http://www.maverickhealth.com/ en info@maverickhealth.com Copyright 2010 2010-05-01T04:00:59-05:00 http://www.maverickhealth.com/site/nurse-practitioners-valuable-but-undervalued/ http://www.maverickhealth.com/site/nurse-practitioners-valuable-but-undervalued/#When:04:00:59Z NP World News is the official news publication of nurse practitioners. Its contributors and columnists are thought leaders in the NP profession. This is the third column of 2010 for NPWN. In my column “NPs On the Edge” I write about issues relating to NP practice, health and health care reform. Click “Read Full Post” if you would like to leave a comment. For Nurse Practitioner World News May/June 2010 By Carla Mills, ARNP The day healthcare reform was signed into law, the future prospects for nurse practitioners (NPs) changed—whether for better or worse remains to be seen. Thirty million newly insured patients will enter the healthcare system over the next few years, all seeking primary care. Community health centers have already been targeted to receive $11 billion dollars in government funding. But, as valuable as NPs are, the profession continues to be undervalued in terms of reimbursement and practice authority. Reduced Medicare reimbursement rates for NPs compared with physicians and the lack of direct reimbursement to NPs from most private insurers will make it difficult, if not impossible, to make NP run community health centers—or any NP care delivery site—financially viable. Under present laws, NPs are reimbursed only 85% of the amount Medicare pays physicians for the same services. Private insurers usually tie their reimbursement practices to what Medicare allows. This is an open-and-shut case of unequal pay for equal work. If NPs’ payments were to drop to 85% of the proposed 21% cut to physicians’ pay, it will put NPs out of business altogether. When reimbursement falls below the cost of delivering care, no healthcare provider—whether a physician or an NP—can stay in business. The assumption that the law of supply and demand will solve the provider shortage is flawed. It takes years of education and clinical experience to grow a skilled clinician, and we already have a shortage of providers, even before 30 million more people seek care. Medical professionals have been increasing their patient volumes for more than a decade in an effort to compensate for pay cuts. Current patient volumes have already dramatically reduced patient visit times, which has done nothing to either reduce costs or improve care. There are nearly 150,000 NPs already trained and currently practicing, who are hampered at every turn by low reimbursement rates and restrictions against practicing to the full extent of their education and ability. The professional energy that NPs are spending to try to remove these barriers wastes valuable time that would be much better spent creating innovative, patient centered healthcare delivery systems. Community health centers and convenience-care clinics are just two examples of new ways NPs are finding to provide direct care to patients. Valuing the Right Things In the last 40 years, chronic diseases have become epidemic. Obesity and smoking are now the leading causes of preventable premature death. These problems and other unhealthy lifestyle behaviors lead directly to a host of other expensive and disabling chronic diseases. While physicians have insisted on having complete and final authority over every aspect of health and medical care in this country, the state of Americans’ health has continued to decline. Historically, physicians have been the most valued and highly paid health providers in the system. They deserve and have received credit for giant strides made within their scope of practice, which is primarily treating diseases and performing many life-saving treatments and procedures. Although these functions are very important, they come late in the process, while disease prevention, which is the focus of many NPs’ practices, may result in greater overall cost savings for the individual and the healthcare system as a whole. Purely medical fixes send the wrong message to patients: don’t bother taking care of yourself. Eat yourself into a diabetic state, and when you are 100+ pounds overweight, come to us and we’ll fix it. The focus on treating, not preventing, disease has created a country of uneducated and dependent patients. If there is to be any hope for health and healthcare reform, it will depend on independent, well-educated patients who are skilled in preventive self-care. It’s time to stop over-valuing those providers who treat the sick and under-valuing those providers who promote health. It’s time to empower NPs. It is the only way the healthcare system can be brought into balance. The Value of NPs Under the physician-controlled medical system, patient education has suffered more than any other aspect of care over the last 40 years. It is an area in which NPs have proven themselves to be superior providers. I am constantly shocked to see my patients making important health choices based on incomplete knowledge and/or misinformation. Educating patients takes time and patience—two qualities that physicians freely admit are in short supply in their own practices. Patients need reassurance, support, good information, and acceptance in order to learn to how to effectively prevent or self-manage chronic diseases. Finding effective treatment approaches that fit an individual’s world view can be tedious and frustrating work. There are small victories and frequent setbacks. The work is far from glamorous, and there is absolutely no reimbursement for it under the current payment structure. This explains why physicians are opting out of primary care—no money, no glamour. They have become accustomed to having plenty of both. Valuing NPs There is a tsunami of patients on its way. More than thirty million patients will become insured over the next 10 years. It is predicted that 10 million of them will enter the system with chronic diseases that have never been diagnosed or treated. The remaining 20+ million are predicted to be younger and basically healthy. Never has such an opportunity to put prevention into practice been offered to healthcare professionals. It’s a historic chance to start turning back the scourge of chronic disease. As Florence Nightingale transformed medical care over a century ago, NPs are poised to transform it for the next 100 years. How? By being creative and innovative! NPs have a responsibility to make their value to the healthcare system clear to everyone involved. But NPs need support too—from their patients, from the physicians with whom they work, from the media, and, most urgently, from lawmakers. It’s time for everyone to stand up for NPs and acknowledge their value. It’s time to remove the practice barriers that prevent them from being as effective as they could be. It’s time for NPs to have full practice and prescriptive authority within their scope so that they can practice without dependence on physicians. The principle of equal pay for equal work demands that NPs receive the same reimbursement from Medicare and private insurance companies that physicians do for providing the same services. If the value and valuation of NPs are not reconsidered and the crippling financial and practice restrictions persist, there is a very real danger that NPs’ unique brand of healthcare will