A Harris interactive poll found that 42 percent of adults maintained some sort of personal or family records. But, only 13 % did so electronically.
The biggest concerns are privacy and accuracy and these issues are deterring adoption.
http://www.KeepSeniorsHealthy.com and http://www.PassportMD.com are two sites that we have created for FREE service so that people will begin to adopt personal health records. We emphasize security and protection. We do not ask for social security numbers and adhere to the strict guidelines of the BBB privacy Seal.
Other companies that offer similar services are http://www.medicalert.com and http://www.capmed.com .
Here is a list of findings from the Harris Interactive Poll..
Of the people that keep a record of their health:
68 % keep it in a drawer
15 % in a formal health record book
13 % in an electronic health record
the biggest concerns by patients' regarding personal health records are:
Privacy 68%
Security 66%
Errors in records 37%
Wont be accessible in times of emergency 37%
Cant keep it up to date 33 %
Info from doctors wont be accurate 29%
Inability to transfer records 26%
Inability to understand items 20%
other 5%
Other blogs that contain some great health information are:
http://www.thehealthcareblog.com/
http://blog.thirdage.com/?p=613
http://www.highlandpdx.com/blog/?cat=12
http://blog.lib.umn.edu/schwitz/healthnews/2005_02.html
Wednesday, November 08, 2006
what does it mean that my doctor doesnt have Electronic Medical Records? Is he behind the curve?
Most doctors do not have electronic medical records , called or referred to as EMR's. However, the trend is changing and doctors really should go electronic. It simply is better medicine. Today, only 15 % of doctors have EMR's in place. This is a very low number and represents a low adoption rate. I incorporated an EMR into my practice several years ago, and it has improved efficiencies and allowed all of our doctors to practice better medicine.
Doctors are reluctant to "go electronic" given the cost burdens and technology obstacles , so until this minimizes , adoption will be slow. However, it is a better way to practice medicine , it is better for the physician and better for the patient. Eventually all practices will go electronic, but this may still be a decade away. Doctors should be financially incentivized to adopt EMR's to minimize the barrier to adoption.
According to a recent article in http://www.healthleadersmedia.com there are several myths that doctors need to "debunk" before adopting EMR's.
1. All EMR's are alike. This simply is not true. Some systems are more template oriented, http://www.medinotes.com and some are more elegant document management solutions, so called hybrid systems, such as http://www.srssoft.com/ . Others are more comprehensive such as NextGen. A issue to consider is data compatibility and the recent EMR certification commission for Healthcare Information Technology. Certification should only figure in on a small level ..as there are many great companies, like medinotes and SRS that have not yet received the certification. Certification to many companies may be cost prohibitive so physicians should not let this totally sway them.
2. EMR's are a fad. Emr's are not going away so physicians will eventually need to come to grips with this.
3. The technology is the hard part. Actually the hard part is adapting work flows to the technology, rather than the technology itself. Bigger groups can retain a dedicated technology position to maintain their systems, this will need to be outsourced for smaller groups.
4. The software is the expensive part. This is not true. The big cost are maintanence, licenses, technology support and hardware.
5. Computers interfere with patient relationships. This is not true either my patients really appreciate that my practice has computers in each room. They embrace this rather than object to it. There is a sense of comfort for the patient knowing that their physician has taken the time and effort to continue to advance their medical practice.
Doctors are reluctant to "go electronic" given the cost burdens and technology obstacles , so until this minimizes , adoption will be slow. However, it is a better way to practice medicine , it is better for the physician and better for the patient. Eventually all practices will go electronic, but this may still be a decade away. Doctors should be financially incentivized to adopt EMR's to minimize the barrier to adoption.
According to a recent article in http://www.healthleadersmedia.com there are several myths that doctors need to "debunk" before adopting EMR's.
1. All EMR's are alike. This simply is not true. Some systems are more template oriented, http://www.medinotes.com and some are more elegant document management solutions, so called hybrid systems, such as http://www.srssoft.com/ . Others are more comprehensive such as NextGen. A issue to consider is data compatibility and the recent EMR certification commission for Healthcare Information Technology. Certification should only figure in on a small level ..as there are many great companies, like medinotes and SRS that have not yet received the certification. Certification to many companies may be cost prohibitive so physicians should not let this totally sway them.
2. EMR's are a fad. Emr's are not going away so physicians will eventually need to come to grips with this.
3. The technology is the hard part. Actually the hard part is adapting work flows to the technology, rather than the technology itself. Bigger groups can retain a dedicated technology position to maintain their systems, this will need to be outsourced for smaller groups.
4. The software is the expensive part. This is not true. The big cost are maintanence, licenses, technology support and hardware.
5. Computers interfere with patient relationships. This is not true either my patients really appreciate that my practice has computers in each room. They embrace this rather than object to it. There is a sense of comfort for the patient knowing that their physician has taken the time and effort to continue to advance their medical practice.
Tuesday, November 07, 2006
Would you want to speak to your doctor via email?
Would you rather get an email from your doctor or a phone call?
It might not matter what you want , currently doctors are slow to adopt email as a form of communication with patients.
For instance, in 2000-2001, 1 in 5 doctors were using email with their patients, today 6 years later that has only moved to 1 in 4 doctors.
There may be many reasons for this slow adoption
1. lack of reimbursement for their time to write or consult via email. (although docs really dont get anything for speaking with patients by phone).
2. Liability. I think a big hurdle is docs concern over putting what they think or advise in an email that, if incorrect advice, may come back to haunt them over a malpractice allegation. This is, in my opinion, the single biggest hurdle.
3. Difficulty with rendering a true opinion via email. Another reason may be that it is difficult for a doc to render an opinion without seeing or actually "hearing" their patient explain their problems. Email , currently, may be inadequate to provide enough of a picture for the doc to feel comfortable rendering advice or an opinion.
what are your thoughts ? Are you ready for an email consultation
It might not matter what you want , currently doctors are slow to adopt email as a form of communication with patients.
For instance, in 2000-2001, 1 in 5 doctors were using email with their patients, today 6 years later that has only moved to 1 in 4 doctors.
There may be many reasons for this slow adoption
1. lack of reimbursement for their time to write or consult via email. (although docs really dont get anything for speaking with patients by phone).
2. Liability. I think a big hurdle is docs concern over putting what they think or advise in an email that, if incorrect advice, may come back to haunt them over a malpractice allegation. This is, in my opinion, the single biggest hurdle.
