to this study, Beer Consumption Increases Human Attractiveness to Malaria Mosquitoes, over at PLoS One.

That’s intriguing, no? So we went hunting for more beer-and-health studies. And we found:

Silicon in beer and brewing, from UC Davis researchers. It was published earlier this year in Journal of the Science of Food and Agriculture.

It concludes: “It is confirmed that beer is a very rich source of silicon.” Don’t doze off — silicon is connected to bone health. But, as the 80beats blog over at Discover points out, the study doesn’t suggest that means beer is good for bone health.

Here was a popular interpretation of that research, from New York Daily News: Study finds beer is good for your bones: Light-colored ales most effective against osteoporosis

Beyond that much-touted but overhyped study (which, to us, suggests an unquenched desire for more beer research), we found not too much of late.

But perhaps there’s more high-quality beer-and-health research out there that has passed under Booster Shots’ radar…. If so, let us know. (Note this is not an invitation to send personal anecdotes. We’ve said it once, we’ll say it again: Anecdotes are not data.)

We could look further ourselves, but it’s Friday evening…

In the meantime, we’ll leave you with this summary of the health benefits of various types of alcohol from the Harvard School of Public Health newsletter. It states:

“Wine, beer, or spirits — each seems to have the same health benefits as long as moderation’s the word (no more than one drink per day for women, and no more than two drinks per day for men).”

A bit more on that topic, from the same newsletter is here:  Is Wine Fine, or Beer Better?

_______________________________

My Take:  You can find all kinds of information in the news today, everything from articles on bankruptcy vs. debt settlement and how to hire a NYC wrongful death lawyer to how to make custom design invitations and who the best Park meadows divorce lawyers are.  And, in between all of this “news,” you’ll find out that one day drinking wine moderately is good for the heart one day, then not so great for the brain the next.  Or the best way to eliminate credit card debt is to file for bankruptcy and start over, then not to file for bankruptcy but hire a credit counseling firm to help you pay it down.

I think whether you’re interested in hiring a Denver divorce lawyer, need legal help from a Bronx construction accidents lawyer, or want to make your own custom baby shower announcements, that you go with your gut and read everything online with a little bit of skepticism.  Trust your instincts.  They are stronger than you probably think.

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Many corporations give out promotional items that are more generally low value items like pens, key rings, and similar items.  But what exactly are corporate gifts? By essence, these gifts are high quality items, like custom gourmet gift baskets, that can show the appreciation and concern of a business towards its clients and employees. Items like customized pens, clocks and leather briefcases are some of the more popular choices. The type of corporate gift that a business will give to a particular client depends on the relationship the two entities have.  This type of corporate gift should not be confused with a get well soon gift basket.

Source:  Los Angeles Times

Jeff Wilcox closes his eyes and imagines a large vacant building literally “buzzing” 24/7, filled with glowing lights, gurgling irrigation systems, whirling ventilators and workers coaxing thousands of pungent marijuana plants to bud.

And that’s just one part of his proposal. Wilcox, a retired builder, owns a campus of aging, idled industrial plants. On a wall in an unused conference room, a sketch of the property shows how he could fill most of the 172,000 square feet with growers raising high-end pot and entrepreneurs turning out brownies, drinks, tinctures and other products.

“My idea was a business park of cannabis,” he said.

He sold the idea to Oakland’s City Council. Desperate for new jobs and tax revenue, the council gave its final approval last month to allow four enormous marijuana factory farms. Wilcox and more than 220 others have expressed interest in applying for the permits to be awarded next year.

The city’s audacious plan has inspired talk that Oakland could become the Silicon Valley of pot, home to the world’s first state-of-the-art marijuana start-ups.

Comparing the economic potential of tetrahydrocannabinol to silicon chips may seem far-fetched. Some observers dismiss the notion as the fever dream of budget-traumatized politicians. But others think Oakland could be uniquely positioned to capitalize on the business opportunities created by the growing tolerance toward marijuana.

Rebecca Kaplan, the City Council member who pushed the plan, has a simple retort when asked whether the vision of Oakland at the center of a marijuana economy is fanciful: Montel Williams. The television talk-show host and motivational coach has multiple sclerosis, smokes marijuana to relieve nerve pain and has visited Kaplan, as she put it, “live in City Hall.”

“He has wanted for years to open up a facility where he could produce really high-end medical cannabis extracts,” she said, explaining that Williams heard through the grapevine that Oakland was the place to do it. “I would love to have Montel Williams here running a business.” Williams could not be reached for comment.

Kaplan said she believed that Oakland has two essential ingredients other California cities do not: political will and industrial space. “Oakland has been a major hub of the medical cannabis movement, so that’s part of what I mean when I say political will,” she said.

No other city has provided such red-carpet treatment. Oakland is essentially trying to set up legal sanctuaries for pot businesses, although the move may prove too brazen for federal narcotics agents who recently called city officials to request a copy of the ordinance.

Only Berkeley, its liberal neighbor, has considered anything similar. The city will ask voters to approve six marijuana operations no larger than 30,000 square feet. But Oakland has 10 times the available industrial space, about 2.3 million square feet, and it rents for half the price.

Berkeley Mayor Tom Bates said Oakland’s stock of empty industrial buildings could make it a “major player.”

“Oakland is trying to become the growing mecca of the north,” he said.

Jeff Jones, who founded Oakland’s first cannabis club, noted that the bayside city has another advantage. “Oakland is not Holland, it’s not Amsterdam; it’s more like Rotterdam. It’s going to be a hub for transport,” he predicted. “I can imagine walking into Holland’s coffee shops and finding a strain of cannabis marketed as made in California.”

There are skeptics. “I think it’s a big stretch,” said Larry Tramutola, a political consultant who lives in Oakland. He said marijuana could have a long-term economic effect on the city but thought it would be minor. “I don’t think it’s going to solve all the budgetary issues,” he said.

