USA Today Series on Health Care Costs

USA Today began a three-part series today on US health care costs. Even the Insured can Buckle Under Health Care Costs, the first article in the series, details the findings of a survey conducted by the newspaper, the Kaiser Family Foundation and Harvard School of Public Health.

"Medical costs are a growing burden for middle-income families with children, as well as for the working class, people with chronic illnesses, the disabled and the uninsured. Many who cannot pay skimp on health care, go without prescription drugs or simply ignore their bills, the survey showed. . . .

"Overall, the hardest hit by medical costs are the uninsured.

"Next are adults under age 65 with insurance who have household incomes of less than $75,000, an analysis of the survey data found. Those in that vast swath of Middle America were far more likely than those richer or older to report not having enough money to pay for medical costs in the past year (33%), to have paid $1,000 or more in out-of-pocket costs for care (31%) or to have skipped medical treatment or a prescription because of the cost (34%).

"Wealthier households and those who report few health problems — two groups that represent nearly half of Americans — had little or no difficulty with medical costs."

Other findings include:

  • 62% percent of those struggling to pay medical bills have health insurance
  • 28% of adults were unable to pay for some form of medical care in the past year
  • More than one in five Americans currently have an overdue medical bill
  • Nearly two out of 10 say health care costs are their biggest monthly expense after rent or mortgage payments
  • Almost three out of 10 estimate they paid $1,000 or more out-of-pocket for health care in the past year on top of premiums
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Olive Oil as NSAID

In an analysis of freshly pressed extra-virgin olive oil, a University of Pennsylvania biologist found a compound, called oleocanthal, that acts like the NSAID ibuprofen. The compounds have different chemistry, which means that oleocanthal may or may not cause the long-term kidney and digestive problems that ibuprofen can.

Four tablespoons of olive oil equal about 10% of the recommended dose of ibuprofen for pain relief, so it’s not a viable alternative to popping Advil. But since sauteing veggies in olive oil instead of butter isn’t much of a sacrifice, I’ll tell myself that every little bit counts.

Extra-Virgin Olive Oil Mimics Painkiller

Hurricane Katrina Relief

Today WebMD published a short article on ways to help Katrina’s survivors. It addresses the benefits of donating cash over goods, how to volunteer, and organizations to consider if you’d like to donate money or time.

I’ll continue to blog about relevant health care news this week, but my problems are small in comparison. I hope you’ve all been able to contact your loved ones affected by the hurricane and its aftermath. Take care of yourselves.

What’s Medical, What’s Private?

Since medical privacy rules (aka HIPAA) went into effect, patients have signed form after form saying that our health care providers and pharmacists have told us that they comply with the laws. With restrictions on who can see, know about or be sent our medical information, it seems as if our private medical information is well-protected from prying eyes. "But that depends very much on what you mean by medical, and what you mean by privacy," maintains Abigail Zuger, MD, in her essay, The Water Cooler, a Font of Good Medicine, which appears in today’s New York Times.

For medicine to shift from treating symptoms or disease to treating whole people, Zuger argues that the social information about patients that was once considered gossip is now relevant to their health care. She writes,

"No longer is a well patient with a sick gallbladder of medical interest for her gallbladder alone…

"Is the gallbladder upset because its owner is eating too much fatty food? Are those deep fried onion ring binges caused by unhappiness in the home? Is there a possibility of domestic violence? Should a social worker and a lawyer be called as well as a surgeon? The scans show only the inflamed gallbladder, but medical caretakers are now encouraged to see beyond the scans.

"Sharing information from every perspective has become the way of the future. In medical school, students are now encouraged to link disparate medical and social details into a cohesive story, a veritable novel about each patient."

If talking about the gory details of my life means that my health problems are better attended to, I’ll provide refreshments for that meeting. How do you all feel about your medical privacy after reading Zuger’s essay? Please leave a comment or e-mail me.

Coexisting Conditions

"Comorbid" is a word I’m seeing more and more in discussions of migraine. I don’t know if it’s appearing in more patient-centered articles than it once did or if I see it more because I read so much more about migraine than I once did. In any case, it’s something everyone with headache should know about.

Here’s the definition: Comorbidities are disorders that have a greater-than-coincidental association with another disease. According to WebMD, disorders that are thought to be comorbid with migraine including stroke, epilepsy, lupus, Raynaud syndrome, multiple sclerosis, essential tremor, bipolar disease, depression, anxiety disorder, panic disorder and social phobia. Meniere’s disease and certain gastrointestinal disorders are also sometimes mentioned.

It’s like being in high school. Maggie, Ann and Peter are best friends and don’t go anywhere without each other. Ann starts dating Steve and he becomes the fourth member of the group. Does Ann cause Steve to be part of the group? Could he have joined them if he was Maggie’s lab partner and she knew her other friends would like him? What if they all sit next to each other in a class and Steve just naturally joins the group? Does it matter which came first or why?