3. Difficulty with rendering a true opinion via email. Another reason may be that it is difficult for a doc to render an opinion without seeing or actually "hearing" their patient explain their problems. Email , currently, may be inadequate to provide enough of a picture for the doc to feel comfortable rendering advice or an opinion.
what are your thoughts ? Are you ready for an email consultation
Are you really ready to retire? You may need more than you think
If you think you are ready to retire, make sure you have done the math...
According to a recent article in Medical Economics, there are many "risks" or "factors" that need to be considered carefully...
here is a list of them to double check:
1. Inflation. Inflation is at 3.8% but could go up to 5%. So, for example, if you plan to retire 10 years from now, $2 million dollars would only be worth 1.35 million or better said, the lifestyle that you have anticipated costing $120,000 would really cost $177, 000.
2. Taxes. The $120,000 you are planning to withdraw annually from tax deferred account will resul in $23,000 tax bill in todays tax scenario.
3. Timing. This is potentially the most devastating. If your retirement in in funds and stocks and the market drops when you retire, then your nest egg will drop too, for instances if the market loses 20% of it's value, your $2 million will drop to $1.6 million.
Here are some sites you can visit for more info:
http://personal.fidelity.com/retirement/retirement_frame.shtml.cvsr
http://www.aarp.org
3. Timing.
According to a recent article in Medical Economics, there are many "risks" or "factors" that need to be considered carefully...
here is a list of them to double check:
1. Inflation. Inflation is at 3.8% but could go up to 5%. So, for example, if you plan to retire 10 years from now, $2 million dollars would only be worth 1.35 million or better said, the lifestyle that you have anticipated costing $120,000 would really cost $177, 000.
2. Taxes. The $120,000 you are planning to withdraw annually from tax deferred account will resul in $23,000 tax bill in todays tax scenario.
3. Timing. This is potentially the most devastating. If your retirement in in funds and stocks and the market drops when you retire, then your nest egg will drop too, for instances if the market loses 20% of it's value, your $2 million will drop to $1.6 million.
Here are some sites you can visit for more info:
http://personal.fidelity.com/retirement/retirement_frame.shtml.cvsr
http://www.aarp.org
3. Timing.
Seniors be weary of "Free" Advice for placement in Assisted Living Centers
Children of aging parents often live a distance from their parents. As a result, either the children or the parents come to rely upon "Placement Services" as it relates to assisted living centers.
These placement services often receive a fee for each new resident that they recruit to a particular living facility. Thus, they are biased.
You can get objective and detailed guidance from the Assisted Living Federation of America http://www.alfa.org or the Nation Center for Assisted Living http://www.ncal.org
If you really need more help, think about hiring a geriatric care manager such as a nurse, social roker, or counselor. They may be expensive but worth it.
Geriatric Care Managers can be searched at http://www.caremanager.org
Other blogs that contain some great health info are:
http://blog.hcfama.org/?p=65
http://www.tabinc.org/blog/archives/2004/11/index.html
http://www.thehealthcareblog.com/the_health_care_blog/2006/09/the_choice_a_lo.html
http://www.thehealthcareblog.com/
http://blog.thirdage.com/?p=613
These placement services often receive a fee for each new resident that they recruit to a particular living facility. Thus, they are biased.
You can get objective and detailed guidance from the Assisted Living Federation of America http://www.alfa.org or the Nation Center for Assisted Living http://www.ncal.org
If you really need more help, think about hiring a geriatric care manager such as a nurse, social roker, or counselor. They may be expensive but worth it.
Geriatric Care Managers can be searched at http://www.caremanager.org
Other blogs that contain some great health info are:
http://blog.hcfama.org/?p=65
http://www.tabinc.org/blog/archives/2004/11/index.html
http://www.thehealthcareblog.com/the_health_care_blog/2006/09/the_choice_a_lo.html
http://www.thehealthcareblog.com/
http://blog.thirdage.com/?p=613
Lung Cancer, A Killer that doesnt give early warning
Lung cancer is a problem. Currently with a cure rate of less than 20% , we need to find early markers of the cancer. This is critical and continues to be a problem.
According to the http://www.cancer.org/docroot/home/index.asp American Cancer Society here are some fast facts about lung cancer:
1. New cases - 174,470 each year
2. Deaths in US 162, 460
3.Men: 92,700 New cases, 90,330 deaths
4. Women 81,770 new cases, 72,130 deaths
5. 44.5 million American Adults smoke
go to : http://www.lungcancer.org/ to learn more about Lung Cancer.
What is on the horizon? According to Dr. Mark Block, a thoracic surgeon in Hollywood Florida, more advances are being made. In a recent article in Florida Trend Magazine, he cites the following promising advances:
1. Chantix http://www.chantix.com/ a new drug designed to help smokers quit cigarettes by blocking nicotines effects. The FDA fast tracked this drug's approval.
2. Vidao assisted thoracic surgery- minimally invasive surgery that allows docs to view inside of chest through small incisions, ideal for biopsies.
3. Endoscopic ultrasound guided fine needle aspiration- helps sample lymph nodes
4. Lung volume reduction surgery- helps patients that were previously unable to have lung cancer surgery due to diseased lungs with poor lung function.
5. CT scans- great screening test for lung cancer
6. New drugs such as Tarceva http://www.tarceva.com/tarceva/patient/index.jsp?hl=en&lr=&q=tarceva
if you have any other comments on lung cancer please post them here...
According to the http://www.cancer.org/docroot/home/index.asp American Cancer Society here are some fast facts about lung cancer:
1. New cases - 174,470 each year
2. Deaths in US 162, 460
3.Men: 92,700 New cases, 90,330 deaths
4. Women 81,770 new cases, 72,130 deaths
5. 44.5 million American Adults smoke
go to : http://www.lungcancer.org/ to learn more about Lung Cancer.
What is on the horizon? According to Dr. Mark Block, a thoracic surgeon in Hollywood Florida, more advances are being made. In a recent article in Florida Trend Magazine, he cites the following promising advances:
1. Chantix http://www.chantix.com/ a new drug designed to help smokers quit cigarettes by blocking nicotines effects. The FDA fast tracked this drug's approval.
2. Vidao assisted thoracic surgery- minimally invasive surgery that allows docs to view inside of chest through small incisions, ideal for biopsies.
3. Endoscopic ultrasound guided fine needle aspiration- helps sample lymph nodes
4. Lung volume reduction surgery- helps patients that were previously unable to have lung cancer surgery due to diseased lungs with poor lung function.
