Medical Malpractice

The care of the person with a thyroid disorder in today's healthcare environment is inefficient at best and is worthy of malpractice at its worst.

Let me explain.

The vast majority of thyroid problems are underproduction of thyroid hormones by the thyroid gland.

It is estimated that approximately 1 in 10 people you meet has a low functioning thyroid gland which is called hypothyroidism. The symptoms of a low thyroid output can be global as the thyroid hormones determine the basal metabolic rate of all cells in the body.

What does that mean?

It means that the rate at which your cells respire, take in nutrients, pump out waste products is determined by how much thyroid hormones you have any any one time in your body.

Low thyroid hormone amount in your bloodstream= slowed down ability to function.

This affects everything: speed of digestion, speed of cognition, speed of recovery, etc, etc. This is why hypothyroidism can have symptoms like brain fog, depression, constipation, unexplained weight gain and coldness.

There are 2 predominant models in today's healthcare environment: medical and alternative.

In the medical model, no thought is given to why a persons thyroid is not functioning well, the only treatment is to give thyroid replacement hormones until the message from the brain to the thyroid which is called thyroid stimulation hormone or TSH, is normalized usually at a value of about 2-3.

The alternative model for hypothyroidism is not about thyroid hormone replacement, it is instead fixated on iodine and tyrosine supplementation to allow the thyroid to make more thyroid hormones.

Additionally, thyroid glandulars and co factors are added to insure no nutrient deficiency exists for thyroid production.

Here is the problem.

Over 80% of all hyothyroid patients do not have a nutrient deficiency of iodine or tyrosine as their mechanism for low thyroid production. And, just giving thyroid hormones does nothing to counteract the basic mechanism that is in play for about 80% of all hypothyroid patients.

What is the mechanism?

It is an auto immune attack by your own immune system on your thyroid! This means that a gene in your body got switched on that tells your immune system to tag the thyroid gland for destruction.

When the immune system ramps up for for an auto immune attack, certain cell messengers called "cytokines" are released. These cell proteins or" cytokines" completely interfere with many aspects of thyroid physiology.

So, lets see how this information fits into the alternative and medical model.

The alternative model will try to get the thyroid to make more hormones by using nutrient combinations. The medical model will not care about the mechanism, just replacement hormones.

It is known that if you introduce iodine wholesale into a community, 2 things happen:

goiters go down and auto immune thyroids go up. So, iodine supplementation in the alternative model may precipitate an autoimmune disease of your thyroid! Or, fire up an auto immunity that was already present. This is definitely not the intended result.

In addition, if the mechanism for the low thyroid is autoimmune, giving iodine does not do anything to dampen the levels of cytokines in the body.

In the medical model, since the thyroid gland is being destroyed by the immune attack, thyroid hormones are prescribed. And while this may help a bit in the short term, it doesn't address the way the thyroid hormones are interfered with by the autoimmune messengers called cytokines. Therefore, you can have a person whose thyroid blood test looks normal but are experiencing many of the symptoms of a low thyroid person because the expression of the thyroid hormones is compromised by cytokines.

Neither approaches come close to helping the person resolve the symptoms associated with hypothyroidism.

Here is what does help.

Dampen the autoimmunity!

When you reduce the auto immune expression, you dampen the amount of cytokines, you improve thyroid physiology.

It's that simple.

Or, at least in concept it is simple. The real work in all of this, for me is to figure out the person's autoimmune triggers, and discover which sides of their T helper system to support. And if person needs thyroid hormone replacement, so be it. By the way one of the most profound triggers for flaring up autoimmunity is eating gluten and all of the other foods that cross react with it.

This approach has a profound effect on the quality of a hypothyroid person's life.

Now they have a way to decrease brain fog and weight, increase energy and motivation, have normal temperature, skin, hair and digestion.

Here is the final kicker: If a person had antibodies to the thyroid, there is over a 50% chance of them demonstrating antibodies to other tissues. These tissues can include nerve (MS), organs (lupus), joints (rheumatoid arthritis) and even brain tissue. Even hormones themselves can have an antibody reaction.

If the immune system flares up to tag the thyroid for destruction, what is happening to these other antibodies? You're right. They cause their own destruction of those tissues.

So, the key to most hypothyroid patients (about 80%) is to dampen their autoimmunity, not just give thyroid replacement hormones or a single nutrient to resolve their symptoms.

So, how do you do that? I will address that in a future e-mail.

Recognizing and treating the neuro-endocrine-immune system in about 80% of all hypothyroid patients is is the most efficient model for hypothyroidism today.

All dental care is cosmetic to a certain extent. There are different levels of cosmetic in the dental procedures. If you are looking for low cost cosmetic dental care - then a dental university would give you very good results.

Remember that having dental insurance doesn't mean that the cosmetic dental work has no fee. Insurance is liking having a coupon for the total cost. You will always have to pay your deductible.

Some people recommend going to Mexico or Thailand to get cheap cosmetic dental care. But a word of caution here. Before you go to any other country for dental work, do a lot of research. It may sound offensive, but there are lots of scams geared toward people from the States especially in Mexico, and if they know you are coming just for treatment, they will know that you will have next to no recourse.

The recent trend in medical tourism is bargain-priced dental treatments in Latin America and Asia where, according to reports, medical and dental practitioners operate modern, well-equipped clinics and centers, many of which are attached to or affiliated with resort and hotel complexes. Check online for several Asian and Latin American dental complexes that cater to American visitors. You will find that typical prices for cosmetic dental care services are around $350 to $500 for a crown, $700 to $1,000 for a full denture, and $2,000 to $3,000 for an implant.

But, again act with caution in these cases. You really don't have a legal recourse in the above countries unless you the country have strong laws to protect against negligence and malpractice.

A safer option would be to go to a university near you that has a dental program and find if they will take you as a patient. You can good quality cosmetic dental care from students and supervising professors for your teeth.

Most people these days go to chiropractors first before seeing their doctors and the reasons are obvious. Chiropractics offers practical solutions to common ailments, especially those related to neck and back pains. Of course, medical doctors will be the ultimate authority when it comes to health treatments but some people have been very comfortable with chiropractic procedures because they are quick and relaxing.

Yet even with some medical professionals actually referring their patients to chiropractors, some people remain skeptical as to the safety of this method of healing. There are those who claim that it causes strokes because of the manipulation of the neck and spinal area, a routine chiropractic procedure. However, the link has not been fully substantiated by research and those who truly understand chiropractics know that people who tend to experience strokes usually experience neck and back pains as initial signs. Hence, there is a percentage, although small, of people going into chiropractic treatment and having strokes.

Furthermore, the facts point to the conclusion that chiropractic-related injuries occur relatively less frequently than those related to medical procedures. Because of this, chiropractors pay 10-50% less malpractice rates than doctors. The number of patients getting ill from back and neck manipulation is also barely.30% of those attributed to over-the-counter painkillers and anti-inflammatory drugs. And in a span of 65 years, only 19 chiropractics-related ailments have been reported. If anything, the numbers point only to the favor of chiropractic treatment being safe and healthy. Of course, patients with sensitive conditions shouldn't undergo any chiropractic procedure unless cleared by their doctors while those who have common back and neck aches should be safe.

When it comes to effectiveness, there is no doubt what manipulation can do to relieve acute or chronic back and neck pains. Binding spinal joints can be such a hassle and loosening them with chiropractic procedures is, indeed, the answer. In fact, what chiropractors do is very similar to to what physical therapists, osteopaths and orthopedists perform on their patients. In the US alone, studies show chiropractors do 94 % of such procedures which means it is a widely accepted alternative to the medical approach. Missouri, for example, has many practitioners, from St Louis chiropractors to those in Chesterfield, Maryland Heights, Creve Coeur and in many other locations. This only adds proof to the thousands of studies that have indicated higher patient satisfaction obtained from chiropractics than any other method of treatment.

Is Having a Professional Coach a Solution to Optimizing your Practice's Performance?

"What do you do?"

The proverbial question we get asked day in and day out by strangers, acquaintances, family, and friends. We are conditioned to answer with our current job or career.

Thanks to an anticipated, planned for and welcomed career change, my new answer is some version of "I am a professional coach."

And the standard response back is, "Really, for what sport?"

"The game of life,"

I say and then the conversation either stops in its tracks, or takes off to some very interesting place.

And in the ensuing conversation, I tell them about this relatively new profession called "coaching" which most often has an adjective in front of coaching such as life, professional, executive, business or other such phrases that identify the coach's niche.

I appreciate the opportunity to have this conversation with you via this newsletter, and hope the information shared will tell what a coach is, and how enhancing your coaching skills or engaging a coach might help improve the performance of your medical practice, and might even be a solution for helping your disgruntled, irritable, difficult to get along with physician, or perhaps the "newbie" physician who is awestruck with the transition from residency.

"What is a coach?"

A coach is your champion; partner; advisor; guide; counselor; consoler; touchstone; personal listener; confidante; teacher or as one coach puts it, "the gardener of your mind." A coach helps you enhance the quality of your professional and personal lives, and reach peak performance and your ultimate potential.