disappear. And if it does, its innovations and insights will disappear with it. This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional. Rants & Raves, NPWN 2010-05-01T04:00:59-05:00 http://www.maverickhealth.com/site/the-american-medical-association-doesnt-want-you-to-read-this/ http://www.maverickhealth.com/site/the-american-medical-association-doesnt-want-you-to-read-this/#When:04:01:52Z They say a blog is like a shark – feed it or it dies. I want to explain why the frequency of my posts has declined. Unlike many blogs, the posts I write are not about things that happened 15 minutes ago. While at times I write opinion posts (admittedly more so in recent months), what I really would rather be doing is sharing interesting ideas, research and information that will help you take the best possible care of yourself. But just because I’m not here as often doesn’t mean there’s not a lot already on the site for you to keep coming back to read. (I know exactly how long visitors spend on the site, gentle readers, and you have not read most of what is already here.) I am confident there is useful information on this site that you have not yet explored. Read this post if you want to know what is keeping me from writing more blog posts these days. They say a blog is like a shark – feed it or it dies. I want to explain why the frequency of my posts has declined. Unlike many blogs, the posts I write are not about things that happened 15 minutes ago. While at times I write opinion posts (admittedly more so in recent months), what I really would rather be doing is sharing interesting ideas, research and information that will help you take the best possible care of yourself. But just because I’m not here as often doesn’t mean there’s not a lot already on the site for you to keep coming back to read. (I know exactly how long visitors spend on the site, gentle readers, and you have not read most of what is already here.) I am confident there is useful information on this site that you have not yet explored. This post explains the issues that are keeping me from writing more blog posts these days. Health Reform is Passed and Signed into Law On March 23, 2010 President Obama signed health care reform into law. That stroke of a pen changed everything about health care for everyone – nurse practitioners included. NPs have been functioning in almost every corner of the health care system for more than four decades and many, like me, are primary care providers. Because of health care reform there is a tsunami of patients headed for a health care system that does not have enough primary care providers to take care of them. Yet in spite of that the AMA (American Medical Association) in this linked document (which they did not release to the public) along with some other physician organizations continue to oppose giving NPs the full practice and prescriptive authority we need. As an NP in primary care, I face crippling practice restrictions everyday that make delivering quality care both inefficient and more costly than it needs to be. One NP’s Story Let me tell you my story and you decide whether the AMA’s position is meant to serve you or is serving only the AMA. And please, don’t take my word for it, read the links below for other opinions and studies on the safety of NP practice. In my case, I share a busy internal medicine practice in Naples, Florida with a single physician. We work in our practice like any two doctors would (though I am an NP). But rather than each having our own separate patients we both see everyone in the practice – patients go back and forth between us depending on our schedules and their preferences. We don’t divide the patients up by “easy” or “hard”. And whenever one of us takes time off the other one covers the whole practice. We work this way because, as an NP, I have experience and expertise the physician does not – because she’s not a nurse. As a physician, she has experience and expertise I do not – because I’m not a doctor. But 90% of what we both do is exactly the same – whether she does it or I do it we are providing the same care. And because we come from different disciplines, by practicing in this way, we can deliver a broader spectrum of care that either one of us would be able to deliver by ourselves. This physician does not, nor has she ever, “supervised” me. I have been practicing medicine and nursing in this way for over 15 years. I’m not sure I would have ever landed any job I’ve ever held (except, perhaps, my first one right out of grad school) if I required “the watchful eye” of a physician to oversee the care I provide. Physicians are far too busy themselves to “supervise” other providers. The position the AMA and others have taken with regard to NP autonomy is about control and money only – not your safety. NPs’ quality of care has been proven over and over (and they know it). See the links at the end of this post to see for yourself. Support NPs So what does all that have to do with a blog being like a shark? Nothing really, except I don’t want the blog to die because I can’t feed it as often as I would like. I hope the health care wars will end soon so I can come home to the blog for good. In the meantime I am out there speaking and writing. I am working for the legislative reform of draconian laws that are limiting your access to care. Until the impediments that keep NPs from doing what we are trained to do are lifted, the best I can do is send in posts from the front lines. This is one of them. Please support NPs. Write your elected officials, write the newspapers, post comments on websites (even this one) about your experience with NPs. Stand up for NPs. We have always fought for you and are fighting for you now – but we can not do it alone. Thanks for being here. Related Links: The New Doctors in the House Do physicians deliver better care than Advanced Practice Registered Nurses? The effect of Evercare on hospital use. This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional. Rants & Raves, Health Groups, Women, Men, Elders, Hall of Shame 2010-04-16T04:01:52-05:00 http://www.maverickhealth.com/site/putting-prevention-into-practice/ http://www.maverickhealth.com/site/putting-prevention-into-practice/#When:04:00:54Z NP World News is the official news publication of nurse practitioners. Its contributors and columnists are thought leaders in the NP profession. This is the second column of 2010 for NPWN. In my column “NPs On the Edge” I write about issues relating to NP practice, health and health care reform. Click “Read Full Post” if you would like to leave a comment. For Nurse Practitioner World News March/April 2010 By Carla Mills, ARNP Who is responsible for putting prevention into practice: individuals or society? If it’s an individual’s responsibility, then what business does society (that is, health professionals, employers, insurance companies, and the government) have interfering in people’s personal lives? If it’s society’s responsibility, is it cheaper to practice preventive care, or should we just wait until people get sick and then treat them? In fact, health is a shared responsibility between a society and its citizens. Society is responsible for maintaining a healthy environment: clean drinking water, safe and healthy food, nontoxic air and soil. Individuals are responsible for their own personal health habits and for paying the price for the choices