Even Dale Gieringer, an Oakland resident who as the head of California NORML advocates for marijuana legalization, has doubts. He noted that state law blunts the get-rich-overnight incentive that powers Silicon Valley. Only nonprofit collectives are allowed to grow pot.

But Oakland, like Silicon Valley, has been fertile ground for entrepreneurs and innovative thinkers, luring them from all over. Jones is from South Dakota. Richard Lee, who started the first trade school to train marijuana businessmen, moved from Texas. Steve DeAngelo, who came from Washington, D.C., runs Harborside Health Center, a $20-million-a-year dispensary that has become the largest and arguably the most professionally run marijuana retailer in the world.

“As we get closer and closer to legal cannabis, more and more new players are going to want to get into cannabis,” DeAngelo said. “I think it’s a sign that this industry is emerging out of the shadows and into the light, and we are gaining acceptance among mainstream figures.”

Critics argue that this is not the same as making it legal to buy Viagra or bet in online gambling casinos.  Pot, critics maintain, is just as beneficial for the health of many individuals as those who are taking sports nutrition supplements to treat knee injuries or a dislocated shoulder, or those who can’t perform sexually and turn to online drug suppliers for access to discrete treatment for erectile dysfunction medication.

Wilcox is one of those mainstream figures. He says he started smoking pot when he was 15 and now uses it medicinally for back pain, but the 50-year-old single father with three teenagers is strait-laced. He sold his construction firm five years ago and retired. But he was bored. He didn’t see marijuana as a business opportunity until DeAngelo approached him about growing in his buildings, which are next to Harborside.

“I don’t look like a pothead, obviously,” he said, “and I struggled with the moral issues for a while, security issues, everything else; and then I decided I wanted to do something with my life.”

Now he is Oakland’s equivalent of a Sand Hill Road venture capitalist and a tilt-up office developer rolled into one. He has money, connections and 7.4 acres off Interstate 880.

Wilcox, who knows his way around City Hall after two decades as a major contractor, approached the idea shrewdly. He set up a company called AgraMed and spent $16,000 to study its economic potential. The 68-page report concluded that he could sell marijuana worth $59 million a year. With a 5% pot tax that the City Council decided last week to put on the November ballot, Wilcox’s operation could pay Oakland $3.4 million a year in taxes. “We did this to move the legislation,” he said.

He also sought help from Dan Rush, a local labor leader with City Hall clout, and promised to hire hundreds of union workers. He reached out to Lee, who is well-regarded at City Hall. He donated $20,000 to the legalization initiative that Lee is backing in November. He hired a lobbyist. He made a few modest political donations.

And he made it known that he was willing to spend $20 million to convert his buildings into an incubator for marijuana businesses. “It’s just such a mind-boggling thing. It makes you speechless,” said Arturo Sanchez, who oversees the city’s medical marijuana programs.

Wilcox won over City Council members despite intense opposition from some marijuana activists and growers who supply the Oakland market. Wilcox, who cheerfully acknowledges he enjoys a good brawl, boasts that he won the turf war.

“There was a transfer of power,” he said. “In essence, you could say big business is here.”

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My Take:  I’m sure the state of California is on an inevitable path to passing a law that will once and for all give medical marijuana a legal spot among the options for treating health conditions. I don’t’ think the online casino  or fake sports nutrition sites should be used as comparisons, but there is some link between marijuana and pain and this is what many medical marijuana  prescription holders want it for.  This isn’t about high-tech equipment or stress test systems to monitor the heart.  That’s what doctors and their fancy telementry monitoring systems and EKGs are for.  This is about people who reap significant health benefits by smoking something that’s already widely available and relatively cheap to buy.  Legalizing it makes sense. 

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If you are looking for the best California breast implant surgeon you have resources.  Ditto for an Oakland California (CA) Botox doctor.  Click here to link to a solid resource.

 

Source:  Live Science

A mental disorder linked to outbursts of anger and remorse has been found to be nearly twice as common as previously thought.

The research has sparked debate within the psychological community about the diagnosing of a mental illness whose symptoms overlap with normal, if undesirable, human behaviors, as well with as symptoms of other disorders.

Intermittent explosive disorder (IED), which is characterized by flying off the handle and overreacting to stress, was first recognized by the American Psychiatric Association in 1980. Now, as the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is the book psychologists use when making diagnoses, is undergoing evaluation and revision, some are calling for new criteria to be used in identifying IED and other related disorders.

The next edition of the book, the DSM-V, is planned to be released in May 2013, almost 20 years after the last edition, the DSM-IV, was published in 1994.

“IED is a behavioral disorder that is a medical condition in the same way that depression or panic disorder is – it is not simply ‘bad behavior,’” said Emil F. Coccaro, a professor of psychiatry and behavioral neuroscience at the University of Chicago. “Aggressive behavior is under genetic influence and IED runs in families.”

How common?

It’s not clear how many people have IED. The DSM-IV states that “reliable information is lacking, but Intermittent Explosive Disorder is apparently rare.” However, others say IED is much more common than previously thought.

A 2004 study of 253 Baltimore residents estimated that 4 percent of people develop the disorder at some point during their lives. But according to a 2006 study published in the Archives of General Psychiatry, “Depending upon how broadly it is defined, this disorder affects as many as 7.3 percent of adults, or 16 million Americans, in their lifetimes.”

The reason one study found IED to be nearly twice as prevalent as the other, Coccaro said, was in part due to gray areas in the diagnosis guidelines.

“The disorder was under-diagnosed,” Coccaro said. “The proposed changes will lead to it being diagnosed to a more correct degree.”

One problem with the current criteria is that they don’t clearly delineate the severity level or the frequency of aggressive outbursts that define IED, said Coccaro.

“Looking at the criteria as written, having only three aggressive outbursts in one’s life could give you the diagnosis,” Coccaro said. “However, people with only a few aggressive outbursts in their life do not look that different from other people. You really need to see much more frequent outbursts whether they involve very severe aggression or not.”

