Tuesday, February 12, 2008

HOW TO BE AN ORGAN DONOR

HOW TO BE AN ORGAN DONOR
JAMA 1.19.08, NIH
Today many organ transplant patients have a new lease on life. Many organs are needed: heart, kidney, liver, lungs, pancreas, and intestines. Other body tissues are also needed: cornea, heart valves, and skin.

You say which organs and tissues you want to donate.

STEPS TO TAKE

1. Tell your family and doctor.
2. Fill out the back of your driver license and also a donor card.
3. Make 5 copies and give one to your doctor, your lawyer, your family, your glove compartment and your wallet.
4. Give someone power of attorney to make medical decisions for you when you are incapacitate. It may be your doctor, friend, or family member.
5. Make a living will and also an advance care directive. These legal documents state your wishes in case you can’t communicate.

CONDITIONS

1. Being a donor does not change how an emergency treatment would be handled. The emphasis is always to save your life.
2. Your donations go to those with severe illnesses who are on a waiting list. Medical factors are rated. No one gets a jump on the list because of being rich or being a celebrity. Today elderly get transplants of damaged organs from elderly patients.

GIVE THE GIFT OF LIFE TO SOMEONE IN NEED

VIST US AT: www.americanacupuncture.com

HEALTH CARE ELECTION POLITICS

HEALTH CARE POLITICS 2008
HARVARD SCHOOL OF HEALTH, NEJM 1/14/08

Both republican and democratic parties are showing different visions on how the voters health care should look. It is a top issue with both parties in the primaries. Employer sponsored insurance has sponsored the general health care system since the 1940s. Over 160 million non elderly americans are now covered. Will the intensity become the same as when President Clinton was first elected?

A survey in November by the Harvard School of Health showed:

DEMOCRATS

The democrats mainly complain about the quality and the cost of their health care. Half of the respondents felt the system was not bad enough to rebuild, and even 20% said it was excellent.

Democrats want universal health coverage and tax incentives to make it affordable. They want their employers or the government to pay for their health coverage. They also want more coverage and more benefits..

It is the number one problem to democrats and they feel the government should make it work. They would even pay more tax to get more insurance coverage. They want everyone to have health care with the government to help. They would like costs controlled and more health insurance coverage available.

REPUBLICANS

Republicans seem satisfied with the cost and quality of health care and are not worried about paying more or losing their coverage. They consider the war, economy, and immigration to be greater issues than health care.

They also would like the cost of health care reduced, but don’t want the government involved. They prefer the individual to purchase his own coverage.

High deductibles are fine. They want catastrophic coverage and like health savings accounts. It is the individual’s responsibility expect the private health insurance companies to give good coverage.


THE DEMOCRATIC PLAN

The aim is to finance minimal coverage by play or play employer mandates requiring businesses to offer workers insurance or pay a tax. Small businesses would be exempt and those that offered insurance would get a tax credit.

Private insurance issuers would be tightly regulated to allow everyone access to insurance. There would be new purchasing pools where individuals and businesses could buy insurance from any number of private plans. Government would subsidize individuals with low income. Medicare would not change. Medicaid would cover more low income americans.

The plans avoid details of budgeting the health care spending and centralized government cost controls. The plans mention cost saving measures as electronic medical records and focusing on preventive medicine. All this would be funded by canceling Bush's tax cut and a tax reform.

Hilary Clinton's plan requires all Americans to have insurance. Sen. Obama's plan mandates coverage only for children but does not rule out other changes.

People who can afford insurance must purchase coverage or pay a penalty. Health care becomes a responsibility not simply a right. Healthy persons must join insurance pools to share the risk and ensure coverage for all.

Since health care is unaffordable to many Americans, this plan depends an enforcement mechanism, the price of insurance, and generous government subsidies.

THE REPUBLICAN PLAN

Senator McCain has not release a detailed health plan but favors incremental expansion of insurance coverage and a change in tax policy so there could be more access and more control. It would shift enrollment form employer sponsored insurance to the individual. McCain offers a tax credit for Americans buying health insurance from an employer ore employer sponsored insurance, since these contributions are tax exempt. He pushes for more generic drugs and to coordinate how health providers are paid. He woulde decentralize market oriented reforms rather than universal coverage. This plan is not likely to increase coverage nor control costs.

THE BALANCE OF POWER


In the end, the values and beliefs of the candidate are most important. How committed is the candidate and can he or she deliver health change? Experience, stands on issues, leadership ability, character, and like-ability all are factors. Does the candidate share the voter’s views, values, and beliefs on issues most important to the voter? How health care should look like depends on how satisfied every voter is with his health care situation. in the end we can't take the candidates literally. The next president will have a different plan than what is proposed in the primaries. After all, the congress passes the laws.