they make. Who Pays? Current “health care reform” (more aptly called “insurance reform”) seeks a way to provide affordable, universal health insurance that will cover medical expenses for accidents and illness without limitations on preexisting conditions. But to expect insurance companies to cover both preventive care and disease management at a low price and to offer the same benefits to everyone is simply unrealistic. The reality is that the care an individual gets is going to depend on the care an individual is able to afford. Insurance companies can stay in business only when they have a large pool of premium-paying customers who do not file claims. That’s how they get the money to pay for the people who do file claims. The situation today is that an aging population is moving into the years of highest medical utilization, and a younger population is choosing to opt out of health insurance because it’s too expensive and they are not required to buy it. When the uninsured end up in the emergency room, they receive the most expensive care; but lacking insurance, many have no means to pay for the care. This perfect storm has led to personal financial disasters and a failing health care system. The situation is in desperate need of reform. Historically, health insurance has paid for the largest portion of total health care expenses. The public has shared little responsibility for the rising costs of care. Now the public wants health care reform to provide both medical and preventive services and to do it at a lower cost. This is an unrealistic attitude, and one that threatens to bankrupt our country and topple our economy. Does Prevention Save Money? An article titled “Does Preventive Care Save Money” in the February 2008 New England Journal of Medicine reported, “Some evidence does suggest that there are opportunities to save money and improve health through prevention.” Yet in August 2009, the Congressional Budget Office sent a letter to the US House of Representatives Subcommittee on Health reporting that “Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.” As with all complex problems, the devil is in the details. Some interventions save lives and save money; others save lives but cost more; and others save neither lives nor money. From society’s standpoint, we must continue to identify those interventions that save both lives and money and aim to practice them—providers and patients alike—100% of the time. This is why evidence-based practice is advocated as the gold standard of quality health care. From an individual’s standpoint, it’s time we recognize that everyone is going to be paying more for health care. We had all best start budgeting for it. Not everyone will be able to afford a new Jaguar; some may be able to afford only a used Volkswagen. We must each tailor our expectations for what we can personally afford. The cheapest way to save money and reform health care is to decrease utilization, that is, to stay out of the system as much as possible. The best way for each person to do that is to stay healthy, pay for routine screenings (out of pocket, if necessary), and make smart health choices that put prevention into practice in our personal lives. Does Prevention Save Lives? Only a few preventive interventions have been analyzed from both a cost and a lives-saved perspective. The same New England Journal of Medicine article reported that the following interventions have been shown to be both life-saving and cost-saving. But they are not practiced nearly enough. Daily aspirin for adults—Fewer than 50% of American adults now take a daily aspirin. Smoking cessation counseling by a health professional, including an offer for medication and other assistance to quit—Only 28% of smokers receive this counseling now. Colon screenings for adults age 50 and older—Only 50% of people in this age group keep up to date with colon screening. Annual flu shots for adults age 50 and older—Only 37% get them now. Breast cancer screening for women age 40 and older at least every 2 years— Currently, 67% of women have recommended breast cancer screenings. Annual chlamydia screening for sexually active young women, which would prevent 30,000 cases of pelvic inflammatory disease—Only 40% of the target population gets screened regularly now. The New England Journal of Medicine article also listed the following as worthy of further study: Screening for diabetes, hypertension, high cholesterol, depression, stress and anxiety, medication compliance, exercise behaviors, weight status, and dietary habits The cost-effectiveness and clinical outcomes of health risk assessments and counseling of adults and children Effectiveness of smoking cessation programs for youths and adults Role of fast food in chronic disease risk development, and whether health warnings should be placed on these foods as they are on tobacco products Smart Health Choices A free society cannot and should not dictate personal health behaviors, even if they prevent disease. It is unreasonable to think a health professional, an employer, an insurance company, or the government can keep people healthy. Ultimately, health is a personal responsibility, personal expense, and personal effort. Every individual must choose his or her own life habits and path. Knowing how to stay healthy and how to reduce the need for expensive sick care services is the most cost effective way to prevent disease and lower health care costs and utilization. Each of us will personally bear the costs of our own health choices and health outcomes, in terms of both money and quality of life. Nurse practitioners’ preventive interventions beg further study. My book, A Nurse Practitioner’s Guide to Smart Health Choices, outlines the national treatment guidelines for those health risks the New England Journal of Medicine article deemed worthy of further study. The book details simple measurements that NPs, and patients themselves, can use to determine if preventive interventions work. Nurse practitioners manage chronic illnesses and teach people how to stay well. NPs promote healthy behaviors, see that screenings are up to date, and educate patients how to make smart health choices. NPs put prevention into practice. This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional. Rants & Raves, NPWN 2010-03-01T04:00:54-05:00 http://www.maverickhealth.com/site/dont-give-up-on-haiti/ http://www.maverickhealth.com/site/dont-give-up-on-haiti/#When:04:00:41Z These are trying times - wars overseas and terrorist threats at home, a miserable economy, a health care system in crisis and Washington politicians behaving with more pettiness and self-interest than squabbling two year olds – well, it’s just plain disheartening. This week a patient of mine lumped Haiti’s problems in along with all those others I just mentioned but I begged to differ. Haiti is neither a governmental nor political problem – it is a humanitarian one. It is not our governments’ problem to solve, it is our own as individuals. We can save Haiti by not giving up on her. Read this post to see how. These are trying times – wars overseas and terrorist threats at home, a miserable economy, a health care system in crisis and Washington politicians behaving with more pettiness and self-interest than squabbling two year olds – well, it’s just plain disheartening. Haiti – Whose Problem Is It? This week a patient of mine lumped