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"Heart Disease is the leading cause of hospitalization and death among mid-life and older women in the United States.  More than one in five women has some form of heart or blood vessel disease and the chance of a woman having heart disease increases with age. One in every three women will die of coronary heart disease or heart attack, and the death rate is about 35% higher for African-American women.  Many women believe cancer is the number one killer of females but, according to the American Heart Association, nearly twice as many women in the U.S. die of cardiovascular disease as from all forms of cancer."

Betty Soldz's Heart Disease: Little Reported and Diagnosed Late

Concierge Care Characteristics and Considerations for Medicare

Concierge care is practiced by a small number of physicians located mainly on the East and West Coasts. Nearly all of the 112 concierge physicians responding to GAO’s survey reported practicing primary care. Annual patient membership fees ranged from $60 to $15,000 a year, with about half of respondents reporting fees of $1,500 to $1,999. The most often reported features included same- or next-day appointments for nonurgent care, 24- hour telephone access, and periodic preventive care examinations. About three-fourths of respondents reported billing patient health insurance for covered services and, among those, almost all reported billing Medicare for covered services.

Two principal aspects of concierge care are of interest to the Medicare program and its beneficiaries: compliance with Medicare requirements and its effect on beneficiary access to physician services. HHS has determined that concierge care arrangements are allowed as long as they do not violate any Medicare requirements; for example, the membership fee must not result in additional charges for items or services that Medicare already reimburses. Some concierge physicians reported to GAO that they would like more HHS guidance. The small number of concierge physicians makes it unlikely that the approach has contributed to widespread access problems.

GAO’s review of available information on beneficiaries’ overall access to physician services suggests that concierge care does not present a systemic access problem among Medicare beneficiaries at this time. In comments on a draft version of this report, HHS agreed with GAO’s finding on concierge care’s impact on beneficiary access to physician services and indicated it will continue to follow developments in this area.

Read the entire report, Physician Services: Concierge Care Characteristics and Considerations for Medicare

Three Reports

The medical field of treating chronic pain is still in its infancy. It was only in the late 1980s that leading physicians trained in treating the chronic pain of terminally ill cancer patients began to recommend that the “opioid therapy” (treatment involving narcotics related to opium) used on their patients also be used for patients suffering from nonterminal conditions. The new therapies proved successful, and prescription pain medications saw a huge leap in sales throughout the 1990s. But opioid therapy has always been controversial. The habit-forming nature of some prescription pain medications made many physicians, medical boards, and law enforcement officials wary of their use in treating acute pain in nonterminal patients. Consequently, many physicians and pain specialists have shied away from opioid treatment, causing millions of Americans to suffer from chronic pain even as therapies were available to treat it.

The problem was exacerbated when the media began reporting that the popular narcotic pain medication OxyContin was finding its way to the black market for illicit drugs, resulting in an outbreak of related crime, overdoses, and deaths. Though many of those reports proved to be exaggerated or unfounded, critics in Congress and the Department of Justice scolded the US Drug Enforcement Administration for the alleged pervasiveness of OxyContin abuse.

The DEA responded with an aggressive plan to eradicate the illegal use or “diversion” of OxyContin. The plan uses familiar law enforcement methods from the War on Drugs, such as aggressive undercover investigation, asset forfeiture, and informers. The DEA’s painkiller campaign has cast a chill over the doctor-patient candor necessary for successful treatment. It has resulted in the pursuit and prosecution of well meaning doctors. It has also scared many doctors out of pain management altogether, and likely persuaded others not to enter it, thus worsening the already widespread problem of undertreated or untreated chronic pain.

The executive summary of Treating Doctors as Drug Dealers; The DEA’s War on Prescription Painkillers by Ronald T. Libby at the CATO Institute

The National Women's Health Resource Center has presented a report, Pain and Women's Health:

When she thinks back on it, Janine Willis figures the nightmare began 20 years ago, when she injured her neck in a relatively minor car accident. But an operation in 1992 seemed to resolve the problem, giving her five fantastic years. Then, in 1997, she re-injured herself pruning an apple tree in her backyard. And the downward spiral began.

For the next eight years, Ms. Willis, now 43, of Castro Valley, CA, visited dozens of health care professionals and underwent numerous treatments. She lost valuable years in her young children’s lives and placed her marriage on autopilot as she moved through her days in a fog of pain.

Through it all, too exhausted from the pain and pills to even get out of bed some days, she still had to convince people that her pain was real. Despite the pills, the shots and the physical therapy, despite the fact that doctors couldn’t find anything wrong with her neck anymore, she hurt. Really hurt.

