May 30, 2009

Why am I a Vitamin D advocate? Here's why..

As a health economist whose career was spent evaluating medical technologies, starting with the hypothesis that they do not work (i.e., show me!), it's been difficult for me to accept my own evolution to an advocate for Vitamin D testing and supplementation.
It took a failed hip replacement to get religion (as outlined in my Jan 1 post). Now, I may have tendency to go too far with my enthusiasm (see May 17 post), but I just found a great keynote presentation by Michael Holick, M.D., at a European medical symposium on calcium which explains why I'm a believer. Holick is a professor of medicine and physiology at the Boston University Medical School, and director of BU's clinical research center. We're not physicians, but this is still a fun presentation and will teach you a lot about why the medical profession is gradually coming around to the importance of Vitamin D. Ostoporosis, osteomalacia, fibromyalgia, rickets, TB, psoriasis, rheumatoid arthritis, prostate cancer, colon cancer, breast cancer, MS, ..etc. He'll make you understand the evidence and you'll enjoy the talk. So click on his presentation and take the 20 minutes to listen. Also - it will allay your fears (and maybe your doctor's fears) of overdoses.
Dr. Holick's own web page VitaminDHealth.org is geared toward physicians but is a great resource on clinical questions regarding D.
Update: June 22- A really interesting comment pointed to this blog post by an anthropologist whose contrary view seems very well reasoned.

May 28, 2009

Social Security-Medicare for the @65 crowd

Since my time for Medicare eligibility is creeping up at its petty pace, I paid attention to this report out of the Kaiser Family Foundation, detailing how the cost-of-living-adjustments (COLAs) for Social Security (SS) and the Medicare Part B premium updates are going to interact for 2010 and 2011. And, since many of my friend-readers are in my age group, you should know about this too.
First off -- for 2010 and 2011, it looks like the SS COLA is going to be 0%. (If you're old, you did well in 2009 with your 5.6% COLA increase, so don't complain.) But Medicare premiums are going to increase, which means that your net SS check would decline.
But WAIT, there's a "hold-harmless" clause in the law that says -- with certain important exceptions outlined below -- if the extra Medicare premium exceeds your SS COLA update, the Medicare Part B premium will be adjusted down, so your net SS check doesn't decline. So, that means with a 0% SS increase, you won't have to pay more for the Medicare premium in 2010 and 2011. Great huh?
But WAIT... it might NOT help you, especially if you're around my age and are not going to be enrolled in BOTH SS and Medicare in 2009. (About 25% of all 2010 Medicare beneficiaries don't get the benefit.)
The three groups who will NOT benefit from this hold-harmless clause, and WORSE, who will actually pay for the entire cost increase for all 100% of beneficiares are as follows:
  1. People who are NOT in both programs in 2009. That's US, baby, especially if we have our critical 65 birthday Jan 1 or after. Or, if we delayed taking our SS until the full benefit kicks in when we turn 66. So, if you're entering one or both programs (SS & Medicare) in 2010 or 2011, you'll be paying higher Medicare Part B premiums, not only for self, but for your older sisters (!!!!) and brothers who will be sitting pretty. (About 3% of 2010 Medicare enrollees fall into this category according to KFF.)
  2. People who are "filthy rich." According to government, that's anyone who's in both programs in 2009 but whose "modified adjusted gross income" was $85,000 or greater for individuals and $170,000 or greater for couples. (For vast majority of us, MAGI=AGI. For full definition, click here.)- about 5% of Part B enrollees.
  3. People who are in such dire straits that they're eligible for both Medicare AND Medicaid. They don't pay any Medicare premiums anyway..The Medicaid program pays Medicare on their behalf. (Medicaid is a shared Federal-State government program, so our tax dollars or Treasury debt will pay for this part of the Medicare population's increase.) (About 17% of 2010 Medicare enrollees.)

Bottom line? If you're in Group 1 and/or 2: get ready for a 2010 Medicare Part B premium of $104.20; if not, you have to pay only $96.40 a month. In 2011 it becomes even more Kafka-esque: You'll pay $120.20 if you come of age in 2011 (group 1) or if you're still rich. Your not-so-disadvantaged older sisters will still be paying $96.40.