Haiti’s problems in along with all those others I just mentioned but I begged to differ. Haiti is neither a governmental nor political problem – it is a humanitarian one. It is not our governments’ problem to solve, it is our own as individuals. We can save Haiti if we don’t give up on her. I wrote in my last post right after the Haiti earthquake about how important it was to send money immediately. I am writing now to say we must keep sending money as Haiti moves through the years of recovery to come. Since this is a humanitarian effort it is up to humans, not governments, to provide the relief. If we were struck by a disaster we would hope others would do the same for us. The U.S. government, the United Nations, the World Bank, the World Food Program or other large global organizations – none of them – not even all of them combined have the money to rebuild Haiti. They may have the personnel and equipment and expertise, but they do not have the money. We individual humans must contribute that. Being Human I’ve been reflecting on what my patient said about Haiti being just another disaster on the world stage that will tax our resources and strain our economy more, but I can’t think about it that way. To me it’s more personal than that. There but for the grace of God go I. I have decided I am going to give $10 every month to the Red Cross specifically for Haiti for as long as it takes. It’s a very small sum of money I know. But if humans all over the world each give just a little, it will become a lot. It is humanity’s job to help Haiti rebuild and become a model for other humanitarian projects in the future. If one million people contribute the same small amount I do – that’s 120 million dollars a year, if two million contribute that is 240 million year – if 100 million people contribute – well, you get the idea. It won’t affect your taxes, your services or the national deficit because it’s coming directly from you – not your government. Humanitarian aid is humans helping other humans – it’s not a governmental or political issue. In fact, the trick is keeping governments from interfering. It doesn’t have to be a lot of money, but if a lot of humans give a lot can get done. I’m tired of the bickering and fighting in Washington, I’m frustrated with the economy, I’m weary of wars, I’m angry at terrorists and I’m fed up with the profiteering and turf wars that are keeping health care reform stalled. Some things should be out of bounds where partisan politics are concerned and humanitarian aid is one of them. I still believe in humanity so I’m not giving up on Haiti anytime soon. I hope you won’t either. Photo credit: The Big Picture at Boston.com This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional. Rants & Raves 2010-02-26T04:00:41-05:00 http://www.maverickhealth.com/site/defining-nurse-practitioners/ http://www.maverickhealth.com/site/defining-nurse-practitioners/#When:04:00:14Z NP World News is the official news publication of nurse practitioners. Its contributors and columnists are thought leaders in the NP profession. This is the first column of 2010 for NPWN. In my column “NPs On the Edge” I write about issues relating to NP practice, health and health care reform. Click “Read Full Post” if you would like to leave a comment. For Nurse Practitioner World News Jan-Feb 2010 By Carla Mills, ARNP If NPs are to have a positive impact on health and health care, we must clearly define ourselves for the public and the media. People need to know what makes us distinct and different from doctors and other types of nurses. Ignorance about NPs has stunted our professional development and slowed our evolution as a profession. Health challenges confront a world with a rapidly aging population and an epidemic of chronic lifestyle diseases. NPs can keep people well and manage the care for those who become sick. But in order to do so, the special talents and skills of NPs need to be clearly defined. If given the necessary authority and the opportunity, NPs are prepared to dramatically and positively change the way health care is delivered. To define something, one must understand both the meaning of the term (in this case, “nurse practitioner”) and the nature, essential qualities, and boundaries of the words’ meaning (that is, what makes nurse practitioners different from doctors and other types of nurses). Defining our particular uniqueness is challenging because nurse practitioners are both doctors and nurses, yet we are neither. When Organized Medicine Defines NPs Our failure to clearly define ourselves created a vacuum that enabled organized medicine, under a pretext of protecting the public, to presume to define us. Long ago, organized medicine appointed itself arbiter of all health care and all health care providers. For years, it has defined NPs using rhetoric that is aimed at shaping public opinion and restricting NP practice. Terms like “non-physicians,” “physician extenders,” and “mid-level providers” have been widely used to refer to both NPs and physician assistants—as if the two are indistinguishable. These labels diminish NP authority and impede the growth and expansion of NP practice. Constant repetition of these doctor-centric terms in the media has successfully wormed them into the common vernacular and misled everyone about the true nature of NPs. These pejorative terms define NPs not according to what we are, but rather according to what we are not. They obscure the quality of our expertise and deny the potential benefits we can deliver as independent providers. These terms do not protect public trust at all; rather, their use more closely resembles antitrust. NP Titles Obscure NPs’ Nature As nursing professionals earn additional degrees, certifications, and honors, they add more and more letters after their names until their titles become unwieldy and indecipherable. These titles are meaningless to the public and media, and they obscure NPs’ common characteristics. Much has been written about the use of the title “doctor” by DNPs and other doctorate-educated nurses. Nurses who have earned a doctorate degree have every right to use the title “doctor.” But just because one has a right to do something, does that make it the right thing to do? Until a universally understood nomenclature is used by the nursing profession to clearly communicate to the public what distinguishes different types of nursing professionals from doctors and from each other, confusion will prevail. Creating this unnecessary confusion is a disservice we inflict on both the public and ourselves. The public understands the words “doctor” and “nurse.” It needs to understand “nurse practitioner” better. Sticking with just these 3 titles and not cross-pollinating them would make it easier on everyone. We make more productive use of our valuable time when, instead of explaining and reexplaining what kind of nurse or doctor we are, we spend it on substantive matters that affect our patients. NP Defined All NPs are RNs, but all RNs are not NPs. Although both RN and NP practice is rooted in the profession of nursing, the scope of practice is different. NPs and RNs share the same core values and mission. All nurses stand up for and stand by patients suffering mental or physical illness. As RNs, we are formally educated and clinically trained to care for the sick and the infirm. As NPs, after receiving more formal education and more