She’s not alone. A 2005 nationwide survey sponsored by Stanford University Medical Center, ABC News and USA Today found that more than half of all Americans have either on-again, off-again pain or daily chronic pain, with about four in 10 saying their pain interfered with work, mood, day-to-day activities, sleep and their overall enjoyment of life.

Read the report, Pain and Women's Health, at the National Women's Health Resource Center

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• Center for Science in The Public Interest - A lobbying group that is a "nonprofit education and advocacy organization that focuses on improving the safety and nutritional quality of our food supply and on reducing the carnage caused by alcoholic beverages; it represents citizens' interests before legislative, regulatory, and judicial bodies."

• Centerwatch - International listing of industry-sponsored clinical trials that are actively recruiting patients .... searchable by therapeutic area and geographic region. A section focusses on clinical research studies conducted by the National Institutes of Health, the National Cancer Institute's PDQ database and the Warren Grant Magnuson Clinical Center in Bethesda, Maryland. The site also includes profiles of the research centers themselves as well as the industries providing trials.

• Dartmouth Atlas of Health Care - "The major goal of research at CECS (Center for Evaluative Clinical Science) is the accurate description of the health care "system" in the United Sates, and the pursuit of answers to such questions as, What do variations in resources and utilization mean? Is more health care always better? What opportunities exist to reallocate excess capacity to other uses - to fund a Medicare pharmacy benefit, for example?" To quote: There are substantial differences in the amount of money spent on Medicare enrollees, depending on where they live...There is overwhelming evidence that the "system" of care in the United States is not a system at all, but a largely unplanned and irrational sprawl of resources."
  

• disAbility.gov - A one-stop portal to access federal government services, programs and information relating to disabilities. Resources are organized into categories including Recreation and Travel, Tax Credits and Deductions, Housing and Transportation, and Choice and Self Determination. Do be aware that you'll probably have to increase the point size in order to read this site!

• Scorecard (Environmental-Pollutants, Toxins) - Culled from government databases, the Environmental Defense Fund provides information on air pollutants. Enter your ZIP code and find about local polluters, which chemicals are emitted and the associated threat to your health. There have been, as expected, critics of the site: manufacturers reply that just because a company emits a high concentration of chemicals doesn't necessarily mean local residents are actually exposed to those levels.

• European Scientific Cooperative on Phytomedicine - Although this site (once you have an identifier and password) will give you access to adverse reactions to herbal remedies, they actually do lobby to promote the use of those same remedies that they assess, while promoting research in the field. There is a multi-lingual translating facility on the site.

• Federal Drug Administration: - The ultimate government food and drug site: particularly well-designed and easily searchable site depending on your concern: public health advisories, drug evaluation and research, new approvals, food labeling and nutrition, dietary supplements, warnings and alerts etc.

• FDA Oncology Tools - This web page can be searched by specific types of cancer and by approved drug therapies. Users can directly access such documents as cancer drug labeling, approval summaries, and advisory committee transcripts. Links to the divisions responsible for review of oncology products are on the site, too, such as the Center for Drug Evaluation and Research, Biologics Evaluation and Research, and Devices and Radiological Health, etc.

• FDA Women's Health - Press releases, talk papers, guidance documents and specialized areas such as diet and nutrition, cosmetics, contraception, pregnancy and motherhood, prevention and treating disease, links to other organizations and publications such as Mammography Matters.

• The Food and Nutrition Information Center - You can access all of FNIC's resource lists and databases, as well as many other food and nutrition related links from this award winning site. There is dietary supplement and herbal information and an index of poisonous plants, cholesterol lowering supplements, a council against health fraud and a Mayo Clinic article (Blurbs on herbs: The potentially beneficial and the toxic ). Other aspects are food composition data, trans-fatty and sugar content, facts about fast food and reports and studies.

• Foundation for Osteoporosis Research and Education -The foundation offers Osteoporosis information services, community education lectures, medical professional education lectures, bone mineral density testing (Dual Energy X-ray Absorptiometry) and Clinical research studies. The bone density testing programs are available in California, in the East and the South.

• Gastroenterology and Hepatology Portal (Johns Hopkins) - Patients and physicians with questions about digestive diseases can turn to this site for answers. A high graphic site that describes diseases of the intestine, liver and stomach in an easy-to-understand presentation. There are illustrations and x-ray and endoscopic pictures pictures of disease processes. Information about causes, preventions, diagnosis, treatment and complications are provided. An online forum allows expert opinions with a chat room. Funding comes from pharmaceutical companies.

• Gay and Lesbian Health Association - It's not necessary to join the association in order to find helpful links to other organizations and health care sites.