So as you can surmise, coaching is a dynamic process of discovery, growth and development. Coaching creates an environment where there is freedom from judgment and from expectation, yet one of accountability and growth. In a coaching relationship, it is safe to question, appear vulnerable, observe, explore, experiment, learn and change. The process is designed to ensure lasting change and promote continuous growth.

In the hectic, demanding world of health care, professionals and leaders must find a way of staying on top of the surf, so that they are not sucked down and out by the riptide. A coach helps his client ride the wave, navigate through the rough waters, and enjoy the ride. There are so many reasons for physicians to feel disenchanted with their chosen profession, their calling. Having a coach helps them get back in touch with their passion for being a healer.

"So, a coach is like a therapist?"

Therapists typically work with people who need help becoming emotionally healthy. They deal with past issues and how to overcome them. So therapists tend to work with dysfunctional people to get them back to functional. Coaching is action oriented. It is about achieving growth through identifying and reaching goals, rather than by working through past issues. So a coach helps people go from functional to exceptional.

Another interesting distinction is that a coach is not a mentor although a coaching relationship has some characteristics of mentoring. Most often, a mentor is someone in your company who is higher up in the organizational structure, and is bestowing knowledge upon you to prepare you for greater responsibility and upward movement. In contrast, a coaching relationship is a partnership which draws on the wisdom and the knowledge of both parties. The coach does not have an agenda other than what his client wants.

"OK, I understand, but what application does it have to my business world?"

Executive coach

is the term most frequently used to refer to coaches who work with businesses, professionals or in your case, medical practices. In essence, instead of two parties, there are three---the company, the client and the coach. The leaders of the most successful companies recognize that the attraction, development, motivation and retention of highly talented people are the biggest contributors to maximizing the company's success. They see the engagement of a coach as a proactive, positive way to help an employee, most often a manager or a professional, reach certain goals, change some behaviors, or develop specific management competencies. The employee agrees to these expectations and to working with a coach; and the employer engages the coach for the employee. The confidentiality of the coaching conversation remains sacrosanct; the employer is notified only if the employee is not participating.

In the business arena, a coach is sometimes referred to as a consultant. While there are some similarities, as importantly, there are some key differences. A consultant brings expertise, and thus answers to the proposed question or challenge. Typically, he then leaves the company with a report and recommendations to implement. A coach has expertise and answers; however, he works with you to identify the answers that will work best for the company and then stays through the implementation steps to ensure the changes materialize and the results are realized.

"So an executive coach can help me improve the performance of my people and thus, my bottom line?"

Yes, executive coaching is an investment in human capital just like traditional training and education programs. In fact, coaching and training frequently go hand in hand and studies have shown that doing so improves productivity 88% versus 22% with training alone. (Public Personnel Management, Winter 1997 v26 n4 p4610) The coaching assists his client in overcoming the obstacles that otherwise would prevent him from inculcating the imparted knowledge. Humans are creatures of habit, and we all know that breaking habits and embracing new ones is a great challenge. A coach helps us get out of our own way, so that we can reach for and accomplish greater things.

"You know in my practice, our focus is on teamwork. How does an executive coach help with that?"

Actually the principles applied to coaching individuals also apply to coaching groups or teams of people. A coach can assist a team in optimizing the communication amongst the members and maximizing the synergy of the group. As a result, performance and outcomes are maximized--which is critical in today's world of declining reimbursements and increasing malpractice premiums. Especially with teams, coaching helps shorten the learning and the doing curves, so minimizing the investment of time and expenses while optimizing results.

"Gosh, I am now thinking that I would really enjoy working with a coach."

Actually, many executives/CEOs work with coaches for they are frequently the "lone man on the totem pole". Being a practice manager means you are the "lone man," with many unofficial "bosses" -that is a huge challenge to navigate alone. Some of your physicians may feel the same way. A coach gives you someone to bounce ideas off of; express concerns and fears; brainstorm ways of handling difficult issues; role play difficult conversations; etc. Using a coach actually helps reduce your stress. Of course you have colleagues and others that assist you, but the differentiating factor for a coach is that he does not have an agenda, or a "stake in the game", and thus, is all about you.

"How do I learn more or find a coach?"

The International Coaching Federation, http://www.coachfederation.org, is the recognized organization that most professional coaches belong to. The site has more information about coaching as well as a list of coaches by area. The nice thing about coaching is that the most common medium of delivery is the phone. Majority of coaches offer a free
introductory session, and are truly interested in educating others about coaching. You can also download a handbook on executive coaching at www.executivecoachingforum.com.

Janet Crawford MBA, MHA is CEO of Tiberius Enterprises, Inc. and an Executive Coach. She has a heartfelt connection to the medical profession, having worked as a healthcare administrator and practice manager in her previous life. She can be reached at 540-342-2844 or jc@tiberiusenterprises.com, and the company's website is www.tiberiusenterprises.com.

Originally published in Virginia Medical Group Management Association newsletter, Vol. 6, No.1 Winter 2005

Cellulite formation is something that people do not want to have. Aside from the fact that it makes the skin look awful, it can also cause an irreversible defacement on the surface. However, there are some helpful and natural means that supports in preventing and alleviating cellulite.

There are a lot of ways to remove cellulite from the body. It is apparently seen with natural treatments and for others, results may come from medications. Before going for the more expensive options, please take a look at some of the natural ways to combat the occurrence of cellulites.

Anti cellulite diet

Observing proper and healthy eating habits may not be an easy task for a lot of people, nevertheless, it may possibly help in the problems about cellulite. In spite of that, the knowledge of taking in a balanced meal is not enough. People must take into consideration the food that they will include in their diet.

An individual who decides to have an anti cellulite diet should be aware of the food that are known to contain substances that efficiently fights against cellulite formation. In addition to that, one should also know what food contain stuff that speed up and aid in the formation of cellulite. This simply means eating healthy foods and getting rid of the junk foods.

Cellulite creams

Another way of getting rid of cellulites is applying creams designed to counter act this problem. These creams go deep into the skin and directly act on the problem area. They flush away toxins and unwanted fat, enhance blood circulation and strengthen the connective tissues. It should be taken note however that not all of these creams really cure cellulite.

Creams with the proper combination of anti cellulite components should be carefully chosen to prevent waste in both time and money. Although, some creams may not be as effective as others, they, nonetheless, aid in lessening the unpleasant appearance of the skin due to cellulite. On the other hand, buying creams that contain unsuitable mixture of ingredients would have no support to change your body's appearance. It would be best to check upon buying if the creams include L-carnitine, green tea, vitamin A and even caffeine.

Exercise

Exercising is one effective alternative for people who have cellulite and find it costly to go through medical treatments. However, if one decides to choose exercise as a cure for cellulite, then it should be done accurately and devotedly. You just need to bear in mind that your routine should be in coordination with your schedule because if this is broken, then the effects would not be that evident.

Combating the cellulite problem could be done in more ways than one. If the above-mentioned procedures will leave you with negative results because of malpractice, you may opt to go for the surgical treatments. Consult your doctors at once before undergoing any other medication.

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Cellulite Cream Benefits And Shopping Tips -> Cellulite Cream Benefits

Throughout Southern California and especially in Beverly Hills and Los Angeles people are inundated with advertisements about plastic surgery. Some ads depict a plastic surgeon as the "Top" or "Best Plastic Surgeon in Beverly Hills or Los Angeles". Others promote "safe Liposuction" or the newest laser that can give you phenomenal esthetic results with a few zaps during your lunch hour. With all this information how should a man or a woman go about finding the right plastic surgeon? In pursue of the best plastic surgeon should they travel to Beverly Hills or should they search the internet? Should they choose a plastic surgeon based on their credentials and degrees? After all, what do these degrees and credentials really mean?

Being a plastic surgeon who has practiced for many years in Southern California and knows many other plastic surgeons in Beverly Hills and Los Angeles, I myself was frustrated when I went about finding the right plastic surgeon for myself! This is how I went about researching the best plastic surgeon for me.

First, I went to the American Society of Plastic Surgeons web site which only lists Board Certified Plastic Surgeons. The other option would be to contact the American Board of Plastic Surgery. This Board is the ONLY recognized board for training and certifying Plastic surgeons for cosmetic surgery of ALL body parts. The Board of Cosmetic surgery is not recognized Board by the American Board of Medical Specialties. Its members can purchase a certificate practically after attending few limited classed without having had a broad surgical training in plastic surgery. The Board of Facial Plastic Surgery offers a certificate to ENT or Otolaryngologist whose training is limited to only that of head and neck.

Once I found the list of all Board Certified plastic surgeons throughout Southern California, including Beverly Hills and Los Angeles, I research them via the California Medical Board to find if they have had complaints or malpractices. Has their medical license ever been restricted or held; and have their privileges to perform surgery at any hospital has been taken away. If a large group of doctors at a prominent hospital no longer allow a certain doctor to practice there, do you want him to practice on you!

