From the Baltimore Sun:

Diana Moore learned the news through the neighborhood grapevine. Her family's primary-care physician of seven years would no longer accept Moore, her husband and daughter as patients - unless the family paid a $4,500 annual fee.

The physicians at Charter Internal Medicine in Columbia are overhauling the practice, ditching the insurance-dependent model and instead charging a flat yearlyfee in exchange for the promise of 24-hour access to doctors, unhurried appointments, home visits and state-of-the-art annual physicals.

Known as "boutique" medicine or "concierge" care, the national trend appears to be sweeping across Maryland as primary-care doctors feel the financial crush of rising costs and low insurance reimbursement rates. Physicians say the model allows them to trim their patient loads and give patients quality care without worrying whether insurance will cover it.

"Primary-care doctors are seeing 30 to 40 patients a day - that's too many," said Dr. Harry A. Oken, who has been with Charter Internal Medicine for more than 20 years. "It's not about the money. It's about having the time to spend with your patients to keep them healthy."

There's already a shortage of primary care doctors, and they're not as well compensated as specialists.

"Doctors have nowhere to turn but to try to find a different business model," said Dr. Ronald Sroka, president of the medical society, known as MedChi. "Some people want more than their insurance company will provide, and some people are willing to pay for this additional service."

Sroka, who practices in Crofton, said that after paying salaries and expenses, he makes about $15 to $20 an hour. He said he's not sure if he can last more than another year or so, working some 80 hours a week to keep up with his bills.

For those of you thinking of finding a "boutique" doctor, keep in mind that you'll still need insurance. Hospital stays, blood work and ambulance rides are not included.

For a little more, the doctor will see you now [Baltimore Sun](Thanks, Robert!)
(Photo: Getty)

Most of the doctors in question said that they used vitamins and headache pills, but some also prescribed antibiotics and sedatives. The study says that in most cases the doctors described these prescriptions to patients as “a medicine not typically used for your condition but might benefit you."

From the NYT:

Dr. William Schreiber, an internist in Louisville, Ky., at first said in an interview that he did not believe the survey’s results, because, he said, few doctors he knows routinely prescribe placebos.

But when asked how he treated fibromyalgia or other conditions that many doctors suspect are largely psychosomatic, Dr. Schreiber changed his mind. “The problem is that most of those people are very difficult patients, and it’s a whole lot easier to give them something like a big dose of Aleve,” he said. “Is that a placebo treatment? Depending on how you define it, I guess it is.”

But antibiotics and sedatives are not placebos, he said.

Of course, placebos have shown to be effective. The NYT says that 30 percent to 40 percent of depressed patients who are given placebos get better, which is almost as good as the results from real anti-depressants.

Half of Doctors Routinely Prescribe Placebos [NYT]
(Photo: Getty)

Because we didn't already have enough to worry about this week, the New York Times took a moment to remind us that recessions and crime go hand-in-hand. Consider:

• 1970s: New York almost dies, neighborhoods follow.
• 1987: Stocks crash. The next year, murders soar.

"Every recession since the late ’50s has been associated with an increase in crime and, in particular, property crime and robbery, which would be most responsive to changes in economic conditions. Typically, there is a year lag between the economic change and crime rates."

Nearly 80 police departments say that the subprime meltdown is already boosting crime rates. In Santa Anna, foreclosed homes have been converted to playgrounds for gangs and whores.

New York is enjoying record-low crime rates, even with 4,000 fewer officers than we had eight years ago. Of course, the police department is funded by tax revenue, and New York, more than most, depends on Wall Street for a double-digit chunk of budget grease. Former top cop Bill Bratton said:

Those are tough choices. Where are you going to put the scarce tax dollars? I would advocate it is the wrong thing to do if you start impacting police.

Mayor Bloomberg disagrees and told the police to slash $94 million from this year's budget. Next year, the cops are set to lose another $192 million.

Of course, these social scientists don't really know anything. Some think bad times and foreclosures lead to falling wages, unemployment, and crime. Others think crime is caused by the prosperity and gaudiness found in good times. So unlike the countless investors driving us inexorably towards recession and potential stabbings, you can take solace in the uncertainty.

Keeping Wary Eye on Crime as Economy Sinks [The New York Times]
(Photo: Getty)

The NYT has an interesting article about the movement to standardize the bracelets:

The goal is to prevent potentially dangerous mistakes, like giving the wrong food to an allergic child, or allowing a patient with balance problems to walk unescorted down a freshly waxed hallway. The drive was spurred, in part, by a notorious 2005 Pennsylvania case in which a patient nearly died because a nurse used a yellow band thinking it meant “restricted extremity” (don’t draw blood from that arm), as it did at another hospital where the nurse sometimes worked, when at this hospital it meant D.N.R.

While the new color-coding has been quickly embraced by at least 20 states and endorsed by the American Hospital Association, the purple bands, typically embossed with the letters D.N.R. to reinforce the message, are meeting with some resistance.

The nation’s leading hospital-accreditation agency, known as the Joint Commission, has expressed caution about the new system, citing concerns about branding patients by their end-of-life choices, or inadvertently broadcasting those choices to family and friends who have not been consulted.