Coccaro said that the criteria should require that a person has had three episodes involving physical assault against other people or destruction of property within one year, with a degree of aggressiveness “grossly out of proportion” to the situation. Also, the aggressive behavior should not have been committed to achieve a logical goal, such as attaining someone’s money.

The criteria should also be written so that doctors diagnosing IED must rule out that the anger attacks, as they are sometimes called, aren’t related to other mental disorders that also involve problems of impulse control, such as antisocial personality disorder, conduct disorder and schizophrenia, Coccaro said.

Anger attacks

According to the current criteria, a “blow up” occurs when a person with IED becomes enraged and fails to resist their aggressive impulses. They may strike or otherwise hurt another person, threaten to hurt someone, or destroy property, according to the DSM-IV.

“Typically, these people perceive a slight when none was meant and they ‘blow up,’ or they get frustrated by something, or by a rejection, and they ‘blow up,’ “said Coccaro.

During an anger attack, a person with IED expresses a degree of hostility that is grossly out of proportion to any sudden psychosocial stressors. The explosive behavior is often preceded by a sense of tension and is immediately followed by a sense of relief. After the episode, a person with IED may feel upset, remorseful, regretful, or embarrassed about their aggressive behavior, according to the DSM-IV.

Road rage, domestic abuse, and angry outbursts or temper tantrums that involve throwing or breaking objects may be signs of IED, according to the Mayo Clinic. According to Coccaro and other researchers, treatment for IED may involve medication, such as Prozac, and psychotherapy to help control aggressive impulses. People with the disorder have been shown to responds positively to a combination of both.

Improving the criteria, Coccaro said, may further increase the number of people diagnosed with IED.

“The criteria in DSM-III and IV were poorly set up and encouraged clinicians not to make the diagnosis if the patients seemed to be generally impulsive or aggressive,” Coccaro told Life’s Little Mysteries.

Beyond IED

Confusing or inaccurate diagnosing guidelines are not as common as they used to be in the DSM, Coccaro said, but still exist. As more research is done on any disorder, it becomes better understood and defined more accurately. While some aspects of anger-related disorders remain mercurial, ongoing research has helped to bring data and awareness to the problems that exist.

How IED and other disorders will be defined in the upcoming edition of the DSM is still in question, as the DSM Task Force considers the comments and opinions of health professionals, patients, professional societies and researchers regarding the current definition, classification and diagnosing standards.

“There have been discussions about whether IED will change in the DSM-V, but no decisions have been made yet,” Jaime Valora, a spokesperson for the American Psychiatric Association, told Life’s Little Mysteries.

Still, Coccaro is hopeful that those revising the DSM will consider his research’s findings so that the latest edition of the manual can be used to more accurately diagnose people.

“Typically, changes are due to better data about a disorder that makes the writers and editors of the DSM make changes in the criteria,” Coccaro said.

________________________________

My Take:  I’ve got so many issues with this I don’t even know where to begin.  I have a teenager daughter who wants eyelash extension kits for her birthday.  I think she’s too young and she thinks I’m out of touch. She flew off the handle a few days ago and threatened to run away to her dad’s house. He’s a  Crestview FL plastic surgeon and he’s got no time or interests in having her with him regularly.

I’ve got no qualms with lash extensions, but I think at age 13 it’s a little bit much.  I know she’s also asked about seeing a Panama City FL facelift doctor and that was nixed right away.  She thinks she needs a nose job.  She’s beyond her years in wisdom, but it’s clouding her judgment severely.  She’ll be wearing evening dresses and carrying a mink stole by the time she graduates if she keeps this up. There won’t be enough evening gowns in the world for her closet either.

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European guidelines have changed to allow patients a shorter waiting.  Get back on the road after receiving an implantable cardioverter defibrillator (ICD).  They only have to wait three months after the ICD placement for secondary prevention of sudden cardiac arrest according to new European Heart Rhythm Association (EHRA) guidelines

This update cuts in half the length of time before a return to driving previously recommended by the EHRA and still recommended by the American Heart Association and Heart Rhythm Society.  Richard L. Page, MD, president of the Heart Rhythm Society, said that the change is reasonable and follows a general trend to reduce the duration of driving restrictions, although no changes in the AHA/HRS guidelines are expected.

Action Points

Explain to interested patients that American guidelines recommend waiting six months to return to driving after implantation of an ICD for secondary prevention and one week after implantation for primary prevention.

Note that the guidelines do not reflect national or state regulations or law enforcement on driving restrictions after ICD placement.

“It can be very frustrating for patients who have this sort of limitation on driving when it’s much longer than this,” he said, “especially in comparison to previous years when patients were required to wait six or 12 months if they were allowed to resume driving at all.”

Compliance with the recommendations has been a problem, he noted.  The EHRA taskforce behind the guideline update — led by Johan Vijgen, MD, of Virga Jesse Hospital in Hasselt, Belgium — agreed that improving adherence is a pivotal issue along with adequate education at discharge and follow-up.

The taskforce emphasized that the risk of sudden incapacitation in these patients while driving — which could pose a public safety threat — stems mainly from their underlying condition rather than the ICD itself.

The taskforce’s review of the literature in the secondary prevention population turned up retrospective and survey- or interview-based studies suggesting no higher risk of patient fatality or traffic accident risk than seen in the general population.

Nevertheless, the most influential evidence in making the six-month recommendation was from a prospective study of patients largely treated with antiarrhythmic drug therapy rather than ICDs.  It showed that most syncope, sudden death, and recurrent ventricular fibrillation or hemodynamically-compromising tachycardia events occurred in the first month after discharge from the hospital and was only moderately elevated for the next seven months.  Compelling evidence came out to challenge these recommendations, though, in 2007.

The prospective TOVA study revealed that the absolute risk of an ICD shock within one hour of driving was low and occurred primarily in the 30 minutes after driving (relative risk 4.46, 95% confidence interval 2.92 to 6.82) rather than during driving itself (RR 1.05, 95% CI 0.48 to 2.30).