5. CT scans- great screening test for lung cancer
6. New drugs such as Tarceva http://www.tarceva.com/tarceva/patient/index.jsp?hl=en&lr=&q=tarceva
if you have any other comments on lung cancer please post them here...
Monday, November 06, 2006
Chicken soup or Zinc, which fights colds better?
Who is right: Grandma or Science?
Well, according to a recent article in Health Magazine, Dr. Prasad at Wayne State University, has done research which shows that you will catch fewer colds by taking 45 milligrams of "elelmental zinc". He goes further to say that if you feel a cold coming, you can get over it in half the time by taking zinc acetate lozenges every 3 -4hours.
The website, http://www.coldcure.com/ talks about this even more...
Bad news for Chicken soup, but, good news is ..no one has looked at wonton or hot and spicy yet.
Well, according to a recent article in Health Magazine, Dr. Prasad at Wayne State University, has done research which shows that you will catch fewer colds by taking 45 milligrams of "elelmental zinc". He goes further to say that if you feel a cold coming, you can get over it in half the time by taking zinc acetate lozenges every 3 -4hours.
The website, http://www.coldcure.com/ talks about this even more...
Bad news for Chicken soup, but, good news is ..no one has looked at wonton or hot and spicy yet.
Foods thatTrigger heartburn
According to a recent article in Health Magazine, http://www.health.com/health/
here is a list of the top 9 foods that cause indigestion and heartburn:
1. Alcohol
2. Chocoloate
3. Coffee
4. Garlic
5.Citrus fruits and Juices
6. Peppermint
7. Tomatoes and tomato sauce
8. Peppers (all types)
9. Onions
So, no complaining when you order a late night munchie , large Domino's pizza ( http://www.dominos.com/ ) , with onions, peppers and sausage and pepperoni. (And dont think that because sausage and pepperoni is not listed above, that you will be okay with that)
here is a list of the top 9 foods that cause indigestion and heartburn:
1. Alcohol
2. Chocoloate
3. Coffee
4. Garlic
5.Citrus fruits and Juices
6. Peppermint
7. Tomatoes and tomato sauce
8. Peppers (all types)
9. Onions
So, no complaining when you order a late night munchie , large Domino's pizza ( http://www.dominos.com/ ) , with onions, peppers and sausage and pepperoni. (And dont think that because sausage and pepperoni is not listed above, that you will be okay with that)
Tuesday, October 17, 2006
Popular herbal remedies may be riskier than you think
Here is a list of popular herbal remedies you might find at a natural health store...I will list them and their potential effects:
1. Garlic- lowers antiplatelet and LDL cholesterol. Also, may cause adverse effects if taken by patients on anticoagulants.
2. Ginkgo biloba- can increase anti coagulation. May cause adverse effectsin patients predisposed to seizures.
3. Green tea-popular for it's anti oxidant properties. But, it can affect the absorption of asthma mediations and stimulatns such as pseudophedrine and atropine. It may also increase blood pressure.
4. St. John's wort- used to treat mild depression. But, it may adversely interact with MAO inhibitors and anti depressants or it may sped the absorption of other drugs such as chemotherapy.
5. Valerian- used to treat insomina but may heighten the effects of prescription medications used for insomnia or anxiety. Can also cause a paradoxical reaction.
So, be careful and check with your doctor before taking these remedies...
1. Garlic- lowers antiplatelet and LDL cholesterol. Also, may cause adverse effects if taken by patients on anticoagulants.
2. Ginkgo biloba- can increase anti coagulation. May cause adverse effectsin patients predisposed to seizures.
3. Green tea-popular for it's anti oxidant properties. But, it can affect the absorption of asthma mediations and stimulatns such as pseudophedrine and atropine. It may also increase blood pressure.
4. St. John's wort- used to treat mild depression. But, it may adversely interact with MAO inhibitors and anti depressants or it may sped the absorption of other drugs such as chemotherapy.
5. Valerian- used to treat insomina but may heighten the effects of prescription medications used for insomnia or anxiety. Can also cause a paradoxical reaction.
So, be careful and check with your doctor before taking these remedies...
Starbucks may be on to something
Many recent medical studies support the contention that coffee is the "elixir of the Gods"... Apparently, up to six cups of coffee a day may help reduce the risk of heart disease, diabetes, alcohol related cirrhoses and liver cancer.
Coffee is a rich source of anti oxidants and thus my reduce the inflammation association with certain disease states.
It is interesting to note that caffeine isnt a factor as decaf coffee apparently had the same benefits.
Maybe if we push the envelope...we can get medicare to pay for our starbucks card...(dont hold your breath)...
Coffee is a rich source of anti oxidants and thus my reduce the inflammation association with certain disease states.
It is interesting to note that caffeine isnt a factor as decaf coffee apparently had the same benefits.
Maybe if we push the envelope...we can get medicare to pay for our starbucks card...(dont hold your breath)...
Friday, October 06, 2006
Interesting medical tidbit:Having Trouble Sleeping, Try Grapes
According to http://www.webmd.com , a recent study in the Journal of the Science of Food and Agriculture performed in Italy, showed that grapes contain melatonin. Melatonin is a natural sleep hormone.
The human brain makes melatonin to regulate cycles of sleep and wakefulness. Melatonin levels risk in the evening as a cue for sleep but wane as morning approaches. In many grapes tested, melatonin was found including Nebbiolo, Croatina, Sangiovese, Merlot, Marzemino, Cabernat Franc, Cabernat Sauvignon and Barbera.
Hmmm….Grapes. Wine. Sleep. Sounds relaxing.
The human brain makes melatonin to regulate cycles of sleep and wakefulness. Melatonin levels risk in the evening as a cue for sleep but wane as morning approaches. In many grapes tested, melatonin was found including Nebbiolo, Croatina, Sangiovese, Merlot, Marzemino, Cabernat Franc, Cabernat Sauvignon and Barbera.
Hmmm….Grapes. Wine. Sleep. Sounds relaxing.
Interesting Medical Tidbit:Snoring can mean more than a bad night’s sleep
According to a recent, http://www.webmd.com/ article…
Snoring happens when air flow through the mouth and nose is partly blocked , causing the soft palate to vibrate. Most commonly it is caused from the base of the tongue and can be reduced if you change your position from lying on your back to your side.
How many people snore?
25% of adults snore most of the time.
20 million Americans have sleep apnea.
What is sleep apnea?
