Dec 10, 2012

What your health bills will be under Medicare

Here is a page from the Medicare.gov Website that tells you what the various programs pay for, and how much they cost in premiums.  I liked it because it is succinct and easy to understand.

Oct 2, 2012

Rules for Converting Vitamin D25 measurements

For those of us in USA, we use ng/ml, whereas the rest of the world uses nmol/l to measure Vitamin d25 blood levels. This makes it difficult to understand what researchers are using as cut-off points for "low" or "high" threshold values.
Here is the conversion formula:

  • to convert nmol/L to ng/mL, multiply nmol/L by 0.4;


  •  to convert ng/mL to nmol/L, multiply ng/mL by 2.5.]

Sep 12, 2012

Vitamin D and Multiple Sclerosis: more hints of effect

Admittedly, the high-quality evidence linking Vitamin D3 supplemention to moderation in  the course of multiple slcerosis is limited and somewhat conflicting.  Here's a new, very small, randomized clinical trial from Finland, which seems to suggest that D3 supplementation at high doses DOES make a difference.  At least it keeps hope alive until bigger, more definitive studies are reported in the future.  If it were I, I wouldn't wait to find out.

And, this just in, from National Library of Medicine's Medline page, a report of a study that followed a large number of individuals over time, recording their Vitamin D levels.  Those authors found a strong negative association between blood levels of Vitamin D (25OHD) and severity of symptoms.

Aug 29, 2012

Vitamin D Thwarts winter colds and flu in children

A study about to come out in Pediatrics (and noted by NIH's Medline web site) shows that giving daily Vitamin D supplements to children with LOW levels of Vitamin D reduces their susceptibility to winter colds and flu.  Conducted by Mass General Hospital researchers, but in Mongolia where there is an ample supply of  non-sunlight in winter.  Also, lots of kids deficient in Vitamin D in the winter.  Perhaps Mongolian milk isn't fortified with Vitamin D. (This last sentence reveals my utter lack of knowledge of modern life in Mongolia.) So, American kids might do better in winter on Vitamin D levels even without supplements.
But, what if your kid doesn't like milk and doesn't drink enough --4 glasses a day at the very least --to keep levels up?  Has your  pediatrician  tested his/her Vitamin D  levels? If not, you might gently suggest at the next visit (especially one in the winter time) that you'd like the doctor to test Vitamin D, or at least ask him or her whether it has been tested in the past (in the winter time).

Aug 14, 2012

Quick access to ratings of nursing home quality

Over the years I've had plenty opportunities to observe nursing homes in action, not only for my parents' generation, but also for my own post-surgical rehab.  And, recently I've spent a good amount of time visiting an older friend who spent a lot of time in several nursing facilities in the Maryland suburbs.  This nursing home rating tool, made available through ProPublica, is an excellent summary source of information, and the information you can get by clicking on an individual home's profile dovetails with my own impressions of the various places I've recently seen.
So, I'm entering this post into my "citizen portals" label, recognizing that I (and you) may have plenty of reason to research information on potential nursing homes.  If a friend asks for advice, all you have to do is remember my blog's name:  www.theviewfrombethesda.blogspot.com  and they will be able to get to this applicaiton.

Jul 10, 2012

High doses of Vitamin D prevent fractures in oldsters

I know, I know, it's getting boring.  Here's a study, summarized by Medline Plus (Natl Library of Medicine), showing that in older people, doses above 800 IU are necessary to get a reduction in hip fractures.  So, all that conservatism in the IOM study is missing out on the fact that oldsters such as us may need a whole lot more vitamin D than they suggest.

Jun 28, 2012

SCOTUS OPINION on Obamacare- Read it here!

Here is the C-span link to the Supreme Court opinion on the ACA.
Who would have thought that logic (i.e., a mandate that is enforced as a tax is a tax! and Medicaid is a voluntary program, that States can opt out of in pieces) would prevail?

Is this another switch in time that saved nine?  Or the opposite?  Only time will tell.  My relief tells me exactly where my own opinions lie.

Jun 24, 2012

What's the best outcome of SCOTUS on Obamacare?