Based on those findings, the guidelines taskforce decided to shorten the driving restrictions but not below three months, “since patients resuscitated for cardiac arrest very often need extensive time to recover from the event,” they said.

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“Patients should have an assessment of their functional class and cognitive functions before resumption of driving,” they added.  The literature review for risks after ICD implantation for primary prevention confirmed the generally lower risk for sudden incapacitation while driving; leading the taskforce to conclude that there is no need for driving restrictions after recovery from the procedure.

However, because patients need to refrain from extensive use of the arm on the side of implantation in the first weeks after the procedure to prevent complications, the updated guidelines recommend delaying driving until after a system integrity check at least four weeks post implant.

This is a more conservative recommendation than the one-week restriction imposed by the AHA/HRS guidelines, Dr. Page noted.  Other recommendations in the European guideline update include:

• A three-month driving restriction after an appropriate ICD shock
• No driving after an inappropriate ICD shock until measures are taken to prevent another
• A one-week delay in return to driving after replacement of the ICD
• A four-week driving restriction after replacement of the lead system
• No restriction for patients refusing an ICD for primary prevention
• A seven-month restriction for patients refusing ICD implantation for secondary prevention

Of course, these guidelines are for noncommercial drivers and not professional drivers of commercial vehicles who were recommended to have permanent restrictions.  The guidelines, hopefully, will serve to unify the varying national driving policies across Europe; at least that is what the taskforce hopes for.  It was noted by Dr. Page that in the US, individual states do not have consistent regulations, but they do have uniform national guidelines.

“In every case, I would just recommend that doctors be aware of their local regulations and that they advise their patients to make sure that they are aware and abide by the local rules regarding driving,” he said.

____________________________________

My Take: These guidelines sound very reasonable to me.  I just wonder why the US has not followed their example.  Do we hear in the US know something your does not?  Maybe a little research into the matter might reveal a few things.

I do know that the US has many restrictions for people who have any kind of medical problem.  I also understand the reasoning behind those restrictions.  If someone, who has a severe disability, has the chance of causing an accident, it is best to restrict that person’s ability to drive.  I for one, have a disability that could conceivably result in a car accident.  However, I beat my Dr. to the punch and stop driving before they could restrict me.  I know, that there is a possibility of not being able to use my hands to properly steer the vehicle and avoid an accident.  However, many people are too stubborn to admit that they may not be able to drive.

As teenagers, we fight hard to get that driver’s license because it is a symbol of adulthood.  Once we have it, we do not want to lose it because it is part of being an adult.  I think many people who face the possibility of losing their license because of a disability or impairment seem to think it reduces their status as an adult.  Others, lose their license because of simple stupidity like driving while intoxicated or not paying all of their tickets.

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J. James Rohack, MD. outlined his goals for the next year during an interview.  They Texas cardiologist is just as comfortable working his 23-acre ranch as he is caring for the hearts of his patients.  He plans to use a down to earth work ethic and compassion for patients to tackle the challenges facing medicine and the nation’s physicians.  Dr. Rowe hack was initiated as the president of the AMA during the organization’s annual meeting this June.

The first in his family to attend college, the medical graduate of the University of Texas Medical Branch at Galveston charted a path toward a career in cardiology at Scott & White Clinic in Temple. These days, his routine consists of a pre-dawn, two-hour drive from his home in Bryan through Central Texas to the community-based, multispecialty clinic.

As he embraced the Lone Star state’s culture and diversity, Dr. Rohack, 55, has worn many hats, including the occasional ten-gallon one. An affinity for education led him to a professorship at the Texas A&M University System Health Science Center College of Medicine. His roots at UTMB — whose primary mission until the late 1990s was caring for the state’s uninsured and indigent — and at Scott & White Clinic — which started as a prepaid health care system for railroad workers — now drive Dr. Rohack to help usher in health system reform, one of his top priorities.

His other goals include Medicare payment reform, eliminating waste and redundancy in the health care system, and eradicating racial and ethnic disparities.  Despite a full agenda, he doesn’t plan to sacrifice too much time on the ranch with his wife of 30 years, Charli, and stepdaughter, Elisha. He’s committed to toiling the land, often while catching a football game on the radio.

AMNews: What are some highlights of your career that helped define you as a physician?

Dr. Rohack: Since I was the first one to go to college, I didn’t have specific aspirations of getting into the medical profession. Clinical psychology was something that interested me. When I finished at the University of Texas El Paso, the president of UTMB came on campus and he talked about the mission. And at the time, if anyone didn’t have health insurance they were sent to UTMB for their health care. So as the major referral center for the state, it highlighted to me what the mission of giving back really was.

I also had the opportunity as an intern to start a continuity clinic, something new at the time. It was a way you could start seeing patients in your first year and then follow them over time. So I actually had patients that I had cared for, for six years. So it gave me the important lesson that, if the education system teaches about the body parts and not the whole person, then patients get frustrated because they are not sure who their physician is.

AMNews: What particular passions in medicine do you want to see realized this year?

Dr. Rohack: We have to make sure people have health care access and insurance coverage. We also recognize that we, as physicians, have to be part of the stewards of the health care dollar. And who best to know when one is talking about technology or different therapies, what really is the best for patients on an evidence basis. So in this next year, I’m convinced that with the $2.3 trillion we’re spending in health care and [a predicted] increase of 6.7% per year, we can slow that curve by getting rid of some of the waste we have in our system.

And clearly we have to do more on racial and ethnic disparities. … Just like cardiologists have to break through the barriers that heart disease is a man’s problem, physicians also need to break through the barriers that racial and ethnic disparities are solely due to a lack of health insurance. … In Texas, we are going to become a Hispanic majority state in a very short period of time. Every day I have patients in minority populations come in, and because they are not aware of certain medications or ways I’m talking about disease, they go home and they don’t take their medications or they may not have access to medications.

AMNews: Health system reform seems to be at the top of many lists. Where is the AMA in that conversation?

