Acupuncture Associates
News News News
May 2008
PREVENTATIVE MEDICINE FOR THE EARS
Although acupuncture can sometimes be helpful for ringing in the ear (tinnitus), hearing loss is much more difficult to treat. As is usual, preventative medicine is best.
Exposure to levels of sound as low as 85 dB can result in hearing loss, so loud music played though headphones and common household items such as vacuums and coffee grinders are potentially dangerous. Lawnmowers, garden equipment, and many power tools also generate enough noise to damage hearing. A screaming child can also easily create levels that will cause damage, as can many theater sound systems.
Also of concern is the potential for loud noise to create stress levels that can damage the heart, an observation consistent with Chinese medical theory.
We recommend that hearing protection be worn whenever exposure to potentially damaging noise levels occur. Inexpensive foam earplugs should be carried in your purse or brief case, and always used whenever power tools are in use. Take them with you whenever you go to a movie theater or concert, and adjust your music devices to play at safe levels.
If you think you have “adjusted” to loud noises, it is likely that you have already suffered hearing loss. (L.B. Grotte, M.D.)
MEDICARE DISADVANTAGE
Congress is always ready to make a bad situation worse, and they are experts when it comes to adding a new layer of inefficient bureaucracy to an already failing medical system. One of the more recent is the legislation creating the “Medicare Advantage” plans that were supposed to reduce the out of pocket costs of Medicare patients and reduce payments to insurance companies, saving taxpayers’ money.
In fact, according to a Government Accounting Office report dated February 28, 2008, Advantage plans in 2007 were paid 13% more than the cost of care in fee-for-service Medicare, and, in addition, 19% of patients paid more for these services than they would have in regular Medicare.
“The real beneficiaries of Medicare Advantage are the insurance companies, which have profited handsomely”, stated John Dingle (D. Mich.). (JAMA April 9, 2008 Vol.299 No.14 p. 1657)
FAMILY PHYSICIANS DISSATISFIED WITH PRACTICE
A 2007 survey found that 59 per cent of family physicians would choose a different career path, given their present experience with practicing medicine. 22 per cent said they would not choose medicine, and 37 per cent said they would become a surgical/diagnostic specialist. (Family Practice Management April 2008 p. 16))
DIMINISHING NUMBERS OF CARDIAC SURGEONS AHEAD
One-half of cardiac surgeons are over 53 and many are contemplating early retirement due to financial factors and decreasing job satisfaction. According to Dr. Andrew S. Wechsler, professor of cardiothoracic surgery at Drexel University in Philadelphia, the pipeline of future surgeons is “essentially nonexistent”.
Dr. Wechsler points out that the falloff in applicants for training positions began about 4 years ago and positions now exceed applicants. Last year there were 97 applicants for 130 training positions, and only 68 were graduates of American medical schools.
Dr. Wechsler told a conference of the Society for Cardiovascular Angiography and Interventions that he feels the quality of the applicants has dropped off also: “anyone who has reasonable qualifications will be accepted by a program somewhere.”
Reimbursement for cardiac surgery today is, in real dollars, about 30% of what it was 15 years ago, cases have become more complex, and the average yearly cost of malpractice for surgeons in Pennsylvania is $125,000. Training programs have decreased the number of years and the breadth of experience that was once required to try to entice students to enter the field, but without success.
Referring physicians are likely to find fewer excellent quality cardiac surgeons, predicts Dr. Wechsler. (Family Practice News, March 1, 2008: p. 10)
FEDERAL OVERSIGHT “INADEQUATE”
The US Department of Health and Human Services inadequately supervised Medicaid demonstration projects in Florida and Vermont, which were supposed to be budget neutral by law, so they actually cost $6.9 billion more in Florida and $246 million more in Vermont.
“Once again, beneficiaries are being moved into managed care plans that offer fewer benefits but produce zero savings for the federal government”, complained Frank J. Pallone (D. NJ), chairman of the Energy and Commerce Committee’s Health Subcommittee. (JAMA April 9, 2008 Vol.299 No.14 p. 1657)
ALCOHOL IN MODERATION BENEFICIAL FOR COGNITION
People who drink moderate amounts of alcohol (14-28 standard drinks a week for men, 7-14 standard drinks a week for women) have better verbal skills, memory and speed of thinking than teetotalers or heavier drinkers. (The Australian National University Press Release).