Having narrowed my list of Board Certified Plastic Surgeons in Southern California, I wouldn't just choose one from Beverly Hills, Santa Monica, West Los Angeles, or Encino. After all, I am not interested in how beautiful their office looks or if their zip code say 90210. I am not interested in being on the extreme makeover or the swan TV shows. I just want the best plastic surgeon for me. In fact, I am willing to travel a bit to find the most qualified, experienced, and compassionate plastic surgeon who can understand my needs.
Next, I reviewed before and after plastic surgery pictures on their internet web site photo gallery, or at their office. Although it is good to see many before and after pictures on their web sites, some plastic surgeons don't show all their pictures on their web site, because of privacy restraints. In fact, I greatly limit the type and extent of facial pictures that I show on my web site in order to preserve my patient's privacy.

Meet the doctor, and not just his "aesthetic consultant" who speaks with a fancy accent! Does the cosmetic surgeon spend time with you and go over your questions or concerns. Does the plastic surgeon understand what you want, rather than what he wants? Is he or she able to demonstrate to you before and after pictures of other cases similar to you? Is the plastic surgeon honest with you in describing limitations, shortfalls, or even complications that he might have had on similar cases? Also, look at the support staff. Are they friendly? Are they the type of people who are going to be available to you after surgery?

Finally, don't forget that your plastic surgeon, no matter how great, can't perform your surgery in a virtual world. The credentials, skills, and experience of the anesthesiologist who is going to keep you alive during surgery is no less important than the skills of your plastic surgeon. Most patients are not aware that some centers don't even use an anesthesiologist, or don't have the basic monitoring equipments. Fancy office furniture doesn't mean that you will be also having your surgery performed at an accredited and certified Surgery Center. I personally, would not have my surgery in a surgery facility that is not accredited by AAAHC, AAAASF, or Medicare; and doesn't have a Board Certified Anesthesiologist.

Having said all this don't make your this important decision based on advertisements, TV shows, and fads. Trust our gut instinct!

Each year hospitals end up killing twice as many people than automobiles, some 90,000 deaths in the United States. It is not from malpractice, it is due to infections. Hospital infections affect over 2 million patients every year. Scientists are working to prevent these infections one of the newest innovations is silver nano-particles. Microscopic anti-microbial coated nano-particles would be used to keep the infections at bay. Tools used in surgery would be coated with these particles, along with perhaps rubber gloves. One of the companies working on this scheme is AcryMed, which makes surgical devices in Portland, Oregon.

Almost any medical device, which is used in surgery or pokes through the skin are potentially at risk to spread deadly infections. Deadly microbes can live on biofilms or thin layers of slimy biomaterial so small that they cannot be seen without a microscope. If someone is infected it could cost over $50,000 to keep them in the hospital to treat them, obviously the return on investment to sterilize and coat the surgery utensils makes sense. Silver has been used to treat infections throughout time and there are ancient writings of its use in both Greek and Roman writings.

Recently another coating technology has come onto the scene, the use of titanium dioxide, which is being used on laboratory counters, fast food restaurant stainless steel food preparation tables and on military equipment in case of chemical or biological attack. A silver based wound ointment is an obvious use for this technology as well, for military medics and first responders. These coatings are relatively easy to apply using similar hydrophobic methods used in glass coatings to prevent water spots and make them chip resistant. Think on this and all its potential applications.

Millions of people turn to chiropractors each year for alleviation of pain and other health related problems. Even though the field of chiropractic care has been around for more than a century, there are many people who have never been to a chiropractor or do not understand what a chiropractor can do for them.

Here are some answers to the most commonly asked questions on the subject:

What is chiropractic care?

The chiropractic field was founded on the idea that manipulations of the spine can cure and prevent many aches, pains, and disorders. Chiropractors find joint and vertebrae that are out of place or "subluxated" and adjust the spine so that everything is once again in its proper alignment.

Is it safe to be adjusted by a chiropractor?

The good news is that yes, it is safe to be adjusted by a chiropractor. This field has prided itself on using natural and alternative health treatments, especially those that are noninvasive and do not involve medications. It is also interesting to note that chiropractors pay only a fraction of what medical doctors pay for malpractice insurance.

Is the method of adjustment the same for all patients?

No. The doctor will typically take some x-rays of the spine to look for displaced vertebrae in the spine as well as several other possible spinal issues. Taking the results of the x-rays and the symptoms described by the patient, the doctor will tailor the treatment plan to the needs of each individual case.

There are even unique treatment plans for children. Those in the chiropractic field believe that birth can be a major cause for spinal trauma in infants, warranting a quick check. Older children can also benefit from spinal manipulations when they are complaining of a myriad of other health concerns.

Is chiropractic care safe for pregnancy?

It is generally considered safe for pregnant women. Lower back pain is a very common complaint for expectant mothers regular chiropractic care can help ease that pain and even put the body into a better position for labor. Pregnant women should get permission from their physicians before trying any new treatments or adjustments.

Can back surgery patients benefit from chiropractic care?

Yes, and in fact, regular spinal manipulations after back surgery can help avoid future back surgeries. As it is today, almost 50 percent of back surgery patients who do not undergo any other treatments will experience a repeat of former pain and symptoms in the following years, requiring more surgery. Chiropractic care can reduce this possibility and may even help people with back pain to find relief without any surgery at all.

Can chiropractic care cure all health problems?

No. Not all health conditions are directly related to the spine and its alignment, like cancer and diabetes for example. Yet chiropractic care can be surprisingly effective for so much more than just back pain.

It can reduce and cure many conditions associated with the nerve system function such as neck and back pain, headaches, stress reduction and conditions such as sciatica. If you, or your family, suffer from any of these conditions, its time you tried out this alternative medical therapy.

How we diagnose diabetes in today's world is not an easy answer. The medical literature is dominated by studies looking for cutoff points. Over 120 systolic and you've got high blood pressure. Over 30 BMI and you're obese. Over 126 fasting blood sugar and you're diabetic. Cholesterol over 75 and you're on statins (ok..so maybe it's 200, but I'm sure there are those out there who would shoot for 75 if they could...)

Study after study after study. Literally BILLIONS of dollars are spent to determine at what point a patient becomes labeled with something. And, in today's society, being labeled = being on medication.

All of this labeling is the driving factor in all of medicine and the use of pharmaceutical treatment approaches. On the flip side, it is completely irrelevant to a physician who is going to facilitate lifestyle changes in a patient to improve their health and lower his or her risk of chronic disease.

Do I need to check a blood pressure or fasting glucose to make recommendations to a patient to avoid refined carbohydrates? Of course not. I have yet to be sued for malpractice for recommending lifestyle changes to a patient. (I can see it now...a heated jury trial. My patient on the stand stating, "But he made me eat more BRUSSELS SPROUTS!!" The collective gasp of dismay from the jury ensures the demise of my case...)

But from a mainstream medical standpoint, nothing is done unless there is a named condition. They are handicapped without the studies allowing the labeling of someone at risk and the subsequent cultural acceptance to use medication at this point. The ENTIRE system pivots around this concept.

So a recent commentary in the Journal of Internal Medicine laments the problem and the pros and cons with using HbA1c as a marker to determine diabetes. Or rather, using HbA1c as the marker to label a patient and begin pharmaceutical treatment.

But where is the problem??

HbA1c is a marker known as glycosylated hemoglobin. When sugar levels go up too high in the bloodstream, a reaction called the Maillard reaction irreversibly damages protein. As in "permanently". So, when we check HbA1c in a patient's bloodstream, we are actually checking how much hemoglobin has been irreversibly damaged by elevated sugar. But all we're checking is a single protein; every other protein of the kidneys, liver, brain, heart and pancreas is likewise damaged.

T-i-s-s-u-e d-a-m-a-g-e. Tissue damage. Tissue damage.

Yup. Pretty much anyway I read it, it's a bad thing. Lower is absolutely better. I don't care whether it's 10%, 7% (this is the treatment goal in diabetes) or 5.5%. I want it lower and I'm not going to hesitate to tell a patient to exercise more and eat less refined carbs to achieve this. I'm not going to wait until the percentage passes some magical point where THIS is when I start making recommendations to patients.

Read more the commentary here http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2012.02513.x/abstract

What we call health care is a bad deal for the consumer. The name alone is a lie. It should be called "sickness care" or even "sickness facilitation " because, for those who are covered, it tricks them into placing the responsibility for their health on their doctor. This is a big mistake.

We are each individually in charge of our own health. How can the doctor be at our side all day and night to counsel us to "Put that cigarette out!" or "Don't eat that cheeseburger! Remember your high cholesterol!" By the time we are forced to go in to the clinic by some scary symptom, we are already in trouble. It is too late for health care -- now it's time for drugs and scalpels.

Depending on a doctor for information on preserving your health is like closing your barn door after your horse has escaped. It's too late for doing the easy, inexpensive course of action. Now, you're in for it!

So, forget about health care. Health care is not about health. It is all about getting you back on the factory floor or back in your cubicle, ready to work, so you can keep paying your premiums. It is about extracting as much money as the law allows by sending you in for tests, which you may or may not need. It is about selling you prescription drugs that you are instructed to take for the rest of your life -- drugs that counter the effects of your bad food choices, for example.

Doctor: "The lab tells me you haven't brought your cholesterol down with a change of diet and exercise since the last time I saw you, John. What I can do -- to get you down into a safe range for your LDL -- is give you a prescription for Lipitor."