Dr. Rohack: Health system reform that doesn’t have the physicians as part of the solution is doomed to fail. … If physicians aren’t at the table, we’ve got 1993/1994 all over again where physicians were excluded. And when it came out, it was clearly something that was not going to be implementable or acceptable. Now as opposed to the past, the AMA is involved in coalitions with other groups — the business community, insurance community, hospital community — saying, how do we continue to evolve our system so we can meet these basic principles of affordable, quality care and choice … without stifling innovation. …

I’m excited. The first nine months of presidency are going to be crucial ones, because it appears the stars are lining up in Congress, as well as in the White House and the private sector, and businesses, patients, physicians are all saying keeping our current health sector status quo is unacceptable. …

Clearly, the [May 11] meeting at the White House with the president and the other components of the health sector highlight the AMA’s representation of America’s physicians to assure patients have affordable high quality health care. It also signaled that the private sector, when focused on a common goal, can achieve that goal when working together with the public sector as a facilitator and not a barrier. … Our pledge was to try to reduce [health care spending] to a 5.2% growth. We want to make sure that, with this whole process of quality improvement and focus on variation tools we really didn’t have 30 years ago, that we can put that into action to reduce unnecessary costs.

AMNews: Where does the discussion on Medicare payment reform stand?

Dr. Rohack: We have to fix a broken Medicare physician payment system. The danger of that is, at the time we’re talking, there’s a proposal in the Senate to not have this changed and just kick the can down the road another couple of years. That’s just fiscally irresponsible, because three years down the road, the first of the 4 million baby boomers are going to hit Medicare. We already have silos where if I, as a physician, see that patient with heart failure five times a year to keep them out of the hospital, the hospital payment actually gets the reward and the physician doesn’t get any share in saving the Medicare system as a whole. So it’s a [contradictory] message when, on the one hand, the Medicare program is saying we want to improve care, control certain chronic diseases … and oh, by the way doctor, when you do that, we’re going to cut your payment.

AMNews: Texas has touted the successes of its 2003 tort reform measures, yet national activity seems to have quieted.

Dr. Rohack: The reason medical liability reform was successful in Texas is that people who normally would not vote that way saw the impact of [having] no doctor. … We’ve had a change in Congress, and the discussion on medical liability reform has taken a different way. [It's] a recognition that reform has to be part of the solution in controlling health care costs. But it may not be a global cap, like we have in Texas. It may be some alternative mechanism like health courts, expert witness qualifications, alternative dispute resolutions. Mechanisms that still try to provide efficiency if someone is injured, but also recognize that the current jackpot justice lottery system doesn’t really drive improvement in quality and safety.

AMNews: How have you adapted to the transition to the AMA presidency?

Dr. Rohack: This year I stopped seeing new patients, because I felt it wasn’t good for patients for me to see them once and then not see them again for a few weeks. But my nurses always have access to me, so every day I get e-mails. We are also blessed with an electronic medical record system … so if a patient has a problem and I don’t recall the fine details, I can go through our Web system. … Some patients I’ve been seeing for over 20 years, so many were concerned I was no longer going to be their physician. It reminded me very tangibly that we are put in a trusted place with our patients.

AMNews: Are there any family activities you will miss during this time?

Dr. Rohack: Elisha and Charli are very important to me. Elisha is a special child. She’s 41. She’s mentally handicapped and she is like pure love. That’s another reason in my travels … I try to be home for her because mentally handicapped kids don’t have abstract thought, so she’ll get depressed if I’m not there.

The other big thing I’m going to try to make sure I have time for is the manual labor on the ranch. I help my wife on our wildlife rehabilitation facility. And I thoroughly enjoy mowing the grass and cutting down trees … It’s fun. It’s relaxation to me. Charli has evolved her [animal rehabilitation] practice to specializing in birds of prey, hawks, vultures … so yes, you have the president-elect of the AMA transporting animals to the Texas A&M [University] College of Veterinary Medicine. Charli has been taloned more than me because obviously she deals with this all the time. The other thing is, out on the ranch, I also protect my ears when using a mower, things like that, because as a cardiologist that’s very important.

AMNews: Texas is a big football state. Any particular loyalties?

Dr. Rohack: There are five seasons in Texas: winter, spring, summer, fall and football. So I am a proud graduate of UTEP. … And as a faculty member [at Texas A&M University] I live in the community and I’m supportive of the Aggies. If A&M ever plays UTEP, I’m for UTEP. But when it comes to the rivalry games, the University of Texas in Austin is the big gorilla. … so any time A&M can beat Texas, I feel UTEP is vicariously supported.

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My Take: Well, he seems to talk a good game.  If he means what he says, he might be able to do something.  However, they have been talking about Medicare reform for years.  The government has done very little on this front so far.  I am a Medicare recipient and I know what I get and what I do not get, like dental care.

There are so many aspects of Medicare that can be confusing to anybody, including those who consider themselves experts.  Everybody on Medicare needs to learn what is connected to his or her condition.  You cannot leave it up to the doctors or the Medicare HMO.  Some doctors will actually fight for their patients’ rights and others have too many patients to do it.  The Medicare HMO is only concerned in getting their money and how much they spend, not for the patient.

Each person on Medicare needs to read their patient rights.  That is the key to getting the benefits that they allow.  However, to understand all these rights, you practically have to be a lawyer who specializes in medicine.  The government needs to make these rules and regulations in a form that is understandable by the average person and not just lawyers.

The main problem with Medicare is that most of the people on it are also on a limited income.  They cannot afford to pay extra for the things that they need such as dental care.  They cannot afford some of the co-pays that are required by Medicare or the HMO.  This means that they do not get the medical care that they want or need.  However, there are those people who are eligible for Medicare because of age and really do not need it because they have plenty of money.  There are many rich people who are on Medicare simply because they are eligible.  Maybe if these rich people, who could afford the best medical care, were not on Medicare, Medicare could afford to help those who do not have the money for the medical care they need.

