And one Mayo report admits that there’s been a rift between alternative practitioners and conventional doctors for a long time. The times they are a-changing, says Mayo. As many as half the doctors in the United States now refer people to complementary and alternative practitioners. In fact things are changing so quickly that something considered to be alternative one day may be an accepted treatment the next.

One of the reasons conventional Western medicine has been slow to accept alternative treatments is a lack of scientific research. As with many issues, it’s a money thing. Research is expensive. Drug companies pay for research in hopes of coming up with a new drug to patent so they can get their money back – plus profit. But it’s hard to get a patent on treatments that have been used for thousands of years or herbs you can grow in your back yard. Recently the National Institutes of Health has been stepping up research into alternative medicine using taxpayer money.

But a problem for researchers is that complementary and alternative treatments aren’t formulized. The Mayo Clinic points out that in a typical research study, participants take the same treatment for a condition. But complementary and alternative practitioners prescribe different treatments for people with the same condition. It’s hard to draw overall conclusions for these individual therapies.

It’s important to get the vocabulary down when we talk about complementary and alternative medicines, which are not necessarily the same thing.

"Complementary treatments" are thought of as treatments used along with conventional therapies your mainstream doctor may prescribe. For example, you might be taking a prescription medicine for anxiety and compliment that with tai chi or massage.

"Alternative" means treatments you are using instead of conventional methods. For example, you might decide to see a homeopath or naturopath instead of a regular doctor.

So how do you decide if a treatment is right – not to mention a good investment – for you? The Mayo Clinic suggests you steer a middle course between uncritical acceptance (I mean, is your sister-in-law really that smart?) and outright rejection (your co-worker might know what he’s talking about). Be open-minded yet skeptical – at the same time. Get information from a variety of sources and evaluate the information carefully.

The Mayo Clinic has two more bits of advice for you if you want to try complementary or alternative treatments. First, let your doctor know. There are treatments – certain herbs, for example, that can interact with standard medications.

Second, remember that your lifestyle choices make a big difference. Most health care professionals, whether they’re conventional, complementary or alternative, will tell you that nutrition, exercise, not smoking, stress management, adequate sleep and safety practices are key for a longer life, better health and a wiser investment of your health care dollar.

Click here to read more information from the Mayo Clinic

Nov. 17 - Big Brother? Naw, just your insurance company

Who’s that looking over your shoulder as you swallow your daily regimen of pills? Your insurance company?

You’ve probably already seen higher premiums and co-pays for your prescription drugs. But medical research analyst Jane DuBose says managing pharmacy costs is something like playing a shooting game in a carnival arcade. As soon as you hit one target, another pops up.

In an article published in Health Leaders News last week, DuBose described some ways insurance companies are changing drug benefits – and in some instances, they'll make things even more confusing for consumers than they already are. For example, if you’re tearing your hair out trying to understand your three-tiered drug benefits, some companies are adding a fourth tier.

Usually the tier system works like this. On the first tier are generic drugs and your co-pay is something like 10 dollars. Generics are less expensive versions of a drug that hit the market place after the original, brand-name maker’s patent expires. The second tier might be for brand name drugs, which are more expensive, and your co-pay is higher: say, 20 dollars. The top tier are the most expensive or "non-preferred" drugs. Usually they’re "non-preferred" because less expensive alternatives are available. Your co-pay might climb to 35 dollars. The new fourth tier might cover lifestyle-oriented drugs.

So far, the tier system is working, as far as insurers are concerned. Generic drug use is growing and is likely to continue. For one thing, more generic drugs are becoming available. A study by Express Scripts determined that some 17 percent of brand-name drugs sold in this country last year will be available generically within the next five years. By the year 2007, some health plans say generics will account for at least half of their total pharmacy bill and cost savings will be in the billions of dollars.

So the insurance industry is taking upon itself the task of educating both doctors and consumers about generics. For years, drug makers have inundated doctors’ offices with sales representatives who make sure the doctor knows about the latest drugs. Now insurance companies are providing physicians with information about generics, including computer programs that the docs load into their Palm Pilots. One program, called Epocrates, explains and promotes generics.

Some insurers are taking yet another page out of the drug makers’ sales manual, providing physicians with samples of generics to hand out to patients.

Health plans are turning to the Internet to educate consumers. Before you visit your doctor, your insurance company might suggest you visit its pharmacy web site so that you’ll be better informed when you and your doctor discuss your prescription options. Discuss? Ah, yes. The days of assuming doctor-knows-best when prescribing may be coming to an end. Insurers suggest that consumers, after studying a website, will be able to understand better their medication options by comparing differences in effectiveness and safety, as well as exploring alternatives and computing costs.

Analyst DuBose notes that the insurance companies have had a few breaks in controlling drug costs over the past year. A big one was the FDA’s decision to switch a top-selling prescription drug, Claritin, to over-the-counter status. That meant insurers no longer had to cover the drug. Consumers also benefited because Claritin’s over-the-counter price dropped substantially.

The other big savings occurred when studies raised questions about dangers of hormone replacement therapy for post-menopausal women. That led to a drop in HRT sales – and fewer benefit claims.

Despite some savings and more efforts to pass costs on to consumers, insurers expect pharmaceutical cost increases to continue. New drugs are hitting the pipeline, especially biotech drugs that are much more expensive than the ones they’re replacing. And in some cases, health plans are voluntarily spending more for drugs. Your insurance company may encourage use of pharmaceuticals for conditions like cholesterol management, diabetes, asthma or depression because clinical data show that would drive down overall healthcare costs in the long run.

In fact, at least one company – CIGNA – is looking at policy holders’ benefit claims and notifying doctors if patients aren’t taking their medicine. So your insurance company is not only looking over your shoulder, it's going to tattle on you.

Nov. 10 - Doing it right the first time

He’s baacck. Seems like I can’t turn on the TV, radio or pick up a magazine without seeing that once familiar shock of thick, white hair and hearing that nasal, fast-paced voice. Former Speaker of the House Newt Gingrich is everywhere – for the same reason most former office-holders return to the talk circuit: he’s promoting a book.

In fact, the former speaker is selling more than a book. He’s promoting a plan to radically transform America’s health care system.

It would have been nice to interview Mr. Gingrich directly but frankly, we just couldn’t work him into our schedule. As you may recall, Gingrich is pretty talkative. So I think I can sum up some of his major points in less time than he might take.

The title of Gingrich’s new book is "Saving Lives and Saving Money." And he’s very specific about looking at health care issues in exactly that order. Saving lives is the top priority, he says. If you do that, money savings will follow.

Gingrich says the reason we’re not getting anywhere with health care reform is that everyone focuses on finances, as though that were what health care is all about. First, he says, you have to do the morally correct thing, which is to save lives. Unless people believe that’s what reform is about, they won’t tolerate it. Gingrich cites the public’s resistance to HMOs because an HMO is viewed as caring only about money.

He argues that if you do the right thing right the first time, it is cheaper, not more expensive. That, he says, is a top fiscal issue in health care. Here are a few of his statistics: Doing the right thing right the first time would eliminate two million hospital-induced illnesses, a million and a half nursing home-induced illnesses, and anywhere between 44,000 and 98,000 people a year killed by medical error in hospitals.

The Agency for Healthcare Research and Quality issued a report last summer with a list of patient safety modifications that would save one hundred billion dollars a year. Another study, comparing hospitals in Phoenix, Arizona, determined that the hospital with the best patient outcome rate turned out to be 20 percent less expensive than the hospital with the worst rate.

In Gingrich’s words: "It’s the opposite of buying a Ferrari. In the health system, if you go to the very best, it can be less expensive."

So how would Gingrich make the right thing happen in the first place? Well, besides being a skilled politician, Gingrich is a respected historian, and he’s a fan of Theodore Roosevelt. Under the Roosevelt administration in 1903, the Food and Drug Administration was established with government setting and monitoring standards. Gingrich would use that as a model for health care.

The conservative Republican says he wants the federal government to guarantee that everyone will have access to health insurance. But he opposes having the federal government as the delivery system or the single payer for health care. As an example of how this might work, Gingrich notes that we have electricity codes without having federal building contracts. In other words, government sets the standards and the health care system operates within those standards.

Gingrich also wants a health care system that has greater incentives for individuals to be directly involved. Patient involvement is much simpler in this Internet age, Gingrich notes. A patient with an uncommon ailment or disease can learn more about it on the Internet than a general practitioner can be expected to know.

Gingrich says the way to change health care is to focus on the patient: patient safety, patient choice, patient knowledge, and patient responsibility. As an example, he cites welfare reform, which required welfare recipients to find employment. Gingrich says we can also expect all Americans to know something about their own health and have some responsibility for their own health care.

He admits that’s a challenge. Here’s a direct quote:

"It means that we have to say to people who are grossly overweight and drink a bottle of gin a day and are risking being a diabetic, ‘You know, you have a problem. Your doctor doesn’t have a problem. You have a problem.’"

(Click here to read the transcript of an interview with Newt Gingrich by Jeff Goldsmith of Health Affairs)

Oct. 27 - Herbal remedies: How much is enough?

Seems as if I can’t sneeze these days without someone telling me to take echinacea. Or if I have a momentary lapse of memory, someone’s sure to recommend ginko. We Americans spend more than six hundred million dollars a year for herbal health care products. But are we buying the right stuff and how much do we need?

A study published today in the Journal of the American Medical Association says the use of botanical and dietary supplements has increased 380 percent, but despite this booming popularity, there are no federally established standards for ingredients or recommended daily doses. In fact the study determined that listed ingredients and recommended dosages for the most popular herbal products vary widely.

The study by researchers at the University of Minnesota looked at the 10 most popular herbs. Now one of the most confusing aspects of herbal remedies is determining what to use them for. So I researched the research. I looked up those top ten herbs to find out why anyone would want to take them in the first place. I used two commonly available sources: Rodale’s "Encyclopedia of Herbs" and healthy.net on the Internet. Here’s what they said, and please note. I’m not making any recommendations. There is conflicting scientific evidence about herbal remedies. I’m just telling you why people commonly buy these products.