The commission also said that children who do not understand the system had been prone to trade the wristbands like baseball cards.

Awwwwkkwaaarrrdd. The main takeaway for the consumer is that hospitals make mistakes, so it's a good idea to ask questions about the bracelets that they put on you and make sure that everything is as it should be. If something doesn't seem right, speak up for yourself or for your family.

Hospital Bracelets Face Hurdles as They Fix Hazard [NYT]
(Photo:Chester Higgins Jr./The New York Times)

The six companies that won't pretend to cure cancer anymore include:

• Ni-Gen Nutrition of Troy, Mich., which allegedly marketed an electrolyte liquid and apricot seeds as cures.
• Westberry Enterprises of Pineville, La., which the agency said sold teas that contained algae and other ingredients.
• Jim Clark's All Natural Cancer Therapy of Louisville, Ky., which allegedly sold digestive enzymes and coral calcium as treatments.

• Omega Supply of San Diego, which allegedly sold hydrazine sulfate, a substance classified by the government as a potential cancer-causing agent.
• Herbs for Cancer, which allegedly sold 16 types of teas to fight specific cancers, plus a 17th type for "cancers not on our list."

FTC cracks down on bogus online cancer cures [The Los Angeles Times]
FTC Sweep Stops Peddlers of Bogus Cancer Cures [FTC]
Cure-ious? Ask. [FTC]
(Photo: Getty)

The substances detected in the latest tests mirrored those cited in the earlier AP report.

Chicago, for example, found a cholesterol medication and a nicotine derivative. Many cities found the anti-convulsant carbamazepine. Officials in one of those communities, Colorado Springs, say they detected five pharmaceuticals in all, including a tranquilizer and a hormone.

"This is obviously an emerging issue and after the AP stories came out we felt it was the responsible thing for us to do, as a utility, to find out where we stand. We believe that at these levels, based on current science, that the water is completely safe for our customers," said Colorado Springs spokesman Steve Berry. "We don't want to create unnecessary alarm, but at the same time we have a responsibility as a municipal utility to communicate with our customers and let them know."

Of the twenty-seven municipalities to test their water supply, seventeen returned positive results. The water in Boston, Phoenix and Seattle all turned up crystal-clear.

What about the country's largest water provider, New York City?

The City Council called for an urgent-sounding emergency meeting in April to order the Department of Environmental Protection to test the city's water supply. In response, the D.E.P. declared: "the testing of finished tap water is not warranted at this time."

Drugs affect more drinking water [AP]
PREVIOUSLY: AP: 41 Million Americans Drink Water Contaminated With Antibiotics, Anti-Convulsants, Mood Stabilizers, And Sex Hormones
(Photo: mikelens)

The first list is a bare-bones compilation naming 20 medications and the potential issue for each. It provides no indication of how widespread or serious the problems might be, leading some consumer advocates to question its usefulness, and prompting industry worries that skittish patients might stop taking a useful medication if they see it listed.

Food and Drug Administration officials said they are trying to walk a fine line in being more open to the public while avoiding needless scares. Congress, in a drug safety bill passed last year, ordered the agency to post quarterly listings of medications under investigation.

"My message to patients is this: Don't stop taking your medicine," said Dr. Janet Woodcock, who heads the FDA's Center for Drug Evaluation and Research. "If your doctor has prescribed a drug that appears on this list, you should continue taking it unless your doctor advises you differently."

Google proficiency obviously doesn't confer a M.D., but that doesn't stop some consumers from freaking out at the first sign of trouble. With that in mind, the FDA issued its list with this crystal-clear caveat:

The appearance of a drug on this list does not mean that FDA has concluded that the drug has the listed risk, or that FDA has identified a causal relationship between the drug and the listed risk. It is on the list only because FDA has identified a potential safety issue.

Potential Signals of Serious Risks/New Safety Information Identified by the Adverse Event Reporting System (AERS) [FDA]
FDA posts its first online list of drugs under investigation for safety problems [AP]

High fructose corn syrup has become a favorite target of the health-conscious as an alleged cause of America's obesity boom. A typical 2-liter bottle of soda contains 15 ounces of corn syrup, according to the U.S. Department of Agriculture. Whether it's really at fault is open to debate.

The Corn Refiners Assn. contends that high fructose corn syrup is just as natural as table sugar and honey. Others say it's not natural at all, because it is manufactured through a chemical process and does not occur in nature by itself. The Center for Science in the Public Interest called the corn refiners' campaign "deceptive."

We prefer real sugar, and eagerly greet Passover as the holiday with the Kosher Coke. How about you?

Gawker Media polls require Javascript; if you're viewing this in an RSS reader, click through to view in your Javascript-enabled web browser.

Consumers are raising cane over corn sweetener [The Los Angeles Times]
(Photo: Getty)

Acrylamide forms naturally when starchy foods are baked or fried. Studies have shown the chemical, which also has industrial uses, causes cancer in lab animals and nerve damage to workers who are exposed to high levels. The Food and Drug Administration is researching whether acrylamide in food poses a health risk.