Patient: "Sorry, Doc. I just can't give up my favorite foods -- eating's the only pleasure I have left after the wife left me. And taking walks around the block just isn't my style."

Doctor: "That's fine, John. We'll try Lipitor, then, and see how that works for you. Schedule a follow-up appointment with my staff before you leave. Call me if you have any problems."

Health care is a rip-off because:

It doesn't address the real problems that cause most of our illnesses (Namely: our diet, smoking, excessive drinking, and lack of exercise)

By the time we begin to have symptoms of some disease, it is usually too late for inexpensive intervention

Most of what ails us, we bring on ourselves -- to correct the after-effects of this is an enormous task...So health care is really not about caring for our health, it's about facilitating our bad behavior and then extracting as much money as possible from whatever source -- the patient, the employer, or the taxpayers in general

Out-of-control malpractice claims, together with the need for doctors to keep their high-tech diagnostic equipment in use, have encouraged doctors to order many unnecessary and expensive tests

When the federal government got involved is when costs skyrocketed (with the advent of Medicare in 1965)

Setting the whole complicated mess under the thumb of the insurance industry added another layer of bureaucratic expense and the need for ever-increasing profitability because these are publicly owned corporations that are expected by the stockholders to show improved profits every quarter

This distorts the quality of care and gives incentive to finding new services to sell. It's all about the bottom line, not about the health of the patient anymore.

Our health insurance system, by itself, adds 20% to the cost of the medical services provided. Other countries have better health results for 1.5-6% administration costs! We're being over-charged, plain and simple.

The pharmaceutical industry charges markups of 2000-30,000% of the ingredients in the drugs they sell. Fifty percent of their costs are not for research and development(much of which is subsidized by the taxpayers), but for their marketing expenses -- everything from fancy dinners for doctors who sell lots of their medicines, to the many two and three page ads in magazines urging patients to "Ask your doctor if Dynofab is right for you," to all-expenses-paid trips to Hawaii to educate doctors on that company's latest prescription drugs.

In the end, we all must pay for the rich system of perks and comforts of those who have been entrusted with our health. Or, we must find out for ourselves how to maintain our own health.

With the present system, the public is not clearly shown how to prevent disease, nor how to maintain optimum health for a long successful life. We are encouraged to turn this sacred task over to others, many of whom know little about how to maintain health and a great deal about ways to make a lot of money by shunting patients through a labyrinth of tests, drugs, and procedures at a substantial profit for the providers, even if the patient doesn't survive it all.

To be fair to doctors, very few of them know much about how to preserve health through intelligent nutrition. They only live to an average age of 57, while their patients live an average of 75 years, more or less. So, doctors are not experts on health -- it is more accurate to call them sales agents for drugs, diagnostic tests, and surgery.

Asking Congress to negotiate us a better deal is foolish. The wise consumer will find and implement a comprehensive program to protect their own health, so they will not find themselves begging for medical care at the end of their life. Without knowledge, the consumer has no power in the negotiation for a fair deal.

All the unsophisticated, unhealthy consumer can expect is a rip-off when they are forced to beg Congress for affordable health care. Who would like to break the news to them?

If you should befall something is tragic as a birth injury in your family then it is imperative that you know a competent birth injury lawyer. No one could ever imagine the trauma and heartache a person goes through when dealing with an issue like this, and so having information in regard to birth injury lawyers is not easy to find in many cases. It is of course a trauma that we never plan for.

You should know as someone going through this that you don't have to do it yourself. By getting in touch with a birth injury lawyer you can get much needed information to assist you in a time that you are struggling to get through. A birth injury lawyer can also be a source of support and empathy as well, but their main function is of course in helping you seek justice. A birth injury lawyer can make sure a birth injury lawsuit is done properly and with as much care as possible.

Not all birth injuries are due to incompetence and or negligence. It is hard to understand that sometimes when you are personally involved. A birth injury lawyer works with qualified medical professionals to assist it in finding out exactly what happened, how it happened, and why it happened.

If it is in fact discovered that the birth injury was caused by incompetence or negligence, the birth injury lawyer will help you to seek a fair settlement. If findings of an investigation lead to evidence that the birth injury was not caused by malpractice or negligence, at the very latest you will know exactly what took place without a shadow of the doubt and that will be worth some peace of mind.

When choosing your attorney, make sure you choose a qualified professional that specializes in the field. A lawyer that handles real estate or automobile accidents is not what you want. Your family lawyer probably will not be able to offer specific help in this matter either, but they may be of value to referring you to a qualified for injury lawyer. Referrals are your best bet if you can find one. Usually when attorneys are referred that means they're pretty dang good at what they do. Basically which you want is your very best chance for possible to mete out justice.

Few situations have a greater potential for problems as when dealing with money and relatives. If you've ever had a child ask you for a loan or a distant relative request money to start a business, then you know just how touchy these situations can be. Here are some real-life situations, along with some simple steps to help you safely navigate the tricky waters that result from mixing family and finances.

John and Sue were approached several years ago by their son, a recent medical school graduate. He wanted to purchase some land on which he and his family would eventually build a home. When it came down to working out the details, he discovered that he needed help. Scrambling to make the deal work, he pressed Mom and Dad.

They agreed by signing for the loan and titling the property in their name. Their son made the monthly payments directly to the bank. But John and Sue didn't realize the risk they were taking.

John and Sue are medical professionals and have protected their assets from lawsuits using malpractice insurance, special trusts and partnerships. From a liability standpoint, they have protected the 'front door threats' but ended up leaving the back door wide open.

John and Sue just discovered that their son is in the final phase of moving a house onto the property. Suddenly John and Sue realized that they were the ones that would be liable if one of the workers was injured or killed.

It was different for Frank and Jane. They thought it would make a good investment to buy a home near their daughter's college. She could live there while she was in school, and they could sell the house after that. The home was in their name and the loan was in both the parents' and child's name. It seemed like such a good idea at time.

Now their daughter has finished school and recently married. Guess where she and her husband are living? And guess who has yet to pay a penny in rent? Worse yet, Mom and Dad are left holding the bag. It is way past time for their chick to sprout wings and fly on her own, but there's little motivation to leave that comfortable nest.

For Sam, a successful surgeon, it's not just the kids that want a piece of his wealth. It seems like a week doesn't go by that he doesn't hear about some hot business idea from a distant relative or casual acquaintance.

There are several steps you can take to avoid these uncomfortable situations. First of all, don't let emotions force you into making bad business decisions. As much as you want to help your child, don't let short-term situations push you into long-term commitments you'll regret later.

Assuming you're comfortable offering financial help, the number one rule is to eliminate any possible confusion or uncertainty by having everything in writing. There are several inexpensive software packages available that have a myriad of legal documents that can be modified for your unique situation.

Second, consider using a go-between, such as a lawyer, CPA, or financial advisor. This person will work for your best interest and keep the emotional aspect to a minimum. And in the event that your child or relative doesn't keep their end of the bargain, the go-between can do the dirty work on your behalf.

This brings us to our third point, which is to enforce any agreements you have. It doesn't do much good to have a contract you don't actually enforce. Otherwise they won't be motivated to fulfill their obligations.

And if you're like Sam and tired of being pestered by relatives for money, a financial go-between could be the perfect solution. After a while, the word will get out that you're no push-over and your go-between can still determine any ideas that actually do have merit.

By keeping details in writing, using a go-between, and enforcing agreements, you'll help your kids learn to be responsible adults and stand up on their own. And hey, maybe someday when they've become successful, you can hit them up for a little payback of your own. "Son, have I got an opportunity for you!"

Choosing the right form for your business has a wide array of effects, including but not limited to:

• what you can treat as deductible expenses
• how you file tax returns
• whether you are legally responsible for mistakes made by someone else
• how insulated your personal assets are from business liabilities

People often do business as a sole proprietor if they are in business alone, providing something relatively straightforward, with practically no risk that anyone would ever sue. Sole proprietors include Schedule C in their personal tax returns every year, but not an entire separate tax return. It takes minimal fuss: get some business licenses, and maybe register a Doing Business As (DBA) name for the business with the state, county and/or city. On the whole, of all forms of business, this is the least hassle.

But if anyone does sue the business, or if your business gets into financial trouble, there is no boundary between you and the business. Your personal bank accounts, real estate, cars, etc. are on the line. You also cannot take in a partner to help you grow the business.

Although I am not an attorney or accountant, because of my experience I am sometimes asked for suggestions about choosing a form of business. When I asked for guidance myself, lawyers answered with a bias toward legal solidity, without enough regard for accounting and reporting complexities their choices impose. Accountants answered with a bias toward tax efficiency, without enough regard for liability or asset protection issues. To make a good decision, you need to know both angles so you can determine which business form fits best.

Faced with this question, I provide an outline of what I regard as the high points. The person who asks me still needs to consult a legal professional to make a final decision, but they have a clearer notion of what to ask their attorney.

Case Study

Recently I was asked for advice about the right business form for a doctor who believed he was a sole proprietor. Two other doctors joined his practice. Because all three share the same religion, the doctor accepted them on a handshake, with no formal agreement.