First on the researcher’s list was echinacea, which is touted as a blood purifier and antibiotic.

St. John’s wart, in the old days, was burned to clear the air of evil spirits. A more modern consumer might take it as an antidepressant.

Ginko biloba is said to help with vertigo and memory impairment. Some people claim to think more clearly with this herb.

Saw palmetto is described by health-dot-net as a diuretic that can – quote – "tone and strengthen the mail reproductive system."

Ginseng, which is omnipresent in any Asian market you might visit and particularly adored by the Koreans, is credited by some to help every human ailment. The Rodale Encyclopedia defines it as an "adaptogen," which is "a substance that protects against stress, physical and mental." In other words it speeds the body’s return to normal function.

Goldenseal is controversial. Rodale describes it as a potentially dangerous substance whose effectiveness has been exaggerated. Healthy-dot-net claims it is "one of our most useful remedies," especially with digestive problems.

Aloe is used as a skin remedy for slight burns and insect bites.

Valerian is a sedative.

Finally garlic. Ah, garlic. Who cares about its healing properties? It’s just good to cook with, but advocates also say it is a germ killer, a cure for worms and parasites, a remedy for respiratory ailments and high blood pressure, and the Chinese are supposedly investigating garlic’s role in preventing gastric cancer.

So those are the top ten in our beauty pageant of herbs. The researchers went to 20 different stores and found that they had a choice of 880 products marketed under 241 different brands for these ten herbs. What a confusing array! They didn’t analyze the contents of the bottles, but did just what you and I would have to do – they studied the labels.

They compared what the labels said, including the dosage recommendation, with recommendations of clinical and academic pharmacists. Fewer than half the available products were consistent with the pharmacists’ recommendations. Of the ten herbs, echinacea had the fewest number of products consistent in ingredients, and ginseng had the most.

The researchers went to several kinds of stores to buy their herbs – grocery stores, pharmacies, discount stores and health food stores – and that didn’t seem to make a difference in terms of label consistency. What did seem to make a difference was price. The higher priced herbs were more consistent with the recommendations.

In general, the study concludes that people self-medicating with an herb may be ingesting ingredients substantially different from recommended levels.

Should there be government standards for herbal remedies? Well, the AMA journal article notes that could be difficult. Plant products are composed of a number of chemical components and each may have varying levels of biological activity. In addition, various producers may be using various parts of the plant.

For now, if you’re going to purchase herbal remedies, it looks as if you not only need to read the label, but you have to do your homework before you get to the store.

Click here

Oct. 20 - Who pays? A multiple choice question

Whenever you’re talking about health care, whether it’s treatment or research, the big question is, "Who pays?"

This is an especially good question when you hear about some new medical study that conflicts with a medical study that came out the previous week.

A recent report about the importance of taking multi-vitamins is a case in point.

Last June, a federal study more or less rode the fence in recommending multi-vitamins. The U.S. Preventive Services Task Force said it found insufficient evidence to recommend either for or against taking vitamins A, C or E in supplement form. They reached the same conclusion about multivitamins with folic acid or antioxidant combinations for the prevention of cancer or cardiovascular disease.

But just this month, the results of another study were released, concluding pretty much the opposite. The Lewin Group in Virginia aimed its study at senior citizens and found that daily multivitamins can reduce the risk of cardiovascular disease by 24 percent. The daily vitamins also improve immune systems, reducing risk of pneumonia, urinary tract and other infections.

Who paid for the study? The giant pharmaceutical company, Wyeth, which happens to make about 10 percent of the supplements sold in the United States. So do we believe the results or not?

The Lewin Group, which conducted the study, says it used a – quote – "systematic literature review of the most rigorous research available." The study announcement coincided with a two-day meeting in Washington that brought together leading health and nutrition experts from all over the country to plan future research on daily multivitamin use. Wyeth also paid for that.

The study itself approached that question of "Who pays?" – in this instance, who pays for the daily vitamins? Right now, the private individual pays. Neither Medicare nor private insurance covers vitamins because (a) they’re available over the counter and (b) they don’t address any particular disease. There is an occasional exception. For example insurance might cover B12 vitamins for patients suffering from pernicious anemia, but not regular multivitamins.

The Lewin Study reports that if daily vitamins were provided for all our senior citizens, Medicare could end up saving more than one-point six billion dollars over a five-year period. Now, keep in mind that Congress is struggling to come up with a Medicare prescription drug benefit, never mind the common daily vitamin pill.

Still, some health care analysts, say that preventive medicine is essential to lowering medical costs as the baby boom generation approaches retirement and impacts the already stretched Medicare system.

Here’s how the math adds up for daily vitamin use. A year’s worth of over-the-counter multivitamins costs an average of 37 dollars per person. Total cost for every adult over the age of 65 would be 149 million dollars.

The resulting billion dollar saving would come from reduced hospitalizations for heart attacks and infections, reduced nursing home stays and home healthcare. The researchers say they didn’t even include the possibility of cost reductions from prevention of some cancers, diabetes and osteoporosis even though there’s evidence that multivitamins could be a preventive factor in those disease. In other words, there may be more than one-point-six billion dollars in savings. The evidence just isn’t in yet.

The researchers say that we Americans may be the MOST fed people in the world, but we are not the BEST fed. The nutrition experts concluded at the end of their meeting that most Americans do not get optimal amounts of key micronutrients through diet alone. Many people are getting only half their daily requirements.

And it’s not only the old folks we’re talking about. Poor nutrition increases the risk of birth defects and infectious and chronic disease at all ages.

So back to the original question, "Who pays?" Well, in the case of multiple daily vitamin pills, you do and probably will continue to. You can pay for the vitamin pills – less than 40 bucks per person a year. Or you can pay with a higher health risk. Either way, you pay.

(Click here to read a news story about the Lewin study)

Oct. 13 - Drug benefit? Don't hold your breath, but do help yourself

Number one thing, if you’re enrolled in Medicare and you’ve been holding your breath for a prescription drug benefit, you’d better exhale before you explode. The word is: the political logjam isn’t likely to shake loose anytime soon.

Number two thing, in a few minutes I’m going to give you a toll-free number for ordering a free booklet on how to reduce prescription drug costs – whether or not you’re on Medicare. So you may want to go find a pencil to you can write down that number. Don’t worry about missing anything. Most of what I’m reporting today is in the booklet, "How To Be Drug Smart," which was developed by the Washington chapter of AARP – the Association of American Retired Persons – working with state Attorney General Christine Gregoire.

While you’re looking for a pencil, we’ll go back to the number one thing. A couple of months ago you heard that both the United States Senate and the House passed Medicare drug legislation. So why isn’t there a benefit by now? The problem is that the House and Senate each passed very different versions of a drug benefit and they haven’t been able to find a compromise.

At issue are philosophical differences that go to the very heart of the age-old debate over government-involvement versus private enterprise. On top of that, the Bush administration is telling Congress that – whatever it ends up with – Medicaid recipients should not be included in a Medicare drug benefit. There’s another philosophical difference because Medicare has always been like Social Security – available to all who are entitled regardless of income. It’s the kind of difference that pits brother against brother – in this case, Governor Jeb Bush of Florida against President George Bush. All 50 governors are opposed to excluding low-income seniors from a Medicare benefit. The states are already responsible for providing prescription drugs under Medicaid, and they’re feeling a crunch.

At stake is some seven billion dollars a year, and the issue is who’s primarily responsible for these folks – the federal government through Medicare or state governments through Medicaid? Says Governor Bush: "These seniors are Medicare beneficiaries first and should be afforded equal access to a new prescription drug benefit." The administration responds that the federal government shouldn’t have to take on that seven billion dollar cost.

That’s enough about the log-jam. Senior citizens aren’t the only ones looking for ways to cut drug costs. Prescription drugs are one of the primary reasons health care costs have been soaring over the past decade.

Some consumers in Okanogan County are taking advantage of being close to Canada where many drugs are cheaper because of government-imposed price controls. All it takes to buy drugs for personal use across the border is a prescription from a Canadian physician.

There are other options, and many of them begin with a heart-to-heart talk with your physician. When your doctor is writing out a prescription, ask if a cheaper alternative is available. Jay Cohen, a University of California professor and author of the book "Over Dose," notes that drug companies frequently come up with a so-called "new" product that isn’t necessarily better than an older, cheaper drug. He gives the example of new antibiotics prescribed for sinusitis, bladder and respiratory infections that are – quote – "terribly expensive," but he claims they don’t work any better than penicillin or doxycycline, which cost mere pennies per dose.

Another cheaper alternative is, of course, the generic version of a brand name drug. You can ask your doctor to write the prescription for the generic or ask your pharmacist to substitute the generic – which is typically half the cost.

You can also ask your doctor for free samples or coupons, especially if you need only a one-time supply.

If you’re insured but your insurance company says your prescription isn’t included in its formulary – or list of covered drugs – ask if you can substitute a drug that is covered, or ask your doctor to appeal to the insurance company for an exception. A variety of drug company assistance programs and discount cards are available. These are listed in the AARP "Drug Smart" packet – or ask your pharmacist. A word of caution about those programs: they are limited and there are no guarantees. I know of a diabetes patient who was getting medication through a drug company assistance program and was left out in the cold when the company suddenly dropped the program.

All of these and additional tips, phone numbers and Internet links to discount programs are available in the AARP brochure "How to Be Drug Smart," which you can order by phoning 1-800-646-2283. Again, that’s 1-800-646-2283.

Click here for an on-line version of "How to Be Drug Smart"

Oct. 6 - Medical insurance news isn't all that new

When is the news not all that new? When it’s about the increase of Americans who don’t have medical insurance. Nonetheless, last week’s announcement that the number of uninsured jumped by 2.4 million was treated as big news.