THE KEY:

OVER 1/3 OF AMERICANS ARE INDEPENDENT VOTERS WILL IT BOIL DOWN TO WHAT THEY THINK?

Your comments always appreciated.
VISIT US AT: www.drneedles.com

CORONARY DRUG STENTS

DRUG ELUTING STENTS
Jama 1.39.98
Coronary vascularization has improved vastly with drug-eluting stents. The two drug stents: strolimus and pachitaxel stents have lowered coronary restenosis to 5% from 15% with older bare metal stents .

Because companies look for device regulatory approval, they choose patients who have low risks of restenosis as a consequence.

Since approval comparison trials have suggested equal rates of restenosis with these drug stents. Trials for approval occur in all areas of medicine. They are designed to test if the drug or device is helpful under ideal conditions rather then if the drug or device is beneficial in everyday practice. After approval of the drug or device, new studies are expected to help bridge this gap and monitor safety.

WHICH STUDY DO YOU BELIEVE

The strolimus stent was the first available clinically. Early post approval testing showed it was safe and effective in reducing restenosis and also lowering heart complications. They had similar results in their regulatory approval studies.

Later the pachitaxel stent approval studies also showed it was safe and effective and had the same outcomes as its rival strolimus stent.

A study followed comparing both stents in16 randomized head to head trials, and another 38 trial studies. It was found that strolimus stents had lower restenosis rates and lower stent clots than its rival paclitaxel.
This resulted in confusion and was challenging to interpret.

A report by Galloe published in the JAMA January 2008 reported a study that included unselected patients with varied symptoms. This randomized trial study showed no difference in the two stents in all analyzed categories. It was the largest randomized study including all comers.

THE FUTURE

Soon second generation stents this year will be on the market, namely everolimus and zotarolimus=eluting stents.. The vascular surgeon will choose a stent that is based on safety, effectiveness, deliverability, and above all which insurance company will pay for the device.

Studies have become hard to interpret because of different criteria used for patient enrollment. Real world registries and studies are limited because they don’t have valid control groups and they use historical controls. Now with a large database for all procedures, we might find the safest and most effective stents that should be used.

VISIT US AT www.americanacupuncture.com

Monday, February 11, 2008

LESS MONEY HURTS HEALTH CARE

LESS MONEY HURTS OUR HEALTH CARE
JAMA 10.24.07

Increased poverty and loss of jobs are proving harmful to our health care. A 1990 study showed people who earned under 50K lived shorter lives, and their social behavior of smoking and alcohol resulted in need for more health care.

The Poverty rate is up to 12.6% and those in severe poverty, earning under 10K, increased to 22.6%. Seniors receiving Medicare helped this.

Personal Income is down except for the very rich. The median real income dropped 4% between 1999-2004.

The gap between the rich and poor widened. Pretax income for the very rich increased from 31% to 44%. The richest 1% earning over 250K, had their income doubled from 8% to 17% between 1980-2005. A Corporative CEO median compensation was 33 million.

Because everyone is seeing their income dropping except the most affluent, everyone’s health will be affected. This destabilizes civic health of the communities and increases demands on our health care system. We should soon see more severe diseases and see them more often now that we all have fewer dollars.

Family budgets are hurt by rising medical costars and rising medical insurance. Losing your insurance results means not getting needed medications and not having health tests done. Higher hospital admissions and increased cancer rates should result.

It may take a lifetime of poor eating, smoking, and inactivity to lead to cancer and other diseases. We see unhealthy life styles in our youth today. Lack of knowledge makes it difficult for them to change their behaviors.

Increasing need for health care will make treatment more expensive for our aging population who are living longer. Our health delivery system must plan for a greater volume of patients who are not insured.

The solutions are tough. We need helpful economic measures, increased technical skill, more education, job retraining, improved school conditions, and more new family skills in caring for their aged relatives.

Yet there are powerful interests not to improve our personal income. They must be prepared to deal with diseases that occur when people have money problems.

Visit www.americanacupuncture for more information.

CUT OUT THE SALT. STOP HIGH BP.

CUT OUT THE SALT
JAMA 9.20.07


Around the world, 16 million people die a year from cardiovascular disease. Half of these deaths are from high blood pressure.

In America, over 25% of adults have high blood pressure and another 30% have prehypertension. The probability is that 90% of us will have high blood pressure.