After a while, the new doctors left, set up their own practice elsewhere in the same building, and took a large number of his patients with them. To get through the resulting crunch, his wife has been handling the reception desk and other clerical duties. It occurred to the doctor and his wife that perhaps they need to handle the business side of his practice differently.

Obviously, his business form is not the only problem, but this case study is confined to that issue.

When the doctor accepted partners, he formed a general partnership without realizing it. If he shares resources with other doctors without setting up a formal business, that forms a general partnership. In this business form, each of the doctors is liable for any mistakes made by the other doctors and their personal assets are at risk. In other words, if any of the doctors terribly harmed a patient, the patient could sue all three doctors for everything they own.

A case similar to this situation is often cited as an example. A few dentists decided to share a receptionist and waiting room without making formal business arrangements. They did not realize that made them a general partnership until one of them got into trouble and the others found themselves pulled in. The same thing would apply in any similar sharing situation, such as mechanics who share a garage and set of tools without setting up a formal business. It is perilously easy to accidentally create a general partnership in the eyes of the IRS and courts, and the consequences can be financially and legally ruinous.

This doctor was lucky. Nothing terrible happened while the other doctors worked with him, and he is wisely looking at what changes he should make instead of simply going back to his previous structure.

Options On the Table

Now that the doctor is on his own again, he could work as a sole proprietor again. But considering that doctors are at high risk of getting sued, he probably should at least have either a corporation or a limited liability company (LLC) to insulate personal belongings somewhat from any lawsuits that happen in his professional life. After all, he is not the only person relying on those assets. His wife could lose everything, too, simply because he has not protected personal assets from professional risks. (For reasons outside the scope of this article, limited partnership was not under consideration in this case.)

Although giving the business a more formal structure involves extra cost and bother, there are some compensations. In addition to better asset protection, it is easier to take appropriate business deductions on tax returns when using a well suited business form. As the doctor ages, he may want to bring another doctor into the practice again, or sell it when he is ready to retire. Having a joint practice or selling his practice will be much cleaner when it is a corporation or LLC.

The main reason for choosing a corporation would be depth of legal precedent. LLCs are newer and have much less case law behind them.

If Choice is a Corporation

Personally, I thought a corporation would not be the best fit in this instance, but for some people it would be. A "subchapter C" (normal) corporation leads to double taxation on some income--the corporation pays tax on its profits, and the owner (the doctor) pays tax again on any profits that are paid out to him as dividends. For this reason, if he chose to incorporate, I suggested a "subchapter S" corporation. C-corporations can have more owners, issue more than one class of shares, hold more retained earnings, and own more kinds of assets or other businesses. Those abilities are important for large companies but are not factors for his medical practice.

After forming the corporation, he would file a form with the IRS declaring subchapter S status. When times are bad, losses would "flow through" from the S-corporation to his personal tax return, up to the amount in any one year that he uses to "capitalize" the company when he forms it. In one of my businesses, I only capitalized with $1000. When I had a bad year, that loss stretched out $1000 per year on my personal tax return as a deduction until it was used up.

When times are good, he would pay himself a salary from the corporation at a rate that is appropriate for his profession. If there is more profit in the company, that "flows through" to his personal tax return and is taxed as his income, but no payroll tax is due on it. This is a tax break he does not get when he does business as a sole proprietor.

If Choice is Limited Liability Company

LLCs are designed to combine the liability insulation of a corporation with tax treatment like a partnership. What happens to income is similar to what I described for S-corporations, but LLCs have extra advantages. For example, S-corporations cannot deduct the cost of insurance premiums for health, life and disability insurance or medical care for owners of the business. LLCs can, providing a valuable tax break.

If the doctor's wife stops working in the business and the marriage is rock solid, the LLC can also provide some asset protection. This is priceless if someone files a lawsuit against the doctor.

The way liability protection works with LLCs is not the same as with corporations. Incorporation is supposed to insulate owners from liability, but small oversights in running the corporation or small details in a situation can allow a plaintiff to "pierce the corporate veil" and put the owners' other assets at risk. When set up carefully, the LLC can protect personal assets better, with less likelihood of making a mistake that shatters the protection.

This is why I thought LLC would fit the doctor better than incorporation. He wants to stay focused on patient care. LLCs keep asset protection and tax features intact more easily.

The LLC would be set up with the doctor as the managing member. That gives him all the liability for the business. His wife would be a limited member. These roles and their liability traits are similar to limited partnerships, an older business structure of operating partners and limited partners that was not considered in this case. Limited members are not allowed to perform work in the business and have no liability for the business.

Control of the business would be entirely the doctor's. His wife would never do anything in the business. The doctor would own just a small percentage of the business, and his wife would own nearly all of it. (This is why he should only choose the LLC if he has absolute trust in his marriage.)

If somebody won a malicious lawsuit, they could only pursue the small portion that the doctor owns, because all the liability belongs to the managing member(s). The large portion owned by his wife would be untouchable because she would have zero legal liability for the business - since limited members do no work in the business, they are not liable for actions of the business.

Some people believe this is only a dodge to evade responsibility. The reason for doing it is not to deny justice to someone who has a legitimate complaint--the doctor's malpractice insurance should take care of legitimate claimants. The reason for asset protection is to guard against malicious lawsuits, which become more common in a bad economic climate, and to protect his wife from financial ruin because of something in which she had no hand.

Further Possibilities

In case you think losing it all could never happen to you, I am personally acquainted with a few former landlords who lost their entire real estate portfolios because they operated as sole proprietors. They had no asset protection. Each of them lost a lawsuit filed by a tenant about one building, and the court judgement took all their buildings. I also once lived in the same apartment building as a woman who supplemented her income by repeatedly staging slip-and-fall accidents, for which she always accepted out-of-court insurance settlements, until someone tipped off the authorities. Such people really are out there!

There are additional steps this couple can take for asset protection if they own a lot (say, $500,000 or more) of other assets outside the business. That would involve forming at least a separate limited partnership or separate LLC in the same manner as I described for the active business LLC, and transferring assets into it. Ownership and control would be divided in the same manner used for putting the doctor's medical practice into LLC form. The idea behind doing that is to protect most of the assets from lawsuits that might be filed in a personal context because someone believes the doctor is rich. For example, this would protect the doctor's home and bank accounts against the slip-and-fall con artist if she staged one of her falls at his home.

In this case study, limited partnership was stricken from the list before we began, so the case study does not compare all available business forms. We also did not consider trusts or foundations, which are appropriate for some people with high net worth. Even if you think you learned enough here to decide what business form you should use, you should still talk it over with a professional because I have only touched upon high points, not all the many pitfalls and nuances of each business form I mentioned.

In the event that you have a complex tax situation or you want to include especially strong asset protection, I suggest consulting a "tax attorney." That is the most direct way to get both the legal and financial angles dealt with neatly, and attorney-client privilege applies.

Lymphoma is a type of cancer that afflicts the body's lymphatic system. There are two main types of this disease which are referred to as Non-Hodgkin Lymphoma (which was previously called Non-Hodgkin's Lymphoma), and Hodgkin Lymphoma (which was previously called Hodgkin's disease). Generally speaking, both types of Lymphoma have symptoms that are similar in nature, which often include fatigue, a fever, itchiness that is felt all over the body, difficulty breathing, a loss of appetite, coughing, and frequent or drenching sweating episodes.

One of the symptoms that is often noted in early cases of lymphoma is a swelling of the lymph nodes that are located in the neck, armpit, and groin, that are not painful. It is important to note that these symptoms can also be due to other conditions that are far less serious in nature, so it is not uncommon for the disease to be misdiagnosed in the earliest stages. Medical health professionals need to take the proper steps to make sure a proper diagnosis is made so that they are not negligent in their ruling. This includes carefully ruling out other types of diseases, and not simply making a random assumption that the symptoms are due to something minor.

The lymphatic system is comprised of a series of ducts and tubules that are responsible for carrying a material called lymph to various parts of the body. Lymph is a milky type of fluid that is comprised of lymphocytes. The lymphocytes then combine with monocytes and granulocytes to make white blood cells, which are responsible for helping the body to repair the blood and fight off infections.

The lymph nodes are small organs that are shaped like peas and located within the lymph vessel system. The main job of the lymph nodes is to accumulate and produce lymphocytes. Lymph nodes in groupings can be found in the neck and groin areas, under the arms, in the chest, and in the abdominal area. The spleen, which is found in the upper region of the abdomen, as well as the thymus, which is found under the breastbone, and the thymus are also part of the lymphatic system. Lymphocytes are stored in the lymphoid tissue until they combine with the lymph that flows through the lymph nodes. There are two different types of lymphocytes: T cells, and B cells. Lymphoma can form in either type, however B cell lymphoma is far more common in adults, and T cell lymphoma is more common in children.

T cells and B cells have different jobs with the immune system of the body. When an infection enters the body because of a bacterium, B cells take action and begin making antibodies. These antibodies then attach to the bacterium and inform the other cells in the immune system to attack and kill the infection. T cells help to protect the body from viruses. If a virus enters the cells in the body, the body begins to produce proteins that are sent to the surface of the cells that are infected. T cells can then identify the proteins and produce cytokine which destroys the infected cells. Some cytokines can also be attracted to other types of cells, which further helps to eradicate the cells that are infected with the virus. T cells can also help to eliminate certain types of cancerous cells.