Yes, it was a 10 percent increase – the largest in a decade. Yes, it did bring the national total of uninsured to 43.6 million people in 2002. And, yes, that is more than 15 percent of the population.

But none of that was surprising. America’s health care system is employment based – most of us get our insurance through our jobs. We all know that unemployment is continuing to grow in what is called a "jobless" economic recovery. In fact, the economy has lost about 2.7 million jobs since January 2001. High unemployment in an employment-based health care system inevitably leaves a high number of folks without insurance.

But it gets worse. As many as 20 million people who had full-time jobs didn’t have health insurance last year. A New York Times editorial called that number "astonishing." But is it really? Most people were more astonished by the increases they saw in the cost of insurance over the past couple years – in many cases, double digit increases fueled by higher health care costs. Employers are having to pay higher premiums and passing more of the cost onto employees. More and more workers are having to drop coverage rather than pay premiums they can’t afford.

Oh, yawn. You’ve heard all this before.

What is new these days is that politicians – well, some politicians – are beginning to talk about health care in specific terms. For years, political leaders have pledged their allegiance to resolving the health care crisis. But little in the way of specific proposals have come forward since the doomed effort by President Clinton in the early 90s.

Even though the 2004 presidential election is more than a year away, six of the Democratic candidates have made specific proposals to extend health insurance coverage to millions more Americans. President Bush also has a plan to increase insurance availability through tax credits. Tax credits figure into most of the Democrats’ plans too, but aside from that the plans vary widely.

The thing is, will the American voter want to sort through all these complex plans and use that as a basis for choosing a candidate? Well, I don’t want to disparage the American voter, but let's take a look at what’s going on in California.

I have my own theory about what’s really going on in California. All the discerning Californians moved to Washington and Oregon years ago, leaving, well, leaving Californians in a dither over recall and the possibility of a Governor Terminator, er, Scharzenegger.

Meanwhile, as Wenatchee World writer Tracy Warner pointed out last week, the California Legislature was largely ignored recently when it passed landmark health care mandates. The bill, which lacks only the governor’s signature to become law, decrees that employers must provide health care insurance and pay at least 80 percent of premiums. No other state has attempted anything so radical. There’s a lot of debate, pro and con, over this approach -- but the question is, are the voters listening? The health care debate in California seems to be drowned out by the sounds of Arnold Schwarzenneger smashing cars with a wrecking ball to show how he will smash taxes.

I admit, it’s more fun watching cars be demolished than reading insurance charts and graphs. But it’s also not fun being sick, being in pain, being refused treatment or being given inferior treatment because you don’t have insurance. And that’s the plight of a lot of people these days.

It’s unlikely that American voters will choose a president solely on the basis of his health care plan, or lack of one. Even if they did, a president can’t force a plan through without Congress – Bill Clinton proved that.

But what we can do is take just a tiny dose of health care proposals each day to familiarize ourselves with the different ideas that are bouncing around out there. And the ideas do vary – greatly.

The Commonwealth Fund, which is a non-partisan, non-profit organization that analyzes health care issues, has studied and compared all the plans. The least expensive would be President Bush’s idea for tax credits. The Commonwealth Fund says that would cost the federal government 89 billion dollars over a 10-year period and would cover an additional four million people now uninsured.

The most expensive plan is offered by Reprsentative Dennis Kucinich, who wants to expand Medicare to everyone. Kucinich says that would cost six trillion dollars for 10 years. Bush and Kucinich are the two ends of the spectrum. Kucinich is the only candidate proposing what is called universal health care coverage. The other Democrats have varying proposals for mixing private and public insurance and tax credits.

Click here to read The Commonweath Fund analysis of presidential candidates' health care proposals (Acrobat software required)

Sept. 29 - Nothing like a breath of fresh air, but indoors?

We can all breathe a sigh of relief now that we’re nearing the end of wildfire season. Or can we? As if coughing our way through summer smoke weren’t bad enough, health authorities warn there’s another health threat that comes with winter.

The Environmental Protection Agency rates indoor air pollution among the nation’s top environmental health risks. The Mayo Clinic warns that indoor air – including the air in your home – may be even more polluted than the outdoor air of a big city. Protecting air quality in your home is especially important if you have young children, older or chronically ill family members, or if you suffer from cardiovascular or respiratory disease.

There are some ironies at work here. The Mayo Clinic notes that many of today’s newer homes with weather-tight construction and inadequate ventilation actually have higher levels of unhealthy air than older, draftier homes.

The good news is, there are inexpensive ways to improve or protect air quality in your home and avoid expensive health problems. Here are some tips from the Mayo Clinic:

First and foremost, move the smokers outside. People who don’t smoke but who live with someone who does have a 30 percent higher risk of lung cancer than someone who lives in a smoke-free home. Don’t kid yourself that nonsmokers are protected if you have air-filtering devices in your home. They mainly remove smoke’s solid particles but not the gases.

Second, if your house is tightly constructed, improve ventilation by installing exhaust fans. Ventilation is crucial in preventing serious problems such as mold and carbon monoxide from burning fuels. You also want to avoid letting the air in your home become too dry, which can aggravate respiratory problems, or on the other hand too moist, which can promote mold. Ideal humidity levels are between 35 and 50 percent.

Third, we hear a lot about spring cleaning, but there’s also fall cleaning to be done. Limit chemicals in your air by using natural cleaning compounds as much as possible. I’ve been amazed to learn how much of my cleaning can be done with baking soda or with a simple solution of vinegar and water – which is an effective germ killer.

I found an Internet site called "care2" which has some suggestions for fall cleaning: Start with your refrigerator tray. If it’s looking swampy in there, the refrigerator fan is blowing that moldy air right into your home. Put new filters in your furnace and dust heaters and heater vents so that when the heat does come on, it won’t smell like fried dust.

Clean your chimneys and save yourself the embarrassment of having to call the fire department for a chimney fire. Steam-clean your carpets to get rid of dust and dust-mites that get stirred up with every step you take.

If you buy new carpets or upholstered furniture, especially when your house is closed up during winter, you need to aware of a phenomenon known as "out-gassing." This is a concern especially with synthetic textiles that are processed with various chemicals. It’s wise to air out those items in an area like your carport before bringing them into the house.

A number of health authorities recommend testing your home for radon levels. About seven percent of homes nationwide have significant levels of radon. It’s a naturally occurring gas resulting from radioactive decay of uranium. Radon breaks down into other radioactive elements that cling easily to airborne particles, such as dust and smoke. The EPA says radon is believed to be the second leading cause of lung cancer, resulting in up to 30 thousand deaths annually. Smoking in a home with a high radon level compounds the risk.

Most of us in Okanogan County passed up a low-cost way to test for radon a couple years ago. The county Health Department had about 50 kits available. They’re gone now, but the Health Department’s Gary Robbins says you can buy tests from local home supply outlets such as hardware stores. Prices range from about 15 dollars and up. The tests the county had were only five bucks, but it took Robbins about three years to find takers for all 50.

The ROBBINS: Because it is odorless, sightless, people don’t seem to get too excited about it. I don’t know how familiar you are with radon, but it’s a long-term effect like smoking cigarettes. If you have high levels and you breathe it over the years, it could give you lung cancer, and that’s it’s only side effect is lung cancer – known side-effect (chuckle).

MARY (on tape) : Do you think people would be wise to invest in a tester and just check their house. Is there enough evidence in this area to indicate that people should be testing their homes?

ROBBINS: In certain areas and the only way you can know for sure: You could have 100 homes, OK? And 99 of those homes could have low readings and that hundredth home sitting right in the center of them could have a high reading because all radon is is a by-product of decaying uranium. I’ve even checked my office space here. It came back less than point-five, which is really low. I’ve checked my house a couple times. It came back real low.

MARY: In fact, Robbins has no record of high radon readings in the county, but that doesn’t mean we have nothing to worry about.

ROBBINS: According to DOE and EPA the Okanogan Highlands has a high probability for it but I’ve not heard of any high readings there. The reason they say that is because the geological conditions are the same as around the Spokane area and Spokane area has some high readings.

MARY: If you had a positive testing, what then would you be up against?

GARY: Well, it depends on how high the readings were . . . It could be as simple as putting roof vents in or vents in your crawl space. There are a lot of things you could do.

MARY: So 20 or 25 dollars spent on a radon test might be a cheap price for peace of mind. Well, maybe not total peace of mind. Robbins notes there are lots of other things contributing to indoor air pollution, including wood-burning stoves. But there’s one pollutant Robbins is pretty sure you’re going to tolerate.

ROBBINS: Animal dander is one of your worst indoor air problems, but who wants to get rid of their cat and dog?

MARY: Yes, well, I say toss the smokers out and let Fido in for the winter.

Click here for more tips on household cleaning for fall

Click here to read more from the Mayo Clinic about indoor air pollution

Sept. 22 - Medical advances aren't so advanced for the uninsured

Let me introduce you to Jack, a hard-working guy, 62 years old. He recently suffered a heart attack and underwent by-pass surgery, paid for by the health insurance he has through his job. His medical outlook is good.

Jack’s next door neighbor, Joe, is 58 years old. He’s also a hard-working guy, but he’s self-employed and has no medical insurance. He too had a heart-attack but didn’t get by-pass surgery. His prognosis isn’t so hot.

Jack and Joe are fictional characters, but they represent real people based on statistics. I’ve been studying some studies, and here’s what I learned. One recent study, published in the journal "Health Affairs," determined that people who don’t have health insurance are not getting the benefits of advances in medical technology.

Sherry Glied of Columbia University was the lead author of the study. She says that – quote – "Medical technology is a wonderful tool but it’s clear that it’s not reaching everyone who needs it simply because some people don’t have adequate insurance coverage."

Actually, it’s more than "some" people. On any given day, there are more than 41 million people without insurance in our country.