clinical training, we advance our nursing practice to enable us to prevent, diagnose, and treat diseases. The term “nurse” refers to RNs and the term “nurse practitioner” refers to NPs. We all must see to it that the titles are used correctly on every occasion, and we should request a correction every time and every place they are not. The medical profession’s expertise is disease; the nursing profession’s expertise is a patient’s experience of disease and the process of healing. NPs diagnose and treat illness within a larger context than doctors do, because NP care encompasses a patient’s whole life. Personal choices, family circumstances, community, and society as a whole all come under NPs’ scrutiny. The most expert medical care in the world cannot produce healthy citizens so long as lifestyles, the community, and society remain sick. Compared with doctors, NPs tend to spend more time with each patient. NPs do not work more slowly or take more time because they are less intelligent or less efficient than doctors. NPs simply must spend more time, because it is the nature of NP practice. Treatment plans are not dictated to patients by NPs, as they often are by doctors. Rather, NP treatment plans are collaborative agreements reached in partnership with patients after a process that includes evaluating problems, teaching about causes, discussing options, and exploring patients’ own needs and wishes. With this extra time and the knowledge that is gained about the patient and by the patient, NPs are able to deliver care accurately, safely, and according to the patient’s own directives. NPs help patients manage the life changes that come with a chronic disease or a catastrophic event. When it is inevitable, helping patients face death with dignity and grace is intrinsic not just to NP care, but to all nursing care. When people ask me what an NP is, the one-sentence defInition I give is: “I am a nurse who does the same thing a doctor does, but I do it from the perspective of a nurse.” Personally, I wish we had been named “nurse doctors” instead of “nurse practitioners”—it’s a title that’s less vague and more precise. But then nobody ever asked me. This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional. NPWN 2010-02-15T04:00:14-05:00 http://www.maverickhealth.com/site/help-haiti-and-help-yourself-make-a-long-term-commitment/ http://www.maverickhealth.com/site/help-haiti-and-help-yourself-make-a-long-term-commitment/#When:04:00:36Z The devastating natural disaster in Haiti has gripped our hearts and minds. Many are suffering without water and food while suffering injuries and the loss of family, loved ones and shelter from the elements. Those people’s circumstances are utterly unimaginable. Please donate money NOW and plan to keep on giving in the future. Recovery will not be quick. Read this post to help you think through how this disaster can help you help others and help you help yourself. The devastating natural disaster in Haiti has gripped our hearts and minds. Many are suffering without water and food while suffering injuries and the loss of family, loved ones and shelter from the elements. Those people’s circumstances are utterly unimaginable. Please donate money NOW and plan to keep on giving in the future. Recovery will not be quick. Give Money NOW! The images coming out of Haiti are horrible. The delay getting food and water and medical care to the millions who need it is gut wrenching. The tens of thousands of dead are rotting in the streets creating a public health emergency of gigantic proportions. Hopefully you’ve already made a donation to the American Red Cross or some other legitimate aid organization that you know will get the money to those who can get supplies on the ground quickly – even $5 or $10 matters! But don’t plan to stop giving when the news cycle changes. Haiti was on the verge of a major infusion of investment capital that could turn this jewel of the Caribbean from a backward and impoverished third world country into a glittering and prosperous nation. Let’s not give up hope for that future. We can not leave it to governments and movie stars and telathons alone – they don’t have enough money. It’s our $5 and $10 dollars donations – if they keep on coming as Haiti moves through the stages of emergency care, to recovery, to rebuilding – that can bring Haiti and the Haitian people back to life from this terrible disaster. So please don’t go away or forget about Haiti when it’s no longer the top story on the nightly news. What’s In It for You? These are dangerous and scary times. All over the world humans face scary threats. The media reports that experts predict there is a 99.7% chance of an earthquake of similar catastrophic proportions in California any day now. Given it’s own current financial crisis, California is at risk just like Haiti – hopefully better building codes will make such a catastrophe, though still devastating, somewhat less deadly. Natural disasters, terrorism and economic ruin seem to be threatening us from every direction. How are we to cope with it all? Here are 3 ideas that will help: Help others. Donate money now and donate money, goods or services later to stay connected to the rebuilding of Haiti. It will heal them and heal you. Take care of yourself. Those who will survive in Haiti will share two characteristics. One, they were lucky. And two, they are resilient in body, mind and spirit. So let that be a wake-up call for you. Get in shape, maintain a strong mental attitude and stay connected to your spiritual power source – whatever that is for you. Stay in it for the long haul. Haiti’s recovery and your own is not going to happen overnight. Time is the great healer for both the rescuer and the rescued. If you are the victim of a disaster you will stand a better chance of survival if you are in good health and decent shape. Here are some legitimate websites where you can donate money right now. No amount is too small: American Red Cross Clinton-Bush Haiti Fund There are others but double-check they are legitimate before you give them money. And remember, all the experts are saying what’s needed most right now is money. This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional. Rants & Raves 2010-01-15T04:00:36-05:00 http://www.maverickhealth.com/site/organizing-nps-and-np-organizations/ http://www.maverickhealth.com/site/organizing-nps-and-np-organizations/#When:20:48:39Z NP World News is the official news publication of nurse practitioners. Its contributors and columnists are thought leaders in the NP profession. This is the fifth and final column I will write for NPWN this year on subject of NP practice, health and health care reform. Click “Read Full Post” if you would like to leave a comment.For Nurse Practitioner World News Nov-Dec 2009 By Carla Mills, ARNP Synergy is the dynamic and energetic atmosphere created when individuals and groups work together to produce results they could not obtain independently. It comes from two Greek words – syn meaning “together” and erg meaning “to work”, i.e. “work together”. My “NPs on the Edge” columns this past year outline a vision for the future that NPs can achieve if we can only learn to work together synergistically. In my first column in NPWN this year, I evoked two historic nursing visionaries and social reformers. Florence Nightingale brought nurses into positions of respect and advanced the