HinesSight

We are the 1%! (heart-health wise)

My wife and I have proudly marched in Occupy Salem events, chanting "We are the 99%!" But we're pleased to learn that we're also in the 1% -- the percentage of Americans who met all seven metrics of cardiovascular health.

Which are:

• Not smoking
• Physical activity (being active)
• Having blood pressure under control
• Maintaining healthy blood glucose levels
• Maintaining healthy blood cholesterol levels
• Maintaining a healthy body weight
• Following a healthy and balanced diet

I barely made it past the body weight criterion, finding that my six feet tall'ness and 182 pounds of weight'ness gave me a BMI (body mass index) of 24.7, just a bit under the 25 that qualified me for normal weight.

Otherwise, though, I'm clearly in the Healthy Zone on the other six criteria. And it really isn't all that difficult to do. 

Yet only 1.2% of Americans met all seven metrics during 2005-2010, compared to an also-measly, but somewhat better, 2% from 1988 to 1994.

Conclusion: Americans are in bad shape.

That's obvious from watching my fellow citizens gorge themselves on crappy food, and try to cram their fat butts into airplane seats that are plenty wide for normal bodies -- but not the abnormally obese American physique.

Health insurance plans and employers are catching on to how much medical care money goes to pay for conditions that could have been prevented if people had healthier lifestyles. Good news.

If people's insurance premiums were partly based on how many of the seven heart-healthy metrics insurees met, that'd be a monetary incentive to engage in healthier behaviors. 

PETA warns women about screwing a vegan guy

Geez, I didn't know that us vegan/vegetarian men were so dangerously erotically powerful.

But thanks to PETA (People for the Ethical Treatment of Animals), I've learned the truth about BWVAKTBOOM, "Boyfriend Went Vegan and Knocked the Bottom out of Me." Have a look.

 

Is it true? Of course! You've just learned about this via a blog post on the Internet. Don't you believe everything you come across in cyberspace?

(This woman has a different attitude, but she writes for Slate, which is almost mainstream media. So trust the PETA video; go vegan/vegetarian -- sexually safely, though.)

Do my telomeres look longer? (I'm taking astragalus)

About four years ago I shared my supplements list with a mildly- to un-interested world. Seems like a good time to do it again, since there's been some Big News in the non-prescription nostrums I take every day to keep disability, disease, and death at bay.

I've gone from 22 supplements to 19.

Gone are two algae oil sources of DHA and EPA, as I've replaced these with Ultimate Omega fish oil. Even though I'm a vegetarian, I decided that consuming fish oil was OK, karma-wise, since there doesn't seem to be an equally good non-animal source of omega-3 fatty acids.

Garlicin and gingko biloba bit the supplement dust. Vegetarian glucosamine was replaced by Celadrin, a joint health compound (that also contains some animal stuff) which has some decent research behind it. Pygeum and saw palmetto were dumped in favor of two prescription prostate-symptom-reducing drugs, dutasteride and tamsulosin (brand names: Avodart and Flomax; I take generics).

I added Super Zeaxanthin for eye health, and -- most recently -- Astragalus for telomere lengthening and general health promotion. Having telomeres that are as long as possible seems to be pretty important, according to anti-aging research cited in Scientific American.

Peter Pan stayed forever young in Neverland. In real life, some scientists are looking at telomeres, or regions of repetitive DNA at the ends of our chromosomes, to try to arrive at something like a real version of this story.

Telomeres consist of up to 3,300 repeats of the DNA sequence TTAGGG. They protect chromosome ends from being mistaken for broken pieces of DNA that would otherwise be fixed by cellular repair machinery. But every time our cells divide, the telomeres shrink. When they get short enough, our cells no longer divide and our body stops making those cells. Over time, this leads to aging and death.

Astragalus appears to slow down this process.

New York-based T.A. Sciences claims to be the only company in the world manufacturing a supplement in a pill form that has been lab tested and shown to stop telomeres from shortening, in hopes of halting the aging process. The product, TA-65, comes from extracts of the Chinese herb astragalus, which has been used for medicinal purposes for more than 1,000 years, says Noel Patton, chief executive officer of the company. 

I'd take TA-65, but it's freaking expensive: $219 for 30 capsules, but it looks like the cost could be $1,000 a month for a higher dosage. I'd like my telomeres lengthened, yet not that much. And there's good reason to be skeptical of what T.A. Sciences is up to. So I bought some Solaray Astragalus for $6.54 per 100 capsules through Life Extension.

Hey, if I feel like my telomeres are longer, maybe they actually are. (Please compliment me on my pleasingly lengthy telomeres if you see me in person; that'll help with my placebo effect.) Dr. Oz is big on astragalus, for what that's worth.

By middle age you’re not only feeling exhausted; your cells are also starting to wear out. The reason? Shorter telomeres. Every time a cell divides, a little chunk of telomere gets spent. When you run out of telomeres, the cell stops replicating. My secret cell supercharger is astragalus, an herb that’s been used in Chinese medicine for thousands of years. New studies suggest that a compound in astragalus can affect telomere length in cells. I recommend taking up to 1,200 milligrams of astragalus with a glass of iced coffee or green tea. The caffeine in these drinks naturally boosts metabolism, helping you burn calories.

Here's my updated supplement list. Like I said before, "Do your own research. Make up your own mind."

Acetyl-L-carnitine 620 mg
Align probiotic
Alpha lipoic acid 100 mg
Astragalus 400 mg 
Aspirin 81 mg
Bilberry fruit extract 120 mg
Celadrin 1050 mg
Cold-FX 200 mg
Co-Q-10 60 mg
DHEA 25 mg
Fish oil 1000 mg ("Ultimate Omega") 
Green tea extract 725 mg
Lutein 12 mg
Melatonin 1 mg
Multi-vitamin ("Doctor's Choice for 50-Plus Men")
Pomegranate extract 500 mg
Resveratrol 250 mg 
Super Zeaxanthin
Vitamin D 400 IU

Why I decided to still get a PSA test

I'm a believer in scientific research. I worked as a health planner for over ten years. I wrote a well-received analysis, "Quality of life in allocating health care resources." I understand that much medical care is wasteful, unneeded, and ineffective.

Nonetheless, at my annual physical last week this 63 year old guy still decided to get a PSA test, which is used to detect prostate cancer. Only problem is, the test isn't very effective. In October the United States Preventive Services Task Force recommended against getting the test, in most cases. 

Healthy men should no longer receive a P.S.A. blood test to screen for prostate cancer because the test does not save lives over all and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence in many, a key government health panel has decided.

Reading an article about this in our newspaper, I'd pretty much decided to pass on a PSA test when it came time for my annual physical. If the test causes more harm than good, why get one?

However, I'm fortunate to have a family doctor who open-mindedly discusses options with her patients. We talked about the pros and cons of me getting a PSA test for five minutes or so. In the end, I said "Hey, why not? I'll get a PSA test this year, like I have in the past."

This was what shaped my reasoning: (1) My insurance would pay for the test. (2) I could either ignore the results of the test, or I could pay attention to the results. (3) Either way -- ignore or pay attention -- I'd have more information if I got the PSA test, than if I didn't.

You can read the draft recommendation from the Preventive Services Task Force here. lt seems solid.

Experts at the Oregon Health Science University, a short drive up I-5 from where I live, affirmed the Task Force's review of the literature on PSA test effectiveness. So I'm convinced that, given current knowledge, for most men there's no compelling reason to get a PSA test.

But there's also no compelling reason not to.

It's up to the individual, like me, who is as capable of deciding whether to get a PSA test as to how much importance should be given to the results. Meaning, just as I could have decided to pass on a PSA test, so I could pass on any further diagnosing if the test came back with a positive result.

In the exam room I told my doctor, "The main argument against getting a PSA test seems to be that a positive result often leads to unnecessary treatment, with nasty side effects (impotence, incontinence). However, this implies that patients are helpless to resist the Medical Treatment Machine, which sucks them in against their will."

So I thought, why not? 

A positive test result would worry me, but not nearly so much as it would have before I learned that 80% of positive PSA results are false. Thus usually it makes sense to take a positive result lightly, or even to ignore it completely.

Again, I realized that I could either ignore the PSA test by not getting one, or I could get the test and then ignore the results. (Which turned out to be negative, by the way.) I trusted that my doctor and I could deal with a positive result wisely -- not rushing into a biopsy or surgery without a very good reason.

This attitude is in line with a recent "Perspective" piece in the New England Journal of Medicine: "One Man at a Time -- Resolving the PSA Controversy."

The U.S. Preventive Services Task Force recently released a draft recommendation on screening for prostate cancer, designed for primary care physicians and health systems, and has opened it for public comment until November 8, 2011. After completing a rigorous evidence review, the task force decided to recommend against screening for prostate-specific antigen (PSA), concluding that there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. This grade D recommendation applies to healthy men of all ages, regardless of race or family history. The task force's suggestion for practice for grade D interventions is to “discourage the use of this service.”

...Our perspective is that this evidence of a possible small but finite benefit from the largest trial would best support a grade C recommendation for men 55 to 69 years of age. With a grade C recommendation, the task force would be recommending “against routinely providing the service” while indicating that “there may be considerations that support providing the service in an individual patient” and stipulating that “there would need to be at least moderate certainty that the net benefit is small.” The task force's suggestions for practice in the case of a grade C recommendation include the suggestion that they “offer/provide this service only if other considerations support offering or providing the service in an individual patient.”

A grade C recommendation would allow the patient to be involved in the decision to skip or choose a PSA screening test, after a discussion with a primary care provider about the magnitude of the known harms and the potential for some benefit. The patient could then provide his perspective on how he views the trade-off. Weighing the pros and cons to make a decision about PSA screening is an individual process, and different well-informed men will make different decisions. 

Absolutely.

This is a middle way: recognizing that on the whole, the PSA test isn't called for; but if an individual patient wants one after considering the pros and cons, he should be able to get one.

Amazing! I'm praising Regence BlueCross of Oregon.

This is quite a day.

After a string of highly negative blog posts about what a crappy excuse for a health insurance provider Regence BlueCross Blueshield of Oregon is (see here, here, here, here, here, here, here, here, and here), I've got something good to say about the company.

Today I learned that Regence is going to pay 80% of the cost of the colonoscopy that I had in February, a big jump from the 0% my Regence Evolve Plus plan originally was going to pay.

I complained about this absurdity in "Health insurance companies discourage colon cancer screening."

The procedure went fine. It was even enjoyable, in a drugged-up sense. A flat polyp was found and removed in the first colonoscopy's "bad prep" area. Once again, it turned out to be benign.

This is the good news. The bad news arrived in the mail a few days ago: an "Explanation of Benefits" form from Regence of Oregon regarding my colonoscopy. Total Regence Paid was shown in bold at the top.

The amount: $0.00

Total Member Responsibility to Provider(s) was right next to it. The amount: $805.69

...Perplexed, I phoned Gastroenterology Specialists of Oregon and talked with their insurance company billing person. She told me that because a polyp was removed, Regence considered the entire colonoscopy a "medical procedure," not a preventive screening.

...the billing person told me that every private insurance company she deals with considers that removing a polyp stops a colonoscopy from being a covered preventive service, even though the patient (like me) has no symptoms of colon cancer and the polyp removal is purely preventive, not curative.

Later I got another bill from the physician who did the procedure. That added $938 to my colonoscopy tab, of which Regence again paid nothing (I have a $2,500 deductible).

I was all set to appeal, since preventive services are supposed to be fully covered by Regence's Evolve plans, and I could provide quite a bit of evidence showing that removal of a benign polyp is an integral aspect of a preventive colonoscopy.

When I phoned Regence customer service to get some information needed for an appeal, the person I talked to said "I need to talk with a supervisor" after I asked why Regence didn't pay for my colonoscopy even though the primary diagnosis code was for a screening procedure.

Coming back on the line, she told me that my provider had submitted an adjusted claim and that I'd likely be a lot happier after it was processed.

While we were on vacation the Portland Oregonian ran a story that casts light on Regence's change of heart about paying for colonoscopies where a polyp is found and removed. Browsing through saved papers upon our return, I was encouraged to come across "Colonoscopy coverage creates confusion."

Because near the end of the piece I read:

In addition to Kaiser Permanente and Health Net, Regence BlueCross BlueShield, which has 3 million enrollees in four Northwest states, initially said it charged members the deductible and coinsurance if a colonoscopy found and removed a polyp. But Regence spokeswoman Rachelle Cunningham subsequently said that was a mistake, there should be no cost-sharing charges, and the company was "re-evaluating and re-processing some claims."

She also said patients "might need to take an active role in appealing a claim they felt was processed incorrectly to receive the benefits they are entitled to under the law."

I'd been checking my Regence account online almost every day the past few weeks, figuring that the adjusted claim should be processed soon. This morning I saw that Regence was paying $644.55 for the facility part of the bill, and $750.40 for the physician part.

Leaving me with 20% co-insurance. I'm not going to quibble about that, since a flawed prep and removal of a benign polyp during my colonoscopy two years ago meant that I had a repeat procedure much sooner than if I'd had a normal "all clear" colonoscopy.

So kudos to Regence BlueCross BlueShield of Oregon for deciding, albeit belatedly, that colonoscopies should be considered preventive even if a polyp is removed. This makes me feel better about the company my wife and I fork over $1024 to every month for our individual policies (we're in our early sixties and can't wait to get on Medicare).

That said, I still think Regence's proposed 2011 22% rate increase is obscene.

Today a couple of Regence guys met with the Salem Statesman Journal editorial board. They did their best to justify their rate increase, but I wasn't wildly impressed with the 20 minutes of the video that I watched.

The presentation started off with an oft-repeated statement that the 22% translates into an average of $36 per month for each individual policy holder. Well, not for people like us, who already are paying over $1,000 a month (as a couple) and would fork over more than $200 a month additional to Regence if the rate increase is approved as is.

I realize that the causes of health care inflation are various and widespread. But the Regence executive correctly told the editorial board that the United States health system (actually, non-system) is broken. Costs can't be controlled until we fix the system.

Yet Regence, along with the rest of the insurance industry, tried to stop Obama's health care reform efforts, a.k.a. the Affordable Care Act. You can't have it both ways, Regence. Don't complain that the system is broken at the same time you're trying to keep it that way.

For that huge bit of hypocrisy, I think you deserve to have your rate increase request slashed substantially by the state. Maybe then you'll be motivated to reform the system, rather than simply trying to suck more premium dollars out of your already-strapped policy holders.