There aren’t many web resources that catalog and describe comorbidities. The best I’ve found is Headache Disorders: Common Coexisting Conditions. If you want to know if a specific disease is comorbid with migraine, the best online option is to Google both terms together or use both terms and comorbid or coexist.

Good Q&A on Migraine Basics

My sister and her three kids visited over the weekend, so I haven’t had much time at the computer. I’ll resume regular blogging activities tomorrow (provided that I don’t have a migraine after the loud, frenzied and fun weekend), but there’s an article I’d like to share tonight.

Published in Glasgow, Scotland’s The Herald, A Head Start on Migraine is a simple Q&A on migraine. I like the article because it describes migraine as a complex neurological disease with a variety of symptoms and distinguishes it from a bad headache. Statistics of sufferers come from the UK, so it’s not totally generalizable, but its a good article to send to family and friends who would like to know more about what you go through (or who don’t believe that you have a disabling disease).

News Roundup

It’s a busy day and there’s a lot of news from today and from the week that I have blogged about, so here are headlines and excerpts. They’re in reverse chronological order. I can’t shake the feeling that I’ve missed something. If you know of other relevant news, please post it in the comments. Thanks!

Self Reported Chronic Pain in School Age Children
"The results showed an incredible prevalence of chronic pain (defined as pain for longer than 3 months) at 44% of all responders. Headache was the most common source of pain (38%) closely followed by back pain (17%) and limb pain (15.7%). The effects on daily living tended to impact most significantly on ability to pursue hobbies (girls 60%, boys 57%); sleeping problems (girls 61%, boys 46%); eating problems (girls 48%, boys 30%) as well as numerous other normal adolescent activities."

Pain, Fear of Pain and Expectancy as Indicators of Future Disability
In a study of people with chronic back pain, "…negative expectancies were associated with frequent pain and a belief that their condition was derived from a serious underlying medical problem. Patients with negative expectancy and a fear that activity might result in further injury, re-injury or increased pain, displayed significant differences in suffered pain and functional capacity at one year than those with a positive perspective and no fear."

(I hate when folks assume that pain is caused or perpetuated by attitude, but I can see how expectations can play a role in perpetuating or increasing pain.)

Cigna Offers its Customers Drug Data
Cigna "…has set up a Web site to help its customers find the lowest prices charged by pharmacies for prescription drugs. The site shows prices, including the patient’s out-of-pocket spending, for 52,000 pharmacies nationwide, as well as for mail- order or home-delivery service, the Philadelphia-based company insurer said. Consumers also can compare the costs of brand-name medicines with generic copies."

(via Kaiser Networks’ daily reports)

Wall Street Journal Examines Efforts by Pharmaceutical Companies To ‘Revamp’ Image
"The Wall Street Journal on Friday examined efforts by pharmaceutical companies to ‘revamp their image’ in response to consumer criticism over high prices, safety concerns and ‘aggressive’ advertising. Opinion polls indicate that consumers consider the pharmaceutical industry to be one of the ‘least trusted’ industries…."

Wall Street Journal Examines Evaluations of Clinical Trials by Health Insurers, Others
"The Wall Street Journal on Wednesday examined research by insurers, state Medicaid programs and not-for-profit groups to evaluate clinical trials for prescription drugs and identify any ‘marketing spin’ included in studies published in medical journals."

Drug Trials and the Media
"Media reports of drug trials can lack accuracy and reliability, according to a study published in the open access journal BMC International Health and Human Rights. Researchers say that in controversial issues such as HIV/AIDS prevention drug trials, investigators and funders should engage with the media to avoid misinterpretation and inaccurate reporting."

(This is specifically about HIV/AIDS drug trials, but the issues are relevant throughout drug trials.)

Understanding the Relationship Between Pain, Impairment and Physical Disability
"The association between pain, impairment and disability is frequently observed in clinical practice but the relationship is not as straight-forward as just one to one; for example some patients may have severe pain but little impairment. Consequently, a group of investigators from University of Bergen in Norway set about trying to establish a more concrete idea of the interaction between these relative dimensions to quality of life."

St. Jude Medical Announces IDE Approval to Begin ESCAPE Migraine Study
"St. Jude Medical believes it is the first company to receive FDA conditional approval to study the potential connection between Patent Foramen Ovale (PFO) closure and migraine headaches. A PFO is a structural defect of the heart where a small hole between the right and left atria (upper chambers of the heart) fails to close in infancy. An estimated 25% of the adult population has a PFO but in most people it is usually considered benign.

…The objective is to determine if patients who undergo a PFO closure procedure have a decreased number of migraines over a one year follow-up period as compared to those who are maintained only on drug therapy. Enrollment in the study is expected to begin by the end of 2005."

First Detailed Picture of Migraine Attack
"Using a new method, researchers at Göteborg have managed for the first time ever to provide a detailed picture of an untreated attack. This will be of great significance for the development of new forms of treatment."