The study estimates the cost of denying people the best possible treatment is more than a billion dollars a year because of continuing illness and death. The study specifically looked at uninsured patients between the ages of 55 and 64 and their treatment for heart attack, depression or cataracts.

The researchers found that in one year nearly 500 heart attack patients – just in that age group – did not get bypass surgery for lack of insurance coverage. Another 22 thousand did not receive cataract surgery, and 43 thousand uninsured patients did not get care for depression. The irony of that last figure is that other studies suggest mental health problems are more common among the uninsured and they’re the ones less likely to receive treatment.

So what would it cost to provide coverage for the uninsured? Another recent report, this one by the Kaiser Commission on Medicaid and the Uninsured, puts the cost at anywhere between 34 and 69 billion dollars a year.

Now that sounds like a lot of money, but compared to what? Another billion dollar figure that’s been bandied about in recent weeks is President Bush’s request for 87 billion dollars for Iraq operations. So, there’s one comparison: 87 billion dollars to keep troops in Iraq for a year compared with 69 billion dollars to insure everyone in America.

Urban Institute researchers say that 69 billion dollars a year is relatively small or at least a – quote – "worthwhile investment when considered against the benefits of improved health, increased longevity, and potentially greater national income." The cost of covering the uninsured would be a small fraction of what the United States already spends on health care, which is about 14.1 percent of our Gross Domestic Product. It would raise that figure less than one percent.

The U.S. continues to spend more than any other industrialized country on health care without getting more medical services than the other countries. A current study supported by the Commonwealth Fund says Americans spend more than 46 hundred dollars a year per capita on health care. That’s more than twice the median for other industrialized countries.

Are we Americans upset about the fact that we’re spending more on health care and apparently not getting our money’s worth? Well, even though public dissatisfaction with health care seems to be growing, public opinion polls are showing that health care is not as prominent on voters’ minds as it was a decade ago. That's when Bill Clinton was president and he made a big, unsuccessful push for health care reform.

The Harvard School of Public Health analyzed ten major public opinion polls and found that only 15 percent of Americans now see health care as one of the two most important issues facing us. In the 1990s, as many as 55 percent named health care as a Number One priority.

But the polls are also showing that two-thirds of people responding are either "not very" or "not at all" satisfied with availability or affordability of health care in the U.S. Nearly three-quarters of Americans polled earlier this summer said the government should put a priority on providing health insurance for the uninsured. But fewer than half said they were willing to see taxes go up to support that.

The lead author of that particular study, Robert Blendon, says that even if tax cuts were rolled back, the public is not committed to earmarking that money for the uninsured. The uninsured, he says, will have to compete with other domestic priorities.

Click here for more information about medical advances and the uninsured.

Sept. 15 - Flu shots? A good investment

There was a time when health care decisions were based on, well, maintaining health. Your doctor would give you a pill or a shot or a treatment based on whether it would prevent or cure illness. But the times they have been changing as the health care system becomes less about health and more about money.

The Commonwealth Fund, which is a non-profit organization that analyzes health care issues, has been looking into these economic pressures. Their studies show that while hospitals and health systems try to make quality improvement a priority, the reality is they may lose financially by doing so. A series of case studies supported by the Commonwealth Fund show that programs that might help people stop smoking or manage diabetes unquestionably improve patients' lives. Those efforts have a value to society and may save money in the long run. But there isn't always a immediate pay-back for prevention programs, and that's a challenge when money is tight and bean-counters are looking for places to cut spending.

That's why there's such a scramble to show that various treatments are not only good for your health but "cost-effective." And so there's been a recent study that a pretty routine health care treatment – the good ol' flu shot – really does make economic sense.

A report released last week said that treating people in their 60s and 70s who have the flu with anti-flu drugs is worth the cost, but preventing flu with an annual flu shot is a better strategy.

Researchers knew that treating younger adults with anti-flu drugs is worthwhile from an economic angle because it cuts time off the job. Until now it was not known whether treating elderly flu sufferers would be worth it – economically, that is. Never mind about saving lives.

Dr. Michael Rothberg of Baystate Medical Center in Springfield, Massachusetts, and his colleagues compared the costs of a variety of strategies for dealing with flu in the young and old.

They reported in the Annals of Internal Medicine that it is cost-effective to treat people older than age 65 who had not been vaccinated or who were at high risk for complications due to flu with an anti-flu drug. Once people get the flu there are a variety of medications available, but some have complex side effects and not all are cost-effective.

Rothberg's team emphasized that annual flu shots to prevent the flu are still the most cost-effective strategy. Anti-flu drugs work only if they are started within 48 hours of the onset of flu symptoms.

The other good news this fall is that there will be sufficient supplies of flu vaccine available during the coming influenza season. The Centers for Disease Control and Prevention predicts that everyone wanting to get a flu shot – regardless of age or health status – should be able to get vaccinated.

Production and distribution of the influenza vaccine was delayed in the years 2000 and 2001. Because of that, vaccination was recommended first for the elderly and others who were at high risk for complications from flu. Influenza causes about 36,000 deaths and 114,000 hospitalizations each year. More than 90 percent of the deaths occur among people age 65 or older.

Winter is prime time for flu. The influenza season typically ranges from November though March or beyond. The influenza vaccine is reformulated each year to match the currently circulating viruses. A flu shot doesn't always completely protect from infection, but health authorities say it greatly lowers the risk of a patient dying or becoming seriously ill.

They also say that only about two-thirds of U.S. adults who should get the vaccine actually do.

For example, most adults with asthma – who are particularly susceptible to influenza – are not getting flu shots. Yet the National Asthma Education and Prevention Program considers influenza vaccination – quote – "essential for quality asthma care."

Locally, the Okanogan County Public Health District is gearing up for the flu season. Ella Robbins says flu shots will be available for 10 dollars each in November at various locations around the county. There will be plenty of announcements about times and locations when the vaccine becomes available.

So, if you listen to the experts, spending ten bucks for a flu shot may be the best investment of "Your Health Care Dollar" this fall.

Click here for information from the Centers for Disease Control and Prevention about influenza vaccination

Sept. 8 - Let's chew the fat (or not)

One tiny line on food labels could make a billion dollar difference in health care costs. That’s what the Food and Drug Administration says about a new regulation that will require food manufacturers to tell consumers how much trans fat is contained in their food.

That estimate of billion dollar health care savings is based on a very large assumption. Here’s the assumption: Joe Q. Consumer is going to pick up a bag of something just brimming with trans fats. He’s going to read the nutritional content label, -- now that doesn’t mean the big splashy words on the front of the bag that shout dubious words like "Healthy!" or "Natural!" We’re talking about the little white box on the back with small print that lists all the nutritional contents and percent of recommended daily intake. Next, the FDA assumes, Joe Q. Consumer is going to read the line that says the product has something like four or six grams of trans fat per serving, and he’s going to drop that bag in favor of something healthier.

So tell me. How often do you read those little nutritional labels. Especially the ones on stuff we’ve already branded as junk food – the kind of food that tends to be loaded with trans fats, crackers, cookies, snack food – anything made with or fried in hydrogenated oils.

Besides that, there’s all the controversy about fat. Somebody tells us we should be on a no-fat diet; someone else preaches a low-fat diet; someone else says eat all the fat you want – it’s carbohydrates you should cut. How do we know who’s right?

Well, it might help to get to know fats on a first-name basis. Most nutritionists say that not all fats are bad. Fat is a major source of energy and helps the body absorb certaisn vitamins. Eaten in moderation, fat is important for proper growth, development and maintenance of good health. Fat also adds flavor, consistency and stability to our food and helps us feel full.

There are good members of the fat family and some not-so-good members. Two fats you want to get friendly with are "poly" and "mono." Both have the same middle name "unsaturated." Polyunsaturated fats and monounsaturated fats are the good ones, like olive oil, canola oil, soybean oil and corn oil.

You want to keep your distance from a couple other characters in the fat family: "sat," "hydro," and "trans, " for short, or saturated, hydrogenated and trans fats. A trans fat is formed when food manufacturers turn liquid oils into solid fats like shortening and hard margarine. That’s called hydrogenation.

Trans fats cause double trouble in the body. They raise LDL – the so-called "bad" cholesterol, at the same lowering HDL – the good cholesterol. Those changes in cholesterol levels directly increase the risk of coronary heart disease. Nearly 13 million Americans suffer from coronary heart disease and more than a half million of them die each year.

A certain amount of trans fats are found naturally in foods, primarily animal-based foods. So the FDA isn’t recommending that we eliminate trans fats from our diets.

We are simply advised to choose foods low in both saturated and trans fats.

But how low is low enough? Or, how high is too high? That’s the rub. The FDA isn’t willing to tell us. And that makes the Center for Science in the Public Interest very unhappy. CSPI is a consumer advocacy organization that has been petitioning the FDA to list trans fats on nutritional labels since 1994. The FDA finally agreed this year, but CSPI says the government is doing only half the job.

If you’ve been reading nutritional food labels, you know that there’s a number in the right-hand column that tells what percent of the recommended daily value you’re eating of each nutrient per serving. For example, a label for macaroni and cheese may tell you in the left hand column there are 12 grams of total fat per serving, and in the right hand column it says that is 18 percent of the recommended daily amount. Next it will tell you there are three grams of saturated fat, which is 15 percent of the daily recommendation. And underneath that will be a line saying there are one-and-a-half grams of trans fat, but the percentage column will be blank.

The FDA says there isn’t enough scientific data to determine how much trans fat is too much. The agency does say that the average daily intake of trans fat for Americans is just under six grams. But that’s not necessarily a guideline. Keep in mind that two-thirds of the U.S. population is overweight – and the whole idea behind the new label requirements is to get us to reduce our trans fat intake, not maintain the average.

If we Americans do manage to resist the lure of trans fat indulgences, the FDA figures we could prevent anywhere from 600 to 1200 heart attacks and save up to 500 lives a year. Based on that, the FDA further estimates health care savings would be 900 million to 1.8 billion dollars a year. Now there’s some fat to chew on.