Obscene! Regence of Oregon wants 22% rate increase

I find Regence BlueCross BlueShield of Oregon deeply irritating.

I don't feel this way about any other companies my wife and I do business with. Some I'm basically neutral about, such as State Farm Insurance, while others seem like a good friend -- notably Apple.

But Regence of Oregon is a necessary evil in our lives.

(Yes, I've called Regence "evil and heartless," along with plain heartless; my anti-Regence rants are cataloged by Google here.)

I'd ditch this malevolent entity instantly if it weren't for the pre-existing condition trap on individual health insurance policies like we have, so we're stuck with Regence for three more years until we'll be joyfully eligible for Medicare.

Regence of Oregon's newest mind-boggling outrage upon its individual policy-holders is an insanely large 22.1% rate increase request that'd take effect August 1, 2011 if it is approved.

This follows a string of annual rate increases over the past four years that ranged from 16% to 24%, way over the general inflation rate. Also, way over the health care inflation rate.

I learned this last disturbing fact thanks to Regence of Oregon's own Twitter feed, where an employee has the thankless job of trying to post upbeat tweets about her appallingly depressing company.

On May 12 I read:

What’s driving higher health care costs? New report offers some answers that might surprise you http://n.pr/lbrNiA

Well, what surprised me the most in this NPR article, given Regence's 22.1% rate increase request, is that health care costs "only" increased 7.3% last year. So why is Regence asking for almost three times that?

Apparent answer: greed.

Yesterday the New York Times reported that even though insurance companies are raking in record profits, they still are out to raise their prices substantially. (Their CEOs must be ex-oil company executives.)

Yet the companies continue to press for higher premiums, even though their reserve coffers are flush with profits and shareholders have been rewarded with new dividends. Many defend proposed double-digit increases in the rates they charge, citing a need for protection against any sudden uptick in demand once people have more money to spend on their health, as well as the rising price of care.

Oh my. Yes, it'd be terrible if people had enough money to use their health insurance to get necessary medical care.

This is what my wife and I have learned from dealing with Regence of Oregon over the years: this health insurance company is dedicated to providing its policy-holders with as little health care as possible.

Why? Because every premium dollar spent reduces the amount Regence can spend on administrative costs and squirrel away as reserves (a.k.a. "profits"). Take a look at the Oregon Insurance Division's posting of the 22.1% rate increase request.

Regence of Oregon's administrative costs are 20%.

So right off the bat every premium dollar policy-holders like us send to Regence turns into 80 cents that's available for providing health care. And from painful experience my wife and I know that Regence of Oregon is an inefficient bureaucracy, so much of the company's administrative overhead is wasted.

Public comments on the outrageous rate increase can be made here. I was one of the first (# 7) to do so, saying:

Every year we get double digit rate increases from Regence, along with lousier customer service. This includes last year, when rates stayed about the same only because benefits decreased by the equivalent of double digits. [Also, because we raised our deductible subtantially.] Regence stopped paying for my wife's Restasis (dry eye) medication on July 1, 2010 after forcing individual policy holders to switch to their crappier "Evolve" plans, which really were a devolution.

She was able to win an appeal only after going through horrendous bureaucratic roadblocks with Regence, which is terribly managed. No one knows what anyone else is doing. Inefficiencies abound at Regence, as is obvious to anyone who phones them with even a simple request.

On my side, I saw that another commenter on the rate increase noted how Regence doesn't really have an emphasis on prevention, because it won't pay for services that actually prevent a problem. Such as my colonoscopy, which involved removing a benign polyp -- a central benefit of a screening colonoscopy. So far Regence considers this a "medical procedure" if a polyp is quickly snipped out, leaving me with a bill for the entire colonoscopy.

Ridiculous. I'm tired of paying tons of money to a health insurance company which clearly is dedicated to providing as little health care to its policy holders as possible. Then they have the gall to demand a 22% rate increase after spending the past year trying to deliver as few services as they can within the bounds of legality and ethics -- bounds which Regence tries to stretch at every opportunity.

 

Republicans seek to end Medicare with no debate

You'd think that killing Medicare as we know (and love) it would require some serious open discussion. But nope, not in the brave new world the House Republicans have brought us.

Paul Ryan's proposal to force seniors to buy private health insurance that would pay an ever-decreasing share of their medical costs was announced last week. This week the House is expected to vote on a 2012 budget resolution that implements Ryan's voucher-based Medicare overhaul.

No hearings. No debate. No opportunity for citizens to express their opinions on ending the current Medicare system.

It's the political version of wham, bam, thank you ma'am --a rush to pass poorly thought out legislation that's unsatisfying for everybody but the Tea Party types who want to lower taxes on the rich and screw senior citizens.

Today local Oregon columnist Ron Eachus had a great column in the Salem Statesman Journal on this subject.
Download Ron Eachus column

It is a bold plan, with plenty of controversy. Most of the spending reductions come from the Medicare changes under which recipients are given vouchers they can apply to private health insurance. The Congressional Budget Office points out that it means shifting more costs to Medicare recipients.

This deserves a lot more scrutiny. You'd think it would receive some hearings, some expert testimony, some airing in public before Congress proceeds. Not in today's Congress, not in today's budget wars.

One day after Ryan put his plan forward, the House Budget Committee voted, along party lines, to send a 2012 budget resolution implementing the plan to the House floor, where it is expected to pass this week.

Remember when the Republicans chided the Democrats for ramrodding the health care reform through without enough time to review the bill or consider alternatives?

I sure do.

The Affordable Care Act went through months and months of deliberation, and even that was criticized by Republicans as being too hasty. Yet here they are, rushing a wholesale destruction of Medicare through the House of Representatives in one freaking week!

Hypocrites. S.O.B.'s  And next year, I hope, not re-elected.

(AARP Oregon isn't happy with Ryan's plan. Neither is the national AARP. Not a great start to re-election season for Republicans.)

I'm saving money with a Canadian pharmacy

As a U.S. citizen, here's my bottom-line experience with ordering a prescription drug from a Canadian pharmacy: I'm saving hundreds of dollars a year, and the quality of the generic drug seems just as good.

So, what's not to like? Well, only one thing so far.

The drug I'm getting is Dutasteride, the generic version of GlaxoSmithKline's Avodart, a prostate shrinking medication. (Like I said before, a prostate exam is the only time a man doesn’t want to hear from a female who is inspecting his genital area that he's larger than average.)

The Canadian pharmacy I'm using is called -- no big surprise -- Canada Pharmacy. I've been happy with their service, but wasn't aware that the generic Avodart I ordered was coming from India via the United Kingdom.

I sent in my order for 100 Dutasteride capsules on December 30, 2010. Canada Pharmacy told me it was shipped on January 3, 2011. But the package didn't arrive until mid-February.

When I asked what was taking so long, I got an email that said:

Please be aware that mail service in the UK from where your order has shipped has increased their security measures for items sent to the United States in response to restrictions imposed by the U.S. Department of Homeland Security, and this may cause some delays on the shipment of your order. The recent icy weather has also caused some delays. We apologize for your inconvenience and thank you for your patience.

Hopefully my next refill won't take so long to arrive.

Even with the time it took for me to get the order, I'm happy that I started using a Canadian pharmacy rather than getting brand Avodart through my Regence BlueCross BlueShield of Oregon individual insurance plan.

Regence's increasingly crappy plan, now called "Evolve Plus," has a $500 deductible for prescription drugs. The full price for 30 Avodart capsules from our independent pharmacy has been $108. After the deductible is met, Regence pays 50%, or $54 -- leaving me to pay the remaining $54.

Given that I also take two much cheaper prescriptions each month, for four months I'd have to pay full price for Avodart until the $500 deductible was met. That's $432 ($108 times four).

For the remaining eight months in a year, I'd pay another $432 ($54 times eight). So getting brand name Avodart through our Regence insurance plan would cost me $864 a year, averaging $72 a month for 30 capsules. That's $2.40 a day.

By contrast, Canada Pharmacy sells 100 capsules of generic Avodart (dutasteride) for $145. That's $1.45 a day. So I'm saving 95 cents a day ($2.40 minus $1.45) on Avodart by getting my prescription filled through Canada Pharmacy.

Which is $347 a year.

All I had to do was get a new prescription from my doctor which said something like "generic OK." After scanning it, I emailed the prescription to Canada Pharmacy along with a scan of my driver's license. Pretty easy way to save $347.

The generic Avodart is made by an Indian company, Cipla. I'm comfortable with taking dustasteride that comes from India. A Business Week story says that Cipla has been one of the most successful Indian companies which specialize in making low-cost versions of American drugs.

And Canada Pharmacy assures its customers that the generics it sells are safe:

Yes, Canadian generics are just as safe and effective. Canada has a government agency that tightly monitors the safety and quality of all drugs sold in Canada.

So if you're unhappy, as I was, with how much prescription drugs cost in the United States, even when insurance pays some of the tab, consider a Canadian pharmacy. It's been a good move for me -- $347 a year worth.

(Previously I'd ordered some other items from Canada Pharmacy and signed up for a plan that gave me free shipping for a year for $20, if I recall correctly. So that's why I didn't include the usual $10 shipping fee in my cost savings.)

Health insurance companies discourage colon cancer screening

Colon cancer is the fourth most common form of cancer in the United States. You'd think that insurance companies would want to do their utmost to prevent it. But I've learned that almost all of them don't -- including my insurer, Regence BlueCross BlueShield of Oregon.

On February 18 I had a colonoscopy.

I didn't have any symptoms of colon cancer, but my Gastroenterologist recommended that I get another one, because (1) two years ago my first regular colonoscopy revealed a benign polyp (which was removed), and (2) an imperfect colonoscopy prep obscured part of my colon, so the doctor couldn't see whether any polyps were in that area.

The procedure went fine. It was even enjoyable, in a drugged-up sense. A flat polyp was found and removed in the first colonoscopy's "bad prep" area. Once again, it turned out to be benign.

This is the good news. The bad news arrived in the mail a few days ago: an "Explanation of Benefits" form from Regence of Oregon regarding my colonoscopy. Total Regence Paid was shown in bold at the top.

The amount: $0.00

Total Member Responsibility to Provider(s) was right next to it. The amount: $805.69

I thought, "What the hell?" I was pretty sure that two years ago Regence had paid for most of my first colonoscopy, since this is a preventive screening procedure. I also knew that the Affordable Care Act (a.k.a. "Obamacare") required insurance companies to fully cover preventive care.

Indeed, a summary of Regence of Oregon's new Evolve Plus policy, which I was switched to in July 2010, states:

Preventive care: Preventive services and immunizations are covered according to guidelines set forth by the United States Preventive Services Task Force (USPSTF), Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA).

Some Googling led me to the USPSTF guidelines for colorectal screening, which were referenced by the CDC and seemed to also be the main basis for HRSA policies. Yes, indeed, colonoscopies are a good thing. I read:

Screening for colorectal cancer reduces mortality through detection and treatment of early-stage cancer and detection and removal of adenomatous polyps. The degree to which each of these mechanisms contributes to a reduction in mortality is unknown, although it is likely that the largest reduction in colorectal cancer mortality during the 10 years after initial screening comes from the detection and removal of early-stage cancer. Colonoscopy is a necessary step in any screening program that reduces mortality from colorectal cancer.

So polyp removal is an integral and important part of screening for colon cancer via a colonoscopy. After the doctor spots a polyp during the exam, he or she can remove it through the colonoscope. Screening and prevention go hand in hand, since today's benign polyp can turn into tomorrow's early stage colon cancer.

Why, then, wasn't Regence paying for my colonoscopy, since this is a preventive service under the Affordable Care Act? The government web site that lists covered services says:

If you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, the following preventive services must be covered without your having to pay a copayment or co-insurance or meet your deductible.

Well, my new Evolve Plus policy kicked in on July 1, 2010, so this could explain why the Affordable Care Act doesn't yet control what Regence has to pay for a colonoscopy. But  Regence of Oregon itself says that colonoscopies are fully paid for, as this Regence Evolve Plus flyer says.
Download Regence- Evolve Plus 2011

Preventive care – covered at 100% (no annual benefit maximum) Includes the following when billed as preventive: Routine physical exam, well child care, adult and child immunizations, routine laboratory, radiology and diagnostic procedures including mammography, pap smear, PSA and colonoscopy. (See contract for complete list of preventive care benefits)

Perplexed, I phoned Gastroenterology Specialists of Oregon and talked with their insurance company billing person. She told me that because a polyp was removed, Regence considered the entire colonoscopy a "medical procedure," not a preventive screening.

"That doesn't make any sense," I told her.

Explaining, I said: "At the time I was given a sedative and became unconscious, I had no colon cancer symptoms and was getting a colonoscopy as a screening tool. When I woke up, I still had no symptoms but a benign polyp had been removed. How is it that the colonoscopy changed from being a 100% covered preventive service to a 0% covered medical procedure just because a polyp was removed in the name of prevention?"

(Like many people, I have a high deductible -- $2,500 -- because otherwise my premium would be unaffordable. Since I hadn't met the deductible, Regence didn't pay anything for my colonoscopy. Preventive care isn't subject to the deductible, though.)

"Insurance companies are just trying to save money," she told me. Bastards, I thought.

Colonoscopies aren't a lot of fun. Most people dread getting them. But they're the best way to screen for colon cancer before it spreads, and to excise potentially pre-cancerous polyps.

Yet the billing person told me that every private insurance company she deals with considers that removing a polyp stops a colonoscopy from being a covered preventive service, even though the patient (like me) has no symptoms of colon cancer and the polyp removal is purely preventive, not curative.

Like I said, bastards.

When someone is urged by his or her doctor to get a colonoscopy, the insurance companies don't tell policy-holders that if a polyp is found, you're going to end up getting zero benefits for a preventive service that is described as being covered 100%. That sure sounds like "bait and switch" advertising to me.

Plus, its despicable for insurance companies to act in a way that discourages people from getting colonoscopies. This is a screening tool that is demonstrably effective in preventing colon cancer.

Yet insurers are, in effect, saying to policy holders: "If the doctor doing the colonoscopy removes a pre-cancerous polyp in the course of the procedure, we won't pay for it."

So if somebody is strapped for money, as so many people are these days, he or she could well put off getting a colonoscopy, since there's no way of knowing ahead of time if the insurance company is going to pay 100% or 0% for the expensive procedure.

This is the point made by the American Society for Gastrointestinal Endoscopy (ASGE) and the Colorectal Cancer Coalition.