Everything points to salt as the culprit. In the lsat 30 years the average American has increased his salt intake by 55% to an astounding 4000 mg of salt daily.

Restaurants and processed foods give us 77% of our sodium, 12% is in natural foods, 5% is added to cooking and 6% added at the dinner tables. A typical restaurant meal has 2400-4699 mg of salt.

The American Heart Association and National Heart Institute recommend an intake of less than 2400 mg of salt daily, preferably 1500mg. WHO, the world health organization, has stated excess salt causes hypertension and recommend under 200mg intake per day.

Only 20% of us adhere to these levels under 2400mg daily. Every medical group wants us to cut down 50% on our salt intake. Ideally, 1500 mg daily is our goal.

Because the FDA lists salt as a safe ingredient, called GRAS the generally recognized as sate levels. Hence, the food industry does not have to lower their salt contents. Some people want revocation of GRAS. Then the food industry would need to petition the FDA for approval of salt as a food additive. This would force regulatory amounts of salt in different types of food. Unfortunately, the FDA has its hands full with other priorities.

Finland reduced its salt intake by 40% over the last 30 years by labeling foods with high salt labels, and increased media and print advertising. Britain divided foods into 70 categories: breads, canned vegetables and soups, processed meats etc. Each section has voluntary targets for salt reductions. Food is labeled red for high salt, yellow for medium, and green for low salt. Ireland and Australia are starting programs to meet standards for food.

If we lowered our salt intake by 50%, high blood pressure would be reduced by 20%, coronary mortality by 9%, strokes by 14%, and overall deaths by 7%.

We add 80% more salt by food processing by eating in restaurants. A salted bagel has 4500 mg of salt, a slice of pizza 1600; a Ruben’s sandwich has 3000 mg. Eating a turkey sandwich at home is 300mg and a hot dog is 550mg. Eating in restaurants regularly has added a medical risk to our lives.

Cutting out salt is not the entire hypertension answer. But who really cares! Remember Dr Needless success formula:" Success equals failure minus one. "

Visit our recent medical bog on the importance of Potassium in reducing hypertension Dec 01.2007. For more medical info visit our site:
www.americanacupuncture.com

SALT, THE CARDIAC KILLER

CUT OUT THE SALT
JAMA 9.20.07


Around the world, 16 million people die a year from cardiovascular disease. Half of these deaths are from high blood pressure.

In America, over 25% of adults have high blood pressure and another 30% have prehypertension. The probability is that 90% of us will have high blood pressure.

Everything points to salt as the culprit. In the lsat 30 years the average American has increased his salt intake by 55% to an astounding 4000 mg of salt daily.

Restaurants and processed foods give us 77% of our sodium, 12% is in natural foods, 5% is added to cooking and 6% added at the dinner tables. A typical restaurant meal has 2400-4699 mg of salt.

The American Heart Association and National Heart Institute recommend an intake of less than 2400 mg of salt daily, preferably 1500mg. WHO, the world health organization, has stated excess salt causes hypertension and recommend under 200mg intake per day.

Only 20% of us adhere to these levels under 2400mg daily. Every medical group wants us to cut down 50% on our salt intake. Ideally, 1500 mg daily is our goal.

Because the FDA lists salt as a safe ingredient, called GRAS the generally recognized as sate levels. Hence, the food industry does not have to lower their salt contents. Some people want revocation of GRAS. Then the food industry would need to petition the FDA for approval of salt as a food additive. This would force regulatory amounts of salt in different types of food. Unfortunately, the FDA has its hands full with other priorities.

Finland reduced its salt intake by 40% over the last 30 years by labeling foods with high salt labels, and increased media and print advertising. Britain divided foods into 70 categories: breads, canned vegetables and soups, processed meats etc. Each section has voluntary targets for salt reductions. Food is labeled red for high salt, yellow for medium, and green for low salt. Ireland and Australia are starting programs to meet standards for food.

If we lowered our salt intake by 50%, high blood pressure would be reduced by 20%, coronary mortality by 9%, strokes by 14%, and overall deaths by 7%.

We add 80% more salt by food processing by eating in restaurants. A salted bagel has 4500 mg of salt, a slice of pizza 1600; a Ruben’s sandwich has 3000 mg. Eating a turkey sandwich at home is 300mg and a hot dog is 550mg. Eating in restaurants regularly has added a medical risk to our lives.

Cutting out salt is not the entire hypertension answer. But who really cares! Remember Dr Needless success formula:" Success equals failure minus one. "

Visit our recent medical bog on the importance of Potassium in reducing hypertension. For more medical info visit our site:
www.americanacupuncture.com

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