Click here to learn more about the new FDA label requirements

Click here to learn more about the Center for Science in the Public Interest

Sept. 2 - There's no insurance that discounts are a good deal

Nobody pays full price for anything, right? You go to discount stores, you join shopping clubs, you wait to buy stuff on sale, and if it’s a car you’re buying, you dicker. So why should health care be any different?

Matter of fact, it isn’t. Insurance companies and HMOs have been demanding discounts from health care providers for years. And of course there’s Medicare, which simply pays what it chooses to pay – no matter what the cost. As if health care financing weren’t already complicated enough, there’s a new kid on the block to confuse consumers even more.

We’re talking about so-called "discount plans," which have become increasingly popular in recent years. These plans are sometimes described as an alternative to health insurance, but Washington State Insurance Commissioner Mike Kreidler wants you to know that discount plans are not insurance in any way, shape or form. In other words, these plans are not regulated by the insurance commissioner and he has no control over them.

Kreidler’s office does have some suggestions for people considering discount plans as well as help for consumers trying to make health insurance choices. I’ll wait for a minute to give you a couple of toll-free telephone numbers, so you can get your paper and pencil ready.

The Georgetown University Health Policy Institute operates a consumer guide website called healthinsuranceinfo.net and it also has some information about medical discount plans. Typically, a discount plan requires a monthly membership payment – anywhere from 30 to 70 dollars but sometimes as high as 150 dollars. The member then gets reduced rates from a network of participating providers for medical, dental and vision care, prescription drugs and chiropractic care.

Discount plans advertise that they accept all applicants regardless of health status and existing medical conditions. That, says the Health Policy Institute, along with the relatively low cost make discount plans attractive to people with chronic conditions such as diabetes. These are the folks who have trouble buying private health insurance at any price.

If you are interested in a discount plan, here are some things to consider before you sign up.

First, contact your providers – your doctor, dentist or drug store – to make sure they participate in that plan. And while you’re at it, ask if the provider will give you a discount even without the plan. For example, Mid-Valley Hospital recently adopted a policy giving people without insurance a chance to get a discount if they make arrangements in advance and pay in full at the time of service.

Read all the materials from the discount plan very carefully. Make sure you understand exactly how much you have to pay monthly including any additional costs such as administrative, membership or annual fees. In other words, is this thing really going to save you money?

Insurance Commissioner Kreidler recommends that you take a good look at the company offering the plan. How long has it been in business? Where are the corporate offices located? What methods are provided for settling a dispute?

Here are some other questions to ask: How do you know that the fee will not increase or the discount change? Is there a minimum enrollment time? How do you cancel enrollment? Will your personal information be disclosed to other parties?

These questions and others are available on the insurance commissioner’s web site, or – and here come those phone numbers – you can call the insurance commissioner’s toll-free consumer hot line at 1-800-562-6900. You can also get in touch with the Statewide Health Insurance Benefits Advisors program by calling 1-800-397-4422. The acronym for that program is SHIBA. Trained SHIBA volunteers provide free personal counseling to help you make medical insurance choices. That number again is 1-800-397-4422.

One last piece of advice from Commissioner Kreidler: Before you sign up with a discount plan check with the state attorney general’s office to see if there have been any complaints lodged against it. That number is 1-800-551-4636. All of these numbers and Internet resources are also available on my web site.

Now that I’ve given you all these dire warnings about medical discount plans, I should also say that a friend of mine is enrolled in one and he’s happy with it – so far. He’s a self-employed health care provider, so he’s pretty shrewd about health care finances. Of course, he’s also very healthy. I don’t wish him ill, but I do intend to check back with him about his discount plan if he gets sick.

Aug. 25 - Competition creates heartburn -- for drug makers

OK, you’re settling in to watch a Mariners game and you’ve got all the necessary supplies on hand. The chips, the dip, the nachos, the salsa, the sausage, the beer, and the oven’s timed to pop out a pizza for the seventh inning stretch. But by the ninth inning, the Mariners have blown another lead, leaving three men on, and you’re suffering from America’s No. 1 ailment: heartburn.

We're all pretty much aware that Americans' fondness for fast food is making us fat – sixty percent of us are overweight. And while the fast-food industry is making fat profits, the fattest profits of all, reports the New York Times, are being enjoyed by the companies that make heartburn medication. For many people, that’s the final course after a fast-food binge.

Medications for heart-burn are known as proton-pump inhibitors, or PPI’s. They go by names like Prilosec, Nexium, Prevacid, Protonix and Aciphex. They are the biggest-selling drugs in the world. According to NDC Health, a health information company, PPI’s accounted for about 13 billion dollars in sales last year. Prilosec alone – one of the biggest – had sales of 4.6 billion dollars. That, says the Times, is at least twice the profit generated by McDonald’s, Wendy’s, KFC, Taco Bell and Pizza Hut combined.

But Prilosec, which is sold by AstraZeneca, may not be in fat city for much longer. Cheaper generic versions are about to move onto the market, and last week Proctor & Gamble announced it will begin selling an over-the-counter version of Prilosec on September 15. If you’re using Prilosec now, you are paying – or your insurance company is paying – around 116 dollars for a month’s supply. Even if your insurance company covers the drug, you may have a co-pay of 30 dollars or so. The over-the-counter version will cost about 70 cents a pill – or just 22 dollars for a month’s supply.

Analysts predict that insurance companies and HMO’s will encourage use of generics or demand even higher co-pays to force consumers to use the cheaper drugs. For their part, drug makers are likely to ratchet up the marketing campaigns to keep doctors and consumers loyal to name brands.

So, here's my prediction for television’s fall season: Lots of heartburn commercials. No, no. Not commercials that give you heartburn – they're always around. Commercials about heartburn. Of course, if you want relief from heartburn ads, there will be another new batch of commercials too as competitors line up against one of our best-known prescription drugs: Viagra.

Last week the Food and Drug Administration approved a new drug treating erectile dysfunction. And a third Viagra competitor is under review by the FDA. It will probably be approved before the end of this year.

Viagra has macho baseball player Rafael Palmeiro as its pitchman. Makers of the new drug, GlaxoSmithKline and Bayer, have reportedly hired former NFL coach Mike Ditka, to promote their product.

This may be at least one instance where competition does not lead to a price break. Viagra costs about eight to ten dollars a pill. It’s anticipated the newcomers will be about the same.

So at least initially, the promotion of Viagra and its competitors will not be about price. It will be about the effects of the drugs, and side effects. In other words, be prepared for some pretty specific advertising about male impotence. For example, two of the drugs last for about four to five hours, while another one reportedly is effective for 36 hours. It’s being referred to in the trade as –quote – "the weekender."

Actually, all the drugs work the same way. They limit the action of an enzyme called PDE-5, which in turn inhibits male erection.

Compared to heart burn drugs, Viagra’s sales have been limited – less than 2 billion dollars worldwide last year with more than half that in the United States.

But there’s a lot of potential for all three drugs. The makers figure their product could help half of all men over the age of 40, and so far they’ve reached only 10 percent of their market.

Aug. 18 - Local health care facilities get short-term help

LEAD-IN: Three health organizations in Okanogan County received financial help from the Washington Health Foundation this year. That was good news for the short-term, but what about long-term solutions? Here’s more from Mary Koch with "Your Health Care Dollar."

MARY: North Valley Hospital in Tonasket, Okanogan-Douglas District Hospital in Brewster, and The Country Clinic in Winthrop all received a portion of one million dollars worth of grants distributed this year by the Washington Health Foundation.

The competition was stiff for what the foundation calls its "Viability Grants." There were 91 applications but only 22 awards – including the three in Okanogan County. Foundation staff members say it was tough choosing which projects to fund. Awards went to organizations that were in the worst overall financial condition.

Martin Perlman, communications director for the Washington Health Foundation, says many rural health organizations are doing a good job serving the needs of their patients and clients. But they still face extreme financial challenges.

MARTIN: One of the reasons these grants exist is to be able to provide those needed dollars to allow for, say, purchase of new equipment that’s needed to keep up with medical advances, to provide basic services, to sometimes literally keep the doors open.

MARY: That’s why the viability grants sometimes pay for nuts and bolts items. North Valley Hospital was given 100 thousand dollars basically to buy office equipment. But it’s equipment that will pay off for the financially strapped hospital. Last year the federal government designated North Valley as a Critical Access Hospital, which means that federal reimbursements – which had been spiraling downward – will improve. But the hospital had to spend more to get more. It’s required to change its entire billing system, and the foundation grant will pay for that expensive change.

The Brewster Hospital was awarded 75 thousand dollars. Laura Notestein (NOTE-STEEN) explains how that money will be spent:

LAURA:  It’s actually going to go toward three different goals there. They’re hoping to use it towards – and basically this is all just to keep them up and running – the first is they’re going to move. They have a free-standing clinic right now and they’re going to move that into the hospital to save on rent and things like that. It will also make the hospital eligible for a higher reimbursement rate because all their doctors will be on one site.

MARY: A second portion of the grant goes directly to doctors.

LAURA: They have only a few physicians who are currently covering nights and weekends for C-sections and they’re not being compensated for that. These doctors are on call 24 hours a day, seven days a week so they’re going to use some of this money to help compensate their physicians who are doing that. That’s the most important thing for them right now.

MARY: The Brewster hospital also will use some of the money to recruit additional physicians.

In Winthrop, the Country Clinic will use a 40 thousand dollar grant to purchase an X-ray machine. The clinic offers a number of free programs to patients. Uninsured children are given free health care every Friday. There’s a breast and cervical health program for women over 40 who qualify, and the state’s "Take Charge Program" provides free family planning services for uninsured, low-income patients.

Of course with all those freebies, the Country Clinic is finding that revenue doesn’t keep up with ever-increasing expenses. The clinic reports that last year its operating costs went up more than 26 percent but income increased by about seven percent. The grant’s x-ray equipment will be a crucial part of the clinic’s obstetric services. If the money can be stretched, possibly a small ultrasound unit will be purchased.