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Healthy Homes

As in art, antiques, wine and collectibles, the common denominator of homes represented by real estate brokers is not a particular price range, but rather the distinctive character of the property real estate in Nyack NY.  A good agent can serve clients selling properties of significant interest in all price ranges.  An agent with Rockland County homes for sale can help you find a home that will speak to you and warm your heart and soul as well as give you a healthy environment to live in.

Two popular scents were utilized in one of the most comprehensive investigations done today on aromatherapy.  It failed to show any improvement in pain control, healing or immune response among people that were exposed to them.  These scents were lemon, which appeared to enhance people’s moods positively and the other lavender, which did not seem to affect subjects’ moods at all, at least based on three psychological tests.  Alternative practitioners use these two aromas most often.

Neither lemon nor lavender showed any enhancement of the subjects’ immune status, nor did the compounds mitigate either pain or stress, based on a host of biochemical markers.  In some cases, even distilled water showed a more positive effect than lavender.

The study, published online in the journal Psychoneuroendocrinology, looked for evidence that such aromas go beyond increasing pleasure and actually have a positive medical impact on a person’s health. While a massive commercial industry has embraced this notion in recent decades, little, if any, scientific proof has been offered supporting the products health claims.

We all know that the placebo effect can have a very strong impact on a person’s health but beyond that, we wanted to see if these aromatic essential oils actually improved human health in some measurable way, explained Janice Kiecolt-Glaser, professor of psychiatry and psychology at Ohio State University and lead author of the study.

The researchers chose lemon and lavender since they were two of the most popular scents tied to aromatherapy. Recently, two other studies focused on these same two scents.

For the study, Kiecolt-Glaser; Ronald Glaser, a professor of molecular virology, immunology and medical genetics, and William Malarkey, professor of internal medicine, assembled a group of 56 healthy volunteers. These men and women were screened beforehand to confirm their ability to detect standard odors. Some were proponents of the merits of aromatherapy while others expressed no opinion on its use.

Each person took part in three half-day sessions where they were exposed to both scents. Participants were monitored for blood pressure and heart rate during the experiments, and the researchers took regular blood samples from each volunteer.

For those who are interested in learning how to relax in other ways . . . Students of the Alexander Technique learn to release excess tension allowing the spine to lengthen, the joints to open up, the bones to float away from each other, and the muscles to lengthen. This creates a more coordinated body with graceful movement and improved posture. The result is optimal functional mobility, decreased pain, and a greater sense of well being. The Alexander Technique classes in Manhattan are an educational system that helps people use their bodies with greater ease and efficiency in everyday activities. It improves postural and movement dysfunction by engaging the mind and body to reduce physical misuse.

Because you want to get the most out of your workouts, a comprehensive Pilates fitness program with training video/DVDs on proper techniques for maximum safety and results is needed.  There are also podcasts outlining each exercise with Pilates as well as how to do Pilates correctly.  The secret to Pilates and the secret to flat abs is doing the exercises correctly, so utilize the Pilates DVDs and podcasts that are available online to learn the keys to getting the most out each Pilates exercise so that you can reap the benefits of Pilates.

Researchers taped cotton balls laced with either lemon oil, lavender oil or distilled water below the volunteer’s noses for the duration of the tests.

The researchers tested volunteers ability to heal by using a standard test where tape is applied and removed repeatedly on a specific skin site. The scientists also tested volunteer’s reaction to pain by immersing their feet in 32-degree F water.

Lastly, volunteers were asked to fill out three standard psychological tests to gauge mood and stress three times during each session. They also were asked to record a two-minute reaction to the experience, which was later analyzed to gauge positive or negative emotional-word use.

The blood samples were later analyzed for changes in several distinct biochemical markers that would signal affects on both the immune and endocrine system. Levels of both Interleukin-6 and Interleukin-10 two cytokines were checked, as were stress hormones such as cortisol, norepinephrine and other catacholomines.

While lemon oil showed a clear mood enhancement, lavender oil did not, the researchers said. Neither smell had any positive impact on any of the biochemical markers for stress, pain control or wound healing.

This is probably the most comprehensive study ever done in this area, but the human body is infinitely complex, explained Malarkey. If an individual patient uses these oils and feels better, there is no way we can prove it doesn’t improve that persons health.

However, we still failed to find any quantitative indication that these oils provide any physiological effect for people in general.

The wound healing experiments measured how fast the skin could repair itself, Glaser said. Keep in mind that a lot of things have to take place for that healing process to succeed. We measured a lot of complex physiological interactions instead of just a single marker, and still we saw no positive effect, he said.

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My Take: I do not get it!  I have never heard that aromatherapy is something that helps your health other than relieving stress by helping you to relax.  I was under the impression that that is what aromatherapy was all about, relaxation.  When did they start saying that it could alleviate pain, and make you healthier?

This is like saying that leather chokers with a specific symbol will prevent headaches!  It is true that many cultures have tribal symbol pendants that they wear to prevent disaster or improve luck, but that does not mean it really works.

Now scientists are putting money into research to prove that it “does not work”?  I am sure that there is a better way to waste money!  They could easily have taken that money and put it into research on how to correct chemical imbalances in the brain that cause many of the psychological problems that people have, like schizophrenia.

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Announcements and Invitations

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Birthday Party Invitations are so fun. From 1st birthday invites to 50th Birthdays invites, you will find fun, unique cards available online. Choose from a variety of typestyles or font and different ink colors to match your design or party theme. To make it easy, request matching response cards and thank you cards for each invitation design. If you are looking for party favors, consider the matching personalized candy bar wrapper or one of our photo cookies or other treats.

When Jean called the other day from Palm Springs, she stated that the state was cutting her aid and that she was worried. She was notified that California was cutting back again on the aid for the disabled. Of course, Jean is not her real name. She did not want her friends in LA to know of her living conditions. She thought she would be embarrassed if they knew and considered it to be because of her pride. She is correct in stating that nobody wants to admit that they are down and out.