In other news, a team of Israeli researchers found that fasting plasma glucose decreased from 139.6 mg to 118.0 mg in diabetics who drank 150 ml of wine a day (about 5 ounces). There was also a slight improvement in LDL. (Diabetes Care 2007; 30:3011-3016)
ALCOHOL BENEFIT COMPARABLE TO STATINS
Nondrinkers who began drinking moderately experienced a 38% reduction in cardiovascular events over 4 years compared with continued nondrinkers.
The statistics result from the “Atherosclerosis Risk in Communities”, which is a National Heart, Lung and Blood Institute ongoing prospective study of 15,792 middle-aged black and white men and women free of known cardiovascular disease and diabetes.
Current American Heart Association guidelines acknowledge the drug benefit of alcohol, but caution that “if you don’t already drink, don’t start.” However, Dr. Dana E. King, professor of Family Medicine at Medical University of South Carolina in Charleston believes physicians should challenge the AHA position. He points out: “That’s a bigger effect than you’d expect with initiation of statin therapy”. (Family Practice News April 1, 2008 p 1.)
CALCIUM SUPPLEMENTATION INEFFECTIVE
Calcium not only failed to prevent hip fractures, it actually was associated with an increase in fractures according to a new meta-analysis.
The results apply to both men and women taking either food or supplements. Those who are taking 800- 1200 mg of calcium experienced a 64 per cent increase in hip fractures compared with placebo. (Am. J. Clin. Nutr. 2007; 86:1780-1790)
PROZAC INEFFECTIVE IN TEENS
A study at University Hospitals in Cleveland indicates that Prozac treatment is no better than placebo for treatment of depression in adolescents who also have substance abuse disorders.
Thirty-four adolescents with a mean age of 16 ½ years were studied in treatment and placebo arms, and results demonstrated no benefit for depressive symptoms, psychosocial functioning, or positive drug screens between the groups. (Fam. Prac. News March 1, 2008 p 28)
TWENTY SIX PER CENT OF 14-19 YEAR OLD GIRLS HAVE A SEXUALLY TRANSMITTED DISEASE
A study of the data from the 2003-2004 National Health and Nutritional Examination Survey indicates that more than 3 million teenage girls have at least one sexually transmitted infection and 15% of those have multiple infections. “For any other disease, we would be calling this an epidemic,” states Dr. John M. Douglas Jr., director of the Center for Disease Control’s Division of STD Prevention. (Family Practice News April 1,2008 p 1.)
Ed. Note: One wonders why Dr. Douglas cannot call this an epidemic. It is likely that numbers are comparable for 12-13 year olds, and data that is more recent is likely to show increases. Perhaps the State of Texas should seize all these girls and put them in foster homes.
MORE EVIDENCE ON RED MEAT AND COLORECTAL CANCER
Another study has confirmed the link between consumption of red meat and colorectal cancer. Nearly half a million Europeans were enrolled in the study between 1992 and 1998, when all were free of cancer, and supplied details of diet and lifestyle.
After 4.8 years, 1329 cases of colorectal cancer were recorded. After adjusting for a variety of known risk factors, those who ate the highest amounts of red and processed meats were found to have a 35% greater risk of developing the cancer.
By contrast there was a risk reduction of nearly a third (31%) for people who consumed one portion or more of fish every other day compared with those who ate fish less than once a week. (Journal of the National Cancer Institute, Vol. 97, No. 12, 906-916, June 15, 2005).
IYENGAR YOGA
Twenty-four female subjects who perceived themselves as mentally stressed and who took up Iyengar yoga (two 90-minute classes a week for 12 weeks) reported significant improvements in perceived stress, anxiety, well-being, vigor, fatigue and depression.
There were also significant reductions in headache and back pain. (12th Annual Symposium on Complementary Health Care, 19-21 September 2005, Exeter, UK).