Money for the foundation’s annual viability grants comes from a variety of sources – both private and tax dollars. But our current economy means those sources are beginning to dry up. Is it viable to count on viability grants in future years? Possibly not, admits Martin Perlman.

MARTIN: Yes, we can keep applying what are called Band-aid measures, short-term solutions but that does not solve the long-term problems that health organizations have. That’s why the other component of what the foundation does is taking a look at the larger issue, long-term change, transformation of health care and we have a number of programs, including an upcoming leadership health summit in October that’s going to be addressing that very issue . . . (And you’re right) we could go on making short-term fixes but in the long run if we as, not just the foundation, but our partners – the people of the state, the leaders of the state – need to come together and bring about long-term health care solutions.

MARY: The foundation’s expectations for its leadership health summit on October 28 are so big, it will be held at the Seahawks Stadium in Seattle. This fall we can root for a winning season both for the Seahawks and the future of health care.

Click here learn more about   the Washington Health Foundation

Aug. 11 - Drug makers spend billions to get doctors' attention

You’re sitting in the doctor’s waiting room and you notice someone dressed in an expensive business suit, leather brief case in lap, cell phone to the ear while working a hand-held computer. Chances are the well-dressed stranger is a drug-industry sales representative, there to fill the doctor in about the latest pills on the market and leave a few free samples.

It’s the time-honored method for drug makers to inform doctors about new products – only it’s becoming less honored these days as doctors are more and more pressed for time and the drug industry is getting more and more aggressive about selling its products.

Even though drug makers are spending historic amounts on advertising direct to consumers – more in fact than they spend on research – they still have to get the doctor’s signature on the prescription, and that means marketing to the doctor.

A health care research firm called Verispan reports that since 1999 the number of sales reps employed by the 40 largest pharmaceutical companies in this country jumped by more than 50 percent. There are nearly 90,000 of them.

Some doctors are fed up with the flood of marketing calls while others find some value in them. David Ranii, reporter for the News Observer in Raleigh, North Carolina, surveyed doctors in his area and got mixed reactions.

One complained that the system results in – quote – "a lot of wasted time, money and effort." Yet others, especially rural doctors, appreciate the information provided by sales reps – not to mention the free samples and other goodies, such as office supplies.

You may think you don’t get to spend much time with your doctor, but the sales people are pressured to make their presentations in two minutes or less. A survey by a consulting firm, McKinsey and Company, found that for every 100 sales reps who visit a doctor’s office, only 20 actually got to meet with the physician.

So the drug industry has been finding ever more creative and generous ways to get the doctor’s attention. A recent public television documentary by Bill Moyers showed some of the excesses that have crept into the system. Some doctors – even medical students – are being treated by drug companies to elegant dinners, posh weekend retreats and other amenities.

Even in the Okanogan, doctors have been treated to free dinners at the Breadline in exchange for listening to a drug marketer.

A general practitioner in New York state, Dr. Rudolph Mueller, documented the offers made to him in a single week. He included them in a book he wrote about the system, called "As Sick As It Gets." Here are the five he considered the most excessive:

One rep offered him a 25 thousand dollar lottery ticket. A second rep offered a five hundred dollar fee if he would attend an afternoon education conference sponsored by the drug maker.

The third sales person offered to send a bouquet of flowers to the doctor’s wife on Valentine’s Day if the doctor would listen to a brief sales pitch.

Number Four: The doctor would be paid two thousand dollars per patient if he would enlist patients in clinical research for a particular drug. The catch was, the drug had already been researched and approved. So this test was unnecessary, but would gain some new customers for the expensive drug – the very patients who were participating in the so-called research.

In the fifth offer, Dr. Mueller was promised a free office computer with video, e-mail and internet access for one year if he would use the computer video network to talk with drug company reps at least three times per month.

The American Medical Association does have guidelines limiting gifts to doctors from drug companies. The AMA says any gift accepted by physicians should primarily entail a benefit to patients and should not be of substantial value. Modest meals and other gifts are appropriate if they serve a genuine educational function. The AMA also says cash payments should not be accepted.

The medical association does allow drug companies to underwrite costs of medical conferences in general but not to defray the doctors’ costs for travel, lodging or other personal expenses.

Still, the AMA’s own journal – in an article a couple of years ago – estimated that drug companies were spending up to 13 thousand dollars per year per physician for marketing. The bottom line, says Dr. Mueller, is that drug promotion to physicians in the United States costs more than 10 billion dollars per year, which is more than we spend on educating all medical students and doctors-in-training in this country.

Aug. 4 - Slather up for sun protection

This week brings the annual Stampede celebration to our town, which usually means more than usual exposure to the sun. Cancer experts say exposure to the sun should be a health concern all year round, but this is a good week to pay special attention.

Sun exposure is a significant risk factor for melanoma, the deadliest form of skin cancer. More than a million new cases of skin cancer are discovered among Americans every year, and more than 7,000 people die of melanoma each year. Fair-haired, light-skinned and blue-eyed people have a higher risk, but anyone can get melanoma. Melanoma is on the increase, and more people are diagnosed with some kind of skin cancer each year than all other types of cancer combined. At current rates, one in five Americans will develop skin cancer during their lifetime.

A lot of us were raised with the idea that playing and working in the sun is healthy. Not so, say cancer researchers. In the year 2000, the National Institute of Health added ultra violet solar radiation to its list of known human carcinogens. In other words, the sun can be harmful to your health.

Ultra violet light is made up of two kinds of rays: UVB and UVA. When UVB light enters the skin, it penetrates into the upper layers and causes immediate, visible damage – a sunburn or a suntan. When UVA light enters the skin, it penetrates into the deeper layers and causes invisible damage that results in long-term injuries such as wrinkles, leathery skin and skin cancer. UVB rays are stronger in the summer, but UVA rays are constant year-round. This means sun protection is a year-round concern.

So here are some tips from a melanoma education foundation about buying sunscreen and sunblock products.

Both protect, but in different ways. Sunscreens chemically absorb harmful UV rays, and sunblocks physically deflect them. In both cases, the negative effects of sunlight are reduced but not eliminated. There is no skin product on the market that provides 100 percent protection against UV radiation. That’s why it’s also smart to wear hats, sunglasses, and clothing that covers the skin. Also use shade structures such as beach umbrellas and, very definitely, a canopy on the baby’s stroller.

When you’re buying your sunscreen or sunblock, read the label. You want protection against both UVA and UVB rays, so look for the words "broad spectrum." Then there’s the list of ingredients, and here we get to some real tongue twisters, so bear with me. You want a product that includes avobenzone, which is also known as Parsol 1789, or octylcrylene, or benzophenone, or titanium dioxide, or zinc oxide. If you didn’t catch that list of ingredients, you can find them on my web site. We’ll tell you how in a minute.

Some people are sensitive to a common sunscreen ingredient called para-amino-benzoic acid, or P-A-B-A – PABA. If you break out with an itchy rash, find a sun lotion that’s PABA-free. Most will say so on the label.

The final thing you want to consider is the SPF, or Sun Protection Factor. The SPF number relates only to protection against UVB rays, not UVA rays. That’s why those other ingredients I mentioned are so important – it’s not just the SPF number that matters. SPF compares the amount of time needed to produce a sunburn on protected skin to the amount of time it takes to burn unprotected skin. For example, if your lotion has an SPF of 2 and you ordinarily would start getting a sunburn in 10 minutes, the lotion would delay that to twice as long, 20 minutes. Some researchers advocate an SPF of 15 or higher; others recommend at least 30.

Sun products come in a variety of substances, including ointments, gels, lotions, creams, foams, even wax sticks. The substance doesn’t seem to affect whether they work, and you don’t need to buy a specialized product for children’s skin. The important thing is to buy something you like, so you’ll use it consistently. Cancer protection advocates say put it on every day and re-apply every two hours. Also, if you’re using last year’s tube of sun lotion, check the expiration date on the label. They do wear out.

So what about that healthy tan you’ve been working on? There’s no such thing, say the cancer researchers. Tanned skin is actually damaged skin. They advise against sun bathing and tanning beds. The Skin Cancer Foundation is a little more enthusiastic, however, about sunless, self-tanning products that have been showing up on drug store shelves in recent years. But these products should not be considered a substitute for sunblocks and suncreens.

The self-tanning products are temporary; the color disappears within a week or so. But, says the Skin Cancer Foundation, that’s healthier than a suntan, which causes permanent damage to the skin. The foundation also warns against products that sound like self-tanning lotions. Beware of the words "tanning amplifiers," "tan accelerators," "bronzers,", "tanning promoters," and worst of all, tanning pills. The pills are banned in the United States and have been associated with hepatitis and other ailments.

So take care of your skin – whatever shade it is – cover up, slather up, and have a good Stampede.

Click here for a link to the Skin Cancer Foundation

Click here for a link to the Sabra Dalby Rightmire Foundation for Melanoma Education

June 30 - Medicare debate is not about the elderly

Congress has agreed to disagree about prescription drug benefits for senior citizens. Now we can sit back for weeks or months while the Senate and House sort out their complicated differences on the two very complicated Medicare reform bills.

So this may be a good time for a little review of what Medicare is all about. And if you’re just a youngster, say, 50 or under, this is not a good time for you to tune out. You may think that Medicare is just about old folks, but what’s happening in Congress right now is really all about you.

Medicare has been around since 1965 – nearly 40 years. Many people who are beneficiaries now were just young adults, busy establishing careers and raising families, when Medicare first appeared on the scene. So if they weren’t paying attention then, they may have been surprised when they finally became eligible for Medicare benefits.