She suffers from fibromyalgia, a disease of the connective tissues. Several years ago, Jean says, she was a buyer for the old Bullock’s department stores in L.A. but became afflicted with the painful ailment and finally couldn’t work anymore.

She moved to the desert. It was cheaper living and she’d be closer to her aging mother. Jean is 63, her mother 86. “Turns out she helps me more than I help her.”

On good days, Jean uses crutches. Other days, she’s in a wheelchair. “The pain never goes away.” I hadn’t talked to Jean in more than three years, since the first time she called expressing concern about the state ripping off federal cost-of-living boosts for the impoverished aged, blind and disabled. Yes, that’s legal.

She’s one of nearly 1.3 million Californians receiving federal Supplemental Security Income, augmented by a State Supplementary Program. They’ve always been an easy target — too poor to throw big bucks at political candidates. But, of course, practically anyone who draws a state buck these days is vulnerable.

Faced with what he calculates to be a potential $24-billion budget deficit in the fiscal year starting July 1, Gov. Arnold Schwarzenegger has proposed cutting state supplemental payments for the elderly and disabled down to the minimum allowed by federal law. It would be their third cut this year.

The Legislature already has approved a $20 monthly cut beginning July 1, lowering the grant for single people to $850. That’s it: No food stamps, and that includes any Social Security.

This was the cut Jean had read about. But the governor also is seeking another $20 trim starting in September, reducing the benefit to $830.

The rent for her one-bedroom condo is $850. But “I consider myself lucky,” Jean says, because after a long wait, she finally received a federal rental subsidy administered by a local housing authority.

That’s not the end of her financial woes, however. Jean has a broken tooth and badly needs a crown. But Medi-Cal, she says, will only pay for a type of crown that “dentists don’t even use anymore.” And things are about to get worse: On July 1, Medi-Cal will stop paying for adult dental care altogether.

For those whom need additional medical care . . . . Plastic Surgery is the art of improving one’s appearance with the help of science and medicine. A good Destin Florida plastic surgeon must not only be a good student of science and the wisdom of life, but also possess an artistic eye, the skills, and craftsmanship that allow the best possible care for his patients. This applies equally to both reconstructive and cosmetic surgery. It is all about making a person whole in a way that is visibly apparent first to oneself in a mirror, then to the rest of the world and Florida plastic surgeons have this ability.

Around the time Jean was calling, I got an e-mail from Marta Russell, an Encino-based freelance journalist who has written widely about the disabled. Russell has had cerebral palsy from birth but made good money in the film industry, working on special effects, until she also contracted fibromyalgia and landed in a wheelchair. “I am in chronic pain,” she says.

She’s not poor enough to be on SSI but does need help at home “to empty trash, do laundry, pick up things that are heavy — to stay out of an institution.”

Schwarzenegger has proposed reducing caregiver pay under the In Home Support Services program — used by 446,000 Californians with disabilities — from a maximum of $10.10 per hour (including benefits) to $8.60. That will make it tougher to find help.

Worse for Russell, she wouldn’t be deemed sufficiently impaired under the new rules to qualify for IHSS. “I can’t imagine how I’m really going to deal with it,” she says.

“I expect suicides, premature deaths, a horrible disruption of the social fabric. . . . We’re headed toward market-based social Darwinism where only the fittest will survive.”

The governor hopes to save $402 million during the next fiscal year with his latest SSI-SSP cut. Reducing caregivers’ wages would save $124 million, and disqualifying the majority of current IHSS recipients would pocket $385 million.

Of course, Schwarzenegger’s proposed cutting goes much deeper than that. He also wants to completely eliminate the state’s main welfare program, which benefits 1.3 million people, and save $1.4 billion. And he’s trying to scuttle the Healthy Families program that provides medical insurance for 930,000 children of low-income families, netting $369 million.

“I know we all have to sacrifice something, but are the wealthy sacrificing anything?” Jean asked.

They’d say they’re paying hefty taxes.

State budget director Mike Genest was asked another version of Jean’s question by a reporter: “Why are all the poor people being cut?”

Genest: “The government doesn’t provide services to rich people. We don’t provide very many services even to the middle class. . . . You have to cut where the money is.”

That’s a little stretch. But Genest is mostly correct as it relates to the hemorrhaging general fund. Public schools serve students whose young parents are usually just starting up the economic ladder.

Of the current general fund, roughly 40% goes to K-12 schools and 32% to health and welfare. The next highest expenditures are higher education and prisons, each 11%. Everything’s getting whacked, including employees.

Jean and Russell are among many Californians who are scared after Schwarzenegger “scare tactics” after the failed budget propositions when he warned voters what would happen if the measures did not pass.

Here are some predictions:

Legislature will not allow the governor to completely wipe out welfare and children’s healthcare by targeting aged, blind and disabled. Republicans will not allow him to raise taxes and get Democrats will try to raise them with a majority vote. The $24 billion deficit includes a $4.5 billion reserve the Democrats not allow the governor to record so the deficit will be termed $20 billion. The disabled, blind and aged will suffer because of what may come to pass.

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My Take: I am always amazed at how government can reduce something that is so needed and still collect so much money themselves. For example, the governor of California is reducing the pay of caregivers that are needed by thousands of people. What about the governor taking a cut in pay? Oh, that cannot happen, he does not make enough as it is! NOT!

The government keeps talking about reducing costs to reduce a deficit and get out of the red and back into the black. Yet, they reduce things that are needed and the payee of those that cannot afford a cut in pay. I have read that many cities are cutting the pay of their police force and their fire department! That is ridiculous because they are not paid enough as it is.

I wonder, what would happen if “the government” took a cut in pay. I do not mean deducing taxes, of course that would be fantastic, I mean the senators, governors, mayors, representatives, Congressman and even the president taking a cut in pay. Everybody knows the Congress always votes a pay increase when they start their session every year. Why not make history and vote for a cut in pay instead. They could also stop using limousine services and private jets to reduce costs.