While lymphoma is usually classified as one of the type types that were discussed above, there are actually ten or more forms of lymphomas that are non-Hodgkin. These forms can be staged or categorized by how quickly they are growing or how aggressive they are spreading. The lower the grade, the slower the cancer is growing, while the higher the grade, the more aggressive the cancer.

It is during the earliest stages of this type of cancer when the highest chance for a misdiagnosis is possible. Patients who report the symptoms listed above need to be thoroughly evaluated by means of more blood testing and x-rays. The best way to diagnose the condition is to remove one of the enlarged lymph nodes and examine it in a laboratory under a microscope. Tissue samples and biopsies from other areas of the body can also be quite helpful in order to determine if the disease has spread.

This type of cancer is quite dangerous and can spread at a fairly rapid pace. It is because of this that it is extremely important that a timely and correct diagnosis is made. If a proper diagnosis is delayed for any reason, the results could be catastrophic. More aggressive treatments may be needed, extensive surgeries, and other types of chemotherapy and radiation may be required. In some cases, it may simply be too late once a proper diagnosis is made and the patient may have no chance of survival.

When a proper diagnosis of lymphoma is not made, medical personnel can and should be held accountable. This is a form of negligence and you owe to yourself, your family, as well as other patients to seek justice. The best way to go about this is to contact a personal injury attorney who specializes in medical negligence and malpractice. Because these types of cases can be complex and can be lengthy it is not a good idea to try to file a claim on your own. A personal injury attorney knows the ins and outs of this area of the law and can take proper action to ensure your case progresses properly and has the best chance of success.

Since most personal injury attorneys work on a contingency basis, you will not have to worry about paying anything up front or funding your claim as it progresses through the courts. This will allow you to focus on more important areas of your life, such as your recovery and spending precious time with your family. A personal injury attorney cannot undo the harm you have suffered but he or she can help you to get the justice you deserve so that you can rebuild your life as best as possible.

Your vision is crucial, and it is important that you find a highly qualified and experienced LASIK surgeon that will not only deliver the best possible LASIK surgery but also minimize the risk associated with this procedure. A skilled LASIK surgeon can not only affect the degree to which your vision is corrected but also give you peace of mind knowing that you have received the best and most precise surgery possible.

In general, the best way to find a qualified LASIK surgeon is to check the credentials of the proposed LASIK surgeon at the websites of the American College of Surgeons and the American Academy of Ophthalmology; At the minimum, the surgeon should be a refractive surgeon, a member AND a Fellow of the American College of Surgeons, and a member of the American Academy of Ophthalmology. The surgeon preferably should also be associated with an academic medical center, such as a university hospital or institution.

After checking for skills and a specialty in the field of refractive surgery, the next considerations that you should consider for a LASIK surgeon are experience and quality of equipment. Here is a list of questions that will help you to determine these:

1. How many years has the LASIK surgeon has been performing LASIK eye surgeries? The surgeon should have been performing LASIK eye surgeries for a minimum of three years.

2. How many surgeries has the surgeon performed? The surgeon should have performed at least 500 within the past two years.

3. How many surgeries has the surgeon performed which included the type of refractive procedures that will be used for your specific procedure? The number should be at least 100.

4. If your procedure involves higher order aberrations, will the surgeon perform a Wavefront diagnostic prior to recommending LASIK surgery itself? This is a very important test to have, and not every doctor has the equipment to perform this test. A doctor can easily refer a patient to another office for this test however, and it does not mean that he or she is otherwise not qualified to perform the procedure.

5. What percentage of the surgeon's patients achieved 20/40 vision after the LASIK procedure? The number should be 90%; anything higher should be verified with proof provided by the surgeon.

6. What percentage of the surgeon's patients achieved 20/20 vision after the LASIK procedure? The number should be around 50%, with anything exceeding 65% being verified with proof provided by the surgeon.

7. What types of LASIK technologies does the surgeon offer? It is very important to remember that a LASIK surgeon who has extensive experience with older technologies is MUCH better than an inexperienced LASIK surgeon who possesses the newest technologies; overall, the technology is much less important than the surgeon's ability to use them.

8. Has the surgeon ever been denied malpractice insurance? This answer should be no.

9. Will the surgeon perform corneal topography before and after the surgery? This answer should be yes.

10. What can I expect my vision to be like both immediately after the LASIK surgery as well as two weeks after the surgery? The surgeon's explanation should include minor vision fluctuation regression, halos, and minor starbursting at the very least.

11. What can I expect my recovery process to include? If the surgeon attempts to present LASIK surgery as a quick 20 minute process that will give you perfect vision without any complications, you should consider another surgeon.

Republicans, conservative Republicans in particular, have been notoriously resistant to the idea of universal health care coverage at least since the days of Harry Truman.

But maybe it's time for the Republican Party to take another look at universal health care. A system funded and operated at the federal level could have a number of effects:

· A federal system set up along the lines of Medicare or the Veterans Administration system could control health care costs by limiting payment for services.

· A tax-funded system could take the burden of health care costs off the backs of American businesses by funding it through deductions similar to the current social security system. With deductions divided equally between the worker and the business or paid solely by the employee, this, combined with cost-control methods, could represent a substantial savings over what businesses are paying now.

· Small businesses that cannot now offer competitive health care packages could compete with larger corporations for highly skilled employees, resulting in a tremendous opportunity for growth among these small companies.

· Money freed up from current privately funded health care programs could be used to offer raises to employees and to expand business.

· Providing access to health care to self-employed individuals could expand the pool of workers choosing to work on a freelance basis. This would result in cost savings to companies that decide to contract with freelancers rather than hire employees who expect a benefits package.

· Since all necessary medical costs will be covered routinely by the federal program for all citizens, malpractice and injury lawsuits for medical expenses could drop substantially.

Before Republicans reject proposals for universal health care, they need to examine the possible effects of a federally funded system. They might find that universal health care is both fiscally responsible and pro-business.

Media consolidation is reducing the breadth and depth of the information Americans receive about the important issues that confront us as a nation. Hard facts, in depth analysis, and first person accounts about serious matters like the Iraq War, torture, war profiteering, electronic vote tampering, health insurance cost increases, medical errors & malpractice and a host of other important issues are driven off the mainstream news by things like the ascension of a new pope or the funeral of a statesmen.

Political activists, through years of research, are often better informed than the average citizen about one or more issues, and they are often much better informed than the average reporter. The question is, how can political activists package their data in a format that most American's are willing and able to accept? The answer is by creating independent films that communicate the compelling facts.

Creating a documentary used to be something undertaken only by the media elite. Buying and developing film, using three cameras at a time, cutting and pasting film strips to create the finished product ensured that the vast majority of documentaries were created by well funded professionals. All that has changed.

A political activist needs just a few tools in order to begin creating and selling documentaries nationally.
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Here's how:

Acquire a digital video camera for $300-$600. A mini DV camera is probably best since it uses small one hour tapes that don't cost much. You can pay more for an HD (high definition) "prosumer" camera, but buy what you can afford. While you are at the video store, pick up a good clip-on microphone. You will find getting good sound key to creating a great documentary.

Acquire a new MACINTOSH computer with 500-750 GB of storage for $1500-$2400. I say this as a person who teaches people how to use PCs day in and day out. New Macintosh computers come with the software required to make films. The free iMOVIE software makes loading the images captured on your DV tapes as easy as plugging your camera into the computer and clicking capture. You can load multiple tapes, cut and paste segments, add sound & music tracks, and burn DVDs. Doing all that on a PC takes longer and costs more for the same quality. Learning to use the software and hardware on a PC takes longer too.

Set up an account for your DVD at http://www.CustomFlix.com for $50-$75. CustomFlix is a subsidiary of Amazon. After you set up an account, fill in the blanks about your DVD (including the price), upload some 300 DPI images using their templates to define the cover and face of the DVD. Ship them your DVD. In about three weeks it will be for sale. Note that you never have to spend $2000 to imprint a bunch of your DVDs as used to be the case. CustomFlix does DVD-on-Demand, which means they produce the DVDs when they are ordered. If you order your own DVDs you get them at the base production price (about $7), and the price goes down if you order many copies. If you set the retail price at $14.95 you'll make $4-$7 when someone buys one.

If you don't want to make your DVD available on Amazon, check out http://www.Mixonic.com and http://www.Lulu.com who do DVD-on-demand as well and have no setup fee at all.

Promote your DVD by telling people about it at events. You may even want to buy a bunch to sell. Let other activists purchase your DVD at a discount. Customflix makes this pretty easy. You just give them a discount code.

Reach a national audience try keyword advertising through http://www.google.com/ads. Note that I've found ads that cost $0.05-$0.25 per click-through do better than those that cost more.

Post excerpts from your DVD on http://www.Revver.com, http://www.YouTube.com and video.google.com. Its free and its a great way to get exposure for your work. Creating Google ads that point at your video on these sites is a great way to get the word out about your issue, and perhaps sell a few DVDs to people who want to know more. Just make sure your video clips show your web address.