evolution of medicine by sanitizing operative procedures and hospitals. Lillian Wald founded the Henry Street Settlement and the Visiting Nurse Service in New York City in 1893, creating public health institutions still at work today. Both of these women established nurses as social reform leaders. Their actions and achievements prove that disrupting the status quo is essential if the goal of social change is to be achieved. If NPs today are to live up to these visionary leaders’ legacy, we must match their bravery and tenacity with our own. We must come together with their same determination to solve the major public health problem of our time – chronic lifestyle diseases. In my second column I wrote that in order to fulfill our social responsibility and put right a broken health care system, full practice and prescriptive authority for NPs is essential. This is a non-negotiable mandate that must be demanded by every individual NP and every NP organization. It should be the unifying political cause that directs our legislative agenda. We can not equivocate and we need not doubt ourselves. The essence of NP care suits the health needs of our time just as perfectly as Nightingale’s and Wald’s care suited the health needs of their time. We must defend and take ownership of our methods of practice. We must describe our unique expertise to everyone who does not understand us. At every opportunity we must challenge demeaning labels such as “non-physician”, “mid-levels” and “physician extenders”. We must constantly explain the distinctions between the titles “nurse” and “nurse practitioner” until NPs are well understood. In my third column I laid out the core measurements for optimum health that will prevent and treat chronic diseases. Reaching these goals requires a combination of healthy lifestyle behaviors and, sometimes, medications. NPs are the only health care professionals who are trained in both medicine and nursing. NPs are trained to treat both the health problem itself and the patient’s response to the problem. Helping patients get to goal on all of these measurements is the only way chronic diseases will ever be effectively controlled and prevented. Then in my last column I discussed the need for NPs to reach out to the media. Overcoming our social invisibility is the key to having a voice and having influence. Neither legislators, government leaders nor the general public will pay any attention to us until we are seen and heard from in the media. Challenges for NPs and Our Organizations So far NPs have not been effective organizers. NP organizations suffer from fragmentation, divisiveness between different groups, and low membership numbers relative to the total number of NPs. It is hard to say they truly represent NPs given the fact that the majority of NPs do not support them by joining and paying dues. Their small sizes and small membership numbers prevent them from garnering the resources and clout they need to accomplish any meaningful political reform or effective media outreach on behalf of NPs. [See the list below of the current membership numbers of the national NP organizations.] Lack of coordination and resource sharing between national, state and local NP organizations dilute what money and energy members do contribute. Individual and organizational NP initiatives repeatedly hit dead ends because their efforts aren’t supported or carried forward by a unified community of organized NPs working synergistically with the nursing profession as a whole. NP organizations and educational institutions continue focus only on NP issues and ignore issues of public health leaving us lacking in social relevance. It’s time we take a giant, bold collective leap over the edge and into the future. NPs need to get organized. The NP profession is made up of 147,000 disconnected individuals and a whole host of disorganized organizations, foundations, networks and councils – all have some growing and changing to do and it needs to be done fast. NP Organizations Need to Organize NP organizations need to coalesce, merge and share resources. If they want to attract more members (and more dollars) they must prove themselves competent and relevant to a larger percentage of 147,000 practicing NPs. Reaching out and inviting all NPs (clinicians, educators, researchers, and administrators) to the table and incorporating all the divergent views will find innovative solutions to old problems. Abandoning the status quo will allow NPs to evolve into something more socially relevant. Specifically, all NP organizations should coordinate their efforts to pursue the following three unified agendas: Obtain funding and grass roots support from a majority of NPs in order to lobby effectively to obtain full practice and prescriptive authority for NPs across all 50 states. Advocate boldly for a national health initiative led by NPs to get every American to goal on every single health risk. Launch a robust and coordinated media outreach campaign that explains and promotes NPs’ vision, authority, and expertise and outlines a clear health care plan for the public. Individual NPs Need to Become Activists NPs have an unprecedented opportunity at this moment in history. It is up to each one of us to take full advantage of it. Whatever your passion, whatever cause you support, whatever you believe – act on it and invest money in it. As I see it, every NP should be making 3 types of donations: time, money and self. Every NP should Reach out to local, state and national politicians and legislators at every opportunity. Explaining NPs’ urgent need for full practice and prescriptive authority and how we will use that authority to provide exactly the type of health care that’s most needed and in shortest supply. This is easy to do these days via email. It’s a donation of time. Join and pay dues to local, state and national NP organizations. Don’t skip organizations because you’ve given to a group on another geographic level. Make additional donations if you feel the organizations’ performance is adequately representing your interests. Do it today! It’s a donation of money. Reach out to the media. Write a letter to the editor. Call in a story to your local newspaper. Get interviewed on a local radio show. Meet the press whenever and wherever the opportunity arises. It’s a donation of self. Synergy = Energy Squared United and cohesive NP organizations, when aligned with 147,000 NP activists, all working toward the same solutions – that would be a powerful force for health reform! Finding solutions to the difficult social and behavioral problems that lead to disease is both a humanitarian issue and a political one. Eliminating the causes of chronic disease will require changing the very nature of our social values and disrupting many of our social structures. NPs can help guide those changes if we will work together energetically and synergistically. National NP Organization Membership #s TOTAL # of NPs in the U.S. = 147,295 as of 02/2009 (Pearson Report, 2009) AANP (American Academy of Nurse Practitioners) = 26,600 members as of 09/2009 ACNP (American College of Nurse Practitioners) = 4,500 members as of 10/2009 NPWH (National Association of Nurse Practitioners in Women’s Health) = 2,500 members as of 11/2008 NAPNAP (National Association of Pediatric Nurse Practitioners) = 7,000 members as of 04/2008 GAPNA (Gerontological Advanced Practice