This is a serious disorder that interrupts a person’s breathing during sleep.
What doctor should you see?
An ENT (Ear, Nose and Throat) that specializes in sleep disorders.
What are treatment options?
Somnoplasty is a minimally invasive procedure that uses radiofrequency to shrink tissue in palate, uvula and tongue and thus help sleep without obstruction. Also, a CPAP machine delivers forced air through the nose to the throat and help open blacked airways, ease breathing and reduce snoring.
Sleep apnea if left untreated can increase risk of heart attack and stroke. Snoring runs in families.
If this article put you to sleep, let me know…
another great blog that has some info
http://www.2ndwindexercise.com/blog/199.htm
http://www.buzzhit.com/buzzblog.html
http://www.health.loversenses.com/sleep-disorder/insomnia-in-senior-citizens
Snoring happens when air flow through the mouth and nose is partly blocked , causing the soft palate to vibrate. Most commonly it is caused from the base of the tongue and can be reduced if you change your position from lying on your back to your side.
How many people snore?
25% of adults snore most of the time.
20 million Americans have sleep apnea.
What is sleep apnea?
This is a serious disorder that interrupts a person’s breathing during sleep.
What doctor should you see?
An ENT (Ear, Nose and Throat) that specializes in sleep disorders.
What are treatment options?
Somnoplasty is a minimally invasive procedure that uses radiofrequency to shrink tissue in palate, uvula and tongue and thus help sleep without obstruction. Also, a CPAP machine delivers forced air through the nose to the throat and help open blacked airways, ease breathing and reduce snoring.
Sleep apnea if left untreated can increase risk of heart attack and stroke. Snoring runs in families.
If this article put you to sleep, let me know…
another great blog that has some info
http://www.2ndwindexercise.com/blog/199.htm
http://www.buzzhit.com/buzzblog.html
http://www.health.loversenses.com/sleep-disorder/insomnia-in-senior-citizens
Pet Owners: Touching Dog Food causes Diarrhea .
According to the Centers for Disease Control, everyone should wash their hands thoroughly with soap and water before handing your dog a treat made with meat or fish.
These treats contain raw beef and salmon, which is a known cause of salmonella infection. In fact, nine people became sick recently because they handled these types of dog food. The people developed diarrhea and one of them was hospitalized.
People at increased risk for infection or serious complication from food poisoning include:
children under 5
older adults, ie the elderly
people with weak immune systems
These people should avoid contact with animal based pet treats.
http://www.PassportMD.com is a free service that creates your personal health record but did you know you can use http://www.PassportMD.com to also create your Pet’s health record and upload and store their health history, shots and vaccination information.
These treats contain raw beef and salmon, which is a known cause of salmonella infection. In fact, nine people became sick recently because they handled these types of dog food. The people developed diarrhea and one of them was hospitalized.
People at increased risk for infection or serious complication from food poisoning include:
children under 5
older adults, ie the elderly
people with weak immune systems
These people should avoid contact with animal based pet treats.
http://www.PassportMD.com is a free service that creates your personal health record but did you know you can use http://www.PassportMD.com to also create your Pet’s health record and upload and store their health history, shots and vaccination information.
Tips for Saving Money on Your Prescriptions
According to a recent article in http://www.webmd.com/
Here are some simple steps that may help you lower your prescription costs:
Look into drug company prescription saving programs
Shop around retail pharmacies for the lowest prescription drug prices.
Consider using mail-order pharmacy services
Ask you doctor if you can take over the counter (otc) medicines
Ask if you can have a generic substitute for any brand medication you were prescribed.
Great Resources to learn about lowering your Prescription costs
Medicare drug coverage http://www.medicare.gov/ (1-800-633-4227)
Partnership for Prescription Assistance http://www.pparx.com/ (1-888-477-2669)
Together Rx Access http://www.togetherrxaccess.com/ (1-800-444-4106)
GlaxoSmithKline patient assistance programs http://www.gskforyou.com/ (1-866-475-3678)
GlaxoSmithKline Coupons and other offers http://www.gskforyou.com/ (1-866-475-3678)
Other blogs that have great information:
http://www.thesunsfinancialdiary.com/2006/11/07/50-ways-to-save-on-medical-bills-from-cnnmoney/
http://blogs.record-eagle.com/?p=282
http://peterlupus.com/healthtips/2006/10/02/senior-care-health-tips/
http://www.realhealthynews.com/2006/07/using-meal-programs-can-help-keep-seniors-healthy-study/
http://www.care2.com/news/member/895715132/204840
Here are some simple steps that may help you lower your prescription costs:
Look into drug company prescription saving programs
Shop around retail pharmacies for the lowest prescription drug prices.
Consider using mail-order pharmacy services
Ask you doctor if you can take over the counter (otc) medicines
Ask if you can have a generic substitute for any brand medication you were prescribed.
Great Resources to learn about lowering your Prescription costs
Medicare drug coverage http://www.medicare.gov/ (1-800-633-4227)
Partnership for Prescription Assistance http://www.pparx.com/ (1-888-477-2669)
Together Rx Access http://www.togetherrxaccess.com/ (1-800-444-4106)
GlaxoSmithKline patient assistance programs http://www.gskforyou.com/ (1-866-475-3678)
GlaxoSmithKline Coupons and other offers http://www.gskforyou.com/ (1-866-475-3678)
Other blogs that have great information:
http://www.thesunsfinancialdiary.com/2006/11/07/50-ways-to-save-on-medical-bills-from-cnnmoney/
http://blogs.record-eagle.com/?p=282
http://peterlupus.com/healthtips/2006/10/02/senior-care-health-tips/
http://www.realhealthynews.com/2006/07/using-meal-programs-can-help-keep-seniors-healthy-study/
http://www.care2.com/news/member/895715132/204840
“Consumer Driven Health Care”, Fad or Reality?
Consumer Driven health care is a industry term for basically… allowing consumers, ie patients, to be better informed about where and how they receive their medical care. It is a rising tidal wave that has not yet caught on with the actual health care consumer…but, is a force to be reckoned with on the corporate side. There are companies that are responding to anticipation of empowering the health care consumer.
What do I mean by empowering the health care consumer?
This “empowerment” is “code” for giving the consumer information about quality, performance and price in regards to health care. The theory is that is a consumer who knows how much a procedure costs at various institutions and weighs this against the quality or “grading” of the delivering doctor or hospital, they will make a better choice and ultimately drive down health care costs and improve health care results.