Make sure you get releases for anyone you put on film. You can find the form anywhere on the internet. You should also ask people you interview if its OK to use them in your documentary while the camera is running. Make sure you tell them the documentary will be available on Amazon so they know it will be commercially available. Putting someone on film without having their permission is likely to get you sued.

Will you make a million dollars making documentaries?

Probably not. I know folks (www.conceptionmedia.net) who went to Fallujah just days after the US stopped bombing it and had interviews with the inhabitants returning to the ruins. Mainstream media is very unlikely to pick up your documentary no matter how good it is. Keep that in mind while making it and budget accordingly. Not everyone will enjoy Michael Moore's (Fahrenheit 9/11) or Robert Greenwald's (Iraq for Sale) success.

On the other hand, its very likely that a political activist who is actually politically active will have no problem breaking even on most their projects. Perhaps more important, a tidal wave of documentaries that address the issues people care about is the best remedy for our nation's extremely consolidated media.

The cost of health insurance has rocketed over the years. Many have cited the increased the use of health care services as a reason. As a result, any form of healthcare reform must reduce spending. Some people fear that a public option run by the government would lead to rationed care and negatively impact Americans' health. However, there are other ways to make health insurance less costly. Consumer-directed health care, often likened to high-deductible health plans, would control expenses by putting them in patients' own hands. Part of the reason healthcare is so expensive is because consumers are unaware of how much services actually cost. The North Bay Business Journal's Lary Kirchenbauer suggests that consumer-directed healthcare is a main part of the solution. Individuals and families already bargain shop to find the best deals on over-the-counter medical supplies like Tylenol and bandages, so expanding our out-of-pocket spending might be a way to fix our current system.

Unlike most other types of insurance, health insurance is expected to cover nearly all medical expenses. Patients are unsure of what their symptoms actually mean, so they believe that they're better safe than sorry and visit a doctor. Breathless news coverage of deadly illnesses and freak accidents causes paranoia in even the most logical people. Why take the risk if, under typical health insurance plans , your only out-of-pocket expense is a tiny co-payment? Also, many people assume that the doctor will set them straight. Unfortunately, some physicians have motivations other than providing quality, cost-effective healthcare. If you come in demanding a medically unnecessary examination, some doctors might acquiesce and perform the procedure; if they don't, and you later fall ill, they may be vulnerable to a malpractice lawsuit. This occurs when a patient is unaware of the true costs of health care. Accurate information, coupled with greater financial responsibility, would probably result in at least some patients forgoing unneeded treatment. Such avoidance could go too far, but in moderation would be very effective in lowering health insurance quotes.

Kirchenbauer's proposal is a free-market strategy for insuring more Americans by decreasing the cost of private insurance. Passing more of the costs onto consumers would allow them to shop around for the best doctors. A system similar to auto or homeowners' insurance--in which policy owners are responsible for the cost of routine maintenance--is what he recommends. Due to that, these types of insurance often cost less than health insurance. Consumer-directed healthcare is supposed to decrease costs without a government mandate or public option. It has greater appeal, because individuals, as opposed to a bureaucracy, would be able to make their own healthcare decisions. Although deductibles are higher than standard health insurance, premiums are lower; encouraging regular health care (think oil changes for your body). Since insurers wouldn't have to take responsibility for as much cost, affordable health insurance would become available to all.

Energy therapies and energy psychologies are blowing the doors off conventional therapies and attracting more and more attention from both the media and the public. Look for things to get rough and tough as MDs, PhDs and highly specialized practitioners attempt to preserve their turf. The healing arts are being shaken from physical therapy to psychotherapy and the shocks are causing a restructuring of healing methods and products. In the last couple of hundred years there's never been a tougher time to be a doctor or a psychiatrist, and it won't get easier any time soon. What's happening?

First and easiest to notice is that the law and controlling professional bodies are creating more peril and paperwork for health practitioners every year. By adding thousands of new laws and professional requirements every year (from every state and federal legislators), regulators and legislators impose increasingly heavy legal burdens on the practice of healing. Litigation drives the cost of practice through the roof when insurance costs (including the cost of specialists in most practices to handle insurance claims) are based on the probability of malpractice suits. The two parts to that cost are a public who feel less and less personally important to their caregivers, and more and more just "cases", without individual worth and identity. There's a huge and widening lack of trust in medical systems that are managed by accounting principles rather than by medical ones.

The second part of the "peril and paperwork" problem is the increasing willingness of people to sue their caregivers. Lots of reasons are blamed for this and probably there are many real ones, but without assessing the why of it, it's still very clear that most medical doctors and many other types of therapists have to assume they will be sued by a patient at some time in their practice. The worst part of that for the professional is not just the skyrocketing costs of insurance, but that cases are almost always won on the basis of the quality of the attorney rather than the quality of care in question. That's very hard on a professional who is trying to stand on the moral high ground in his or her practice, and it's a big part of why many MDs are choosing to just give up and seek other careers. (Yes, this is happening.)

All that is just part of the back story. The story here is energy therapies, or energy psychology, or alternative therapies, where change is occurring with breathtaking speed. Most readily credible are those therapies that are based -- at least somewhat -- on Chinese medicine and acupuncture, which claims a history of at least 2,000 (some say 8,000) years. And there are quite a few of those. Lines get a little blurred, even here, because some of these energy therapies are attuned to physical issues while others are more directed to emotional or psychological issues, and some work with both. Moreover, the escalating popularity of them is partially related to speed; they all work faster than conventional psychotherapy, including Cognitive Behavioral Therapy and its two or three offshoots.

So what are we talking about here, medicine or psychotherapy? Well, both, but not so finely distinguished as we are accustomed to.

From early in the last century, medicine has recognized that some diseases are caused by the mind (they are referred to as psychosomatic) and it has been increasingly accepted that many physical conditions could be helped by mental therapies, or by energy medicines (acupuncture, chiropractic, osteopathy, homeopathy and others). Energy therapies and energy psychologies push the envelope even further by succeeding in healing some physical conditions by addressing the underlying emotional issues. The idea is that all (or certainly most) physical dysfunction rests on an emotional structure, and that if the emotional structure is taken down (released, resolved, collapsed) then the related physical issues will just go away. Of course, they are not one hundred percent successful, but neither is conventional medicine. And cost is a huge factor, considering that end of life healthcare (is that a misnomer?) exhausts most peoples' financial resources.

It's a bit messy to work your way through all the details, and we've only touched the surface here. Nonetheless, many people are doing it and their numbers are increasing. One interesting model is Emotional Freedom Techniques (EFT) developed by Stanford Engineer Gary Craig. His website, http://emofree.com is among the most popular alternative healthcare sites on the Internet; it's full of endorsements and success stories from around the world. His advisory board includes more thatn a dozen physiciansand PhDs, some very well known. He is clearly creating a bridge between energy practices and conventional medical practice. Maybe it's the beginning of a trend; maybe he's being instrumental in creating a direction for this big change in healthcare. One thing's certain: the practices of healthcare are changing and they will never again be what they were.

Patient recall and the law present regulatory issues that are important for professionals. If you are subject to litigation, or if you are called as a witness, you may need to produce documentation of appointments and appointment recall information that are relevant to care and treatment of a patient.

Appointment data can become critical evidence when it comes to documenting diligent follow-up care and patient compliance. Take for example the case of a patient with a suspicious breast mass who fails to follow-up for scheduled appointments despite multiple email reminders, and develops metastatic cancer. Another example is a patient with glaucoma who fails to respond to requests by email to setup an appointment for eye examination and loses vision because of inadequate medical therapy. These cases are typical examples of patients who expose themselves to medical risk for failing to comply with your advise. But at the same time, these cases also exposure your practice to increased legal liability.

Having an electronic trial showing adequate patient recall can serve as important documentation that you have made good faith attempts to properly care for your patient. Several online scheduling programs have sophisticated features for organizing patient recall that are free and easy to use. Having your own electronic trail of email notifications to patients allows you to archive appointment records and rapidly retrieve appointment information when it is needed. When properly configured, records pertinent to patient appointment are at your fingertips. These records may be used to support your case in the event of a lawsuit for abandonment or failure to notify.

Proper patient appointment recall and the law demand having adequate procedures for backing up your appointment recall records and avoiding unnecessary malpractice liability. A sophisticated online appointment scheduling system can provide efficient patient recall and essential medical-legal documentation.

Health insurance company earnings were released, showing billion dollar profits by the major insurance companies. Despite these earnings, all of the insurance companies continue to increase their premiums on an annual basis. I am writing as a small business owner, health care provider, and health care consumer to describe my concerns about health insurance abuses.

As a small business owner, the annual 15% to 45% health insurance premium rate increases are unaffordable. Each year, as our employees age, we reduce benefits to afford minimal health coverage. As health consumers, our care is inferior and restricted by insurance company bureaucracy, and we have additional increased out of pocket costs. Just this past week, it was reported on how health insurers have posted billion dollar profits, at the cost of reduced care for the insured. How is this fair? It is time to remove the anti-trust exemption that protect insurance companies, and permits them to abuse the public.