“Colorectal cancer is a largely preventable disease. Screening for colorectal cancer by colonoscopy identifies polyps and allows them to be removed before they turn into cancer, and that is the basis for colonoscopy as both a screening and colorectal cancer prevention tool,” said M. Brian Fennerty, MD, FASGE, president, American Society for Gastrointestinal Endoscopy.

“We call upon health plans and insurers to fully eliminate the cost burden of colonoscopy colorectal cancer screening by waiving cost- sharing for the screening portion of colonoscopies in the event that they turn therapeutic and a polyp is removed.”

The greatest benefit of colonoscopy is removing polyps that are discovered during screening and by so doing, significantly decreasing the risk for later cancer development.

Converting a screening procedure that is fully covered by insurance with no cost-sharing, to one that does require cost-sharing by the patient after a polyp is found, is both a barrier to screening and inconsistent with the goal of the preventive services provision. The patient who has a polyp removed is the one who benefits the most from the exam and imposing a financial “penalty” could deter the patient from getting screened.

Right on.

But Regence BlueCross BlueShield of Oregon is even worse than this. I told the clinic's billing person that I wouldn't mind paying whatever extra a "polyp-removal colonoscopy" costs versus a "non-polyp-removal colonoscopy." It couldn't be much, since snipping off a polyp is a small addition to the whole colonoscopy experience.

So if Regence said I'd have to do some cost-sharing -- 10% or whatever -- because a polyp was removed during the screening procedure, that'd be fine with me. To refuse to pay anything for a preventive colonoscopy, that's unacceptable.

I'll be complaining to Regence, elected officials, Governor Kitzhaber (a physician), the state Insurance Commission, and anyone else I can think of who could help change this stupid insurance company policy. I don't begrudge insurers an honest return, but gouging policy-holders and risking lives in the name of Almighty Profit is outrageous.

575 pound "Heart Attack Grill" spokesman dies at 29

Karma. It's for real.

How to (almost) enjoy your colonoscopy

I don't know if it's possible for anyone to say "my colonoscopy was fun," unless they're a masochist. I've had three now, two regular's and a virtual, the most recent a few days ago.

None of them was enjoyable, except in this sense: I know that I'll feel much better getting colonoscopies rather than colon cancer. So like I said in a previous post, don't think twice about having the procedure if you're over 50 or otherwise in a high risk group.

Once you're scheduled for one, I've got some tips for making your colonoscopy more pleasant. Some of what I've learned may be peculiar to me, so take your doctor's advice a lot more seriously than mine. These are just some suggestions, based on my experience.

Shop around for a provider. I talked about this in my post where I advised people not to get a colonoscopy in Salem, Oregon, where I live. Again, that's my opinion, mostly based on the insistence of the one and only provider of the procedure in my town to make patients go through a two-day colonoscopy prep.

Recently a friend told me that Salem Gastroenterology Associates made her do this, even though her procedure was scheduled for the afternoon of the third day. So she couldn't eat solid food for over two and a half days. That's highly unusual, based on the research I cited.

Thus if you don't feel comfortable with a provider in your area, look farther afield. I drove to Tualatin, a suburb of Portland, for my two regular colonoscopies because I really like how the folks at Gastroenterology Associates of Oregon treat me -- as a human being, not just a patient.

Usually the doctor knows best. That said, once you've chosen who you want to perform a colonoscopy on you, trust them. It's fine to ask questions and do your own Internet research. But in the end, it's wise to assume that health care professionals are going to know more than you do.

After my first regular colonoscopy, the doctor found a benign polyp. He also said that the colon prep/cleansing wasn't very good in one area of my colon. That's why he wanted me to have a repeat procedure in two years, rather than the usual five or so. I thought of arguing with him, since I wasn't eager to have another colonoscopy so soon. I didn't, though.

Now I'm glad.

The gastroenterologist, Erik Van Kleet, found another polyp in the area that wasn't properly prepped last time. He removed it. Since it was flat, he couldn't see it during the first colonoscopy. I'm also glad that I didn't argue with the clinic's physican assistant when he told me that I should start the clear liquid diet at 5:00 pm, two days before the procedure.

That added eight hours or so of no-eating to my prep schedule. It was worth it, though, to get a clean colonoscopy this time. (I can understand why, in special circumstances, a more than one day prep is called for; my gripe with the Salem clinic is that they required a two day prep for all patients, since usually this isn't necessary.)

Follow the prep instructions, but don't deny yourself. Most people who have had colonoscopies find the prep period to be more distasteful than the procedure itself. I agree. Being a vegetarian, I'm used to grazing frequently. And getting rid of the colon contents by drinking a gallon of laxative stuff isn't my favorite thing to do.

However, when I told a friend I was getting a colonoscopy and angled for some no eating sympathy, he said, "I went on a 21-day fast once." That shut me up, especially since the photo above shows what I bought to get me through about a 1.5-day "fast" where I could consume clear liquids for most of that time.

Jello, vegetable broth (I bought way too much, but it was on sale), white grape juice. Adding up the calories in this stuff, I realized why I didn't lose much weight during my so-called fasting period. Plus, I tanked up in the two hours prior to the 5 pm "no more solid food" deadline on Wednesday (my colonoscopy was scheduled for 10 am on Friday).

At 2:30 I had a large slice of cheese pizza. At 4:00, after I exercised, I ate a peanut butter and apple butter sandwich on whole wheat bread that I'd taken to the athletic club. Then, at 4:20, I managed to stuff down another large slice of Straight From New York pizza before I went to my Tai Chi class. Not surprisingly, I wasn't very hungry all that evening, so starting my liquid diet at 5:00 pm on Wednesday rather than late that night wasn't a big sacrifice.

And as noted above, it worked better for me, according to my doctor. As did a split preparation schedule, in which I drank half of the laxative stuff early Thursday evening, and half early Friday morning (the day of the procedure). Even though I had to wake up at 4 am or so on Friday, I found that drinking eight 8-ounce glasses of the stuff at two different times was more pleasant than chugging the whole gallon all at one go. 

Bliss out during the colonoscopy itself. Once it comes time for the actual procedure, relax. The worst is over. You're on the home stretch. Now comes the genuinely fun part. At least, that was my experience this time, which I wrote about on my other (more philosophical) blog.

As I was getting prepped for the colonoscopy, a nurse told me they were using propofol now. I could expect a much quicker recovery time, with few if any side effects. Once the propofol drip is stopped, the patient wakes up almost instantly.

The name of the drug sounded sort of familiar.

It should have, because this was one of the drugs that was being used by Michael Jackson when he died. It's white appearance leads it to be called "milk of amnesia" (for the benefit of some foreign blog readers, milk of magnesia is an over-the-counter drug commonly used in this country).

...After being wheeled across a hall into the endoscopy room, I was positioned on my side so I was facing a large monitor that soon would be showing my innards. The doctor would be looking at it as he performed the colonoscopy.

Some pleasantries were exchanged with the doctor and the nurses. Then the nurse anesthesiologist said she was starting to inject the propofol. For about fifteen seconds I felt completely normal. I was mildly concerned that the sedative wasn't working.

Next thing I knew, the nurse was telling me "We're all done."

My instant intuitive reaction was disappointment. I was disturbed to be back in everyday reality. It had been a lot more pleasant wherever I'd been, consciousness wise. I sort of felt like I'd jumped into ice water after basking on a warm beach.

Doing some Googling on propofol before writing this post,  I learned this sort of reaction is why the drug is illicitly used non-medically.

There are reports of self-administration of propofol for recreational purposes. Short-term effects include mild euphoria, hallucinations, and disinhibition. Long-term use has been reported to result in addiction.  

I felt completely alert and awake. The only side effect, so far as I could tell, was that feeling of I wish I could have stayed in that pleasant propofol place longer. My first words to the nurse were, "I had some nice dreams. Mostly of having a colonoscopy, but with absolutely no pain, as if it was happening to someone else."

I had a great time during the actual colonoscopy, mostly because I wasn't really there -- just a minimally aware blissed-out me was. Ask your colonoscopy provider if they use propofol as a sedative. And if not, why not? I liked it much better than what was used at my previous colonoscopy.

Bottom line: don't be afraid of getting a colonoscopy. As with most anxieties in life, our worries about what will happen almost always don't come to pass to the degree that we anticipate.

Some aspects of the procedure, like the sedative, may even make you say, give me more. So, enjoy, best you can.

And always keep in mind that no matter how unpleasant a colonoscopy procedure may be at times, it's a heck of a lot better than getting colon cancer.

Regence BlueCross of Oregon: incompetent beyond belief

Yesterday my wife had another frustrating encounter with the Regence BlueCross of Oregon bureaucracy. (Previous ones have been blogged about here, here, here, here, here, and here.)

This further convinced us that people who claim government-run health care would be more inefficient and mistake-prone than the current mostly private system never have had much to do with an insurance company.

There is no way, absolutely no way, that any public organization could be more difficult, irritating, and time-consuming to deal with than Regence Blue Cross of Oregon is. And here's the scary thing: Regence likely is better than truly malevolent for-profit corporate insurance giants.

On the positive side, we just whipped Regence's ass. I'll save the gloating for another post, where I'll share the details of how we (well, mostly Laurel, but I helped some) won an appeal of Regence's wrong-headed decision to drop Restasis, a dry eye medication, from its formulary.

We challenged Regence and won, after several levels of appeal that ended up with an outside expert physician agreeing with us that Restasis is medically necessary and Regence had no valid reason for dropping payment for Laurel's prescription.

Yesterday Laurel phoned Regence to find out when her coverage for Restasis would start up again, and if (as we expect) Regence will be paying us back for six-plus months of our paying the total cost for this spendy medication.

Here's the sorry step-by-step tale of how our much-vaunted "best health care in the world" insurance system responds to a simple consumer question:

(1) Laurel calls the phone number of Patty Nelson, a Regence Blue Cross of Oregon employee in the Member Appeals department. Nelson has been corresponding and talking with Laurel about her appeal. Laurel hears a busy signal.

(2) Laurels hangs up and dials Regence Customer Service. She's told that Nelson no longer works for Regence. Laurel asks to talk to someone else in Member Appeals. The Customer Service rep has no idea how to reach the Member Appeals department.

(3) Laurel is transferred to several other people, none of whom know how to contact anyone in Member Appeals, which apparently is in some sort of underground bunker that is a secret even to other Regence staff. She ends up talking with a supervisor in Customer Service, Corey.

(4) Corey puts Laurel on hold for a long time. Eventually Laurel is told that Corey was unable to reach Member Appeals. So Laurel is transferred to Pharmacy Services.

(5) Someone in Pharmacy Services tells Laurel that she should talk with Kathleen McNulte, a manager who deals with appeals. When the number she's transferred to rings, the answering message doesn't mention McNulte, saying just "Medical Affairs" -- which is only for providers. The message says that messages can't be left at this phone number, because it is no longer in service.

(6) Laurel decides to press the option for providers, something about medical services triage. This gets her disconnected. Dialing the number again, she reaches Customer Service -- which is where she freaking started 40 frustrating minutes previously.

(7) A while later, Laurel tried again. Again she was transferred by Customer Services to Pharmacy Services, where she spoke with a supervisor. This time she was put on hold for about an hour, while she put the phone on speaker, fixed and ate lunch, and did other stuff.

(8) The Pharmacy Services supervisor refused to give Laurel her phone number. No one at Regence offered to search for the information she needed and call her back. Each person insisted that she stay on the line. Finally Jan from Pharmacy Services came back and said that the person she needed to talk to wasn't in today, so she will call Laurel tomorrow morning.

(9) The next day, Jan did indeed phone Laurel. She said that Regence is trying to figure out what Laurel's winning of the appeal means. The information is being "loaded into the system" (even though the overturning of Regence's denial of Restasis coverage occurred several weeks ago). Laurel was told that no name, phone number, or address of anyone at Regence who is working on her case could be given to her.

Supposedly Laurel will get a letter about all this...eventually.

On the other hand, public employees at the state Insurance Commission have been most helpful, available, and competent. Laurel was told by one of them that Regence has had big layoffs lately, and is working with a "skeleton staff."

Funny, our insurance premium hasn't gone down. I wonder where the money from all the cost savings is going. Probably into CEO salaries.

"Obamacare" isn't dead -- most courts have affirmed it

Today one judge, in one federal court, ruled that the health care reform bill's mandate that most Americans buy insurance was unconstitutional.

Before opponents of "Obamacare" (I don't like that term, since he didn't write the legislation, but will reluctantly use it) get all excited, they need to keep in mind this fact:

Fourteen other judges have "either dismissed cases against the law's constitutionality or ruled against those cases."

The mandate remains in effect as Judge Henry Hudson's ruling is appealed. It will take a couple of years before the constitutionality of Obamacare is decided by the Supreme Court.

Meanwhile, implementation of the law will continue as planned. Thankfully.

Because even though the health care reform bill was decidedly imperfect, it's a major step in the right direction: improving the economic competitiveness of the United States and making our citizens healthier.

We won't be able to make much progress on our deficit and job growth problems so long as health care costs suck up an ever-increasing share of the federal budget and business expenses.

Other countries are kicking our butt, health system-wise, because the United States is stuck with spending a heck of a lot more for health care while garnering mediocre health outcomes.

I think Judge Hudson is wrong on the law, and he's really wrong if he believes that health care reform can succeed without almost everybody having insurance.

Insurance companies were the ones demanding a mandate, because if the popular ban on denying coverage for people with preexisting conditions stays in place, a mandate is essential (otherwise healthy people will go without insurance until they get seriously sick, then buy a policy when their health care costs are about to skyrocket).

Also, the United States already has an informal mandate, because most people get needed health care one way or the other. They just often don't pay for it themselves. Uncompensated/charity care is a huge burden for health care providers.

So which is more fair?

(1) Openly requiring everybody to have insurance and subsidizing those who can't afford it, or (2) continuing the current system of shifting costs of unpaid care to the general public in a hidden, inefficient fashion. I'll take door #1 please. Which the Supreme Court likely will affirm also in a few years.

E.J. Dionne has a good column on this issue, "Health care: Legislating from the Bench." He ends with...

There would be ways to preserve the health-care law's basic thrust if the U.S. Supreme Court ruled the mandate unconstitutional. But here is an entertaining thought for you: The whole point of the mandate is to preserve a strong private insurance market as an alternative to a government-dominated system. (Medicare for all, for example.)

If you want to 1. keep the private market, 2. have universal coverage, and 3. have rules barring insurance companies from excluding people from coverage because of preexisting health conditions, you need some way of having everyone paying into the system. You end up with a mandate or something like it.