This is still unproven and controversial. Doctors would argue that there is no meaningful way to “grade” them either based on financial variables or health care outcomes. Often better doctors have sicker , more complicated patients, resulting in more expensive care with less desirable results. The other issue is that if doctors “grade” becomes so important as to impact their bottom line, docs will change the way they practice to get better results both on the expense and health care results side. For instance, they may choose to only treat healthier patients, insuring better outcomes and less expensive insurance costs, so called, “cherry picking”.
In a recent health care congress sponsored by the Wall Street Journal and CNBC, Al Hubbard, assistant to President Bush for economic policy, issued a threat to clinicians: “Make pricing information available without being forced. If you do not do so, we will force you to. We have allies in Congress who are very inclined to be prescriptive with legislation to impose pricing and quality standards on the health care community”. I think that does sound like a clear cut threat, do it, or we will make you do it approach.
Regardless, what is best for doctors, society and patients, is not necessarily aligned.
As a patient, what do you think? What about the doctors that are reading this, what are your thoughts?
We, at PassportMD, Inc. feel very strongly that you can empower the patient, improve health care and at the same time, not threaten a physician’s practice approach. The very first step in this process is giving the healthcare consumer access to their own personal health record (PHR), http://www.passportmd.com/ gives consumer a free Personal health record so , at the very least, they can be better informed regarding their own health and well-being, and pass this information to their provider whenever necessary. This is step 1 in the empowerment process..
What do I mean by empowering the health care consumer?
This “empowerment” is “code” for giving the consumer information about quality, performance and price in regards to health care. The theory is that is a consumer who knows how much a procedure costs at various institutions and weighs this against the quality or “grading” of the delivering doctor or hospital, they will make a better choice and ultimately drive down health care costs and improve health care results.
This is still unproven and controversial. Doctors would argue that there is no meaningful way to “grade” them either based on financial variables or health care outcomes. Often better doctors have sicker , more complicated patients, resulting in more expensive care with less desirable results. The other issue is that if doctors “grade” becomes so important as to impact their bottom line, docs will change the way they practice to get better results both on the expense and health care results side. For instance, they may choose to only treat healthier patients, insuring better outcomes and less expensive insurance costs, so called, “cherry picking”.
In a recent health care congress sponsored by the Wall Street Journal and CNBC, Al Hubbard, assistant to President Bush for economic policy, issued a threat to clinicians: “Make pricing information available without being forced. If you do not do so, we will force you to. We have allies in Congress who are very inclined to be prescriptive with legislation to impose pricing and quality standards on the health care community”. I think that does sound like a clear cut threat, do it, or we will make you do it approach.
Regardless, what is best for doctors, society and patients, is not necessarily aligned.
As a patient, what do you think? What about the doctors that are reading this, what are your thoughts?
We, at PassportMD, Inc. feel very strongly that you can empower the patient, improve health care and at the same time, not threaten a physician’s practice approach. The very first step in this process is giving the healthcare consumer access to their own personal health record (PHR), http://www.passportmd.com/ gives consumer a free Personal health record so , at the very least, they can be better informed regarding their own health and well-being, and pass this information to their provider whenever necessary. This is step 1 in the empowerment process..
Saturday, September 30, 2006
What's the Deal with Sunscreen: Friend or Foe?
Lately, there have been numerous reports surrounding sunscreen....
Questions like "Is it beneficial or harmful" , "Is is worth it for a senior to apply sunscreen", "what difference does it make?" "Are all sunscreens the same? "It sings when I use it, should I try a different one?" "What is the story with the new sunscreen, Mexoryl Sx, that just received FDA approval?"... I will attempt to address some of these issues for you...
1. Recent studies have questioned whether sunscreen is beneficial or harmful. I dont suggest that I know the answer but here is some of the latest opinions... the American Academy of Dermatology, http://www.aad.org still feels strongly that the benefits of use of sunscreen outweighs the potential risks. Despite this , there was another controversial study in the August out of San Francisco by Dr. William Grant, a Ph.D. in the http://www.iiar-anticancer.org/research/research_index.htm Anticancer Research journal that looked at age adjusted types of cancer as plotted by the National Cancer Institute http://cis.nci.nih.gov/ and he found that increase exposure to UVB is associated with a reduced risk of 16 internal cancers, he also went further to show that cancer rates are higher in NE US vs the South and West where levels of environmental UVB is higher throughout the year... he controlled for factors such as smoking, alcohol and ethnicity and he contends strongly, that Vitamin D is critical in reducing the "angiogenesis around tumors, metastasis ....and in helping cell apoptosis". Basically, he is saying that he feels that Vitamin D is critical in reducing the risk for cancer and he feels that Sunscreen may limit the production of critical Vitamin D. Most Dermatologists would argue that throughout the course of the day, even with sunscreen, people get enough sun exposure to generate adequate levels of vitamin D. Dr. Grant asserts that dermatologists dont realize that people get alot of their vitamin D from solar radiation. He advocates going out in the middle of the day for 15-20 minutes so you can create Vitamin D, and minimize the risk of skin cancer. This is controversial as most dermatologists tell you to avoid sun in mid day.
I think this issue is still very, very controversial. From my standpoint, sunscreen clearly makes a difference in reducing the likelihood of getting skin cancer, the most common form of cancer in the United States. I am concerned that studies like Dr. Grants, retrospective multivariate analysis, though statistically sound, are also flawed in their isolation of the importance of the amount of Vitamin D as the critical factor in tumor angiogenesis. I would really like to see a study, that looks specifically at the amount of Vitamin D that is lost through the use of sunscreen and the amount of Vitamin D that is produced by the body in spite of sunscreen all against the amount of Vitamin D shown to be responsible for inhibiting tumor growth. I dont really have an appreciation of this data and thus, before recommending that people go out and get mid day sun and not use sunscreen, I would want more facts and better studies.
Just ask someone, that has had metastatic Squamous cell carcinoma of the skin, a very common scenario, one that accounts for more deaths annually than melanoma. And, one, that is clearly related to sun exposure. I can assure you that they wish that they had used sunscreen.
2. FDA approves new sunscreen...Mexoryl SX , which provides complete broad spectrum UV protection has recently received FDA approval. La Roche Posay http://www.laroche-posay.com/ will maket a broad spectrum sunscreen containing this and Parsol 1789 (avobenxone) and octocrylene. Mexoryl Sx is unique becuase it is highly photostable and filters out UVA and fills the gap left by some UVA sunscreens.