As a health care provider, my income has systematically been reduced, as insurance companies increasingly dictate the care I provide, the fees I receive etc. Additionally, we have been forced to spend more time and money on hiring administrative staff to deal with insurance company errors, obfuscation, and refusal to pay for things that they must. Thus, health insurance companies increase health care costs tremendously simply through their administrative harassment of health care providers. As an example, I counted more than 200 claim errors from one insurance company in one year. This meant that over 200 hours were spent rectifying insurance company errors! Resolution of the problem only occurred after I sought assistance through Congressman Pascrell's office (for which I am immensely grateful). It is no surprise that private insurance administrative costs of 35 to 40% are way higher than those of Medicare, which are 3 to 5%. This high rate of administrative costs is unacceptable, and insurance accountability must be implemented.

In my quest to resolve the high rate of insurance company errors, I learned that insurance companies routinely employ personnel to deal with bad publicity. They employ entire departments to deal with legislators and the public. They spend unknown amounts of money on advertising and lobbying. In this time of economic distress, and with so many problems funding proper health care, what are insurance companies doing spending so much money on advertising and public relations? Who is looking into the huge burden they add to rising health care costs through all of their administrative errors, public relations gambits, advertising, etc?

In the early 1990s, I joined several health insurance panels as a participating provider. Initially, the insurers offered reasonable fees, I signed up, hoping to be part of the solution to the country's health care woes. Within two years, our fees were slashed dramatically. I maintained provider participation with a few panels whose rates were acceptable. Although I dropped out of the lower paying plans (whose compensation would have left me with an income that is similar to the starting salary of a teacher), it was amazing how my name remained in their list of participating providers (a phenomenon known as the "phantom panel"). In all of these years, the fee has never been raised in the few panels in which I remained. In contrast, my medical health insurance rates have risen dramatically, as have my rents, taxes, utilities, malpractice insurance, etc.

There is something wrong in a society when the healers, who require great educational training, are paid at far lower rates than those that deny health care, as is the case with the insurance company executives. Their compensation packages are in the millions of dollars each year, while the health care providers struggle to maintain a middle class standard of living. Health insurance companies contribute to the spiraling, out of control health care crisis.

In my opinion, any successful health care reform must include:

1. Limits on the compensation of insurance executives (in the same way that incomes of all medical health providers have been reduced).

2. Financial limits on insurance company expenditures on lobbying, advertising and public relations efforts. Those funds need to be re-directed towards actual health care.

3. Insurance companies exemption from anti-trust regulations must be eliminated.

4. Insurance company accountability and reduction of their claims processing errors and administrative costs must be reduced so that they fall in line with that of Medicare (3 to 5%). Stringent penalties need to be assessed upon insurance companies that fail to follow this ruling.

If you are in need of a break from your medical practice, then consider different hospitalist jobs around the country. These would be ideal if a sabbatical is needed from your current work or if you are in between positions. Generally, the need for a locum tenens physician is for a limited time. It can range from a month to six months. Others may need a hospitalist for a year. This is one reason why many doctors like these positions.

The nice thing about hospitalist jobs is you can look for one that fits your needs. Maybe there is an area you would like to visit, but wouldn't mind combining work with pleasure. These positions have a lot of flexibility, even though each hospital has slightly different requirements. Some places have you work five days in a row, while others require seven days. Whatever you are scheduled, time off is usually multiple days in a row. Most give seven days off. This makes a position ideal for a variety of reasons.

Most hospitals require board certifications or doctors who are eligible for IM or have FP experience. Depending on the hospital, it will be necessary to know electronic medical records. Other requirements are having advanced cardiac life support training.

The nice thing about these positions is compensation is very competitive. While base pay may not increase very fast, there is usually extra incentives. Plus, everything is arranged and taken care of in regards to travel, housing, and transportation. Doctors are covered under malpractice insurance and licensures are paid for in the state the position is located.

Hospitalist jobs aren't for everyone. Some prefer to stay in one place for a significant amount of time. However, if you enjoy traveling, variety, and are willing to be flexible, these positions are ideal.

There are many Electronic Health Record (EHR) solutions available on the market today. Some are built and priced for large group practices, and others are more modest. All of the viable EHR offerings must comply with standards that the government has set for "certified" EHRs that meet meaningful use criteria and offer the capability to produce required quality measures reports.

At its core, an EHR is used to document information collected during a patient visit and make that information available for future visits. How a visit is documented becomes important because the EHR also will "code" the visit for billing automatically. The EHR process of coding takes a detailed look at what was documented and applies optimized billing codes, thereby generally improving the amount billed for services.

The HITECH section of ARRA provides new incentives for your practice to implement an electronic health record (EHR). Formed in 2000, the Leapfrog Group has for years been advocating improvements in patient safety for acute care through the use of Computerized Provider Order Entry (CPOE), Evidence-based hospital referrals, and NQF Safe Practices. In recent years, Leapfrog's focus has expanded to include safety in ambulatory practice as well through advocacy of EHRs, electronic prescription checking, and disease and wellness management programs. So, you've been considering an EHR. Or perhaps you haven't. This is why you should:

ARRA: ARRA provides up to $44K in incentive payments to a physician to implement and meaningfully use an EHR

Improve Reimbursement: Having an EHR usually drives billable care up because most physicians tend to under-code visits

Improve Patient Care and service: With an EHR, you have the capability to participate in pay for performance programs and maintain useful knowledge about your patient populations. An EHR facilitates electronic review of patient's medical history in a single, easy-to-find location. Lost charts can also be eliminated as well as pulling charts for patient calls, visits, diagnostics or prescription/refill requests. An EHR can provide automated notification of required tests, exams, or follow-ups for patient care. It can also free up more time for your staff to do outreach to specific groups of patients, i.e. diabetics. An EHR can potentially reduce medical errors while improving your office's communication with other physicians. You can have access from home to the chart when the ER calls you at 2am. Lab results can be automatically be added to the chart through the use of interfaces. Critical or alert values can automatically be flagged and brought to your immediate attention.

Cost Savings: An EHR facilitates self-service patient portals, thereby reducing front and back office costs. An EHR can also eliminate the costs of filing charts, and chart transcription. An EHR facilitates more space in the office as paper chart filing areas are reduced and provides the potential for improved supporting documentation in the event of malpractice claims.

In the end, it's more a question of when you'll implement an EHR rather than if. Even if the ARRA incentives are not enough to sway you, you have to ask yourself whether you'll be able to deliver the same quality of care and service as other practices that have an EHR?

According to a recent news article, Big Pharma spends almost double the amount on advertising as on research and development. Of the $235.4 billion domestic sales income in 2004, 24.4% went to promotion, and a mere 13.4% went to research and development. Nevertheless, they keep coming up with more drugs - many of which require drug detox and, in some cases even drug rehab, to quit.

How do they manage to keep new drugs coming at us like bullets from a machine gun while keeping R & D costs down? Truth be told, they usually just make minor alterations - not even improvements - in the old ones.

But why would they want to do that? It seems like such a waste of money.

According to Marcia Angell, former New England Journal of Medicine Editor-in-Chief, now Senior Lecturer in the Department of Social Medicine at Harvard Medical School, and author of The Truth About the Drug Companies: How They Deceive Us and What to Do About It, "The great majority of "new" drugs are not new at all but merely variations of older drugs already on the market. These are called "me-too" drugs. The idea is to grab a share of an established, lucrative market by producing something very similar to a top-selling drug. For instance, we now have six statins (Mevacor, Lipitor, Zocor, Pravachol, Lescol, and the newest, Crestor) on the market to lower cholesterol, all variants of the first."

Statins - drugs commonly used to control cholesterol - aren't among the list of drugs that require drug detox, but many other types of drugs are. Painkillers like OxyContin, morphine and methadone, for example, often require a medical drug detox for withdrawal. The same is true for many of the 176 different antidepressants, antipsychotics and antianxiety medications.

Dr. Angell also quotes Dr. Sharon Levine, associate executive director of the Kaiser Permanente Medical Group: "If I'm a manufacturer and I can change one molecule and get another twenty years of patent rights, and convince physicians to prescribe and consumers to demand the next form of Prilosec, or weekly Prozac instead of daily Prozac, just as my patent expires, then why would I be spending money on a lot less certain endeavor, which is looking for brand-new drugs?"

Why, indeed? Perhaps Big Pharma is trying to keep the R & D costs down so the companies can afford to pay settlements to the families of those who have died taking their drugs. Or perhaps they're using it to re-pay the Federal or State governments for the money spent taking care of people who landed in hospital emergency wards, morgues or in drug detox or drug rehab centers when they overdosed, became addicted, or dependent.

No doubt the ethics of Big Pharma as a whole is in question. And the American public is paying for it: Millions of ruined lives, exorbitant health care costs, well-intentioned doctors actually going out of business because of the high cost of malpractice insurance.

Drugs are ruining our lives, our health, and our health care system. To really handle the problem, we have to stop taking unnecessary drugs. We have to get those who are taking drugs that may be addictive or cause dependency into a drug detox program that can help them get off them, we need to educate others on their dangers, and find other solutions.