If the complicated things you need to do to accomplish these three objectives are ruled unconstitutional, the courts will gradually narrow the options for supporters of universal coverage. A single-payer system might be the only option left. Maybe soon we'll see a new organization: "Activist Conservative Judges for Single Payer Health Care."

But we are not there yet, and here's hoping that when it comes to the health-care law, the Supreme Court decides not to legislate from the bench.

Hexane in veggie burgers is a concern, not a killer

A few days ago my health-conscious wife rushed downstairs from her computer, printed web site pages in hand. "My Boca Chik'n Burgers are made with a neurotoxin," she said, "They're going to kill me."

She wasn't 100% serious... about the killing part. But after some initial skeptical mutterings of that can't be from me, my Googling confirmed that hexane is indeed involved in the processing of lots of veggie burgers which contain non-organic soy protein.

This isn't new news. We just hadn't come across the hexane scare until now.

Back in April of this year, Mother Jones magazine kicked off a frenzy of concern among veggie burger-eating folks like us with a story, "Which Veggie Burgers Were Made With a Neurotoxin?"

Great title.

Guaranteed to generate interest among those who like their burgers made from ingredients that didn't moo at one time. However, when I dug into the details of the story, the seeming health scare turned out to be more worthy of mild concern.

Hexane, a petroleum product, is used to make burgers more low-fat by separating soybean oil from the protein. It's toxicity is low, so to call it a "neurotoxin" is a stretch. A Slate article, "Is Your Veggie Burger Killing You?", was reassuring.

Many non-organic soy products may contain traces of the neurotoxin hexane, according to a report by a research group that supports organic and sustainable agriculture. How worried should soy foodies be?

Maybe a tiny bit, but only because of the lack of data. The FDA does not currently impose a ceiling on hexane residue in soy foods, but it does limit how much of the chemical can be left in fish protein isolate (5 parts per million), as well as in hop extract and spice resins (25 ppm). The study (PDF) that's now in the news found 21 ppm of hexane in soy meal—the defatted soy flakes that are used in products like energy bars and veggie burgers.

The authors of the study told the Explainer that more recent testing has found concentrations as high as 50 ppm. But that's no reason to throw your meatless breakfast links down the disposal. The hexane limits are precautionary. No study has ever tested how much hexane a person can safely eat over the course of a lifetime, but rodent studies suggest that your Thanksgiving tofurkey isn't going to kill you.

The research described in the Mother Jones story came from the Cornucopia Institute, which promotes organic foods and farming. Since hexane isn't found in organic products, the Institute has an obvious interest in tilting consumers away from non-organic soy veggie burgers.

I doubt, though, that the Cornucopia Institute report, "Behind the Bean," is scientifically biased. At least, not much. I couldn't find any out-and-out debunkings of the Institute's study.

Soy that's been processed with hexane is best avoided. My favorite veggie burger is the Amy's Kitchen Texas Burger (I have one for lunch most days). Fortunately, I found an April 2010 press release from the company that said:

Because of concerns around soy protein extracted with hexane, we have eliminated the use of any soy protein ingredient that uses hexane in its processing.

Good for you, Amy's Kitchen. Laurel wasn't so lucky.

When she phoned Boca Burger headquarters, she learned that the Chik'n Burger, and all other Boca soy products, I believe, are still made with hexane processed soybeans. (Factoid: Boca Burger is a subsidiary of Kraft, which is owned by Phillip Morris.)

I'm not going to freak out if I eat some soy that's been processed with hexane. It's still wise to avoid it when possible, though, which is why Laurel has switched to a different veggie burger. A follow-up Mother Jones story had this question and answer:

"Hexane's boiling point is well below grilling temperature (69C, about 157F). That's cooler than even a toaster. Is there any evidence that the slightest bit remains in a veggie burger?"

Vallaeys: "The evaporation argument is often used by the companies that make these products. But what happens to the food when you cook it with this neurotoxic compound? Does it react with other substances and create new compounds before it evaporates? That really has not been studied. We think there should be more testing done on what these substances do to the food.

So a cooked veggie burger may not contain any hexane at all. The Cornucopia Institute study was a useful eye-opener to a potential health problem, but the benefits of being a vegetarian are far out-weighed by any possible slight negative effects of hexane processed soy.

Thus saith "Hexane in veggie burgers: little science behind the claims."

It’s not difficult to avoid all food additives, of course, if you eat a diet based on whole plant foods—always the best choice for health. Paradoxically though, while focusing on a problem that isn’t known to exist, the Cornucopia Institute promotes animal food consumption, as long as the foods come from small-scale organic farms. But omnivore diets have their own set of health problems and always contribute to animal cruelty (no matter where the food comes from).

Prudence dictates that, to the extent possible, foods should be free of all contaminants. But if the occasional veggie burger can help people move toward a healthful and compassionate vegan diet, the benefits of consuming these foods in moderation are likely to outweigh any unproven risks.

Abortion laws show Oklahoma Republicans hate freedom

What happened to Republicans standing tall for defending our "land of the free"? We have a national election in 2008, Obama is freely elected, and now right-wingers are fond of calling him a tyrant.

Huh? A tyrant is someone who takes control by his own means, not under constitutional power.

Which precisely describes attempts in the not-so-great state of Oklahoma to take away the constitutional freedoms of pregnant women.

Reading our local newspaper this morning, my wife called out to me, "This is disgusting. You're not going to believe what's going on in Oklahoma." Well, I ended up believing it. But like Laurel, I find the state's new draconian abortion laws to be appalling. 

Fortunately, the governor has vetoed them. But as the AP story says, there might be enough freedom haters in the state legislature to overrule his veto.

Oklahoma Gov. Brad Henry vetoed two abortion bills Friday that he said are an unconstitutional attempt by the Legislature to insert government into the private lives and decisions of citizens.

One measure would have required women to undergo an intrusive ultrasound and listen to a detailed description of the fetus before getting abortions. Henry said that legislation is flawed because it does not allow rape and incest victims to be exempted.

"Intrusive untrasound" means a probe up the woman's vagina. Forcibly. Without her consent. Since that is the medical equivalent of rape, this helps explain why rape and incest victims are exempted from the legislation.

However Rachel, a women's health blogger, wonders why there should be any distinction between women who have gotten pregnant because of a rape, and those who had consensual sex.

Let’s think about the implication of that statement: it leaves room for the notion that women who consent to sex, should they get pregnant and seek abortions, somehow deserve to be forced to have an object inserted into their vaginas (regardless of medical need or consent) in order to obtain that legal procedure.

Or, if they don’t “deserve” it, it doesn’t really matter, it’s no big deal. It would be “unconscionable” to subject immediate-past rape victims to such an act, but women who haven’t already suffered through rape, whose own experiences of sexual assault may be in the more distant past, who consented to sex, well, it’s the dildo cam for them!

I’ve said before that I don’t think abortion exceptions for rape and incest make any sense from a purely pro-life, “every life is sacred” position. If every life is sacred, it doesn’t matter how it arrived. Those exceptions do, however, make perfect sense from a position that pregnancy and childbirth is the proper punishment for sex.

Last night we watched Bill Maher interview Dr. Jack Kervorkian on his Real Time show. Kervorkian blasted the medical profession, saying "they follow religious ethics rather than medical ethics."

He was mainly referring to end-of-life decisions, where a person's freedom to decide how he or she wants death to come gets tangled up with religious fundamentalism -- such as an irrational belief that God forbids dying under one's own control.

The same religionist attempt to take away individual freedom is evident in the Oklahoma abortion laws. If legislators want to believe in the sacredness of a embryo, that's fine.

But they have no right to impose their religious beliefs on other people. Including pregnant women who have a constitutional right to an abortion.

I'd like to propose that from now on Oklahoma legislators be forced to watch the South Park "anal probe" episode before they vote on any abortion-related bill. And ideally, to undergo that procedure themselves whenever they go to the doctor.

Read this before you choose a Regence "Evolve" plan

Like I said in a previous post, Regence of Oregon's enforced switching of individual health insurance policies to their new "Evolve" plans is bad news for members.

Benefits are reduced considerably, while premiums are rising for many families, since each child now has to be on a separate policy. The Evolve plans' individual premiums for my wife and myself would only be a bit higher, but we were seriously disturbed by the benefit reductions.

For example, the Regence Evolve Core plan only covers a maximum of $1,000 a year for prescription drugs. We're pretty sure that our current "Blue Selections" plans have no limit. My wife, Laurel, noticed that the Regence Evolve Plus plan has a prescription drug benefit that covered a maximum of $4,500 a year, albeit with a $500 a year deductible.

However, the letter she got from Regence informing her of the changeover to Evolve plans said that she'd be switched to the Evolve Core plan, as this most closely matched her current policy.
Download Regence of Oregon new plan comparison

When she phoned Regence to ask about getting the Evolve Plus plan, at first she was told that this wasn't possible since Plus had greater benefits. Thus she'd need to fill out an application for an entirely new policy, which would be subject to underwriting and almost certainly rejected because of her pre-existing conditions.

Laurel argued with the Regence employee, saying, entirely accurately, that the switch to either Evolve plan amounted to a reduction in benefits from what her current Blue Selections plan offers. So how could moving to Evolve Plus be viewed as a benefit increase?

She didn't get anywhere with that argument. Reason and logic don't get much respect in the health insurance industry. Nor does the adage, "the customer is always right."

Overhearing Laurel's conversation -- her side of it, at least -- I could tell that it wasn't going anywhere productive. The Regence employee was stonewalling her request to be switched to the Evolve Plus plan, whose only redeeming quality was that it was somewhat less crappy than the Evolve Core plan Regence intended to move her to.

Then I had a good idea.

I picked up the "Important Notice of Benefit Plan Replacement" that had come in the mail from Regence. I dropped it in Laurel's lap while she was still on the phone with the Regence employee. I pointed at a section and whispered "read that to her."
Download Regence Evolve letter

What if I want a plan other than the one that was chosen for me? We've enclosed a plan summary comparison so can compare your current coverage with all our new plans. If you find another plan that's better for you and the deductible amount is the same as or more than the plan we chose for you, complete the enclosed Plan Change Reguest Form and return it by June 1, 2010.

Bingo!

The woman Laurel was talking to asked her to wait on the line while she consulted a supervisor. A few minutes later she told Laurel that Regence would stand behind what was said in the letter, even though it supposedly wasn't accurate.

So anyone who is being switched to the Evolve Core plan can choose the Evolve Plus plan instead. No complicated application required. All you need to do is check a few boxes and make sure you're requesting an Evolve Plus plan with the same or larger deductible as you have now.

The enforced switchover to the reduced benefit Evolve plans still sucks, for reasons I cited before. But the Evolve Plus plan sucks less than the Evolve Core plan, especially for people who have substantial prescription drug expenses.

Regence of Oregon "Evolve" plans: bad news for members

Health insurance reform may be the law of the land, but health insurance companies like Regence of Oregon aren't done screwing over their members/policy-holders.

My wife and I have individual Regence plans. Mine is the Blue Selections Premier, which I succeeded in switching to last year after going through a horrendous battle with the Regence underwriting department over some minor health problems (a.k.a. "preexisting conditions").

Recently we both got a packet from Regence BlueCross BlueShield of Oregon informing us that as of July 1 we'd need to switch to new plans, as our current plans will no longer be available.

Naturally our first thought was, "We're going to get screwed. The new policies are going to cost more and cover less."

Right on. Regence provided a comparison of my old plan and the new "Evolve Plus" plan that comes closest to what I have now.
Download Regence of Oregon new plan comparison

I'm going to pay $512 a month for the Evolve Plus, a bit more than the premium for my current $485 Premier plan. But the Evolve benefits have devolved downward, considerably. Here's an example:

Now there's a $500 deductible on brand name prescriptions, compared to no deductible before. Also, there is a $4,500 a year maximum prescription drug benefit, compared to no limit before. If someone is on expensive drugs for a serious condition, $4,500 will be used up quickly.

The basic Evolve plan, which my wife is to be switched to, is even worse: it has only a $1,000 maximum for all drugs. That's ridiculous.

It's impossible to compare the cost of the new and old plans, because the benefits have changed so much. This likely is one reason Regence is switching its individual policy holders over to the Evolve plans: instead of announcing another double-digit rate increase, Regence is keeping rates about the same and decreasing the value of benefits by double-digits.

Over on Blue Oregon I commented on a post about a proposal for an Oregon health insurance exchange. 

This sounds like a good idea. My wife and I have individual plans from Regence Blue Cross of Oregon. Recently we, like many others, received a packet notifying us that our plans will be terminated July 1 and we'll have to choose from the new Regence offerings they suggested.

Which offer considerably reduced benefits, albeit at roughly the same cost as our premium now. This, of course, means that Regence has raised its premium price, but not in an open and transparent manner. It's impossible to figure out how much more it will cost us out of pocket because Regence has reduced its benefit package.

Being in our early 60s with pre-existing conditions (who has been perfectly healthy all of his/her life?) we can't change to another health insurance company. I believe the health care reform provision prohibiting discrimination on the basis of pre-existing conditions doesn't kick in until 2014 or thereabouts. So Regence has us and tens of thousands of other individual policy-holders over a "take it or leave it" barrel.

No competition. No free market. The proposal laid out in this post would be a heck of a lot better, especially if the marketplace included a true "public option" run by the state of Oregon.

Last gripe about Regence: their informational materials about the new plans say there is a $2 million lifetime cap on benefits. But this is one of the provisions of the health care reform bill that kicks up immediately -- no more lifetime caps. I've emailed Regence and asked why they aren't complying with the law of the land. Seems crazy that new health insurance policies issued after passage of the bill don't reflect its provisions.

Today I called Regence and asked about the $2 million lifetime cap. I was told that Regence is complying with the health insurance reform bill and will implement its provisions as required.

OK. I didn't really expect that Regence would ignore the law. But it seems to be doing its best to get around it.

There no longer can be a lifetime cap on health insurance policies written after September 23, 2010. Existing policies with caps will change to the new "no cap" rule at renewal time.

So if we'd been able to stay on our current Regence plans, the $2 million lifetime cap limitation seemingly would have been removed on July 1, 2010 -- our renewal date. But Regence has chosen to force all of its individual policy holders to change to a new plan on July 1. Which obviously is before September 23.

How convenient. For Regence of Oregon.

Because now it looks like the lifetime cap will remain in place until July 1, 2011, which gives Regence a whole year during which it can tell members who have an expensive serious illness, "Tough. You've used up your $2 million. Better get going on your garage sale -- or bankruptcy plan."