ISRAELI HEALTH MINISTRY WARNS AGAINST SOYA
Israel’s health ministry has recommended that consumption of soya products be limited in young children and avoided as far as possible in infants.
In addition, it recommends that adults consume soya products only in moderation. They are concerned about emerging evidence, mostly from animal studies, that the high phytoestrogens present in soya may be implicated in male infertility and some kinds of cancer.
Soya consumption is high in Israel as kosher food practices prohibit consumption of dairy products within six hours of eating meat. (Jerusalem Post, 7/20/05).
Research carried out in Belfast, Northern Ireland, has suggested that men consuming large quantities of phytoestrogen rich soya, have lowered sperm quality and that the reproductive capability of boys might be damaged by too much soya in the diet. (http://news.bbc.co.uk/2/hi/uk_news/northern_ireland/3513607.stm)
21.2% of the women taking HRT reported a return of hot flushes, vaginal dryness and night sweats compared to 4.8% of women in the placebo group. (JAMA. 2005;294:183-193)
PROSTATE CANCER DIAGNOSIS INCREASES RISK OF HEART ATTACK BY 50%
Even for those with no history of cardiovascular disease, telling a man he has prostate cancer boosts the overall risk of heart attack and cardiovascular events by 50 per cent in the first year, particularly in the first week after learning of the diagnosis, where the risk of dying increases 800%.
Men aged 54 or younger are nine times more likely to die from cardiovascular events within a year of diagnosis, whereas those 55 to 74 have a 200% risk increase. The risk drops to 30% in those over 75.
Dr. Fang Fang, at a symposium on genitourinary cancers in San Francisco reported these findings as well as the fact that the risk of clots increases 300% and stroke risk also increases. (Family Practice News, April 1, 2008 p. 33: www.familypracticenews.com)
"What Were They Thinking?" Department
THE SAME EMPTY PROMISES EVERY ELECTION SEASON
How is it possible that in a country as diverse as ours, with legions of talented and accomplished citizens, that the only choices possible for high political office are offered from a pool of multi millionaire lawyers?
It is ironic to hear so much babble from newsreaders and the candidates themselves about the quality of their "experience". With regard to the practice of medicine, the record shows that the only experience that all these candidates have in common is the experience of creating mischief.
Decades of experiment with government control has provided an impersonal and ineffectual medical industrial complex and created enormous inefficiency and expense. The result has also been an increase in suffering and death consequent to third party interference into the patient physician relationship.
For those candidates who suggest they have solutions to improve health care, let’s see some evidence. They are all already in the Congress, so how is it that they have never been able to demonstrate how well their solutions will work when applied to the single payer systems that they have already crafted, such as the Veteran’s Administration System, Medicaid, or Medicare?
A small demonstration project would at least provide some evidence that these lawyers know something about solving the problems they have already created, instead of the vague promises that are provided during fund raisers, stump speeches, and farcical "debates".
Can anyone believe that once in the executive branch, that these incompetents will suddenly become wiser and smarter and more capable of doing the opposite of what each has spent their career doing in the legislative?
For example, there are now about 150,000 pages of Medicare regulations and mandates. A vast and expensive bureaucracy is required to administer and enforce this system, create oceans of paperwork, and provide layers of obstructions to patient care. Even though Medicare is mandatory and supposedly all inclusive, it is so inadequate that patients are forced to purchase "medigap" insurance at considerable extra expense and yet more confusion.
Congress has predictably "reformed" medigap insurance regulations, and of course there is another confusing add-on with Part "D" passed in 2006. Thanks to that program, seniors have another 1,413 plans across the country to choose from to try to obtain their overpriced and side effect laden drugs. In addition, there are 1,649 Medicare "Advantage" plans offering drug benefits in thousands of local markets.
And, these are not "benefits" but programs that have to be paid for separately by enrollees.
Despite increasing evidence of inadequate care, all of these single payer systems are still going broke.
Even more astonishing, the Medicare program is just as confusing and hostile to physicians who want to provide medical care to our over 65 citizens.