3. Sunscreens are not all the same, generally speaking the recommended sunscreens are those of at least an SPF of 15 and are "broad spectrum" such that they filter UVA and UVB light. After that, the difference really is in the vehicle..ie whether the sunscreen comes as a lotion (more liquid format), a cream, a gel, a stick or a spray on. The main issue here is to use whatever format you prefer as long as it doesnt irritate your skin and that you understand that you need to re apply it after sweating or swimming , for example.
4. Sunscreens are very expensive. Almost cost prohibitive if you use them the way the manufacturer recommends. This is an issue that for some reason is glossed over. I really think the costs of sunscreen is not discussed enough... I would recommend comparing prices via sites on the internet or typical retail outlets. Sometimes more expensive doesnt equate to more effective.
5. Putting aside the controversy of whether or not sunscreen is actually beneficial or harmful until more evidence is presented, I believe that sunscreen should be applied even if you are older and a senior. It is true that much of the sun damage you received is an accumulation over your lifetime, but, the sun you receive as a senior will do much more damage quicker than that same sun would do when you were young. In other words, you may still benefit from sunscreen as a senior and thus you should practice sun safety.
Questions like "Is it beneficial or harmful" , "Is is worth it for a senior to apply sunscreen", "what difference does it make?" "Are all sunscreens the same? "It sings when I use it, should I try a different one?" "What is the story with the new sunscreen, Mexoryl Sx, that just received FDA approval?"... I will attempt to address some of these issues for you...
1. Recent studies have questioned whether sunscreen is beneficial or harmful. I dont suggest that I know the answer but here is some of the latest opinions... the American Academy of Dermatology, http://www.aad.org still feels strongly that the benefits of use of sunscreen outweighs the potential risks. Despite this , there was another controversial study in the August out of San Francisco by Dr. William Grant, a Ph.D. in the http://www.iiar-anticancer.org/research/research_index.htm Anticancer Research journal that looked at age adjusted types of cancer as plotted by the National Cancer Institute http://cis.nci.nih.gov/ and he found that increase exposure to UVB is associated with a reduced risk of 16 internal cancers, he also went further to show that cancer rates are higher in NE US vs the South and West where levels of environmental UVB is higher throughout the year... he controlled for factors such as smoking, alcohol and ethnicity and he contends strongly, that Vitamin D is critical in reducing the "angiogenesis around tumors, metastasis ....and in helping cell apoptosis". Basically, he is saying that he feels that Vitamin D is critical in reducing the risk for cancer and he feels that Sunscreen may limit the production of critical Vitamin D. Most Dermatologists would argue that throughout the course of the day, even with sunscreen, people get enough sun exposure to generate adequate levels of vitamin D. Dr. Grant asserts that dermatologists dont realize that people get alot of their vitamin D from solar radiation. He advocates going out in the middle of the day for 15-20 minutes so you can create Vitamin D, and minimize the risk of skin cancer. This is controversial as most dermatologists tell you to avoid sun in mid day.
I think this issue is still very, very controversial. From my standpoint, sunscreen clearly makes a difference in reducing the likelihood of getting skin cancer, the most common form of cancer in the United States. I am concerned that studies like Dr. Grants, retrospective multivariate analysis, though statistically sound, are also flawed in their isolation of the importance of the amount of Vitamin D as the critical factor in tumor angiogenesis. I would really like to see a study, that looks specifically at the amount of Vitamin D that is lost through the use of sunscreen and the amount of Vitamin D that is produced by the body in spite of sunscreen all against the amount of Vitamin D shown to be responsible for inhibiting tumor growth. I dont really have an appreciation of this data and thus, before recommending that people go out and get mid day sun and not use sunscreen, I would want more facts and better studies.
Just ask someone, that has had metastatic Squamous cell carcinoma of the skin, a very common scenario, one that accounts for more deaths annually than melanoma. And, one, that is clearly related to sun exposure. I can assure you that they wish that they had used sunscreen.
2. FDA approves new sunscreen...Mexoryl SX , which provides complete broad spectrum UV protection has recently received FDA approval. La Roche Posay http://www.laroche-posay.com/ will maket a broad spectrum sunscreen containing this and Parsol 1789 (avobenxone) and octocrylene. Mexoryl Sx is unique becuase it is highly photostable and filters out UVA and fills the gap left by some UVA sunscreens.
3. Sunscreens are not all the same, generally speaking the recommended sunscreens are those of at least an SPF of 15 and are "broad spectrum" such that they filter UVA and UVB light. After that, the difference really is in the vehicle..ie whether the sunscreen comes as a lotion (more liquid format), a cream, a gel, a stick or a spray on. The main issue here is to use whatever format you prefer as long as it doesnt irritate your skin and that you understand that you need to re apply it after sweating or swimming , for example.
4. Sunscreens are very expensive. Almost cost prohibitive if you use them the way the manufacturer recommends. This is an issue that for some reason is glossed over. I really think the costs of sunscreen is not discussed enough... I would recommend comparing prices via sites on the internet or typical retail outlets. Sometimes more expensive doesnt equate to more effective.
5. Putting aside the controversy of whether or not sunscreen is actually beneficial or harmful until more evidence is presented, I believe that sunscreen should be applied even if you are older and a senior. It is true that much of the sun damage you received is an accumulation over your lifetime, but, the sun you receive as a senior will do much more damage quicker than that same sun would do when you were young. In other words, you may still benefit from sunscreen as a senior and thus you should practice sun safety.
Diagnosis of Alzheimers made Earlier through the skin
Alzheimers disease, http://www.alz.org/ affects all of us, even if we dont personally have the disease. It may affect you through your family or friends. This devastating disease can be crippling to a family and an individual. Early diagnosis would be extremely beneficial.
There was a recent report out of the HealthDay News and other sources such as http://www.healthday.com/ that discuss Alzheimer issues... Most recently it was noticed at the West Virginal university health Sciences Center http://www.hsc.wvu.edu/ that since Alzheimer's disease tends to affect the body systemically, a skin test that looks at two forms of enzyme degradation of the protein, amyloid, might be detectable by skin biopsy and provide an easy, non invasive way to diagnosis the early stages of Alzheimers...
Other recent reports that came out this September about Alzheimers worth noting are:
1.
Red Wine May Help Prevent Alzheimer's
Cabernet Sauvignon appears to inhibit proteins that cause plaque buildup in brain
2.
Restricted Diet May Help Prevent Alzheimer's
Low-calorie intake influenced a variety of age-related diseases in monkey study
3.