Health insurance companies have a horrible P.R. problem. I don't know anyone, not a single person, who has good things to say about the health insurance industry. Like I said, when we got the mailing from Regence our first (and also last) reaction was:

This has got to be bad news. We're getting screwed. Regence never does anything that benefits its members or health care providers; it only cares about its own profit margin.

There's only one real solution to the problems health insurance companies cause: get rid of them. Or at least heavily regulate them. The reform legislation that's been passed does neither, unfortunately.

That's why I'm on the opposite side of the Republican mantra, "Repeal and replace."

No, we've got to keep what we have and make it much stronger. If insurance companies like Regence persist in playing their selfish corporate games at the expense of their policy holders, pressure will build for that to happen.

"Health, Money, and Fear" shows weakness of reform bill

Last night I listened to a couple of Oregon physicians nail what this country needs to do to solve our health care problems. In short: a single payer system, Medicare for all.

They convinced me that in many ways the health care reform bills being considered by Congress are going to move us in the wrong direction. I'd already had misgivings about this legislation; now I'm as worried that it will pass as that it will fail.

Salem's Progressive Film Series, a class act, showed "Health, Money, and Fear" yesterday. You can watch the entire movie at OurAilingHealthCare.com.

It was made by Dr. Paul Hochfeld, a Corvallis E.R. doctor. He spoke after the film, along with Dr. Michael Huntington, one of the Mad As Hell Doctors who recently made a cross-country trip to push for real health care reform.

I worked in health planning and health policy research for over a dozen years. It's disturbing that the same problems being grappled with back in the 70's and 80's are still with us -- and are even bigger now. 

Hochfeld and Huntington said that the current health care reform legislation is better than nothing. But not a whole lot better, because it basically brings tens of millions of more people into a crappy, inefficient, over-priced health insurance system.

Make that non-system.

Right off the bat they asked the audience if our health care system needed to be fixed. Just about everybody raised a hand. Then they said: "Wrong answer. We don't have a health care system. It isn't a system at all."

It's a mess. Fareed Zakaria echoed Hochfeld and Huntington in a recent Newsweek column:

There are two great health-care crises in America -- one involving coverage and the other cost. The Obama plan appears likely to tackle the first but not the second. This is bad economics but also bad politics: the crisis of cost affects 85 percent of Amercians, while the crisis of coverage affects about 15 percent.

Obama's message to the country appears to be "We have a dysfunctional health-care system with out-of-control costs, and let's add 45 million people to it."

A single-payer system clearly is the way to go. And it's just as clear that neither Congress nor Obama wants to head that way, unfortunately.

I wanted to ask Hochfeld and Huntington some questions, but didn't get to.

One issue I wondered about got answered pretty well in the Q & A session after the movie: given that there are so many problems facing U.S. health care, why do you seem to feel that changing the payment system to single-payer is the most important thing to do?

They said that when health care providers know they'll be seeing a patient for a long time, maybe for the rest of his or her life, there are going to be big incentives to focus on preventive care and health promotion. People won't be drifting out of the system (oops, non-system) when insurance coverage is lost.

A nationwide electronic records system would be much easier to implement with a single-payer system. Research on what treatments work best would be greatly facilitated, leading to better health outcomes at lower cost.

Malpractice lawsuits would be reduced under a single-payer system. Patients wouldn't worry about going bankrupt if a medical care glitch resulted in them needing more treatment. And they would feel warmer and fuzzier toward their health care providers once those nasty money-grubbing insurance companies don't stand between people and their doctors.

It looks like if a single payer system ever is going to be available to Oregonians in the semi-near future, it will be the state of Oregon that makes it possible. 

Hochfeld and Huntington appeared fairly optimistic that this could happen. If John Kitzhaber, a reform-minded physician, becomes governor again the chances would be considerably higher, since Kitzhaber isn't wild about the direction health care reform is taking now.

Bill Maher dangerously wrong about swine flu vaccine

Oh, Bill, I'm so disappointed in you. I love your HBO show, "Real Time with Bill Maher." But last Friday's episode showed me that you've gone bonkers over your obsession with vaccinations.

Which you said usually aren't needed, and are ineffective. However, you're wrong.

Dangerously wrong, as Michael Shermer ("Skeptic" columnist for Scientific American") says in an open letter to you -- which hopefully you'll take to heart.

Saying on your show that pregnant women and young children shouldn't get a swine flu vaccination is horribly irresponsible. The CDC says that pregnant women are at higher risk of serious illness and death from swine flu, and need to be vaccinated.

Yet there was Maher, spouting ridiculous crap about how vaccines are more dangerous than the problems they prevent, and that no healthy person has ever died from the swine flu (apparently if you've ever eaten anything not on Maher's approved food list, like jello, you're "unhealthy," so it serves you right if you croak from the flu).

What this shows is that while Maher is properly skeptical about unfounded religious dogma, he's got a huge blind spot in other areas that produces an equally delusional view of reality.

Blogger P.Z. Myers, an atheist biologist, talks about the Bill Maher conundrum. Maher is so right about some things, and so wrong about others.

Maher made a provocative movie about religion this year, Religulous, and that's the kind of thing we want to acknowledge and encourage, but at the same time…Maher is as loopy as they come on medical matters. He's a conspiracy theorist who blames Big Pharma for controlling health care, thinks modern medicine is a failure, and promotes 'alternative' therapies that don't work. It is a serious embarrassment.

More than that, as noted above -- a dangerous embarrassment.

It's one thing to spout nonsense about general issues that don't directly impact someone's health and well-being. But telling people they shouldn't get vaccinations because immunization isn't "settled science" -- that's super-irresponsible.

After watching last Friday's "Real Time," my feelings about Maher have changed.

Watching his closed-mindedness about the swine flu vaccine, I got to wondering what other unscientific views he harbors, and how this affects his positions in additional areas. We've got several Real Time episodes stored up on our DVR. I'm leaning toward deleting them unwatched as a protest against Maher.

The truth about swine flu is out there. BIll Maher just needs to take his blinders off and see it for what it is. Swine flu vaccine fearmongering is bad, bad, bad.

Michael Shermer ends his open letter with a hope that I share.

One of the most remarkable features of science is that it often leads its practitioners to change their minds and to say “I was wrong.” Perhaps we don’t do it enough, as our own blinders and egos can get in the way, but it does happen, and it certainly happens a lot more in science than it does in religion or politics. I’ve done it.

I used to be a global warming skeptic, but I reconsidered the evidence and announced in Scientific American that I was wrong. Please reconsider both the evidence for vaccinations, as well as the inconsistencies in your position, and think about doing one of the bravest and most honorable things any critical thinker can do, and that is to publicly state, “I changed my mind. I was wrong.”

If you aren't convinced that Maher is wrong, this science blogger (a physician) should change your mind.

Wow! A warm and fuzzy health insurance moment.

It's hard to believe, given my antipathy toward health insurance companies, but yesterday I actually felt warm and fuzzy toward one -- for a few moments.

I've been arguing with Regence BlueCross BlueShield of Oregon about its denial of my application to change from an individual Plus plan to the Premier plan. I fell into the dreaded pre-existing condition black hole, even though I'm an unusually healthy 60-year-old guy.

After sending the Regence underwriting department records of my last two physical exams, I got a phone call from a manager. She told me that the denial was being reversed, as the two minor health problems I listed on my application weren't serious.

Good news.

People in a similar situation, take heart: you can appeal a screwy health insurance company decision and win. It just takes some persistence (two letters and three phone calls, in my case).

The Regence manager was quite pleasant. I found myself saying some quasi-nice things about health insurance companies during our conversation.

"When I browsed through your web site," I told her, "I liked that Regence supports the notion that someone's medical condition shouldn't affect their ability to get health insurance. Hopefully in a few years all this pre-existing condition stuff won't be an issue. But for now I realize that if Regence stopped considering pre-existing conditions, and other companies still did, you'd end up with the sickest people, which would hurt your bottom line."

Talking with a real live health insurance company manager, I realized that she was trying to do the best job she could and wasn't an evil person.

"It's too bad, I said, "that the health care reform debate in this debate has become so angry and hateful. People screaming at congressional representatives at town hall meetings isn't the way toward a better functioning health care system."

On that subject...

I did my share of Vietnam War protesting in the late '60s. Which involved some screaming, I'm pretty sure (can't recall precisely; as they say, "if you can remember the '60s, you weren't there").

Conservatives back in that era were fond of talking about the Silent Majority: the bulk of Americans who were at home raising families and at work making a living -- not out on the streets raising hell at protests.

Now, more than a little strangely, it is the right-wingers who are disrupting meetings with angry shouting, trying to drown out calm, reasoned discourse about an important national problem.

What happened to the acclaim given to the Silent Majority, Republicans? And the disdain given to those who engaged in raucous rage-filled protests?

Here's evidence that the majority of Americans do want health care reform legislation passed by Congress:

Percentage of those polled who believe the current health care system needs major reform: 55%. Percentage of those polled who believe that it is important to pass a major health care reform bill in the next few months: 69%.
Download TIME health care poll

Why? Well, many reasons, both personal and policy-related. On the latter front, I came across this graph in a recent issue of New Scientist.
Download Health costs and life expectancy

It shows that the United States spends hugely more money on health care per capita than the United Kingdom, Canada, Australia, or Japan, but our life expectancy at birth is considerably lower.

Pay more. Get less. That's a recipe for major reform.

Of health insurance companies. Of individual lifestyle choices. Of how doctors and hospitals are reimbursed for the services they provide. Of how we determine which health care options are most effective.

I'm hoping that our congressman, Rep. Kurt Schrader, has a town hall meeting in our area this month.

I'm eager to attend, so I could tell any right-wing crazies who try to take over the meeting with a screaming fit, "Hey, you're acting just like we hippies did in the '60s. Welcome, brother. Got any weed?"

Health insurers shun people with health problems

Here's a personal story -- a single vignette out of countless others -- that shows why the United States needs to reform our screwed-up health care system, pronto.

Earlier I wrote about how we labored to fill out a lengthy on-line Regence BlueCross BlueShield of Oregon application: a request to change our individual coverage from Plus to Premier, since that seemed to fit our needs better.

Yesterday my wife and I got individual letters from Regence. Bottom line: denied. Here's how my letter started out.

Thank you for your application requesting a change to your current coverage.

After carefully reviewing your health application and any available claims history we find that we are unable to honor your request for a change in your coverage based on the following condition(s) and/or symptom(s):

Hyperlipidemia
History of enlarged prostate

Our inability to honor your request for a change is based on the medical history profile, which contains risk factors that fall outside our Individual plan underwriting guidelines. We apply our risk criteria fairly and consistently to all applications we receive for coverage.

Well, this must mean that Regence rejects almost everybody around my age (60) who just has a few minor medical problems, because I'm on the upper end of the healthy bell curve, for sure.

My dreaded "hyperlipidemia" consisted of a one-time total cholesterol reading four years ago of 212, which dropped instantly into the 160's after I started taking a generic low-dose statin, and now sits at 181.

So for one year, according to the American Heart Association, I was at a borderline-high risk level, and now I've settled into the desirable level by taking $10 per month lovastatin.

My other big risk factor, which also popped up in 2005, was a moderately enlarged prostate. At the time, I blogged about my family doctor finding evidence of this via the least enjoyable part of my physical exam.

This was my first prostate exam where I got a running verbal commentary from the doctor: “Hmmmm. Feels pretty normal. Regularly shaped. Just about normal size. Well, let’s make that a normal size for men your age who have a somewhat enlarged prostate.”

Great. A prostate exam is the only time you don’t want to hear from a female who is inspecting your genital area that you’re larger than average. Maybe Flomax will get me nearer to normal.

Which, it did. Along with Avodart, a complimentary drug I started taking a few years later.

And that's the sum total of the medical problems that caused Regence BlueCross BlueShield of Oregon to deem me outside of their underwriting risk factors.

I feel sorry for the many people who are denied coverage completely because of pre-existing conditions, since I was only denied a change to another Regence plan. The ugly truth is this:

Health insurance companies don't want to insure people who aren't healthy.

That, of course, includes almost everyone at one time or another. In 2008, one in five Oregonians who applied for individual health insurance were rejected due to pre-existing conditions. 

Crazy. The private sector of our health care system is dedicated to providing as little health care to people as it can get away with.

To a patient, health care fulfills a need. To the insurer, health care is a cost that detracts from profits.

A MSNBC piece, "When you are denied health insurance," explains that in the 1930s hospitals began offering insurance policies that were fair and affordable.

But commercial insurers, who joined the game in the 1950s, had another obligation: pleasing shareholders. The simplest way to make money was to try to attract healthy customers, who were less likely to rack up big medical bills. That way, insurers could charge lower premiums yet still clear a profit. Excluding sick people wasn't so easy when insurers agreed to cover the employees of a large corporation.

But denying coverage to risky prospects who sought coverage individually was simple. If an applicant had a history of illness, weighed too much or worked in a job that carried greater-than-usual physical risks such as mining or construction, the insurer would charge higher rates or simply refuse coverage. And once a few insurers started screening applicants, the others were forced to follow suit — or chance winding up with all the sickest people, a certain path to bankruptcy. Within a decade, such weeding out of the infirm or those likely to become so was common practice.

So that's how we've arrived at the insane situation where people who need health care, even if they have relatively minor problems, are rejected by private insurance companies. That keeps profit margins up.

And the United States' health ranking down. We spend more of our GNP on health care than any other country, yet the performance of our health system ranks 37th in the world.

People our age, over 60 but under 65, get particularly screwed if they're retired and couldn't continue with an employer-based insurance plan. Which describes us.

I'm suspecting that Regence is eager to get us onto Medicare and off our current policy. So they weren't going to approve our request to move to a different plan, since they'd prefer we didn't have any Regence plan but have to put up with us for another four to five years.

Tomorrow I'm planning to phone Regence and ask some questions about why I was rejected. Check the comments to this post for any updates to our story.

Quality of life in allocating health care resources

Imposing title for a blog post. It may sound kind of boring, but before we die each of us -- more than likely -- is going to face the bioethical question, "What kind of life is worth living, and at what cost?"

Back in the 1980s I lived and breathed health policy issues. That was my job. Also, my passion.

Recently I got to reminiscing about the days when I worked with Portland psychiatrist Ralph Crawshaw and Senate president John Kitzhaber (who later became Oregon's governor) on a project that laid the foundation for the Oregon Health Plan.

Getting into spring cleaning, at my wife's urging I started going through some boxes in the garage that held old memories. Out popped some Oregon Health Decisions publications -- an organization that I helped found, and was executive director of for several years.