Nurses Association) = 1,805 members as of 06/2008 NONPF (The National Organization of Nurse Practitioner Faculties) = 1,100 members as of 10/2009 This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional. NPWN 2009-12-28T20:48:39-05:00 http://www.maverickhealth.com/site/top-ten-holiday-gifts-for-good-health/ http://www.maverickhealth.com/site/top-ten-holiday-gifts-for-good-health/#When:04:01:45Z Here are Maverick Health’s top ten holiday gifts for good health. Too often the holidays end up in a tailspin of bad health choices. We overeat and gain 5 lbs that we never seem to lose, we feel stressed and we spend more than we planned on gifts that aren’t always appreciated or good for those to whom we give them. But this year things can be different. I’ve looked for some healthy gift ideas for your friends and loved ones that say “I care about you and your health”. Check them out. Here are Maverick Health’s top ten holiday gifts for good health. Too often the holidays end up in a tailspin of bad health choices. We overeat and gain 5 lbs that we never seem to lose, we feel stressed and we spend more than we planned on gifts that aren’t always appreciated or good for those to whom we give them. But this year things can be different. Here are some healthy gift ideas for your friends and loved ones that say “I care about you and your health”. A Nurse Practitioner’s Guide to Smart Health Choices by Carla Mills, ARNP. (A shameless plug for my own book, but it’s the best darn guide I’ve been able to find for people who want to take control of their own health and health care.) Send it as a gift – we’ll gift wrap it for you! Or buy it for yourself! If you don’t agree that it’s one of the most useful health books you’ve ever read, just tell us so and we’ll refund your money – guaranteed.) Here are two very important books that I recommend to 95% of my patients. They are best given together and read in this order: First read In Defense of Food by Michael Pollan then read The End of Overeating by David Kessler. Kessler’s book picks up where Pollan’s book leaves off. They are well written and easy reads – not “how to” books. I read them last summer and they have literally transformed my relationship and attitude toward food and restaurants in a good way. Jumpsnap Cordless Jump Rope. I own one of these and this is my favorite exercise “gadget”. Aerobic exercise strengthens the heart. The heart is a muscle and the more you work it the stronger it gets. Jumping rope is a fabulous aerobic exercise. The problem comes if you want to jump rope inside (say if you are traveling or the weather is bad). Ceilings are often to low to use a standard jump rope. The Jump Snap is electronic and has no rope so it can be used in hotel rooms or wherever there’s not enough ceiling height for a standard jump rope. Tip: Jumping rope is a secret weapon in the quest for aerobic fitness and weight loss. Jumpsnap makes a great gift. Be sure to check with a health professional before beginning any new exercise program if you have not been physically active. Pedometer. Walking is healthy and safe for almost everyone. If you don’t see your gift recipient wanting to jump rope there are other ways to increase physical activity and burn up more calories. One of the most gentle and effective ways is walking. The daily goal is 10,000 steps everyday but studies have shown inactive people only walk about 3,000 steps a day. Clip a pedometer on every day and add 500 steps each day until the goal of 10,000 steps is reached. How? Park further away from stores, take the stairs, walk the mall, take a nature walk – be creative! This device incorporates “exercise” into one’s daily life. Sun Mountain Speed Cart V1. This gift was recommended to me by Bob Carney, the creative director for Golf Digest, as a healthy idea for all the golfers out there (you know who you are). Bob writes, “I’ve got three or four fitness machines that never get used. The one healthy thing I, and a lot of my middle-aged friends do, is walk the golf course. Remember, it’s a six-mile walk on average for 18 holes and I play about 50 rounds a year. This product by Sun Mountain is cool because it allows you easily to walk when you play and not have to carry your bag. Unlike a lot of clunky pull carts, or expensive motorized ones, it’s light, easily-storable, and sturdy.” He denies working for Sun Mountain but says this product did get listed in the 2009 Golf Digest “Hot List” Gold Selection this year. Add a pedometer and you’ve got a fun fitness plan! Yoga Force Mat. This environmentally friendly, well cushioned, non-slip mat would make a great gift for the yoga practitioner on your gift list. Whether they practice at home or at a yoga studio, the lines on the mat help keep postures properly aligned – plus it is just plain cool looking. I wish I had one. Rx Tote Medicine Bags. I really wish all my patients had one of these. Anyone who takes medications should have a place to keep them organized (and should carry them to all appointments with health providers). These kits keep meds travel ready, too. Having all medications in one place vastly improves your chances of taking them correctly. I can’t tell you how much time/energy we waste/spend in my practice just to make sure that our records of what patients are supposed to be taking match what patients actually are taking. I only wish the pill boxes included in these kits were the larger 4 time a day/week rather than the once a day/week kind. Most people on multiple medications take them more than once a day. Make that one change to this product and it will be perfect. A Recipe for Life. Good nutrition is so fundamental to good health that without it good health is improbable if not impossible. There are so many diet and cookbooks out there, but not so many nutrition books. Susan Dopart is a registered dietitian who has written an attractive and nutritionally sound book with lots of good recipes to teach you the basics of good nutrition. My book (another shameless plug) teaches the basics of good health, Susan’s book teaches the basics of good nutrition. Put the two together and you have a powerful recipe for better health. Save a Child. There is nothing that will enrich your holiday more than giving generously to someone less fortunate than you. Save the Children offers many opportunities for any budget to help children in need. Unlike many gifts which are opened and forgotten, these gifts literally transform and even save lives. Plus you can add a cuddly goat or sheep plush-toy to your order to give the child you help something to unwrap and enjoy this holiday season! A Slow Christmas is a FREE GIFT FOR YOU OR A LOVED ONE. This refreshing and calming blog by Porter McConnell deserves a visit. Porter writes “According to the American Psychological Association in this survey and this one, too), holiday stress can contribute to stress-related illnesses. Perhaps the most important way to help people improve their health is for them give themselves permission to take it easy at Christmas this year. The holidays are supposed to be a time to relax and have fun, not to get stuck running endless eleventh-hour errands in a crowded mall. We need to slow down Christmas, and start enjoying it. If we don’t, our health and well-being suffer.” I agree with Porter. Her blog has inspired me to slow down my own holiday this year and it’s feeling good! Best Wishes