''Everybody's trying to figure out how to lower levels (of acrylamide) without significantly, adversely affecting taste,'' said Michele Corish, an attorney for Lance, which produces Cape Cod chips.

Corish said the modified snacks will be available nationwide. Messages left with the other three companies were not immediately returned Friday night.

The attorney general's office said the levels of acrylamide in most Cape Cod chips are already near the compliance level as defined by the settlement. However, Brown said Cape Cod Robust Russets contain 25 times the acceptable amount.

Corish said ''Robust Russets'' chips are no longer being sold.

Pringles was not included in the settlement because they are not potato chips, and Proctor & Gamble along with McDonald's, Wendy's, Burger King, and KFC agreed back in 2005 to either "properly label their products or lower levels of the chemical."

Settlement will reduce carcinogens in potato chips [AP]
(Photo: Getty)

1. Do not allow children to use a cell phone, except for emergencies. The developing organs of a fetus or child are the most likely to be sensitive to any possible effects of exposure to electromagnetic fields.

2. While communicating using your cell phone, try to keep the cell phone away from the body as much as possible. The amplitude of the electromagnetic field is one fourth the strength at a distance of two inches and fifty times lower at three feet. Whenever possible, use the speaker-phone mode or a wireless Bluetooth headset, which has less than 1/100th of the electromagnetic emission of a normal cell phone. Use of a hands-free ear piece attachment may also reduce exposures.

3. Avoid using your cell phone in places, like a bus, where you can passively expose others to your phone's electromagnetic fields.

4. Avoid carrying your cell phone on your body at all times. Do not keep it near your body at night such as under the pillow or on a bedside table, particularly if pregnant. You can also put it on “flight” or “off-line” mode, which stops electromagnetic emissions.

5. If you must carry your cell phone on you, make sure that the keypad is positioned toward your body and the back is positioned toward the outside so that the transmitted electromagnetic fields move away from your rather than through you.

6. Only use your cell phone to establish contact or for conversations lasting a few minutes, as the biological effects are directly related to the duration of exposure. For longer conversations, use a land line with a corded phone, not a cordless phone, which uses electromagnetic emitting technology similar to that of cell phones.

7. Switch sides regularly while communicating on your cell phone to spread out your exposure. Before putting your cell phone to the ear, wait until your correspondent has picked up. This limits the power of the electromagnetic field emitted near your ear and the duration of your exposure.

8. Avoid using your cell phone when the signal is weak or when moving at high speed, such as in a car or train, as this automatically increases power to a maximum as the phone repeatedly attempts to connect to a new relay antenna.

9. When possible, communicate via text messaging rather than making a call, limiting the duration of exposure and the proximity to the body.

10. Choose a device with the lowest SAR possible (SAR = Specific Absorption Rate, which is a measure of the strength of the magnetic field absorbed by the body). SAR ratings of contemporary phones by different manufacturers are available by searching for “sar ratings cell phones” on the internet.

Of course, science doesn't actually know for certain whether cellphones are safe or whether they cause debilitating brain tumors. "Further research is needed" is a common refrain, though this is the sort of thing that will work itself out over the next decade as more, um, tumors data become available.

Important Precautionary Advice Regarding Cell Phone Use [University of Pittsburgh Cancer Institute via firedoglake] (Thanks to Shaula!)
(Photo: Getty)

Here’s how it works: Many health insurers contract with PBMs to administer their drug plans. Among other functions, the PBMs negotiate lower drug prices with pharmacies. But some PBMs, under a practice allowed by Medicare, then charge a higher price to health insurers and, ultimately, both the government and patients. Though the opaque practice is common in the private insurance market, Medicare currently has a proposal to curb it, because the agency is worried the tactic, by inflating patients’ drug costs, is speeding their pace toward the “doughnut hole” coverage gap.

The differences between what the PBMs pay pharmacies and what they charge the plans can range from a few dollars to well over $100. In one case, a Medicare patient filled a prescription for a 90-day supply, or 270 pills, of the generic antinausea medication prochlorperazine. The difference between what the PBM, Express Scripts, paid the pharmacy and the price that showed up on the patient’s explanation of benefits was $146.53.

Well, that seems high. The PBM told the WSJ that mark-ups over $100 are rare, and that the money is used to help " fund programs that drive patients away from branded drugs and toward generics that ultimately still cost less."

Generics Are Cheap, but They Could Be Cheaper [WSJ Health Blog]
(Photo: Daquella Manera )

Thankfully, Caitlin's story ends well. After Florida Governor Charlie Christ's office read about Caitlin and had a nice quiet chat with Aetna, the insurer quickly to agree to pay the full cost of Caitlin's $113,000 operation.

The moral of the story: if your heartless insurance company changes its mind about a life-saving operation, call the media and the governor.

Why was a brain surgery patient turned away? [News 10]
Governor Crist hears Tampa Bay's 10 story, and takes action! [News 10]

Nearly a third of the Association's $62 million budget comes from big pharma, which also showers individual practitioners with lucrative 'consultation fees'. The problem isn't that the profession lacks adequate ethics guidelines or regulations, but that some psychiatrists simply ignore the rules.