One of the surprises may have been this infamous lack of prescription drug coverage that Congress is wrestling with. The lack of drug coverage reflects the enormous changes that have occurred in health care since the 1960s. Princeton University economist U. E. Reinhardt notes that if you were buying private medical insurance in 1965, it wouldn’t have covered drugs either. He says most private insurers didn’t begin coverage of prescription drugs until the early 1990s. Until then, says Reinhardt, "drugs did not play nearly the important role in clinical therapy that they do today."

Now, according to the Alliance for Health Care Reform, the cost of prescription drugs for Medicare beneficiaries is projected to amount to 1.8 trillion dollars through the year 2012. Congress is budgeting a mere 400 billion dollars over the next ten years. Let’s see, 1.8 trillion dollars minus 400 billion . . . zero from zero is zero, zero from zero is zero . . . well, you get the picture. There’s going to be zero benefits for a goodly number of Medicare recipients. Says the reform alliance: "No matter what the outcome, seniors will face high drug costs."

Just as an example, under the bill that passed the Senate last week, anyone spending less than a thousand dollars a year on drugs would pay monthly premiums but get no benefits. According to the Seattle Post-Intelligencer, that’s 41 percent of Medicare recipients in Washington state. And then there’s the notorious "doughnut hole" in the version passed by the House. There’d be no benefits for people spending between two thousand and forty-nine hundred dollars a year on drugs.

Of course, paying premiums without getting benefits is what insurance is all about. The idea is that some people are going to have very high medical costs while most will have very little. So we all pay a small amount to cover the big bills for the unfortunate few. In 1998, just six percent of Medicare beneficiaries used more than 25 thousand dollars in services each. That six percent of the folks used up more than half of annual spending. On the other hand, forty-one percent of Medicare beneficiaries cost the program less than 500 dollars a year. Those folks paid in more than they got out.

Supposedly, we never know whether we’ll be the one saddled with the high medical costs. In fact, when you look at the overall medical costs of the elderly – Medicare actually pays for only 55 percent of the total bill.

The other part of the pending Medicare legislation – the part that will be really significant for younger folks – is reform. Ask current Medicare beneficiaries if they think the program should be reformed (other than prescription drugs) and they pretty much say "no." Surveys show the majority of senior citizens are satisfied with the way the program works. Other studies show Medicare has done a better job than private insurance in keeping health care costs down. And Congress has kept a two percent lid on administration costs, which means 98 cents out of every Medicare dollar goes directly to health care. Some economists have estimated the overall administrative costs for health care in the United States is up to 30 percent – thirty cents out of every dollar going for management.

So why the need for reform? Well, you may be skeptical about the ability of politicians to be forward-thinking, but Congress is reading the handwriting on the wall. Medicare’s funding is based on the theory of transferring resources between generations. In other words, the Medicare taxes paid by today’s workers are paying the health care costs of today’s elderly. Today's workers are trusting that tomorrow’s workers will pay their health care costs when they become elderly.

Problem is, thanks to the Baby Boom generation, we’re going to run low of workers just when we have a whole lot of elderly to take care of.

Medicare is the fastest growing of all government benefits programs. Analysts say the picture will change even more dramatically beginning in the year 2011 – just eight years from now – when the first baby boomers reach 65.

Now there are 40 million Medicare beneficiaries. By the year 2030, when the youngest boomers turn 65, the Medicare rolls will have swelled to 70 million.

How are we going to pay for that? That’s what Congress is arguing about right now. So the younger you are, the more this argument is likely to affect you.

Click here to go to the U.S. government Medicare information site

Click here for the Alliance for Health Reform

June 23 - Can money buy you health?

We in the Okanogan are blessed with a healthy place in which to live. Blue skies, wide open spaces, none of that big-city pollution or the high stress level of traffic jams and crowded neighborhoods.

We live in the largest county of Washington state, with one of the smallest populations. You'd think we'd be the healthiest people in the state, too, wouldn't you? Trouble is, figures provided through the Washington Health Foundation indicate we're not a particularly healthy bunch.

The foundation publishes a county-by-county "health profile." It compares birth rates, death rates, and a number of other factors that are considered in overall public health issues.

Bottom line? Okanogan County has a higher mortality rate than the state average. If you live in Okanogan County, you're more likely to die than the average Washington state resident. Of course, we're speaking mathematical odds here. In other words, for every ten thousand Washington residents, about 81 will die each year. But in Okanogan County, the probability increases to nearly 86 out of 10,000.

The leading cause of death is the same for both our county and all of the state. That's heart disease. It causes about one out of every four deaths. Cancer related deaths are slightly lower in Okanogan County than the state average. But if you're accident prone, this may not be the best place for you to live. Our county has more than twice the number of accidental deaths per capita than the rest of the state each year. Our suicide rate is also slightly higher.

So we folks in the Okanogan are dying at a faster rate, but we also have a higher birth rate.

Birth rates are based on the number of births to all women between the ages of 15 and 44. Every year, for every one thousand women in that age bracket, our county sees 71 new babies. That's almost ten babies more than the state average.

The county's high birth rate has been coming down. While the rest of the state remained steady throughout the past decade, the birth rate in Okanogan County dropped by almost nine percent. There's been an especially noticeable drop in births to teen-agers, ages 15 to 17. The county is still well above the state average for teen births, but between 1991 and the year 2000, the teen birth rate dropped by more than a third.

There are some other factors that are likely to lead to health problems in infants in Okanogan County. There's a higher percentage of babies born with low birth rates and a lower percentage of mothers getting early prenatal care. The percentage of mothers who smoke during pregnancy is also higher than the state average.

All of these issues – teen pregnancies, low birth weights, lack of prenatal care and smoking moms – have been shown to significantly affect the health of youngsters.

The Washington Health Foundation also includes some other statistics in its county health profile. Okanogan County ranks dead last among the state's 39 counties when we look at median household income. The average household in Washington state has an annual income of more than 50 thousand dollars. In Okanogan County it's less than half that – under 24 thousand dollars. During the booming 1990s, households statewide enjoyed a 50 percent increase in annual income. Here in this county, we saw an increase of just 15 – one-five – percent.

Okanogan County has nearly twice as many people in poverty as the rest of the state. The statewide poverty rate is 10 percent, and in the county nearly 20 percent. About 14 percent of the state's children are in poverty, while in our county one out of every four children is impoverished.

What do these money issues have to do with good health? A significant amount, says the Washington Health Foundation. The reports says that income gaps are known to contribute to disparities in health. As the old saying goes, money can't buy you love. But maybe it could buy us better health.

Click here for a link to the Washington Health Foundation

June 16 - Talking around the health care crisis

What if someone called a meeting to determine your future and you weren't invited? That's been going on in the health care system for many years, says James Whitfield of the Washington Health Foundation.

Whitfield was in Okanogan recently for one of the foundation's community round tables to discuss the health care system. The foundation is holding these forums in every county of the state in hopes of determining what ordinary people think about health care.

Problem was, in Okanogan County at least, only about a dozen people showed up to make their views known, and most of those were people working in the health care system. No local government or elected officials attended. In other words, the foundation was hearing from the choir.

Nonetheless, the round table program represents an effort by a broad coalition of organizations to develop solutions for what many people are seeing as a health care crisis. Partners with the foundation range from AARP to the Children's Alliance, business, consumer groups and most professional health organizations.

A video produced by the foundation provides a "diagnosis" of the problems with our health care system from those many points of view. Business owners say their employee insurance costs are skyrocketing and employee expectations for health care are unrealistic. Consumer groups say employees cannot afford the increased costs that are being passed on to them.

Health care providers complain about the tension between what people want and what they need from health care. Hospitals are battered economically by the ever-increasing costs of drugs, salary demands and new technology.

Dennis Braddock, Secretary of the Department of Social and Health Services, says the amount of money involved in health care is -- quote -- "mind boggling." He says the system is extremely complex, but none of that complexity benefits the patient. Braddock says, point-blank, because our health care system is so complex, someone is always cheating. In his words: "Everybody has to cheat to make the system work."

Besides the round table programs, the Washington Health Foundation has been conducting statewide polls. The results show that at least half of us believe the health care system needs fundamental or major changes.

The majority of us support significant actions to maintain government subsidized health care such as the Basic Health Plan. Sixty percent of us are willing to pay higher fees or co-pays and slightly more than half of us would accept higher taxes.

But we're pretty evenly divided over whether the health care system should be government based or private enterprise.

So how would you fix the health care system?

Even though the turn-out for the Okanogan round table was small, the range of ideas was broad.

Some people said the solution should begin with government, that government has to decide whether health care is a priority. Other people suggested just the opposite. Health care, they said, depends on individual accountability. Individuals have to become pro-active on their own behalf.

Several people noted that much of the demand for health care services is caused by poor lifestyle choices. There was support for better education about health and training in life-long sports. One suggestion was that in the Okanogan a health care priority should be construction of an indoor swimming pool for year-round, life-long exercise.

Health care administrators said there's too much politics involved in government reimbursements. For example, rural hospitals and clinics are not reimbursed equally with urban facilities, where the votes are. Yet rural costs are just as high if not higher.

And one doctor warned that if tort reform legislation isn't passed, the system will find itself without doctors because of the incredible costs of medical liability insurance.

These ideas from Okanogan County residents will be compiled with those of people from around the state. The foundation says it will release the final results in October and pass them on to public and private leaders who are trying to develop solutions to our health care crisis.

Click here for more information about the Washington Health Foundation.

June 2 - Obesity adds weight to health care costs

If you don't smoke, you've probably been saving money for quite some time on your insurance – life insurance, medical insurance, homeowners' and maybe even auto insurance.

The next trend in the insurance industry may be to reward you for keeping your weight down. An analysis of health care costs published in May shows that illnesses related to obesity are costing Americans as much as smoking-related diseases.The study was underwritten by the federal Centers for Disease Control and Prevention.

Health analysts are viewing the fattening of Americans as an epidemic. The majority of us now are overweight. The number of obese people went up 70 percent over the past decade. Obesity is hitting all ages, especially the elderly. People over age 65 now account for roughly one-fourth of the obese population, and the older you are, the more expensive obesity becomes.