If you want to complain to your congressman, see my post of April 29 on How to Contact your Congressman or Senator. As for me, I'm just going to accept this surcharge as payment for the many times sister Janet took me to the Castle Theater in Irvington NJ to see Sylvester and Tweety bird. She could have let go of my hand at Springfield and Clinton, and the world would have been spared my blog!

Message to Janet: You're going to owe me a steak dinner in 2011!

May 26, 2009

A Heroine for Our Time -- Brooksley Born

When I started blogging back in October 08 with screeds against Rubin, Summers, Greenspan, and Phil Gramm (The 4 horsemen -- Hear No Evil, See No Evil, Speak No Evil, and Evil) I did mention "our gal Brooksley Born" as the voice in the wilderness back in the late 90's.
Today, the Washington Post has a wonderful profile of Born, and it's a MUST READ for 2 reasons.
First, it should make us email the White House, demanding that Larry Summers actually apologise for his role in the meltdown as a condition for keeping his job. Alan Greenspan did it, and I've forgiven him. Phil Gramm is a jerk, and he's now out of Congress, so we won't worry about him. Rubin...well, he's only in the background today, and he made a half-apology, which is good for neanderthal man. But Summers has apologised only for not having predicted an 8-year Republican administration that would 'ruin' all his great work. (Heard that one on Boston's WBUR On Point, April 3, 2008.) Is an apology enough? For that man, it's a necessary first step to humility, the economist's equivalent of sobriety.
Just as important, though, is the profile of Brooksley Born's life in the Post article, which should be read by every post-feminist woman (i.e., 20-somethings) who hasn't lived in a time when a truly extraordinary woman would face barriers at every turn. I was shaking after reading the story. She was a pioneer at a time when professions weren't open to women, and she was active in the women's movement to help open up opportunities. Sandra Day O'Connor's and Ruth Bader Ginsburg's stories we know. Brooksley Born's I didn't. I love her!

May 19, 2009

Face Masks and Swine Flu

My earlier questions (May 7 post) about whether face masks will be available if the "novel H1N1" (aka Swine!) flu becomes more Spanishy over time has been answered by an excellent article in today's Time Magazine. (We'll miss the mainstream news media, won't we?) "New Pandemic Fear: A Shortage of Surgical Masks".
Short answer -- yes, they'll be in shortage, but maybe they don't work anyway. All I know is that I rub my nose a lot, and having something between my hands and it would be a good thing in an airplane, or anywhere in public, for that matter. Hand sanitizer is still a must, of course.
Friend Linda (a true health policy wonk--some of you know her) shared 2 N95 masks with me on my last plane trip -- which I still have (thankyoulinda) -- and also shared the following email (from May 7) from a major distributor of N95 masks :
The N95 mask that you are looking for is on a manufacturer backorder currently. We do have a similar N95 mask. It is from Kimberly Clark. Our item # is 153-4801. The difference is it is slightly smaller and a little different shape, but still is N95 equivalent. It is on page 261 of our catalog. It comes 35/box and the price is $40.79/box. Please take a look at that mask in our catalog. If you do not have a catalog, please visit our virtual catalog on our website at www.henryschein.com.
So, there you have it. Info on whether the gov't is ready (no), and a ready source (at least as of May 7) of N95 masks.
Hope I don't have to retract this post. It's so embarrassing.

May 17, 2009

What the Credit Card companies know about you

New York Times Magazine has a great article today on what corporations can learn about you by looking at your credit card purchases. "What does your Credit Card Company Know about you?" Read it, be outraged, and then start thinking about ways to subvert the card companies. I'm so glad that I've been paying for beer with cash but dentist bills with my Mastercard. I learned about this from the blog of the Public Interest Research Group (PIRG), which I find chock full of items that put me in touch with my inner populist. (Reminder to self: find a blog to put me in touch with my inner authoritarian.)