Alzheimer's Symptoms May Arise From Mutant Genes
It's a possible new dimension to the disease, researchers say
4.
Early Memory Lapses Could Warn of Alzheimer's
But detecting, treating sooner might also help slow the disease, experts say
Have you had personal battles with this disease? I have seen rapid deterioration of patients and people and families as they have watched their loved ones fall victim . Seniors are very aware of this problem and research will continue to make progress on a diagnostic front and therapeutic front. Do you feel we are putting enough resources towards this disease?
There was a recent report out of the HealthDay News and other sources such as http://www.healthday.com/ that discuss Alzheimer issues... Most recently it was noticed at the West Virginal university health Sciences Center http://www.hsc.wvu.edu/ that since Alzheimer's disease tends to affect the body systemically, a skin test that looks at two forms of enzyme degradation of the protein, amyloid, might be detectable by skin biopsy and provide an easy, non invasive way to diagnosis the early stages of Alzheimers...
Other recent reports that came out this September about Alzheimers worth noting are:
1.
Red Wine May Help Prevent Alzheimer's
Cabernet Sauvignon appears to inhibit proteins that cause plaque buildup in brain
2.
Restricted Diet May Help Prevent Alzheimer's
Low-calorie intake influenced a variety of age-related diseases in monkey study
3.
Alzheimer's Symptoms May Arise From Mutant Genes
It's a possible new dimension to the disease, researchers say
4.
Early Memory Lapses Could Warn of Alzheimer's
But detecting, treating sooner might also help slow the disease, experts say
Have you had personal battles with this disease? I have seen rapid deterioration of patients and people and families as they have watched their loved ones fall victim . Seniors are very aware of this problem and research will continue to make progress on a diagnostic front and therapeutic front. Do you feel we are putting enough resources towards this disease?
Before Traveling, Seniors Should Know their Rights
For most seniors, traveling is getting more and more difficult. Long lines, searches, taking off shoes, and removing clothing are just a few of the issues that younger travellers are taking for granted but seniors find to be a real issue.
If you are a senior, and have any medical problem whatsoever, such as oxygen needs, walkers, canes, for example, that help a senior ambulate, also, become a burden because of the difficulty of getting through an airport today. Understandably, many seniors are simply choosing not to fly, not to visit their children or families for the holidays. And , I understand this... The lines and searches have become a necessary evil one that I would not want to give up...if it was up to me..I wouldnt want anyone to carry anything on board a plane. I know I would travel safer and not worry as much as I do. I am sure it wont be long until new competitive airlines start to offer everything we need on the plane so we dont need to carry anything with us. For instance, i cant wait until I can start using outlook and surf the internet on a plane without carrying my lap top with me. That will be great and i am sure the airlines know this.
But, this article isnt really about that, what it is about , is to point out the "rights" you have as a traveler, all of the airlines, http://www.continental.com/web/en-US/default.aspx , http://www.southwest.com/, http://www.united.com/ , http://www.aa.com/
a recent article in the USA today, http://www.usatoday.com/ describes these very well and i will summarize...
1. If your flight is cancelled, the airline only has an obligation to find you another flight on the next available flight. There will be no compensation for lost time or inconvenience.
2. If your flight is delayed, the airlines have two different prongs of approach: If the delay occurs because of a mechanical issue or staffing issue, then they usually provide hotel or meal vouchers. But if the delay occurs for the more common scenario, force majeure delays (weather or traffic control), then dont expect any perks.
3. If You miss your connection, the airline that caused you to miss your connection is responsible to assist you with rebooking so that you can make your original itinerary. The airline that you missed the flight on has no obligation to help you.
4. If you are bumped because an airline has oversold your seat, then you are entitled to a voucher or compensation, this is calculated based upon how much of a delay your bump causes you. For instance, if you are delayed 2 hours, then you might receive up to $200 or if you are delayed up to 4 hours, you might receive up to $400.
5. The airlines will bump the passenger that typically checked in the latest, so make sure you check in early , if you are concerned about this possibility.
6. If your luggage is lost (10,000 bags were lost last year), dont worry, as 98 % of all lost luggages is found withing a few hours. But, do not leave the airport without first filing a lost luggage report and dont leave the airport without a file number and phone number to call to track your bags progress. If your luggage doesnt turn up within 45 days, then you might get up to $2800 per person for lost luggage on domestic flights. There will be no coverage for jewelry or photo gear. This is the max you will get , no matter how valuable your contents were. If you are waiting for your luggage, and you need to buy necessitities,the airlines will reimburse you $25 a day to a max of $125 a day... but you must provide receipts...so good luck with this.
Unfortunately, since the state of air travel and the plight of the airlines is "up in the air" , with so many operators in and out of bankruptcy, or hemorrhaging just to stay alive, you wont have much leverage with them. I do understand this.
Here is a great sight to review your rights..http://airconsumer.ost.dot.gov/publications/flyrights.htm
Do you have any concerns regarding your rights on airlines? What are your thoughts on how to improve your flight experiences? What do you think would be a better way for airlines to become more profitable
If you are a senior, and have any medical problem whatsoever, such as oxygen needs, walkers, canes, for example, that help a senior ambulate, also, become a burden because of the difficulty of getting through an airport today. Understandably, many seniors are simply choosing not to fly, not to visit their children or families for the holidays. And , I understand this... The lines and searches have become a necessary evil one that I would not want to give up...if it was up to me..I wouldnt want anyone to carry anything on board a plane. I know I would travel safer and not worry as much as I do. I am sure it wont be long until new competitive airlines start to offer everything we need on the plane so we dont need to carry anything with us. For instance, i cant wait until I can start using outlook and surf the internet on a plane without carrying my lap top with me. That will be great and i am sure the airlines know this.
But, this article isnt really about that, what it is about , is to point out the "rights" you have as a traveler, all of the airlines, http://www.continental.com/web/en-US/default.aspx , http://www.southwest.com/, http://www.united.com/ , http://www.aa.com/
a recent article in the USA today, http://www.usatoday.com/ describes these very well and i will summarize...
1. If your flight is cancelled, the airline only has an obligation to find you another flight on the next available flight. There will be no compensation for lost time or inconvenience.
2. If your flight is delayed, the airlines have two different prongs of approach: If the delay occurs because of a mechanical issue or staffing issue, then they usually provide hotel or meal vouchers. But if the delay occurs for the more common scenario, force majeure delays (weather or traffic control), then dont expect any perks.