As a group, psychiatrists earn less in base salary than any other specialists, according to a nationwide survey by the Medical Group Management Association. In 2007, median compensation for psychiatrists was $198,653, less than half of the $464,420 earned by diagnostic radiologists and barely more than the $190,547 earned by doctors practicing internal medicine.

But many psychiatrists supplement this income with consulting arrangements with drug makers, traveling the country to give dinner talks about drugs to other doctors for fees generally ranging from $750 to $3,500 per event, for instance.

While data on industry consulting arrangements are sparse, state officials in Vermont reported that in the 2007 fiscal year, drug makers gave more money to psychiatrists than to doctors in any other specialty. Eleven psychiatrists in the state received an average of $56,944 each. Data from Minnesota, among the few other states to collect such information, show a similar trend.

In both states, individual psychiatrists are not top earners, but consulting arrangements are so common that their total tops all others. The worry is that this money may subtly alter psychiatrists’ choices of which drugs to prescribe.

An analysis of Minnesota data by The New York Times last year found that on average, psychiatrists who received at least $5,000 from makers of newer-generation antipsychotic drugs appear to have written three times as many prescriptions to children for the drugs as psychiatrists who received less money or none. The drugs are not approved for most uses in children, who appear to be especially susceptible to the side effects, including rapid weight gain.

A psychiatrist's office is a "safe space," where it's ok to ask any question, including: "have you received any compensation from any drug company?"

Psychiatric Group Faces Scrutiny Over Drug Industry Ties [NYT]
(Photo: Getty)

According to the AP, the agency will slap its 'most serious warning label' on all Regranex boxes.

The findings come from a long-term analysis of records from health care providers comparing 1,600 patients who took Regranex with 2,800 patients who did not, according to the FDA.

The new label, which is outlined in a black box, advises doctors to use caution when prescribing the drug to patients with malignancies.

Regranex is a man-made version of a substance produced by the human body that helps heal ulcers. Because the drug causes cells to divide more rapidly, the FDA said Johnson & Johnson closely monitored patients for reports of cancer, which spreads through uncontrolled cell division.

The warning is targeted at people who use three or more tubes of Regranex per month, so slather sparingly!

FDA adds cancer warnings to J&J foot ulcer cream [AP]

Raghu writes:

I just came home and checked the expiration date on the Tears Naturale PM, Lubricant eye ointment.

To my surprise, it expired on May 2007 . Well, today is May 16, 2008..

WTF, this stuff goes into the EYES the whole night...

We wouldn't worry. Our father used to give us expired medicine all the time. Six of our seven doctors now say we're just fine!

CVS - Sold me an eye ointment one year after expiration.. [Sunday Afternoon Projects]

Since 2004, UCSF said it provided the names and addresses of 30,590 patients to Target America, paying the company $12,000 a year.

Hospital officials said it contracted with the company to assist "with identifying names of individuals who could potentially receive communications from UCSF."

"Identification of potential donors who were active in the philanthropic community was one objective, along with identifying individuals who had corporate relationships, such as board service, or were affiliated with relevant community programs and health care biomedical organizations," Kaarlela said.

After the breach was discovered, the hospital said it required Target America to hire "an objective third-party firm" to investigate. UCSF received the forensic analysis report March 26. It showed that information was potentially accessible from July 1 to Oct. 9 last year "if a query for a specific name was made." Notification letters were mailed to patients April 4.

To Dixon, the expert on medical identity, the disclosure lag was far too long.

"In Internet years, that's a century," she said.

In January, California began requiring health care providers to alert consumers if their medical information is breached. Swift notification is considered important so consumers can monitor credit reports and bills.

According to Joanne McNabb, chief of the California Office of Privacy Protection, notice should be given "in the most expedient time possible, without unreasonable delay."

"It's a judgment call, the how and the when part," McNabb said. "The idea is to give early warning so that people can take defensive action. On the other hand, you don't want to needlessly worry people."

It's not the worst case of lost records we've seen, but mining for donors seems so much worse than "whoops, lost another laptop!" At least people's social security numbers weren't included with the data. People who think their identity may have been stolen should pour themselves a stiff drink before sitting down to read this comprehensive post.

6,000 UCSF patients' data got put online [San Francisco Chronicle] (Thanks to Paul!)
(Photo: Getty)

The two companies jointly sought an injunction to stop Tyson's ad campaign, arguing the "raised without antibiotics" claim misleads consumers by making it appear Tyson's chicken is safer or more healthful.

Sanderson and Perdue initially based their legal challenge on Tyson's practice of feeding chickens ionophores, an antibiotic used only in animals raised for food. Sanderson and Perdue also use ionophores.

Then during trial in federal court in Baltimore, Tyson officials acknowledged they also inject eggs several days before they hatch with antibiotics that are approved for use in humans. Dave Hogberg, Tyson's senior vice president for consumer products, said it is a common industry practice.

Hogberg said injecting eggs with antibiotics did not undermine the "raised without antibiotic" label because the term "raised" is understood to cover the period that begins with hatching.