It had been a long time since I'd seen "Quality of Life in Allocating Health Care Resources," which I wrote in 1988 on behalf of a Citizens Health Care Parliament. Reading it with fresh eyes, I was amazed at how the issues Oregon and the nation wrestled with then are the same issues being debated now. 

Read the 23 page report and see for yourself. (It's a 1.4 MB PDF file.)
Download Quality of Life in Allocating Health Care Resources

Illustrating how the more things change in health care, the more they stay the same, here's how the report starts off.

Health care in Oregon and the nation faces critical choices. Many attempts have been made to cut health care costs, but spending in this area by both government and the private sector continues to increase much faster than growth in the general economy.

Left unchecked, the burden of rising expenditures for private health insurance and public programs such as Medicare and Medicaid will lead to a growing inability of low- and middle- income Americans to receive health care, and siphon off tax dollars that could be used for other pressing social needs.

The real tragedy is that even though this country spends a far greater percentage of its gross national product for health services than does any other nation, this had not brought us either markedly improved access to health services or better health. The United States infant mortality rate ranks 19th among industrialized nations, and 37 million people do not have private or public health insurance.

Even though I wrote the report, the passage of more than twenty years caused me to read it today as if I'd never seen it before. Here's a few lines that struck me.

The goal of priority-setting is not to limit health care benefits, but to assure that as many of those benefits as possible are made available to people. Resource allocation becomes a concern only when there is a societal obligation to provide the services to be allocated. There is no public outcry about the maldistribution of diamond rings in homes across America, since this is not considered to be a basic human need.

...Rescuers will spend vast amounts of money to save a person trapped in a well when logic argues that more lives could have been saved if that same money were spent differently. The point seems to be that whatever our minds decide, our hearts must be able to live with.

Like most Americans, I'm hoping that a viable national health care plan is going to emerge from Congress and the Obama administration soon -- looks like it could be this year. Whatever that plan looks like, it is going to have to deal with quality of life and resource allocation issues.

I'm proud that Oregon helped lead the way in finding solutions to our health care problems. And pleased that I was able to contribute to that effort.

I'm also happy to learn, via a Wikipedia article, that Portlander Dr. Ralph Crawshaw was still very much alive and kicking in 2005. It was great to work with Ralph back in my state health planning and Oregon Health Decisions days. He was a great guy and a marvelously energetic activist.

Time to panic about swine (H1N1) flu?

I'm trying to decide how concerned I should be about the potential swine flu (officially called H1N1) pandemic.

There's so many things to panic about -- the economy, global climate change, whether Jack Bauer is going to survive his exposure to a lethal bio agent and come back for another season of "24."

I've got to prioritize my anxieties. So where should swine flu reasonably place on a holy shit! list of potential freakouts?

I'd say, about halfway. Nearer the bottom at the moment; could rise considerably higher this fall and winter if H1N1 returns in a more virulent form.

Back in 2005 I got pretty worried about avian flu. My "Masks to protect against avian flu" post has been getting quite a bit of Google'ish attention recently. That scare petered out, which surely helps make many people suspect that the current swine flu excitement is similarly overblown.

Well, maybe. It's looking like the H1N1 strain is acting a lot like normal seasonal flu in the United States. However, that's no reason to relax.

Effect Measure is a good source of info on what's happening with the swine flu outbreak. It's "a forum for progressive public health discussion and argument."

One post talks about the overreaction overreaction. Meaning, we shouldn't overdo our reaction to what may seem to be excessive hype about a possible pandemic.

The irony is that the overreaction backlash will be more severe the more successful the public health measures are. If, for example, the virus peters out this spring because transmission was interrupted long enough for environmental conditions (whatever they are) to tip the balance against viral spread, CDC and local health officials will be accused of over reacting. It's another example of the adage, "When public health works, nothing happens." On the other hand, if local officials do nothing and things get worse, they will be accused of being slow.

Another post notes that normal seasonal flu kills an estimated 30,000 people a year. Swine flu could be worse. Not because it is more virulent, but due to the fact that it's a new strain and nobody has resistance to it.

Now take a bad flu season and double it. To each individual it's the same disease but now everybody is getting it at once, in every community and all over the world. In terms of virulence, it's a mild pandemic. It's not a lethal virus like 1918. But in terms of social disruption it could be very bad. If twice as many people get sick, the number of deaths could be 80,000 in the US instead of 40,000.

My suspicion, from what I've heard and read, is that swine/H1N1 flu isn't going to be a huge problem this spring and summer. Effective measures are being taken to limit its spread. Hopefully these will work.

But it might mutate into a more dangerous form, making next winter's flu season more worrisome than usual. Flu shots almost certainly will incorporate the H1N1 virus. If plenty are available, and most people get them, we should be OK.

Basic lesson, as pointed out by Effect Measure: government public health programs are important. Tax dollars spent in this area produce really useful (and lifesaving) results.

We are pouring tens of billions into infrastructure. I'm a big fan of high speed rail. But the public health and social services infrastructure -- good, job producing infrastructure -- needs attention and needs it right away because of this virus.

Patients should question their colonoscopy preparation

Recently I wrote about my aggravation when staff at Salem Gastroenterology Associates (SGA) , the only place in town that does colonoscopies, brushed off my questions about their two day clear liquid diet preparation for the procedure.

I'd emailed a mention of the post to the SGA nursing staff, saying that I hoped they'd reconsider both their colonoscopy prep protocol and how they respond to patient concerns.

Yesterday I got a phone call from Zoe Wendolowski, who I believe is the nursing head honcho (probably her real job title is more formal).

We had a thoroughly enjoyable lengthy conversation that likely would have gone on even longer if I wasn't getting the Demanding Walk Look from the family dog. I came away feeling that if everyone at Salem Gastroenterology Associates is as pleasant and sociable as Zoe, the patient care there must be excellent.

She invited me to consider SGA for my next colonoscopy -- which is supposed to be in a couple of years -- and I told her that I'd be pleased to do that. But I'm still concerned about their atypical colon prep schedule.

Having worked in the health planning/policy area for fifteen years, I dredged up some memories of early enlightening experiences -- when I'd just started working as a research associate in the Oregon medical school's Family Practice Department.

One of the faculty members there was big on treatment protocols. Basically, flow charts to guide a doctor's decision making process. I told Zoe about the time I observed several experienced family physicians sitting around a conference table discussing urinary tract infections.

It turned out that each of them had a different way of handling this common problem. They argued for their own way of doing things; I can't remember if a consensus ever emerged.

So medicine isn't a science -- not in the sense of physics, where doing this generally causes that with remarkable precision (except in the quantum realm, where probabilities rule).

This is why patients should feel free to question what a doctor wants to do. And physicians should respond openly and non-defensively. Reasons should be given, not the sort of "just because" that I got from Salem Gastroenterology Associates.

I reiterated to Zoe what I wrote to the SGA doctor who was going to do my colonosocopy: the Mayo Clinic, Massachusetts General Hospital, and plenty of other highly respected medical centers typically use a one-day colon prep schedule, so why does your clinic believe a two-day liquid diet is called for?

Until I get a good answer to that question, I'll continue to wonder about Salem Gastroenterology Associates' approach to colonoscopies. Zoe said that they conduct research on the effectiveness of this screening procedure, which is great.

But I told her that they needed to also ask themselves whether they're doing some things just because that's the way it's always been done -- which isn't the best way to practice medicine.

President Obama is calling for more emphasis on comparative effectiveness research. For example, a question dear to my heart (and organs underneath) is whether a one-day colonoscopy prep is as effective, from both a patient and physician perspective, as a two-day prep.

Given that a one-day prep is so common, I suspect there's quite a bit of research to support that approach. However, if Salem Gastroenterology Associates can prove otherwise, they should do so.

If not, SGA may just be a quirky exception to a reasonable typical rule.

This is common in medical practice. There are large variations in how often certain procedures are performed in different parts of the country, as well as varying areas of the world.

Doctors get into habits. Often there isn't any reasonable reason for doing things a particular way other than "this is how we've always done it." As the story mentioned above said: 

At this time, however, comparative effectiveness research enters very little into most of our healthcare experiences. Clinicians still generally make decisions based on often limited research, professional guidelines, and their own experience. They don't have any other options: Comparative effectiveness research exists for only about 30 percent of medical treatments, experts say.

"We know macro answers, like whether surgery helps reduce heart attacks," says Jed Weissberg, associate executive director for quality and performance improvement for the Permanente Federation, the umbrella organization representing physician groups at Kaiser Permanente, which has been a pioneer in this area. "But we don't know answers to precise questions, like for different groups of patients, which drugs or which surgeries work best."

So don't have a my doctor knows best attitude. Question. Do your own research. Become friends with Google. Don't be afraid to ask "Why?"

I told Zoe that everyone agrees the colonoscopy prep -- cleansing the bowel -- is the worst part of the procedure. If it isn't necessary to almost double the time someone is on a liquid diet, why do it?

There may a good reason Salem Gastroenterology Associates typically uses a two-day prep. I just haven't heard it yet.

Think twice about getting a colonoscopy in Salem (Oregon)

First off, note that I said think twice. Your first thought -- "I should get a colonoscopy"-- is absolutely correct.

The procedure saves lots of lives through early detection and prevention of colon cancer, though recent research shows it isn't as effective as previously thought. Now it looks like colonoscopies prevent 60-70% of cancers rather than 90%.

Still darn good. Which is why I had a virtual (CT) colonoscopy in 2006. Naturally I blogged about it.

Last fall an occult (hidden) blood test done as part of my annual physical exam was positive. I asked for a re-test, since I had reasons to think that this was an anomaly. The second test turned out negative.

Regardless, my family doctor and I agreed it made sense for me to get a regular tube-up-the-butt colonoscopy. The procedure is no fun, especially the preparation for it, but colon cancer is a lot worse.

Thus I dutifully made an appointment at the only place in Salem, Oregon that does colonoscopies, so far as I know: Salem Gastroenterology Associates (SGA).

It didn't take long before I was doing my second thinking, because SGA turned out to be a frustrating place for an informed patient to deal with. Since I'd had a previous colonoscopy, albeit a virtual one, I was familiar with the typical preparation procedure.

This involves various dietary restrictions starting a week before the procedure. Then, on the day before the colonoscopy a clear liquid diet is proscribed. No solid food.

Yet when I had my pre-colonoscopy appointment with a SGA physician's assistant, and was given the preparation packet, I saw that the clear liquid diet was to begin at noon two days before the colonoscopy.

Whoa! That was about 14 hours additional waking-time fasting.

Vegetarians like me are used to eating frequently, and I wasn't looking forward to even a 19 hour clear liquid diet (if my colonoscopy was scheduled for 10 am, that's about how many waking hours the usual "day before" prep would last).

I fired up Google and did some research.

The Mayo Clinic said that typically the colon prep is done during the 24 hours prior to the exam. Mass General Hospital, another leading medical center, was more liberal, allowing a light lunch on the day before the colonoscopy.

I couldn't find any prep procedures that started two days before the colonoscopy, though I understood that in special circumstances (constipation, for example) this could be necessary.

My family doctor thought it was entirely appropriate to contact the physician at Salem Gastroenterology Associates who would be doing the procedure and ask about adapting the preparation schedule.

After all, I was a vegetarian who didn't consume nasty colon-clogging animal flesh, and I'd done just fine with a "day before" prep when I had the virtual colonoscopy.

So I wrote Patricia Kao, M.D. a thoughtful, respectful, well-documented two page letter, complete with attachments showing how Mass General and some other gastroenterology clinics handle colonoscopy preps.

I ended the letter this way:

As a final comment, a day or two after I had scheduled this exam I was listening to Dr. Dean Edell on the radio. A woman phoned in with almost exactly the same concerns I had about the colonoscopy prep schedule.

Edell told her that old habits die hard with physicians, that there are alternatives to the “old style” prep, and that doctors learn one way of doing things. He mentioned that his own colonoscopy prep “was horrible” and repeated that there are newer ways of accomplishing this. His ending advice to the woman was to be insistent with her physician.

I don’t particularly like the word “insistent.” I guess I prefer “questioning.” It seems to me that there are good reasons to modify my prep schedule, and I’m confident that we’ll come to a mutually satisfactory agreement on this.

Well, I was wrong. Because I never got to talk with Dr. Kao. Just a front office sort of person, who phoned to tell me that there wouldn't be any changes made to the two-day prep schedule.

I asked, "Why?" The response: "Dr. Kao and Mr. Butler [the physician's assistant] keep up on the latest research and regularly attend conferences."

I told the staffer, "That's nice. But the fact remains that the Mayo Clinic, Mass General, and every other colonoscopy place that I could find on the Internet typically uses a one-day prep, and I'd like to know why Salem Gastroenterology Associates thinks it knows better than the medical consensus."

In reply I got a robotic repeat of "Dr. Kao and Mr. Butler keep up... ."

I hung up the phone. Contacted my family doctor. Asked for a referral to Gastroenterology Specialists of Oregon (GSO) -- who have several offices in the Portland area and were one of the "day before" prep examples I'd mentioned in my Dr. Kao letter.

Everything went smoothly once I made the change to GSO. I was treated like a human being there, rather than a patient who shouldn't ask questions and do whatever I was told.

I didn't agree with everything in the GSO colonoscopy prep guidelines. But at least I could discuss things with staff and get reasons for doing this or that a certain way.

I told them about a "Gourmet Colon Prep" article, written by a nutritionist and physician, which cited research showing that nutritional supplements like Ensure could be taken in addition to clear liquids without messing up the quality of the colonoscopy.
Download Gourmet Colon Prep 

When I had the virtual colonoscopy, Ensure was allowed. It made a big difference to my uncomfortably empty stomach, providing some substance in addition to the clear liquids.

But I survived without it the second time around. When it came time for the colonoscopy itself, that was the easiest part. I went to sleep about two seconds after the intravenous sedative started flowing and didn't wake up until I was back in the recovery area.

The doctor told me that he found a polyp. It was removed. Turned out to be non-cancerous. I'm supposed to have another colonoscopy in a couple of years.

This shows that it's possible to have a "clean" virtual colonoscopy, and within two years get a regular colonoscopy that turns up a polyp. Of course, the same could happen with regular colonoscopies two years apart.

My experience also taught me that if a physican isn't listening to you and is playing the "Just do it, because I'm the doctor" game, head for another medical provider.

I might have gotten an equally excellent colonoscopy at Salem Gastroenterology Associates. But I lost confidence in that clinic after I was treated like a patient rather than a person.