3. If You miss your connection, the airline that caused you to miss your connection is responsible to assist you with rebooking so that you can make your original itinerary. The airline that you missed the flight on has no obligation to help you.
4. If you are bumped because an airline has oversold your seat, then you are entitled to a voucher or compensation, this is calculated based upon how much of a delay your bump causes you. For instance, if you are delayed 2 hours, then you might receive up to $200 or if you are delayed up to 4 hours, you might receive up to $400.
5. The airlines will bump the passenger that typically checked in the latest, so make sure you check in early , if you are concerned about this possibility.
6. If your luggage is lost (10,000 bags were lost last year), dont worry, as 98 % of all lost luggages is found withing a few hours. But, do not leave the airport without first filing a lost luggage report and dont leave the airport without a file number and phone number to call to track your bags progress. If your luggage doesnt turn up within 45 days, then you might get up to $2800 per person for lost luggage on domestic flights. There will be no coverage for jewelry or photo gear. This is the max you will get , no matter how valuable your contents were. If you are waiting for your luggage, and you need to buy necessitities,the airlines will reimburse you $25 a day to a max of $125 a day... but you must provide receipts...so good luck with this.
Unfortunately, since the state of air travel and the plight of the airlines is "up in the air" , with so many operators in and out of bankruptcy, or hemorrhaging just to stay alive, you wont have much leverage with them. I do understand this.
Here is a great sight to review your rights..http://airconsumer.ost.dot.gov/publications/flyrights.htm
Do you have any concerns regarding your rights on airlines? What are your thoughts on how to improve your flight experiences? What do you think would be a better way for airlines to become more profitable
Sunday, September 24, 2006
It's Not Just the Poor that Struggles with Healthcare Costs
According to the Commonweath fund, http://www.cmwf.org/ , it' s not just the "poor" who are having problems footing their healthcare bills. 50% of households earning between $35K and $49 K annually still struggle to make their healthcare bills and health insurance payments. Approximately, 33 % of households earning between $50K and $75 K annually, also report problems with being able to afford their medical bills and health insurance.
Obviously, the rising cost of healthcare is an ongoing problem for Americans. And, it is nothing new. Many factors contribute to this.... corporate profits, rising costs of prescriptions, medical malpractice, insurance crises, new health care technologies, increased regulatory compliance costs and requirements.
I dont think physician salaries play a roll as physicians are continually being asked to deliver more for less. http://www.cms.hhs.gov/center/physician.asp ... Every year it seems your physicians are taking some sort of hit. I really dont think it is fair for the doctor to be blamed for increasing healthcare costs.. unfortunately they are the recognizable and most tangible scapegoat in the healthcare cost process..so they are unfairly often mis represented as being part of the problem. http://content.healthaffairs.org/cgi/content/full/hlthaff.w4.374/DC1
and http://www.aafp.org/online/en/home/policy/federal/background-on-federal-issues/reimbursement.html http://www.californiahealthline.org/index.cfm?Action=dspItem&itemID=113454 http://www.acponline.org/college/pressroom/letter/25jul02.htm illustrate what is an ongoing year after year process of decreasing physician reimbursement.
Obviously, the rising cost of healthcare is an ongoing problem for Americans. And, it is nothing new. Many factors contribute to this.... corporate profits, rising costs of prescriptions, medical malpractice, insurance crises, new health care technologies, increased regulatory compliance costs and requirements.
I dont think physician salaries play a roll as physicians are continually being asked to deliver more for less. http://www.cms.hhs.gov/center/physician.asp ... Every year it seems your physicians are taking some sort of hit. I really dont think it is fair for the doctor to be blamed for increasing healthcare costs.. unfortunately they are the recognizable and most tangible scapegoat in the healthcare cost process..so they are unfairly often mis represented as being part of the problem. http://content.healthaffairs.org/cgi/content/full/hlthaff.w4.374/DC1
and http://www.aafp.org/online/en/home/policy/federal/background-on-federal-issues/reimbursement.html http://www.californiahealthline.org/index.cfm?Action=dspItem&itemID=113454 http://www.acponline.org/college/pressroom/letter/25jul02.htm illustrate what is an ongoing year after year process of decreasing physician reimbursement.
Seniors Ask themselves Should I do a Reverse Mortgage?
Seniors are really asking themselves.. should I tap out? Am I wrong to consider a reverse mortgage?
This is a common questions amongst the elderly...a thought that is traditionally against all of their upbringing..but a real issue today that may have some merit. There are many sources for seniors to read about this to determine if it makes sense for them. For instance, http://www.reverse.org/ or AARP writes about it http://www.aarp.org/money/revmort/
or even, the government through the Federal Trade Commission offers advice to Seniors at http://www.ftc.gov/bcp/conline/pubs/homes/rms.htm.
Seniors should cautiously tread these waters as I am sure there are many scams that prey on their niavete. We have no advice on this subject nor are we being paid to voice any opinion either way. The only purpose of this particular blog is to http://www.KeepSeniorsHealthy.com and when we discuss keeping Seniors healthy.. we look at them from the perspective of keeping them healthy financially, emotionally, and physically.
Another unrelated issue but worthy of mentioning is that "cash out mortgages" soared to the highest level in 16 years in the second quarter of 2006 according to http://www.freddiemac.com/ . Nearly 90 % of Freddie Mac Loans were refinanced with amounts at least 5 % higher than the original mortgage.
This is a common questions amongst the elderly...a thought that is traditionally against all of their upbringing..but a real issue today that may have some merit. There are many sources for seniors to read about this to determine if it makes sense for them. For instance, http://www.reverse.org/ or AARP writes about it http://www.aarp.org/money/revmort/
or even, the government through the Federal Trade Commission offers advice to Seniors at http://www.ftc.gov/bcp/conline/pubs/homes/rms.htm.
Seniors should cautiously tread these waters as I am sure there are many scams that prey on their niavete. We have no advice on this subject nor are we being paid to voice any opinion either way. The only purpose of this particular blog is to http://www.KeepSeniorsHealthy.com and when we discuss keeping Seniors healthy.. we look at them from the perspective of keeping them healthy financially, emotionally, and physically.
Another unrelated issue but worthy of mentioning is that "cash out mortgages" soared to the highest level in 16 years in the second quarter of 2006 according to http://www.freddiemac.com/ . Nearly 90 % of Freddie Mac Loans were refinanced with amounts at least 5 % higher than the original mortgage.
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