According to Tyson's "Core Values," they are a bunch of well-meaning folks "engaged in the production of food, seeking to pursue truth and integrity." After the USDA initially cried foul over Tyson's health claims, the pursuit of truth led Tyson to instead boast that their chickens are "raised without antibiotics that impact antibiotic resistance in humans.” At the time, Tyson said:

“We once again turned to consumers for their guidance and they told us this label more clearly conveys our chickens are not raised with any feed ingredients that could contribute to antibiotic resistance in humans,” said Dave Hogberg, senior vice president of Consumer Products Marketing for Tyson Foods. “The new labeling enables us to continue producing Raised Without Antibiotics chicken, which nine out of ten consumers say is important to them.”

Wow, that statement is just leaking with truth and integrity. Who ever would have guessed a federal court would brand Tyson as dishonest?

Court Orders Tyson to Suspend Ads For Antibiotic-Free Chicken [Washington Post]
Court says Tyson chicken antibiotic claims must stop [BarfBlog]
Tyson to Use New Label for Raised Without Antibiotics Chicken; Company and USDA agree to more informative wording (Press Release) [Tyson Foods]

Council Considers Testing Water for Traces of Drugs [NYT]
PREVIOUSLY: AP: 41 Million Americans Drink Water Contaminated With Antibiotics, Anti-Convulsants, Mood Stabilizers, And Sex Hormones
(Photo: Getty)

On March 15, my dad had triple-bypass heart surgery at Jewish Hospital in Louisville, Kentucky. My mother immediately started planning for his aftercare. My mother is disabled and uses a walker to get around; my father normally takes care of her.

My father's doctors, along with the hospital's case worker and my mother tried to get their health insurer, Anthem Blue Cross/Blue Shield to approve off-site cardiac rehab. They initially approved the request and made arrangements at an approved facility. The day before checkout, March 19, Anthem changed it's mind. My father's doctors kept him another day to execute an emergency appeal. But to no avail, Anthem determined my father was "too healthy" and would have to go home (and basically perform self-care). It pushed my mother to the verge of a nervous breakdown, but thanks to friends and neighbors they made it work. Anthem was kind enough to provide a visiting nurse, three times a week, even though daily care was recommended by the doctors.

Yesterday, they received the attached letter, approving the rehab stay. Well, great, right? Let's go to rehab! Well, no-no-no. The approval was only good until 3/24. So, he'll have to re-apply.

San Francisco's proposal would cover about 200 restaurants with over 20 locations. Each would be required to pay an annual $350 fee to fund a half-time compliance inspector.

San Francisco joins New York City and Washington's King County in the battle to protect consumers with information, a fight that has not gone well for municipalities. California Governator Arnold Schwarzenegger recently vetoed a bill that would require nutrition labeling throughout the state, and New York City was barred by a judge from enforcing its regulations until April 15, when the plan may be tossed altogether.

Subway is the only restaurant we know of to voluntarily display nutritional information on their menus, and apparently, they haven't been driven out of business. Go figure.

San Francisco passes menu label ordinance [ThePacker.com]
San Francisco Mayor Signs Menu Labeling Bill [CSPI]

"Taking it seriously" is a phrase companies use over and over again in public statements whenever they have bad PR. Our series of posts on occurrences of the phrase is our attempt to question how seriously companies are really taking these matters if every time they trot out this phrase by rote.

(Photo: Getty)

Here are some of the key test results obtained by the AP:

• Officials in Philadelphia said testing there discovered 56 pharmaceuticals or byproducts in treated drinking water, including medicines for pain, infection, high cholesterol, asthma, epilepsy, mental illness and heart problems. Sixty-three pharmaceuticals or byproducts were found in the city's watersheds.
• Anti-epileptic and anti-anxiety medications were detected in a portion of the treated drinking water for 18.5 million people in Southern California.
• Researchers at the U.S. Geological Survey analyzed a Passaic Valley Water Commission drinking water treatment plant, which serves 850,000 people in Northern New Jersey, and found a metabolized angina medicine and the mood-stabilizing carbamazepine in drinking water.
• A sex hormone was detected in San Francisco's drinking water.
• The drinking water for Washington, D.C., and surrounding areas tested positive for six pharmaceuticals.
• Three medications, including an antibiotic, were found in drinking water supplied to Tucson, Ariz.

The situation is undoubtedly worse than suggested by the positive test results in the major population centers documented by the AP.

Ok, Drinking Water Is Bad. I Can Switch To Bottled Water, Right?
No. Bottled water is drinking water suspended in a wasteful plastic shell. Like municipalities, water bottlers don't test for pharmaceuticals. Home filtration systems are equally useless against drugs.

Um, Ok. There Is No Escape. Am I Safe?
Eh, maybe. Scientists aren't exactly sure, but the research isn't encouraging. Pharmaceuticals, unlike general pollutants, are specifically designed to futz with the human body. "...recent studies—which have gone virtually unnoticed by the general public—have found alarming effects on human cells and wildlife." 'Alarming effects' means that cancers grow faster, kidney cells stop regenerating, and heart cells become cranky and inflamed.