Obesity is associated with several chronic diseases, including type 2 diabetes, cardiovascular disease, several types of cancer, musculoskeletal disorders, sleep apnea and gallbladder disease.

The bill for obesity-related health care in this country is 93 billion dollars a year. Even if you're just overweight – not obese – your medical costs are likely to be 37 percent higher than people of a healthy weight.

Spread those costs out across the entire health care system, and each of us is spending an average of 732 dollars a year to deal with this weighty issue. That's because the economic burden of obesity is heaviest on the government's Medicaid and Medicare systems. In other words, it's the poor and the elderly who are most likely to be overweight. An obese Medicare recipient spends, on average, 15 hundred dollars more on medical care each year than non-obese seniors.

Obviously we're eating too much of the wrong foods. But contributing to the fattening of Americans is our lack of activity. Another recent study for the Centers for Disease Control and Prevention found that only one in five American adults engage in a high level of overall physical activity. One in four Americans – that's 25 percent – engage in little or no regular activity.

The study found that people who have physically active jobs don't go home and put their feet up. They're the ones who also tend to be active during leisure time. But people with sedentary jobs go home and become couch potatoes.

There's a public policy debate going on about whether the government has any business being involved in the obesity issue. After all what you eat and whether you exercise is your own business, right? Well we used to say that about smoking too.

Eric Finkelstein, a lead author of the obesity study, notes that the government and therefore the taxpayer is financing half the economic burden of obesity. He says the government has a clear justification to try and reduce obesity rates.

So what's the government to do? Health and Human Services Secretary Tommy Thompson, who has been on his own weight reduction regimen, is jawboning the fast-food industry. He wants McDonald's, Burger King and the rest to – quote – "do what is right for Americans." Thompson says fast-food restaurants should encourage their customers to eat properly and to exercise.

I can just hear McDonald's order-takers saying, "You can upsize your fries for just another dollar and five push-ups." Seriously, other suggestions include advertising campaigns, a tax on fatty foods, subsidies for fruit and vegetable purchases and discounted health insurance for people who participate in weight loss programs.

Health cost issues were discussed at a community round table in Okanogan last week, and a local doctor had another suggestion for weight control incentives. He proposed working weight tables into the income tax formulas. Wouldn't accountants love that?

"Let's see, your adjusted gross taxable income divided by your body mass index gives you a tax rate of . . . "

May 27 - Most Americans have billion dollar backs

Oh, my achin' back. If that's your mantra, you're not alone. Back injury is a commonplace ailment, and like the common cold, there's no sure-fire cure.

Dr. Diane Braza, director of the Spine Care Clinic at Wisoncon's Medical College, says up to 80 percent of Americans will suffer back pain at some point in their lives. The costs, in terms of medical treatment and lost work days, is in the billions.

The National Institute for Occupational Safety and Health says back injuries account for nearly 20 percent of all injuries and illnesses in the workplace, costing 20 to 50 billion dollars a year. Presumably that includes lost time on the job.

A study by Purdue University says most back injuries occur outside the workplace. The Purdue researchers say Americans spend nearly six billion dollars a yearjust taking their aching backs to the doctor -- and that doesn't include expenditures for hospitalization and prescription medicines.

Yet another report claims back pain costs 100 billion dollars a year -- much of which goes for unnecessary medical treatment. Dr. Richard Deyo, who is a medical professor at the University of Washington, led a study a couple years ago involving 22 health care organizations, including some HMOs. Not surprisingly, they cut back on traditional and expensive treatments, such as diagnostic x-rays and lengthy bed rest. They found it made no appreciable difference for the patient.

Other studies have come up with similar results. There was a "North Carolina Back Pain Project," sponsored by the University of North Carolina at Chapel Hill. The project determined that repeated visits and procedures did not appear to improve patients' long-term well-being but clearly accounted for substantial health care costs.

So, back to Dr. Braza at the Spine Care Clinic. She says that in about 90 percent of the cases, back pain is caused by a strain or sprain of back muscles, ligaments or soft tissues. These conditions generally heal completely but often recur if prevention strategies are not used. In the remaining 10 percent of the cases, back pain is due to more serious conditions, such as degenerative disk disease or herniated disks in the spine.

More than 200 thousand Americans undergo spinal fusion surgery every year. But the surgery isn't a sure-fire cure, and as many as 20 percent of fusion recipients need more surgery within 10 years.

Now there's hope for even these back patients. The Associated Press reported last week that there's something new on the horizon -- artificial disks that are implanted in the spine. The discs are being used in Europe but are still experimental in this country. AP says doctors expect them to be available in the U.S. as early as next year.

Many patients find relief through chiropractic treatment, acupuncture and physical therapy. Dr. Braza says the best cure is prevention.

We all know lifting is a common culprit in causing back pain. So if you can't avoid lifting, will a back belt help prevent injury? Maybe. Maybe not.

A study published in the Journal of the American Medical Association a few years ago suggests not. The federally-funded study of Wal-Mart employees found no difference in reports of back pain between workers who wore belts every day compared to those who never or rarely used them. And OSHA -- the Occupational Safety and Health Administration -- does not recognize back belts as effective in preventing back injury.

But a different study, this time conducted among Home Depot workers, found a significant decrease in back-related injuries when workers used belts AND were provided with body mechanics training.

Researchers also say there's a psychological component to back pain. One of the North Carolina doctors put it this way: "If you don't like your work and you have back pain, then it hurts more."

Whether you like your work or not, you're better off preventing back pain in the first place. Dr. Braza says there are three simple components to back injury prevention: first, your posture; second, being in good physical condition and third, knowing how to use your body correctly. Click here to read more about her prevention tips. They may save you some pain, and they won't cost you a thing.

May 20 - Health care news beyond the headlines

Democratic presidential candidates have been gaining media attention in recent weeks by rolling out plans to provide access to health care for the uninsured. But, hey. Would everyone who does NOT have health insurance please stand up? The government is trying to figure out who you are. More to the point, the government isn't too sure how MANY you are.

Forty-one million uninsured nationwide has been the figure most reporters and analysts have been using. Last week the Congressional Budget Office said that estimate may be double the real figure. Whatever the number, it's going to loom large in the upcoming presidential campaign. Republicans would like a lower figure. Democrats could use a higher number.

The figure of 41.2 million comes from the Census Bureau, a non-partisan agency. But the estimate of a lower number also comes from a non-partisan authority, the Congressional Budget Office.

Budget office director Douglas Holtz-Eakin says there is no such thing as the typical uninsured American. There are people uninsured for short spells – between jobs – and there are people who have no insurance over the long term.

The budget office says that during any given year, 59 million people are without insurance. But about half of them are uninsured for less than four months. Another 30 percent are uncovered for more than a year. Demographic groups likeliest to face long periods without health care coverage include people with lower income, less education and Hispanics.

By the way, as a result of the presidential campaign four years ago, there are a few people who can count on insurance coverage – for a while at least. Former Democratic presidential candidate Bill Bradley championed universal health care but was embarrassed when it turned out he hired temporary campaign workers who didn't receive health benefits. This time around, Democratic candidates are hustling to provide insurance for their campaign staffers.

In other news last week, reporters gave ample attention to the tax cut bill that passed the Senate. But one little part of the bill that pretty much escaped attention could be important to rural areas like Okanogan County. The Senate voted to increase Medicare payments to doctors and hospitals in rural areas by 25 billion dollars over the next decade.

But when the Senate giveth it also taketh away. The increase would be paid for with a reduction of fees for prosthetics and other medical devices and chemotherapy drugs. Medicare beneficiaries would also have to start paying deductibles and co-payments for laboratory services.

The bill was the work of Senate Finance Committee Chairman Charles Grassley, a Republican from Iowa, who said – quote – "health care providers and hospitals in rural areas should no longer be penalized for doing more with less." Physicians and health care facilities in rural areas long have complained that Medicare's funding formula pays them lower fees than what doctors and other providers in urban areas get.

The American Academy of Family Physicians said the measure is a large step toward correcting inequities between urban and rural providers. The bill still has to be passed by the House.

Yet another headline last week had to do with hypertension, and it may indeed have raised some people's blood pressure. The National Heart, Lung and Blood Institute issued new guidelines for determining how high blood pressure could be to be considered, well, high. And the new standards are, well, lower. And if you're confused, let's just hope your doctor isn't.

Critics of the new guidelines are claiming, among other things, that this is just another marketing opportunity for pharmaceutical companies to push blood pressure pills.

The story that isn't getting as much attention is in this week's issue of the Journal of American Medical Association. The article says that an eating plan called DASH is as effective in lowering blood pressure as a single drug therapy. DASH is short for Dietary Approaches to Stop Hypertension. The DASH plan is rich in low-fat dairy foods, fruits and vegetables. So if enough people just change their diets, maybe the drug makers won't be selling so many pills.

But that isn't the biggest problem facing pharmaceutical companies. The New York Times reports that lawyers who have been winning large settlements and verdicts against asbestos and tobacco companies, now are going after drug makers. The latest trend is lawsuits claiming dangers in medicines have harmed thousands of people.

The newspaper says lawyers are spending millions of dollars preparing cases in hopes of winning billions of dollars in settlements and jury verdicts. The lawyers say the U.S. Food and Drug Administration has failed to protect patients from dangerous drugs and that drug makers have tried to hide side effects. The FDA says medicines are safer now than they have ever been.

Click here for more information about the DASH diet

May 5 - Dental health doesn't make the grade

America is headed for one giant, expensive toothache if oral health care policies don't improve, say a number of authorities.

Three years ago Dr. David Satcher, who was surgeon general at the time, issued a warning report on the nation's dental problems. He said that a "silent epidemic" of dental and oral diseases was affecting some population groups.

Little or nothing has been done since to improve the situation, says a non-profit group called Oral Health America. Last week Oral Health America issued a report ca