Of course, this is just too simple of an idea for them to think up, isn’t it? They would rather put the common American further in debt with less payee and less healthcare benefits. Yet, they’re trying to tell us this is not what they are doing. Think again!

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Natural Beauty

A beauty products company should be committed to providing its customers with the best in organic and natural skin care, beauty and aromatherapy products. They should carefully select brands for quality ingredients, efficacy, and ethical considerations. They should personally test each and every product themselves, like Hugo naturals, and scrutinize every ingredient listed. They might also ask about manufacturing processes. So they can’t assure customers that their products not only help you feel and look your best, but also help the environment.

Medical Care

Doctors around the country need access to products from the nation’s major pharmaceutical firms and medical diagnostic equipment makers, as well as an online source for physicians to purchase tools such as CPT codes online and office testing equipment. More people are living longer with chronic medical conditions such as diabetes and heart disease and other medical conditions. As a result, physicians are performing more routine medical tests in their physician office labs. This equipment includes such things as the INRatio monitor is a diagnostic point of care system that provides Prothrombin Time (PT) and International Normalized Ratio (INR) results using fresh capillary whole blood from a fingerstick and the medical ambulatory blood pressure monitoring system that allows healthcare professionals to automatically monitor a patient’s blood pressure throughout the day.

]]> http://www.healthnutsandbolts.com/the-nightmare-of-california-health-coverage-is-coming-true/healthcare/2009/07/feed 11 http://www.healthnutsandbolts.com/ehr-adoption-accelerated-by-medical-transcription/healthcare/2009/07 http://www.healthnutsandbolts.com/ehr-adoption-accelerated-by-medical-transcription/healthcare/2009/07#comments Sat, 18 Jul 2009 01:55:08 +0000 Another Health Nut http://www.healthnutsandbolts.com/?p=21 Cited: Advance Magazine

In response to Pres. Obama’s provisions and mandate for EHR adaption under the recent HITECH Act, the transcription sector took a message to Capitol Hill on June 3-4. With Pres. Obama pushing for definition and criteria are for “meaningful use” by July, the Medical Transcription Industry Association (MTIA) and the Association of Health Care Documentation Integrity (AHDI) believe that the window is narrowing for the opportunity for that sector to ensure the criteria includes provisions for the evolution of transcription in hybrid capture. There is complex narrative is that need to be preserved and quality outcomes, not just fiscal savings, that drive adoption and integration of systems. The determination of “meaningful use” lies in a hands of the Department Of Health and Human Services (HHS) and each IT vendors are getting ready for those key decision-makers to make up their mind. That message to the legislators was that the HHS needs others involved in that decision-making who are interested in tearing it more towards the technologies that will be deployed and not whether they will be deployed.

Defining “meaningful use” is not the role of HIT but rather of clinicians and experts in health care documentation who can speak to the document workflow process and the complexities of capturing health stories in a way that informs clinical decision-making and promotes coordination of care. If the “meaningful use” definition is shaped only by the vendor community, there is great risk for EHR deployment to fall short of health care’s goals for capturing and consuming health information. All stakeholders, most importantly the patient, lose under such an imprudent integration approach.

More than 120 legislative appointments were held during the 2-day summit through collaborative dialogue from both MTIA business owners and AHDI health care documentation workers who met together with Senate and House members to share the importance of our quality-focused sector in accurately capturing patient health stories. We visited with legislators from 26 states and delivered letters from AHDI members to their respective legislators for 28 states. Each person had an opportunity to share the key talking points and messages prepared for the event, as well as to engage in dialogue with legislators and their aides about the role transcription can and does play in accurate capture. Likewise, we stressed the need to preserve complex narrative in the EHR so that the important nuances of a patient’s story are captured outside of restrictive point-and-click templates. Consideration must be given, as well, to the impact on clinicians who are inefficiently deployed to capture health care encounters rather than engaging in provision of care. And we talked about the value of a knowledge worker positioned in partnership with physicians to ensure the accurate, secure capture and repurposing of health information.

A lobbying firm will be hired by MTIA and AHDI that will help push this message to the right people on the HELP committee (Health, Education, Labor and Pensions) in HHS. These people are the ones who are responsible for the “meaningful use” definition. The lobbying firm will also help get the message and recommendations to David Blumenthal, the National Coordinator for Health IT, to make sure that transcriptionists are not left out of the EHR integration regulations, recommendations and standards. The opportunity to contribute to and participate in this advocacy effort is what both medical transcription service organizations (MTSOs) and MTs are looking for.

You can find out more about the AHDI/MTIA Advocacy Summit by visiting the Summit Web page at www.ahdionline.org. You can just click on “Networking” and “Events.”

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My Take: As a former medical transcriptionist, I think this is great. I only call myself a former Transcriptionist because too many MTSOs have gone out of business because of “outsourcing”. Thus, I am now writing needs comments to you about the above article.

Then as now, I do not have to worry about time and attendance because I work from home at my own speed and when I want. I also never had to worry about making sure that my time got into an online payroll service so that I could be paid because it was all calculated by me in an invoice. To clarify, I was a subcontractor as I am now.

MTs are paid a very good rate. That does not mean that they are able to get a maid VA to do their housework. That does not mean that some of the better ones cannot avail themselves of professional cleaning services Fairfax. The faster you work and the fewer errors you have determine what pay rate you get per line and whether you can afford VA cleaning.

I think that having both the MTSO’s and MTs involved in the decision-making is a good thing. I equate this with having a firefighter involved in purchasing protective gear that he uses to fight fires. It makes sense for everybody to get a fair break with EHRs.

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Online Gaming

I do not mean role-playing games, I mean casinos online. Like medical transcription, this is something you can do from the comfort of your home. You can even play online poker from your home. There are many online casino gaming sites that actually offer you bonuses for signing up. Those bonuses are the equivalent of dollars. If you are any good at gambling, it might be something to look into.

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