Vitamin D & H1N1 - Revisionist thinking

In the past I've admitted to family and close friends to having moved from analyst to advocate in my enthusiasm over Vitamin D. But, as with all believers, I was blinded by the (sun) light! My guru was a California psychiatrist -- John Cannell, head of the Vitamin D Council, an unabashed champion of Vitamin D. His articles reviewing the evidence linking Vitamin D to protection from colds and flu, as well as the recent evidence in the medical literature, have stoked my enthusiasm.

Today, though, I received the May Newletter of the Vitamin D Council, and there's been a lot of learning and backtracking on Dr. Cannell's part regarding the interaction between Vitamin D and influenza, especially pandemic influenza. So, as the queen of retractions, I must say that my enthusiasm was premature. New evidence from Russia, he says, shows that high blood levels of vitamin D (say 50 ng or higher) may reduce the efficacy of influenza vaccines. He seems to suggest that a CDC researcher has known about this for 5 years but neglected to tell him. Well, my good Doctor, you should share in the embarrassment that I feel in telling all my friends via this blog to slather up in D. CDC has no obligation to contact either you or me just because we blog.

I'm now somewhat suspicious of Dr. Cannell's revisionist recommendations regarding the use of Vitamin D in a pandemic. He's still a proponent -- only now he says you must bathe yourself in it to the tune of 5000 IU per day in order to get the preventive benefits, and taking a mere 2000 IU might actually make things worse! And, then he says if you get the flu, immediately take 50,000 IU for a few days running. Read for yourself, and judge.

Still, it's important for you to know your Vitamin D status, and Vitamin D is important for bone health (as I found out much to my permanent dismay) as well as for other diseases.

I'm still on a regimen of high vitamin D and will continue. That's because I have such low levels naturally that I must bathe myself in it anyway. But, for now I'm through pretending that I've seen the enemy and it's Vitamin D deficiency. Mea culpa (as usual).

May 7, 2009

Swine Flu, Air Travel, and Me

Few people could match me in vigilence about infectious diseases. I follow the great University of Minnesota CIDRAP web site, which sends a daily email newsletter on what's going on in the world of infectious diseases, from flu to food-borne infections. I have a lifetime supply of Purell hand gel, bought back in the days of anthrax (CBO's building was closed for over a month). And, I have a supply of surgical masks and gloves (though no surgical knives). And, I follow my own advice about the importance of Vitamin D in maintaining innate immunity against flu and colds.
So, when I made a weekend trip to Austin, Texas on Saturday, you would think that I would have worn a face mask on the plane. But, no! I did have two with me (one for each way), but I never took them out of their bag. Why not? I would have felt very silly as the only person on the whole plane wearing a face mask. And, they're a nuisance, too. On the plane to Austin, there were almost no coughs (yes, I did monitor coughs), but on the way back the plane was full of hackers. Even then, I was not tempted to bring out the mask because I figured it would be too late anyway if any of those coughers were swine babies. And, I'm not young, and I take 2000 IU of Vitamin D every day. So, I felt I'd done enough.
From this I conclude that Americans will not use masks unless they are required to do so as a matter of policy. The government, or the airline, or the airport authority must require (or strongly suggest) the use of masks to get people to act defensively. And, they probably would have to provide them as well.
In Japan people wear masks on the street whenever they have colds; it's considered the polite and socially responsible thing to do. Everyone was wearing masks in Tokyo last week. We are not Japanese.
I need to do research on whether the US government is stockpiling masks for distribution should the need arise. Do airlines have emergency stocks to allow for continued operations during flu season?
Nobody seems to know what will happen to the swine flu after the sun disappears this fall, or whether it will grow in lethality. The government is doing a good job agonizing over whether to produce a vaccine for the fall. I have a lot of faith in those decisions. But I still think it would be good for individuals to invest in some N95 face masks, a big supply of Purell (which flew off the shelves of my supermarket last week), and after labor day, a daily supplement of Vitamin D (1000 IU per day should do it until flu starts to arrive, unless you're deficient. Are you? Bet you don't know. )