Physicians who want to participate in Medicare have to comply with those 150,000 pages of arcane and constantly changing regulations. Congressionally mandated price controls on payments, but not overhead, threatens the financial well being of their practices.
Thanks to the Kennedy-Kasselbaum legislation passed in 1996, should a bureaucrat somewhere in the Medicare system decide that a treatment or test was "unnecessary", physicians participating in Medicare face felony prosecution and jail time.
Most doctors don’t have the resources or time to contest these arbitrary decisions in court or through an appeal process that has already been rigged by the bureaucrats. Doing so means they face even further financial risk as well as those criminal sanctions. What a wonderful system! Is there any wonder that fewer and fewer physicians will accept new Medicare patients?
On these problems of "universal care", the candidates have all remained mum. It is easier to tell lies and offer platitudes than to face up to the problems which they and their Congressional colleagues have created over the past 60 years.
We Already Have a Single Payer System
The fact is, there is already a single payer for all medical care in this country. That payer is you. Ultimately, all of the funding for everyone’s medical care comes from you, either directly, or through your payment of taxes. Businesses don’t pay for medical care, though they add another layer of inefficiency that drives up the price.
"Cost sharing" or "shared responsibility" are just more lies made up by politicians and their fat cat friends.
Businesses who pay for part of the medical bills or "insurance" of their employees ultimately recover their expenses by withholdings in the paychecks of its employees. They pass them along to consumers by factoring them into the price of its products. You pay again, on both counts.
But, thanks to Congressional ineptitude and greed, in addition you are forced to pay even more for the profits of wealthy companies to dole out a tiny percentage of what you have paid, back to you and your physicians, while creating a tangle of regulations and obstructions.
Just as with government medicine, the existence of a bloated and complicated third party regulatory system in the private sector interferes with treatment and creates unnecessary and unjustified expense.
Increasing percentages of a physician's time is spent complying with these regulations. There is only so much time in a workday, so that time comes out of your visit, and distracts your doctor from actually dealing with your problem. As noted in these pages elsewhere, much of medical practice now consists of generating "procedure" codes to submit to third party payers. There are no "results" codes, so there is no incentive whatsoever in our system for doctors to actually solve your medical problems.
Most doctors would actually like to help you feel better. They want to apply all the skills they learned during their long and demanding training. But very soon after entering the "real world" of "medicine as a business", most realize that they are not working for you.
To get along in the "system" and remain financially viable, they have to please their masters and beg them for a trickle of cash flow to pay their expenses and staff. To do this, they have to see patients in shorter intervals to satisfy the billing system-lords. The cost and expense of specially trained coding and billing staff are added to overhead, though these don’t add any value to medical care.
Think about it. As the single payer, you are already on the hook for all the expenses of your physician, his staff, his overhead, and those of the hospitals, clinics, and their staff and equipment.
Ultimately, all of the costs for drugs, surgical devices and their research and development have to come from you.
That is a pretty big bill, but at least the American people could potentially get what they pay for. If there were a free market, we could demand accountability and reward those who provide better service, just as in unregulated businesses.
But politicians have larded on top of these considerable expenses all the much larger costs that are funneled to regulatory bureaucracies and into the coffers of the fat-cat corporate buddies of the Legislative branch. Moreover, their monkey work has disconnected the natural alliance of patient and physician as they have removed any leverage that you might have once had to choose the most appropriate course of care .
Of course, these corporate beneficiaries are mighty contributors to election campaigns, ensuring that only those who see the world through fat-cat eyes can even think about running for office.
Citizens have been hearing these same lies from politicians for decades, with the result that most people cannot afford all the third party profits that legislation has created. Hiding these amounts under the rubric of "health care costs", instead of "Congressionally mandated inefficiency" is a convenient fallacy.
Predictably, as total costs have ballooned, the call goes up from the candidates that we need everyone to contribute more to insurance company profits by championing mandatory "health insurance for everyone".
Given their track records, no matter which of the three candidates that have been selected for your approval actually becomes president, the system will be worse in four years.
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