This Sucks. What Is The Government Doing?
Ah yes, the government. Maybe they can offer an encouraging and meaningful response? Let's turn for reassurance to Benjamin Grumbles, the EPA's assistant administrator for water:

"We recognize it is a growing concern and we're taking it very seriously."

AP Probe Finds Drugs in Drinking Water [ABC]
(Photo: Getty)

Secretary of Agriculture Ed Schafer said his department has evidence that Westland did not routinely contact its veterinarian when cattle became non-ambulatory after passing inspection, violating health regulations.

''Because the cattle did not receive complete and proper inspection, Food Safety and Inspection Service has determined them to be unfit for human food and the company is conducting a recall,'' Schafer said in a statement.

A phone message left for Westland president Steve Mendell was not immediately returned.

Federal officials suspended operations at Westland/Hallmark after an undercover Humane Society video surfaced showing crippled and sick animals being shoved with forklifts.

Two former employees were charged Friday. Five felony counts of animal cruelty and three misdemeanors were filed against a pen manager. Three misdemeanor counts — illegal movement of a non-ambulatory animal — were filed against an employee who worked under that manager. Both were fired.

Authorities said the video showed workers kicking, shocking and otherwise abusing ''downer'' animals that were apparently too sick or injured to walk into the slaughterhouse. Some animals had water forced down their throats, San Bernardino County prosecutor Michael Ramos said.

USDA Makes Nation's Largest Beef Recall [AP]
PREVIOUSLY: USDA Stops Production At Meatpacking Facility After Undercover Video Showed Sick Cows Being Abused
(Photo: flikr)

[Drug researcher Dr. Dennis Mangano] believes Trasylol should have been taken off the market when he published his study in January 2006, a study that associated the drug's use with kidney failure requiring dialysis and increased death of those patients. Between the study's publication and November 2007, when Bayer removed the drug, "There were approximately 431,000 patients who received the drug," says Mangano. "As I calculated, 22,000 lives could have been saved. It's about a 1,000 lives per month," he tells Pelley.

In September 2006, Mangano presented his observational study of 5,065 patients in 17 countries to the FDA in hopes it would persuade them to pull the drug. Bayer senior executives attended the meeting to defend their product and at the time, their company had results from its own research that confirmed Mangano's results. But the Bayer executives failed to disclose the existence of the study. Mangano says this was irresponsible. "The [Bayer] representatives at the meeting...should have disclosed fully to the FDA that a study was done...even put the meeting in abeyance until the data were found or discussed," Mangano tells Pelley. "Good medicine demands that you protect the patient. That's the issue here and not the drug and not the profit margin," he says.

The chairman of the FDA committee that held that meeting, Dr. William Hiatt, told 60 Minutes that he would have voted to remove Trasylol from the market if he had known about Bayer's study. He also took issue with Bayer's failure to disclose it. "I thought it was unusual. I thought it was truly inappropriate," he tells Pelley.

22,000 died amid delayed Bayer drug recall: doctor [Reuters]
(AP Photo/Roberto Pfeil)

"I was trying to give my sister some candy and when I looked at it, it had a razor blade in it," said Chris, 10-years-old. His mother asked that we not use his last name.

The Pokemon cards and Valentines Day candy is imported from China by Sherwood Brands. In a recorded message Thursday Dollar General ordered all Pokemon candy and two others removed from store shelves.

"The items are the Pokemon cards and valentines candy. Dog valentine and pops and 20 strip, or 20 count strip Heart pops. Removing these items from the sales floor must become your most important priority today," said the recording from Dollar General Headquarters in Tennessee.

Importer Recalls Valentine Lollipops [AP]
(AP Photo/Polk County Sheriff's Office)

Moving to upgrade its walk-in medical clinic business, Wal-Mart is set to announce on Thursday plans for several hundred new clinics at its stores, using a standardized format and jointly branded with hospitals and medical groups.
The first of the new Clinic at Wal-Mart walk-in centers, as they will be called, is to open in Little Rock, Ark., in April and be run by nurse practitioners employed by the St. Vincent Health System, a three-hospital group in central Arkansas.

Wal-Mart also says it plans to brand 200 of the new clinics with RediClinics, one of the Revolution Health companies of Steven Case, the AOL co-founder. Those are to be operated in partnership with various local health care providers. RediClinic, which already operates 13 clinics in Wal-Mart stores, plans to open one of the new units in Atlanta in April and another in Dallas next summer.

"We have learned that people are willing to receive their health care from the front of a store or the back of a drugstore," said Dr. John Agwunobi, a medical doctor who is a Wal-Mart senior vice president. "But customers also have said they would rather it be delivered by a trusted name, a local health care practice, a trusted local provider of care."

Would you use a Walmart clinic?

Wal-Mart Will Expand In-Store Medical Clinics [NYT]
(Photo:Mark Schiefelbein for The New York Times)

In a study published in the journal Epidemiology, the team compared the dietary habits of 465 people with chronic kidney disease and 467 healthy people. After controlling for various factors, the team found that drinking two or more colas a day — whether artificially sweetened or regular — was linked to a twofold risk of chronic kidney disease.