Interestingly, I began my post-graduate school working career as a Research Associate in Family Practice at the Oregon Health Sciences University Family Practice Department.

One of my jobs was designing patient satisfaction questionnaires for the Family Practice Clinic, so doctors-in-training could get feedback on how they were coming across to patients.

I wish Salem Gastroenterology Associates would have sent me such a questionnaire. (The clinic I ended up going to, Gastroenterology Associates of Oregon, does use a patient satisfaction questionnaire -- and got excellent results.)

But I guess this blog post will serve equally well as a way of saying to them, "Respond respectfully to people when they have questions; doctors aren't gods, and shouldn't be preachy either."

If you live in the Salem area, get a colonoscopy when it is called for. But realize that you have options about where to get it. And what sort of preparation you have to go through.

Wellspring Center teaches secrets of happiness

A couple of days ago I learned how to be happy -- in less than ninety minutes. Plus, I got to eat a terrific dinner and drink some excellent Oregon Pinot Noir during the lesson.

Sweet!

This was the first time Laurel and I had been to Woodburn's Wellspring Center for Extraordinary Living.

Yes, Woodburn, a city between Portland and Salem that few people associate with hip, cutting edge, philosophically profound integrative medicine.

When we entered the Wellspring building (a remodeled K-Mart reportedly), I thought "Wow!" The place looked like something you'd find in trendy southern California. Curving corridors, tile everywhere, Zen-like design touches. Tres slick.

I half-expected to see Angelina Jolie and Brad Pitt wandering down the hall from the spa.

Instead we and a bunch of other happiness-seekers were met at the sign-in table by the presenters, Daniel Schweigert, MD and Susan Benner.

Sporting "I am happiness" t-shirts, they radiated energy, enthusiasm, and warmth. As did everyone else associated with Wellspring.

I don't like fakey New Agey personal development seminars and had some doubts about this one, which Laurel dragged me to encouraged me to attend with her. I had to miss my Tai Chi class, and anticipated that I was going to spend a couple of hours thinking "I'd be happier if I hadn't come."

Wrong. Daniel and Susan put on a heck of a happiness show. Nicely organized. Good blend of spontaneity and slides. Right on time. I even didn't mind doing the exercises.

Like spending four minutes speed-writing a bunch of stuff that makes me happy. I enjoyed being bluntly honest and not censoring myself -- which was one of the nine characteristics of happy people Daniel and Susan talked about.

Identification: assess what makes you happy, vs. what you're told by others should make you happy.

These characteristics came from a book by Rick Foster and Greg Hicks, "How We Choose to Be Happy." (naturally, they have a website)

Foster and Hicks say that they researched the book by driving around the country and asking locals, "Who is the most richly happy person around?" After getting a name, they'd head off to talk to the person and find out his or her secrets.

Here's a summary of what they found. I liked the initial item in Foster's blog post, given the crappy economic news that keeps on hitting us these days.

Having the intention to react differently to circumstances. The instant we make the choice to relax when we're paying exorbitant prices at the gas pump, or we cool our rage and decide to laugh at talk radio, we leave behind the heavily stressed flight-fight-freeze reactions of our "victim brain." We feel a lot happier -- and it's biochemically a good choice for our health.

We may not be able to choose our circumstances or the events around us, but we do have the power to choose our reactions. And happy people take that special power and choose wisely. And, by the way, this is not denial - it's the choice to not let external circumstances over which we have no control guide our reactions.

I asked the first question after Daniel and Susan had finished their presentation. I said that their approach seemed to be somewhat at odds with the oft-heard advice (by Buddhism and other philosophies) that desire is at the root of our unhappiness.

I wondered, couldn't embracing these nine characteristics of happy people become another "to-do" that adds on to our list of unfulfilled desires? Perhaps flowing with whatever happens, what is rather than what could be, is the way to go.

At the same time, I said (brandishing my new love), some material things undeniably make us happy -- such as my iPhone. So, what to do?

Susan offered up a pretty good answer. It's fine to enjoy things, she said, so long as we aren't devastated when we lose them. Daniel added that each of us eventually is going to lose the thing that we're most attached to right now: our body. So we've got to get used to letting go.

One last "who knew?" observation. Who knew that there was such a great healthy restaurant in Woodburn? (not us, for sure) Our dinner was prepared by Vitality, which is just inside the Wellspring front door.

Wish the restaurant was closer to us. Salem is sorely lacking in creative good-for-you menus such as Vitality sports.

Guess I'll just have to keep on practicing detachment. And eating the tofu special at Venti's, my favorite Salem eatery.

Gum graft goes fine (relax, if you need one)

Here's another in what I hope won't be a lengthy series of "don't worry" blog posts about scary sounding health procedures. (See "Root Canal is nothing to fear.")

I had a gum graft this morning. The worst thing about it was facing the fact that I'm old enough to need one, though I realize that people of all ages get gum grafts.

My dentist referred me to a Salem periodontist because he was worried that the beautiful bridge work he'd just redone, which had cost me more than a VW bug went for new back in the '60s, could be threatened by a receding gumline.

So he cheerily said, "I'd giving you a referral for a gum graft evaluation." That sounded ominous. So naturally I fired up Google as soon as I got home from the dentist's office.

I learned that its formal name is a gingival graft.

The usual approach is to chop out borrow some tissue from the roof of your mouth. That is sutured on the gum line, where hopefully it finds a happy new home.

Now, on the Internet I've found that most stories people share about medical procedures have an overarching theme: When Things Go Wrong. So at the moment, the #3 Google search result for "gum graft" is titled "The Procedure From Hell."

The same was true when I researched root canals, and mine went fine. It seems that few patients are motivated to write about their experience when the message is, "No problems, mate."

I talked about this with the periodontist at my evaluation appointment. He said that a balance has to be struck between educating yourself online (good) and scaring yourself half to death (bad).

Speaking of death, one of my first questions to him was whether he did grafts using Alloderm, which I'd read about on the Internet. I liked the idea of not having tissue cut out of the roof of my mouth, and I thought that Alloderm was some sort of artificial material.

But I was told, "It comes from cadavers."

My instant reaction was that I didn't like the idea of having part of my gum be made from a dead person. Plus, my periodontist said that a graft is much more likely to "take" when a person's own tissue is used.

Thus at 9:30 this morning I found myself back in his office, getting ready to be injected with several shots of Novocaine.

Reassuringly, after he was done I heard, "That's the toughest part." And it was true.

I was out the door, my VISA card $840 poorer, in almost exactly an hour. I felt less pain than from a filling or crown work. Afterwards I popped some Ibuprofen that they'd given me, but haven't felt any need to fill a Vicodin prescription.

Everybody's different, of course. Your results may differ. For what it's worth, though, here's some tips and observations.

-- I kept my eyes open throughout the gum graft. Given how much it was costing me, I wanted to absorb every moment of the experience. Such as the drops of red on the gloves of the periodontist and his assistant. Be prepared to see some of your own blood, since there's cutting going on inside your mouth. No big deal -- the bleeding stopped soon.

-- Periodontists must make good fly fishermen, who tie their own lures. I was impressed with the dexterity it took to put in the sutures. Of course, I had an extreme close-up view, since the guy's hands were just a few inches away from my eyes.

-- I was fitted for a roof of the mouth retainer at my evaluation visit. Good move. It protects the site where tissue was removed. I'm barely aware of it now, after wearing it for about 11 hours. I was told that it can come off tomorrow, if I want to remove it. There hasn't been any discomfort at all from the roof of my mouth, probably partly because of this protective device.

-- Don't get home and figure that you can eat whatever you want, even if you're feeling no pain. After I took my first bite of spaghetti with semi-tangy sauce, I did feel some pain at the graft site. Bland food has been my watchword today. Tofu and rice. Macaroni and cheese. Coffee (not too hot), for a mood elevator. Mushrooms. Wine went down fine also.

-- I was given some PerioGard mouth rinse to use. Another good move, as that saved me from trying my usual Listerine mouthwash tonight. I suspect the alcohol in it would create another "ouch" moment, but I could be wrong.

-- Five hours after I had the gum graft, I was out mowing the grass. I read some gum graft stories on the Internet where people said they stayed in bed for days afterward. That may be necessary in some cases. But I wasn't told to do anything but live a normal life, which I've been doing all day (aside from trying to elicit some sympathy from my wife so I don't have to wash the dishes or empty the dishwasher).

I'll add my own comments to this post as my recovery period proceeds. If my brain falls out through the roof of my mouth, I'll let you know -- assuming I have enough gray matter left to type coherently.

For now, here's my bottom line: this was another example where my worries about what would happen turned out to be more of a problem than what actually happened.

I mean, my fretting about how painful the gum graft might be caused me more pain than the procedure itself. Sure, the anxiety was psychological rather than physical, but it was pain nonetheless.

So relax, if you're told you need a gum graft. If yours goes as smoothly as mine has so far, there's no need to worry about it.

Align probiotic seems to work for me

There comes a time in a blogger's posting life when he says to himself, "How much do visitors to my blog want to know about my digestive system?"

This is a question that separates the self-absorbed blogger who believes that the world is interested in the most intimate and mundane details of his body, mind, and soul (namely, the true blogger) from the faux variety.

I've made my choice: to lead the reader deeper into the bowels of me.

Though my digestive story isn't all that interesting. I've simply noted that my late-50s body doesn't handle food with quite the same alacrity that it did when I was younger.

Which isn't a big surprise. My body doesn't do many things as well as it did years or decades ago. But eating is pretty central to my life, as is getting rid of what's been eaten.

In the good old digestive days I never thought about what entered my mouth and left the other end. Whatever I felt like eating, I ate. End of story. When I got into my late '50s, I began to notice that food's effects became less predictable.

Being a vegetarian, my fiber-heavy diet has always made it easy for me to put in regular reading time in the bathroom. But there can be too much of anything, and occasionally I'd find myself making more visits than I wanted to.

Enter Align, a slickly marketed Procter & Gamble probiotic product. I've been taking a capsule daily for a bit over a month, and it seems to have smoothed out most of the wrinkles in my intestinal life.

I already was a daily yogurt consumer. I also was taking another supplement of beneficial bacteria, Kyo-Dophilus. However, when I read about how the active ingredient in Align, Bifidobacterium infantis, had been proven to be effective in a controlled study, I decided to give it a try.

And have been happy with it.

It seems overpriced ($29.99 for a month's supply) but, hey, it's made by a giant capitalist corporation that packages 28 small capsules in foil blister packs stamped with the days of the week and puts them in a fancy box with a breathlessly positive brochure.

Procter & Gamble supplies a "Personal 4-Week Progress Chart" where the user of Align can record his or her digestive trajectory: Great!, Good, Occasionally bothered, Often bothered.

I wasn't sure what to make of the brochure's description about what to expect in Week 3.

You should be experiencing a noticeable improvement in your digestive health – in fact, some people may be noticing you are doing something new.

God, I hope not! The last thing I want is to be broadcasting the state of my digestive health to the world. Except…oops, I'm doing just that right now.

(This isn't anything new, though, having already shared the depths of my intestinal soul in another post about my virtual colonoscopy.)

Behold: my sacred supplements list

OK, I don't actually worship the supplements that I consume every day. So it's arguable whether they're sacred to me. But I sure spend a lot of time genuflecting in their health-giving direction.

I've decided that it's time to share my supplement list with a not particularly interested world. However, likely there are some supplement geeks in the blogosphere who share my fascination with finding just the right combination of concoctions for optimum well-being.

Which sort of is like the quixotic medieval search by alchemists to turn base metal into gold, because no supplement can hold back the inexorable tide of aging and death.

Still, this 59 year-old male and his wife want to postpone the inevitable for as long as possible. Thus we've been researching the pros and cons of various supplements for many years.

We've added to and subtracted from the pills and capsules that fill several plastic boxes, neatly divided and labeled, which accompany us wherever we go. I won't attempt to justify what's included on the list below. The links usually lead to my purchase source – and more information about the product.

About ten years ago I had a good-natured argument with my family physician at the time, a man my age. When I told him about some of the supplements I took, he said "But those haven't been proven to be effective."

I told him, "Well, there's considerable evidence that they are. If I wait for scientifically exact double-blind studies to be conducted on everything I take, I'll be dead. So I'll take my chances on persuasive, though not proven, information about the supplements' benefits."

Nothing since has changed my mind about the wisdom of this approach. I'm in generally excellent health. At my last eye exam, my optometrist said, "It's amazing that you don't need reading glasses at your age. You must be eating something that's causing your eyes to stay so flexible."

Could be the lutein. Or bilberry. Or maybe the DHA and EPA. I don't know. Could also be the luck of the genetic draw. I'm not particularly concerned about which supplements are doing what for me. Just the end result: better health.

Not highly scientific. But practical. And good for the bottom line of the companies that make and sell the supplements below, because I'm reluctant to stop taking any of them even though I've got doubts about the efficacy of some.

Do your own research. Make up your own mind. Here's my list:

Acetyl-L-carnitine 620 mg
Alpha lipoic acid 100 mg
Aspirin 81 mg
Bilberry fruit extract 120 mg
Celadrin 1050 mg
Co-Q-10 60 mg
DHA, algae oil 400 mg
DHA and EPA, algae oil 345 mg
DHEA 25 mg
Garlicin 350 mg    
Gingko biloba 60 mg
Glucosamine, vegetarian 1000 mg
Green tea extract 725 mg
Kyodophilus 3 billion cells
Lutein 12 mg
Melatonin 200 mcg
Multi-vitamin ("Doctor's Choice for 50-Plus Men," I take 1/2 of recommended)
Pomegranate extract 500 mg
Pygeum 200 mg
Resveratol 100 mg
Saw palmetto 320 mg
Vitamin D 400 IU

Root canal is nothing to fear

I just had a root canal, my second. It was almost pain-free. In an hour I was out of the endodontist's chair, standing at the reception desk, where I experienced my only real discomfort of the morning.

An $1,115 charge to my VISA card. Ouch!

Dr. O'Neill and I talked some about root canals' undeserved bad reputation. "The Endodontist's Association has talked about a PR campaign to change public opinion," she said, "but it's hard to fight all those stand-up comics and their 'worse than a root canal' jokes."

Well, I'm happy to contribute this blog post to the Association's cause. Fear not, if you've been told you need a root canal. The procedure usually isn't any more painful than a filling.

I agree with Joe. The crown and bridge work I've had done was more uncomfortable than the root canals. The Chicago Dental Society has come up with ten other things that are less fun than having a root canal.