Here we are, on the possible eve of the supreme court's decision on the constitutionality of the Affordable Care Act (ACA).  I've been grappling with what I want to see as the outcome, from the standpoint of what's good for the health care system, what's good for Obama's reelection, for the Democrats in Congress, and finally, for the crowd of  people who deeply believe that a single-payer health care system (a la Medicare) is best for the entire country.  To clarify, when I think about what's good for the health care system, I have in mind the ultimate effects on cost, quality and equality of access...those three competing objectives of public policies governing the delivery of health care.
What's good for Obama's re-election?  I believe the best thing for Obama politically speaking  is to have the whole bill nullified (except for the Medicare provisions, which nobody is talking about anyway).  That would wipe out the state-level exchanges, the insurance mandate (of course), and all the Medicaid provisions that expand access to Medicaid to all individuals and families with incomes less than 133% of the Federal poverty line (about $14K for individuals;  and $31K for a family of four).  I can't imagine how striking down the insurance mandate could leave in tact the ban on insurers discriminating on the basis of pre-existing conditions, or even the requirement to cover the under-26 crowd (even though some major insurers say they will keep that one.)
I think it would be good for voters to go back to square zero on health care.  It would take the fire out of the conservatives' righteously(?) indignant bellies over the mandate, while leaving the rest of the country to mull the alternatives.
What's good for the Democrats in Congress?  Re-election wise, see above.  Ideologically wise?  What ideology?  Dollars (theirs)  is what matters to them.
What's good for the Single-payer ideologues?  This is a no-brainer.  The mandate goes, the Medicaid provisions stay.  Most Americans do not realize that the Medicaid provisions, in addition to expanding eligibility, require Medicaid to pay for physician services at Medicare rates..  We hear a lot about how Medicare fees are low compared with private rates, but Medicaid fees are 30% lower than that!  And, to top it all off, the Federal government will pick up the entire tab for the health care costs of the new eligibles.  (Yes, yes, that's for 2 years, after which the Federal % drops to 90% and the Medicaid fee schedule rule drops, but who believes that the doctors won't have the clout to extend the fee schedule, just as they have managed to keep fees from plunging under Medicare's law by one-year extensions?)
Bottom line:  an extension of the Medicare-like single-payer system to a greater part of the population, and a gradual acclimation of the public to the idea that universal coverage can only come from a single-payer system.
What's good for the Health Care System?   At this point, I am rooting for a complete nullification, though  I am aware it's a long-shot.  That's because I don't believe in a single-payer system. So, what I mean is that if the mandate is going to be shot down, then I hope they shoot down Medicaid, too. That way, in having to start from scratch, perhaps Congress will put all the people into exchanges, which will treat the lower-income folks with the same respect they treat others. And, instead of  "exchanges," it should be "exchange."   I believe in a regulated market place (much like the Federal Employees Health care system) that offers competing plans meeting minimum coverage requirements.  The exchanges sounded like a good idea, but they are implemented at the state level, which doesn't allow much ability to pool risks, especially in smaller states.  (The state-level exchanges came from the Senate and its nefarious (Demorcatic) leadership, while the (Democratic) House bill had a national exchange system that would have guaranteed a large pool of enrollees.)
At this point, it would be worthwhile to go back to ground zero and let the nefarious Republican leadership deal with the consequences of its political intransigence and the public with another failure of our country to make access to health insurance (and therefore decent access to health care) a right.
What do you think?

Jun 19, 2012

Vitamin D supplementation reduces mortality in the elderly

A meta-analysis from 8 large randomized clinical trials, involving more than 70,000 elderly people, found that  Vitamin D supplementation decreased mortality over 3 years by 7 percent.  That's huge.

May 30, 2012

Vitamin D and Stroke Risk

Now from the journal Stroke, a study from the famous Kuakini Honolulu Heart Program that followed over many years several thousand Japanese-American men living on Oahu, beginning in 1965.  A recent study of stroke outcomes has found that men with DIETS rich in Vitamin D had a 27% reduction in stroke risk, after adjusting for all the other usual suspects (smoking, cholesterol, etc etc).  
Not a clinical trial, but the measurements of diet were well done. Unless Japanese men are so different from the rest of us that we can't generalize, the study is highly suggestive of causation. 
I haven't read the full article, cause I don't have access to Stroke and don't want to pay for an article that should be in the public domain (since the public undoubtedly funded the original study).  But 27% risk reduction in a common source of death and disability isn't something to be ignored.  
To paraphrase my old Turkish friend Isik, "What if it works?"

Apr 25, 2012

LWV should look into transparency of Fracking information

Here's something for a League of Women Voter's initiative to tackle! From ProPublica:   Fracking industry is pushing for legislation that would muddy the information about the chemical composition of fracking materials.  Where is transparancy?  (Not in the water?  Not in the government?)

More on Vitamin D and Alzheimers

This study was just reported and commented on by the Vitamin D Council's Newsletter.  It's French.  They aren't so different. Bottom line -- those with high intake of Vitamin D - sunshine - omega3 fatty acids, or some combination of the above, had lower risks of Alzheimers 7 years later.  To paraphrase President Obama (who was speaking about energy policy), What's not to like ALL OF THE ABOVE?

Apr 17, 2012

Vitamin D supplements in Prostate Cancer

The latest newsletter of the Vitamin D Council pointed to a small study of Vitamin D3 supplementation for a year in low-grade prostate cancer.  It showed that at 4000 IU per day, the markers of cancer severity actually regressed.  But,..there were only 44 subjects in the study.  So, this is merely subjective.  Still, there is little to be lost in supplementing at 4000 IU.

Mar 26, 2012

For Maryland Residents: How to Contact your Rep in Annapolis

Here is the source of all state officials for each residence.  Find your State Representative  Easy... I just wrote all my legislative reps about the travesty now unfolding in the legislature to privatize state assets, setting in process an invitation to official corruption.

Mar 14, 2012

Vitamin D and Alzheimers- Now we're REALLY getting serious!

Here's a piece from the National Library of Medicine's Medline news digest about D3's ability to clear amyloid beta from the brain.  Yeah, really, and turmeric too.  Ever cooked with turmeric?  Me, neither.  Makes me want to take a course on South Asian cuisines.

Mar 13, 2012

Jane Brody reviews evidence on Vitamin in NY Times today

It's hard for me to believe that Jane Brody is still writing columns, as she was a fixture way back when.  Maybe she takes Vitamin D supplements (ha ha).  Anyway, here is a link to her review of current issues in Vitamin D, in today's New York Times.

Mar 6, 2012

Vitamin D supplements prevent stress fractures in girls and young women

Here are the results of a very well designed longitudinal study (the Nurses' Health Study) that clearly shows that girls and young women who get lots of Vitamin D have fewer stress fractures.  Calcium was not that important, contrary to expectations.  It was Vitamin D, Lee!

Mar 1, 2012

A Great Guide to the Supreme Court's Upcoming Review of the Health Reform Law

The Supreme Court seems to be taking this seriously, admitting (???) that they need help in understanding the issues by scheduling 6 hours of argument (compared with usual 1 hour).  A great article in the New England Journal of Medicine, available without a subscription, lays out the issues and the timeline.  It's written for doctors, so it's actually readable for us all, since so many docs don't seem to understand anything about insurance markets and cost control (my editorial comment, of course).  Update as of Mar 15, another article in NEJM.  Clearly, the profession cares about this