• Gene Cards - The Ezer Weizmann Institute of Science Genome and Bioinformatics has provided this website; we've linked to the explanation page to begin with, as genetics and the decoding of DNA are not the most accessible nor easily understood information on the Web. Their statement: The GeneCards Encyclopedia integrates a subset of the information stored in major data sources dealing with human genes and their products (with a major focus on medical aspects). To facilitate access to this type of biomedical information, we continuously extract only those data that may be especially helpful for efficient navigation (e.g., have a look into the GeneCard for BRCA1, the famous breast cancer gene).

• Geriatric Care/WebMD - These resources are scattered around the site but one article is the printed transcript of a session about Geriatric Care Managers and what to look for. There is an article on Communicating With your Doctor here but also consult Betty Soldz's article entitled Communicating With Your Doctor.

• Go Ask Alice! - The best of what a major university (Columbia) can offer in the way of well written information in the medical and fitness field for the lay person. Where else would you find an inquiring letter, "WhatD'Ya Thinko About Gingko?"

• Government Health Publications Online - Even though you can send for some publications (some have minimal charges), a goodly number are on-line to be read: Unproven Medical Treatments Lure Elderly, Medications for Older Adults, FDA Tips for Taking Medicines, Urinary Tract Infections in Adults, Questions to Ask Your Pharmacist, Varicose Vein Treatments, What to Do When a Friend is Depressed, So You Have High Blood Cholesterol, Laser Eye Surgery - Is It Worth Looking Into?, Hepatitis C., Anxiety Disorders, Walking for Exercise and Pleasure, Setting Goals for Weight Loss, Dieter's Brews Make Tea Time a Dangerous Affair, Homeopathy: Real Medicine or Empty Promises?, Making your Medications Work Better.

• Dr. Greene's Housecalls - Reportedly the first pediatric site and hosted by a board-certified pediatrician who takes calls via e-mail. But conditions can be researched on the site before an e-mail might be necessary. There's also a pediatric encyclopedia on the site and finally a forum to share concerns over.

• Harvard Medical School Web Weekly - Articles of the month and excerpts to the special reports.

• Hazelden Foundation (and Bookstore) - The well-known Minnesota-based center for addiction and substance abuse recovery programs.

• HealthAllies - Now that you've been diagnosed, treated and, in some cases, been operated upon, the bill. This site provide something called WebBillCheck, a free service that evaluates the bill, checks it for errors and negotiates a better price if you were overcharged. By using their database can locate the lowest rates for a procedure in your area for that portion of the bill not covered by your provider or elective surgeries.

• Health Canada - The federal department responsible for helping Canadians maintain and improve their health. The French and English site contains a map that relates to the Provincial and territorial governments responsible for the delivery of health care and hospital services. The home page contains a subject index (including women's health) and searching can be accomplished by a searching facility and an a-z index. An 'express lane' takes you to issues which are forefront in the news or information and agencies you might need for planning or in an emergency.

• Health on the Net - In 1995, participants attending a conference on the use of the Internet and the web used for healthcare information passed a resolution to create HON, now also known as Medhunt, a source of web-based medical information, using a search-engine technique.The site states: any medical/health advice provided and hosted on the site will only be given by medically/health trained and qualified professionals unless a clear statement is made that a piece of advice offered is from a non-medically/health qualified individual or organization. French and English.

• Healthcare Utilization Project - A tool for identifying, tracking, analyzing, and comparing statistics (1996) on hospitals at the national level ranked by highest length of stay, total charges or death rates. You can choose outcomes or measures that would be of interest: these can be length of stay (mean or median), total charges (mean or median), in-hospital deaths, and discharge status.

• HealthLink Plus - The Public Library of Charlotte & Meckenburg County, N.C. has put together a site with eight main sections of annotated links to current and authoritative health sites: General Health, Providers, Insurance, Research, Staying Healthy, Mental Health, Complementary & Alternative Medicine and Evaluating Health Information on the Internet. The site is still being added to and in fact, you may suggest a site.

• HighWire Press - A Stanford University publishing house will provide some access to number of the science, technology, and medicine journals it now hosts. Online access to the full text of more than 137,000 articles on the site with three entirely free journals, 51 journals offering free back issues and 32 offering free trial access." Each journal varies as to availability of back issues and length of the free trial period.

• Indian Health Services - Part of the Health and Human Services Agency, this service is responsible for providing federal health services to American Indians and Alaska Natives. Some of the programs offered are: school based, preventive, emergency, environmental, mental health, nutrition, diabetes, alcohol and substance abuse and dental.

• Johns Hopkins Medical Institutions: - One of the most respected of all U.S. medical institutions with a comprehensive range of information and links.

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