The Claim: Too Much Cola Can Cause Kidney Problems [NYT] (Thanks to Sacha!)
Carbonated Beverages and Chronic Kidney Disease [Epidemiology]
PREVIOUSLY: Is Drinking 12 Diet Cokes A Day Healthy? Coke Thinks So.
(Photo: So Cal Metro)

The study shatters the accepted myth that pharmaceutical companies spend more on research than on marketing. In reality, drug companies pour $57.5 billion into marketing, dwarfing the comparably paltry $31.5 billion devoted to research.

Billions of marketing dollars go toward television ads that implore us to "ask our doctor" about drugs we don't need to treat ailments cultured by public relations firms. Yet even more money is spent convincing doctors to prescribe costly medicine—an astounding $61,000 in "promotion per physician."

For the last 50 years, say the authors, there has been an ongoing debate as to which image of the drug industry is most accurate. The industry promotes a vision of itself, say the authors, as "research-driven, innovative, and life-saving," but the industry's critics contend that the drug industry is based on "market-driven profiteering."

The study confirms the more cynical view that drug companies are out to profit first, and save lives second. And there's nothing wrong with that.

Don't be ashamed to ask your doctor if a drug company recently paid for any meals or ski trips. Instead of mentioning the latest drug splashed across the screen, ask how they would use their expansive medical knowledge to treat your condition. Ask how they would treat their child.

Do drug companies do more marketing or research? [SciGuy]
The Cost of Pushing Pills: A New Estimate of Pharmaceutical Promotion Expenditures in the United States [PLoS Medicine]
(Photo: rabbit.marshall)

"This is a huge issue and it goes directly to consumer choice. Consumers are fed up with the government being in their kitchens and they want to be able to make their independent choices about food they want to eat."

What does California, that kitchen-occupier of a state, have to say for itself?

"We found that coliform count is indicative of a healthy and clean and wholesome production process for raw milk," said Steve Lyle, spokesman for the California Department of Food and Agriculture.

Raw milk producers soured on new rules [AP]
(Photo: foxypar4)

The department's action against Blue Shield is the latest example of regulators closing ranks on the cancellation issue. Both agencies are seeking regulations aimed at curtailing cancellations, also known as rescissions. And both are investigating the way these are handled at the state's biggest health plans.

In March, the first of those investigations came to fruition when the Department of Managed Health Care hit Blue Cross, the state's largest for-profit insurer and a Blue Shield competitor, with a $1-million fine after reviewing 90 cancellations and finding alleged law violations in every instance.

The move against Blue Shield marks the first time the Department of Insurance has taken legal action against an insurer over its cancellation practices. But it may not be the last.

Poizner said Wednesday that he had directed his agency "to target this type of forbidden behavior on an industrywide basis and we will continue to take appropriate action as needed."

State accuses Blue Shield of illegal cancellations [LA Times via WSJ Health Blog]
(Photo:Getty)

PFFS is neither traditional Medicare, nor is it the same as private managed care, because it doesn't have an official network of providers.

They are popular among seniors who want the freedom to choose their doctors and avoid the restrictions of managed-care plans. The government pays PFFS insurers on average 19% above the traditional Medicare costs, which allows them to offer richer benefits with lower costs to patients. But, partly because the plans are new and unfamiliar to many providers, some doctors don't accept PFFS plans.

Here's how to avoid the scams, from the WSJ:

1. Insist on seeing a written list of doctors, hospitals and prescription drugs that each plan covers and be sure the plan covers any needed special care, such as dialysis.

2. Call your doctors to confirm that they work with the plan you're considering

3. Insist that the agent show how the plan you're considering compares with other plans for costs and coverage.

4. Confirm that the agent is licensed by the state.

5. Don't provide any personal data, such as a Social Security number, until a purchase is certain.

6. Collect a business card from the agent so that you have his or her full name and contact information.

7. Consider having a family member or friend present when meeting with an insurance agent.

Seven Tips for Avoiding Medicare Sales Scams [WSJ Health Blog]
Medicare OKs Marketing of Three Private Plans [WSJ Health Blog]
(Photo:catheroo)

Most people cook and consume their E. coli burgers in the time it takes for someone to go to the doctor and discover the source of their illness. For recalls following reports of consumer illness, only 20% of affected meat is ever recovered.

The USDA, which regulates meat and poultry, routinely samples thousands of products for harmful bacteria before they leave factories. Test results take a few days to produce.

During that time, companies can legally ship a product. If tests are positive, the product is recalled. Because the meat has been in the market a few days, recovery rates tend to be good: 62% per recall, on average.

There have been 54 meat recalls this year, up from 34 last year. For the most recent recalls, recovery rates are not yet available.

To get more consumers to check homes for recalled meats, the USDA next year plans to publicize names of retailers selling meat that was later recalled. "We think it would be helpful for people to know, 'Gee, that is my store,' " says Petersen.

Most recalled meat is never recovered, likely is eaten [USA Today]
(Photo: amyadoyzie)

Some more findings from the AP:

A third of surveyed doctors said they would order an unnecessary and expensive MRI scan just to get rid of a complaining patient.