That barely scratches the surface. Whenever the Grammys are on I try to expose myself to music I don't usually listen to. But the rappers make me hit the mute button. You know, listening to that atonal #$!*% is worse than…

The American Association of Endodontists points out the gulf between imagination and reality when it comes to root canals.

In an opinion survey of 1,000 adults conducted by the AAE, 63 percent described root canal treatment as either "painful" or "extremely painful." But those respondents who had experienced root canal treatment were six times more likely to describe it as painless, than were those who had never had treatment.

"Fear of root canal treatment truly is fear of the unknown," Dr. Katz said. "In fact, many patients tell us that they dreaded coming in, but they found the treatment easier than having a cavity filled."

So what accounts for the dread of root canals? Some people have lots of pain caused by the condition the root canal is going to relieve. That's one theory—the pain of an abscessed (or "hot") tooth gets mixed up with the comparatively mild discomfort of the procedure to fix the problem.

Staff at Dr. O'Neill's office offered up another idea: that root canals used to be much more difficult, painful, and complicated than they are now. This hypothesis fits with my memory of watching Westerns on TV, when "Gunsmoke" and such were popular.

A dentist reminds us of those not-so-good old days:

For a large part of human history, the only treatment for these death dealing infections was extraction of the offending tooth. Usually done with an instrument known as a pelican, and without anesthesia except for a bottle or two of whiskey (if the patient could afford it), the tooth was RIPPED out as quickly as possible, most frequently breaking the tooth.

I'll take a root canal instead, thank you.

Here's some recommended waiting room reading: the "Meditations" of Marcus Aurelius, a Stoically inclined second century Roman Emperor. I took a copy along today (Staniforth translation). Marcus' wisdom holds both for the dentist's chair and anywhere else.

All things are in process of change. You yourself are ceaselessly undergoing transformation, and the decay of some of your parts, and so is the whole universe.

…Be like the headland against which the waves break and break: it stands firm, until presently the watery tumult around it subsides once more to rest.

"How unlucky I am that this should have happened to me!" By no means; say rather, "How lucky I am, that it has left me with no bitterness; unshaken by the present, and undismayed by the future."

The thing could have happened to anyone, but not everyone would have emerged unembittered.

Well, not completely. When I get my VISA bill, there might just be a touch of bitterness at the four figure charge for an hour's worth of root canal'ing.

Sure beats drinking a bottle of whiskey and having the tooth ripped out, though. So go ahead and embrace your root canal without bitterness. No matter what it costs.

Avodart reduces my bathroom visits

Here’s one of the crucial questions facing a blogger: “Does anyone besides me care about how often I pee?” Well, how will I know unless I blog about it? And, if you don’t care, stop reading.

I suspect, though, that quite a few men of a certain age will find my subject fascinating.

For 50% of men over the age of 50 are said to have an enlarged prostate (90% over 80). In my “Female doctors do it better” post I noted that a prostate exam is the only time you don’t want to hear from a female who is inspecting your genital area that you’re larger than average.

That happened to me about fifteen months ago. At that time I started taking Flomax, a prescription drug that relieves the symptoms of BPH (Benign Prostatic Hyperplasia), which include going often, going urgently, having a weak stream, and frequently waking up at night to go.

All of which described how my 57 year old urinary system was operating. For some inexplicable reason that casts serious doubt on the existence of an intelligent designer, in men the uretha comes out of the bladder and passes through the prostate (which adds fluids to the semen to nourish and protect sperm cells).

When the prostate enlarges due to the effects of the male hormone dihydrotestosterone (DHT), the urethra gets squeezed. And the above-mentioned symptoms appear.

I’d been getting up at least two times a night to go to the bathroom. Recalling my youthful days, that wasn’t at all the case. Sleeping all the way to morning was the rule, not the exception. Then there was the flow thing.

At the athletic club where I work out, I generally use a side by side set of urinals (discreetly separated by a divider). One day I sidled up to pee at the same time as a twenty-something dude. I was struck by the difference in sound between us. One of us was imitating a small waterfall, the other a trickle tube.

You can guess which I was. But now I’m on my way to becoming a gusher again. And a much less frequent visitor to the bathroom, thanks to Avodart.

(Note: I have no financial interest in GlaxoSmithKline, which makes this drug. However, I'd like one. I’m entirely open to accepting cash and/or a free supply of Avodart from GSK if the company wants to express its appreciation for this marvelously positive free blog advertising. Or a Mini-Cooper S convertible, which would entitle GSK to a whole series of Avodart posts and really make me feel younger.)

When I went for my annual physical about three and a half months ago, my doctor told me that my prostate was still “generous.” I didn’t press for details. She said that while Flomax treats symptoms, it doesn’t shrink the prostate. Avodart does, by lowering the level of DHT. I was told that Flomax and Avodart can be taken at the same time, and that Avodart can take six months or so to have an effect.

Well, it seems to be working for me after just a bit over three months. I’m usually getting up to go just once a night now. And the frequency of bathroom trips is considerably less during the day.

Yesterday I peed at the athletic club around 4:30 pm, then went to my Tai Chi class. At 6:15 I drank a large Starbucks latte before beginning my weekly grocery shopping. Got home and took the dog for a walk. Peed again at about 8:00 pm. That’s three and a half hours between bathroom visits, even with a large latte coursing through my bladder.

Much improved from before. So I’m happy with Avodart.

It’s fairly spendy, but insurance is paying half the cost of my prescription. I haven’t noticed any side effects. That’s good, but I would like to experience the side effect of having hair regrow on my bald spot. Avodart is expected to work like Propecia, since it reduces the conversion of testosterone to DHT, one of the causes of hair loss.

I’ll be keeping an eye on the back of my head. Along with paying less attention to toilets.

Omega-3 from V-Pure algae, not fish or flax

Being a vegetarian can be complicated. Fish oil is the best source of Omega-3 fatty acids, which confer important benefits to the heart, brain, eyes, and other body parts/functions.

But I don’t like the idea of eating a once swimming life form (though my wife points out that I take a joint supplement, Celadrin, which contains an ingredient that once was part of a cow).

So I’ve been searching for a karma-lite way to get my Omega 3’s. Several years ago I started taking a couple of flax oil capsules every day. I’ve also tried frozen waffles with hemp seed, which are legal again after the failure of an ill-considered federal attempt to ban hemp products..

Flax is one of the best vegetarian sources of Omega 3. However, it’s still a long ways from matching fish oil. It seems that flax has lots of ALA (alpha-linoleic acid). This is a parental fatty acid that gets converted into the children of DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid).

DHA and EPA are the truly beneficial Omega 3’s. So if ALA doesn’t get converted into them, eating gobs of flax oil or flax seed isn’t going to accomplish much. And from what I’ve been able to fathom (more knowledgeable readers, please correct me), a number of factors prevent vegetarian ALA from being converted into DHA and EPA.

Thus I’ve also been taking Source Naturals’ Neuromins DHA, which comes from algae. It’s billed as a “dietary supplement for the brain,” so I try to never forget to ingest two 100 mg capsules a day. That way I know how much DHA I’m getting, 200 mg—a bit more than my wife gets from her three Eskimo-3 fish oil capsules (130 mg).

Yet Laurel’s fish oil supplement has 210 mg of EPA and I’m batting zero. I’m no expert on the relative value of EPA and DHA, but the couple who wrote “The A-Z’s of Omega 3s” obviously have done a lot of research. They say:

Ralph Holman from the University of Minnesota and the Grand Master of essential fatty acid studies in humans, once summed up the situation by saying 'DHA is structure, EPA is function.'"

Well, I’d like my brain to have both structure and function. So it’s been bothering me that I couldn’t find a vegetarian source of EPA. Earlier this month I embarked on a search for this non-fishy Omega 3 Holy Grail. Thanks to Google, I believe I succeeded.

A few days ago two bottles of V-Pure Omega 3 arrived in the mail from Switzerland. It isn’t sold in the United States so far, to my knowledge. V-Pure is derived from algae by some sort of secret process that the makers are coy about, supposedly to protect their patent.

That makes me a bit wary. However, the bottles I received say that two capsules a day provide 75 mg of EPA and 270 mg of DHA (a lot less EPA than fish oil, but a lot more than nothing). Maybe I’m overly trusting of the European Union and Swiss manufacturing, but I’m taking them at their word.

With just three days of this supplement in my system my brain doesn’t seem to be functioning noticeably differently than before. I do seem to have a clearer view of the world, but that’s probably because I haven’t been watching much Fox News over the Christmas weekend.

So I recommend that vegetarians looking for a good non-fish Omega 3 source check out V-Pure. It’s kind of cool to order from a European web site (they have a currency converter) and I got my order in a shade under three weeks.

I’m skeptical that this product is going to change the world like the maker says. But if it changes my brain and heart for the better, it’s worth the charge to my VISA card.

[Update: thanks to a comment from ET, I was led to this additional information about the benefits of Omega 3 fatty acids and the need to reduce your Omega 6 intake to derive maximum benefit from the "3s."]

My virtual colonoscopy is a walk in the park (and to the toilet)

Nobody other than a masochist says, “Oh joy, I’m going to have a colonoscopy today!”

So I’ve resisted having an endoscope snaked up my butt, even while sedated. I’d heard horror stories about people who suffered a lot of pain during a colonoscopy but were too zonked out to effectively communicate what was going on.

Then I learned about virtual (or CT) colonoscopy. It’s non-invasive (yes!) and doesn’t require sedation. Like most things medical there’s debate over whether conventional or virtual colonoscopy is better.

A 2003 study reported in the New England Journal of Medicine concluded:

“CT colonoscopy with the use of a three-dimensional approach is an accurate screening method for the detection of colorectal neoplasia in asymptomatic average-risk adults and compares favorably with optical colonoscopy in terms of the detection of clinically relevant lesions.”

Good enough for me. My family doctor was willing to write a referral for this endoscopic alternative, and this morning my 58-year old body found itself poised to pass through the maw of Body View Diagnostic Scanning’s CT machine (they’re in Clackamas, Oregon right off I-205; phone 503-653-7226).

It took just half an hour to get both a heart scan and a virtual colonoscopy. The first was completely painless; the latter was a bit uncomfortable because of the carbon dioxide that gets pumped into the colon to inflate it.

But it still was a walk in the park compared to a regular colonoscopy. The preparation procedure isn’t as onerous and there’s no sedation recovery time. Nor any risk of complications, such as a bowel perforation.

The main drawback of a virtual colonoscopy is that suspicious polyps can’t be removed on the spot. However, Body View says that polyps are found in only 7-10% of patients, so I’ll take my chances (I get the results of the scan tomorrow).

It’s important to have a colonoscopy once you’re over 50. But many people don’t, because the procedure is intimidating. What helped to sell me on a virtual colonoscopy was the Boston Medical Center’s pitch to physicians.

It is one thing for doctors to recommend colon screening for their patients, it is another thing for doctors themselves (their spouses and/or parents) to have their own colons checked. Now that an accurate, quick, and safe test is available it is even less excusable to avoid or delay "clearing your colon." Colon screening by Virtual Colonoscopy , at least for a doctor and his family, should be as basic and instinctive as a mammogram for her and a PSA for him once a certain age is reached.

Similarly, the Body View staff told me that they perform quite a few virtual colonoscopies on gastroenterologists. If it’s good enough for MD’s, it’s good enough for me. And Laurel, who has had one also.

Still, neither of us enjoyed the frequent trips to the bathroom during the bowel cleansing that starts the day before the procedure. After 5:30 pm, when you chug down some magnesium citrate, you don’t want to stray far from your new best friend: the toilet.

This has to be done with a regular colonoscopy also, though. And we liked Body View’s more lenient dining guidelines on the day before the exam. I got to have a normal breakfast, then a light low fat/fiber lunch (for me, banana and pasta with plain tomato sauce).

Dinner at 5 pm, such as it was, consisted of a nutritional drink. Then it was cold turkey (or, rather, tofu) for this vegetarian until 10:00 am the next morning, when I was able to eat some post exam snacks provided by Body View.

I’m not used to going without solid food for almost 24 hours. I did a lot of starving-children-in-Africa visualizing to keep things in perspective. It was hard to get to sleep on a nearly empty stomach. While I lay there, initially passing the awake time by feeling sorry for myself, I eventually realized that this is what lots of people in the world experience every night.

Overall, my virtual colonoscopy wasn’t as difficult as I expected. I got used to feeling hungry after a while. I felt almost normal (albeit several pounds lighter) driving up the freeway to Portland this morning.

The two-person staff at Body View greeted me with a smile. They’re pleasant, competent, egalitarian, and refreshingly informal. After the exam I got to view my heart and colonoscopy scans on computer screens and hear a general explanation of the procedures. Plus, get some initial heart scan results.

My cardiac calcium plaque score was 4. Pretty good, but not perfect. This means that my risk of coronary artery disease is very unlikely, less than 10 percent. The Body View guy said that I scored better than about 78% of men my age. I told him that was good news. But since most American men my age are out of shape, overweight, and eat unhealthily, I didn’t consider it great news.

I ended up with a $1,141.25 VISA receipt for my share of the two scans. It was that high because I hardly ever go to the doctor and still had $750 left to meet on my $1,000 Regence Blue Cross deductible.

But as my family doctor said when we discussed the pros and cons of getting these scans (mainly the heart scan; getting a colonoscopy is a no-brainer for anyone over 50), “It just depends on what you want to spend your money on.”

I told her that for eleven hundred bucks and change I could get a nice new computer. Or some other electronic toy. However, if I ended up with undiagnosed colon cancer or heart disease, I’d kick myself for not choosing the diagnostic tests instead.

Do yourself a favor. If you can afford it, or even if you feel that you can’t, get a colonoscopy after you pass the half century mark. With the virtual variety, you’ll hardly feel a thing.

Except a toilet seat, quite a few times, the day before. And some stomach rumblings when midnight snack time arrives and you can't even drink a glass of water. All in all, a small price to pay to markedly reduce the risk of dying from colon cancer.

Check out the Center for Virtual Colonoscopy at Boston Medical Center for more information about this procedure.

Marijuana may stave off Alzheimer’s

Ah, excellent news today: smoking pot may prevent the progression of Alzheimer’s disease.

I’m hoping the effect is long-lasting, since I inhaled enough THC in the 60’s to keep me Alzheimer’s-free for a thousand years (more or less; anyway, the whole universe could just be a speck in the eye of a Cosmic Dude who is just a speck in the eye…time’s got to be an illusion).

What a trip. All these years I’ve heard, “If you can remember the 60’s, you probably weren’t there.” Now it turns out that those cannabis-happy hippie days were good for the memory.

Far out.