A quarter said they would refer patients to an imaging center in which they had a financial interest without revealing the conflict of interest, which could violate certain laws.

Two-thirds of the doctors said they accepted patients who are unable to pay, and three-fourths said they had volunteered without pay at least once in the last three years. Overall, 28 percent of the responding doctors' patients were uninsured or on Medicaid.

Fewer than 1 percent said they had lied to patients, and 3 percent reported withholding information from patients or family that those people should have known. Eleven percent reported breaching patient confidentiality.

Docs Don't Always Turn in Bad Colleagues [AP]
(Photo:Pfau)

A Special Focus Facility is basically a nursing home that is on double-secret probation— subject to twice as many inspections as a non-SFFs, with the threat of funding cuts for non-compliance.

According to the CMS, the average facility isn't perfect (6-7 violations is the national average.) Those designated as SFFs are guilty of either more violations or more serious violations than usual, as well as a history of fixing problems just long enough to pass inspection, then going right back to business as usual. The CMS dubs this "yo-yo compliance," and the SFF program is designed to deal with it by combining more frequent inspections with more stringent enforcement until the nursing home falls back in line.

If the facility in question doesn't shape up, correct the underlying problems that lead to violations and "graduate" from the SFF program (in about 18-24 months) their funding is cut and they will likely close.

How To Use The List:

The CMS offers some tips to people who may be considering a nursing home on the list.

1) Use Nursing Home Compare to look up the CMS survey results and see what "areas may be problematic." It's important, says the CMS, to pay attention to how long the facility has been on the SFF list. If they have been listed for more than 18-24 months, they are either close to graduating or close to losing their funding completely. It's important to know which.

We looked up a random nursing home in Philadelphia that has been on the list for 34 months. There were 24 violations listed, including: Failing to "keep each resident free from physical restraints unless needed for medical treatement," "Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores," "Make sure that each resident's nutritional needs were met," "Provide proof that all residents' personal money which is deposited with the nursing home, is secure," and "Store, cook, and give out food in a safe and clean way."

Most of the violations have been corrected, but a few, including the last three mentioned above, are still pending.

2) Visit the nursing home. While you're visiting, feel free to discuss the violations and ask what the nursing home is doing to improve their patient care. You can contact your local State Ombudsman or Administration on Aging and ask them for more information on the nursing home.

Without further ado, the list of America's Worst Nursing Homes (PDF).

America's Worst Nursing Homes (PDF) [CMS]
Special Focus Facility ("SFF") Initiative - Background (PDF) [CMS]
Nursing Home Compare [Medicare.gov]
(Photo:Getty)

What to Consider When Picking a Plan
Fee-for-Service Plan
Health Maintenance Organizations
Preferred-Provider Organizations
When You're on Your Own
When COBRA Kicks in
Take Advantage of Tax-Deferred Accounts

Understand Your Health Insurance Options [Kiplinger]
(Photo:scarequotes)

The glowing shrimp have yet to sicken anyone, according to the FDA, and are just as safe as colored ketchup. One Thriftway manager said: "We don't hear a lot of complaints about glowing seafood, but then people rarely look at their shrimp and crab in the dark."

However, [the manager] admits that he might "take a peek" at the seafood now and then in a darkened freezer "just in case."

A caller who identified herself only as Barbara told the Seattle P-I on Monday that she had given some cooked shrimp she bought at the QFC in Wallingford to her three "very large" cats Sunday night as a "birthday treat."

An hour later, she said, she was frightened at what she found. She saw a greenish-blue glow coming from the cat bowl on the darkened porch. When she turned on the light, she found the six shrimp untouched. Her porky cats, which she said "would eat your leg off if you stood in one place long enough," didn't touch them.

She pulled open the refrigerator door. The light bulb had burned out weeks ago, she said, but the plastic bag holding the remaining shrimp glowed brightly in the chilled darkness.

Neither Peters nor Barbara, who also ate some of the shrimp, said they were made ill, just a bit queasy at the idea of consuming the glowing seafood.

Glow-in-the-dark shrimp — it's all a little fishy [Seattle PI via Slashfood]
(Photo: Edith Widder/Harbor Branch Oceanographic Institution)

From the WSJ Health Blog:

Diners are well-acquainted with the Zagat Survey approach to rating restaurants, hotels and bars. But now the consumer guide and rating company is teaming up with WellPoint to tackle the world of physicians.

Starting in January, members in some of WellPoint's Blue Cross and Blue Shield plans will be able to go online and review and rate their experiences with doctors. The health insurer, which has 35 million members nationwide, first plans to make the rating tool available to 1 million, though where exactly remains to be disclosed.

Patients using the online tool will get to apply the same 30-point scale that has helped make or break plenty of restaurant reputations. In place of familiar food, décor, service and cost categories, though, doctors will be rated on trust, communication, availability and cost. WellPoint says each entry will display contact information, the 30-point scale ratings in each category, plus the percentage of members who recommend the physician.

According to WellPoint, the site will be monitored for "inappropriate allegations."

Zagat Gets Into Doctor Ratings [WSJ Health Blog]