for Happy and Healthy Holidays! This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional. Rants & Raves, Hall of Fame 2009-11-26T04:01:45-05:00 http://www.maverickhealth.com/site/mammogram-recommendation-what-to-do-now/ http://www.maverickhealth.com/site/mammogram-recommendation-what-to-do-now/#When:04:01:43Z Last week the U.S. Preventive Task Force Services (USPTF) recommended that screening mammograms were no longer routinely required for women in their 40s and that self-breast exam is no longer advised. What!? Is this just cost-cutting or is this good medicine? Read this post to learn more.Last week the U.S. Preventive Task Force Services (USPTF) recommended that screening mammograms were no longer routinely required for women in their 40s and that self-breast exam is no longer advised. What!? Is this just cost-cutting or is this good medicine? Mammogram Recommendation for Whom? Before deciding how to react to these guidelines and whether to follow them or not, the first order of business is to put them in perspective in terms of your own personal and comprehensive health care plan. It is our position here at Maverick Health that neither doctors, task forces, organized medicine nor insurance companies should be in charge of your health and health care – you should. Government agencies (like the USPTF), doctors and insurance companies exist to serve you – not to dictate to you. To get the most out of these services, you must be the one in charge. This means taking on more responsibility for knowing your own circumstances. That’s how you will be able to determine where you fit into these new guidelines. These government agencies come up with these recommendations for whole populations – but treatment decisions must be made by and for individuals. Health Risk Screening in General Cancer and, in fact, all health screenings are designed to discover and treat diseases that may not yet be causing symptoms. The goal of screening is early detection to (hopefully) cure but at least treat problems before they develop into chronic diseases or cause death. Different people have different levels of risk for a long list of chronic diseases and cancers. Risks are the result of family history, personal lifestyle behaviors and, to some extent, luck. I wrote my book, A Nurse Practitioner’s Guide to Smart Health Choices, specifically to help non-medical readers determine their particular risk profile so they are able to direct their health and health care intelligently. Different individuals have different risk tolerances and your choice about what to do about these recommendations depends a lot on your own personal risk tolerance. You may love taking risks. Does jumping out of airplanes sound fun to you? Or you may hate risk. Do you find stepping outside your own home so risky you dread doing it? Most of us fall somewhere in between these two extremes, but our attitudes about risk determine how we choose to handle our health and health care. One size does not fit all. The USPTF Mammogram Recommendation The USPTF recommendation statement was directed at “women 40 years or older who are not at increased risk for breast cancer by virtue of a known underlying genetic mutation (i.e. a strong family history of breast cancer or known BRCA 1 or BRCA 2 genes from prior genetic testing) or a history of chest radiation.” The six USPTF conclusions were: For biennial screening mammography in women aged 40 to 49 years, there is moderate certainty that the net benefit is small. Although the USPSTF recognizes that the benefit of screening seems equivalent for women aged 40 to 49 years and 50 to 59 years, the incidence of breast cancer and the consequences differ. The USPSTF emphasizes the adverse consequences for most women—who will not develop breast cancer—and therefore use the number needed to screen to save 1 life as its metric. By this metric, the USPSTF concludes that there is moderate evidence that the net benefit is small for women aged 40 to 49 years. For biennial screening mammography in women aged 50 to 74 years, there is moderate certainty that the net benefit is moderate. For screening mammography in women 75 years or older, evidence is lacking and the balance of benefits and harms cannot be determined. For the teaching of BSE (breast self exam), there is moderate certainty that the harms outweigh the benefits. For CBE (clinical breast exam) as a supplement to mammography, evidence is lacking and the balance of benefits and harms cannot be determined. For digital mammography and MRI as a replacement for mammography, the evidence is lacking and the balance of benefits and harms cannot be determined. What I Tell My Patients My clinical concern and responsibility is taking care of individuals, not populations. A single case missed is one too many as far as I am concerned. Even though mammography is not the most perfect test in the world, particularly in women under age 50, the practice of combination screening with mammography, an annual clinical breast exam and monthly or bimonthly self breast exam is the best we’ve got at present in my opinion. I plan to continue to recommend a baseline mammogram between age 35 and 40 and will determine frequency after that based on each woman’s particular risks and her financial ability to pay for the mammogram. As for the issue of “adverse consequences” raised by the task force (i.e. anxiety surrounding testing or additional testing such as ultrasounds or biopsies if the mammogram is questionable), that is a non-issue in my opinion. A little anxiety surrounding screening or diagnostic testing pales in comparison to the anxiety associated with a diagnosis of breast cancer. If the mammogram is questionable additional testing clarifies an individual’s breast status at any age. For women 50 to 74 years I’ll continue to recommend annual breast surveillance consisting of screening mammography, annual clinical breast exam and monthly or bimonthly self breast exam. Breast cancer risk increases with age. For women 75 and older in good health I will continue to recommend annual breast surveillance consisting of screening mammography, annual clinical breast exam and monthly or bimonthly self breast exam. Exceptions are when women are in poor health and would not be good candidates for breast cancer treatment or women who tell me that if they learned they had breast cancer they would not want any treatment. This recommendation I really do not understand. What possible “harms” can come from examining one’s own breasts for lumps and who exactly would be harmed? Why anyone would recommend women stop self breast exams is beyond me. My sister picked up her own breast cancer with self breast exam only a few months after her mammogram missed it. Because she caught it early her treatment was less invasive and more likely to have resulted in a cure. I will continue to encourage and teach self breast exams to my patients. For clinical breast exam (done by your health professional at your physical exam) they are saying they don’t know if it does any good or not. I haven’t picked up many breast cancers that way over the years, but I’ve picked up a few. In my practice we recommend annual physical exams, though the “benefit” of those too is under question. It’s an opportunity to do a very detailed exam of the whole body (not just a gynecological exam), check on whether health screenings are all up to date, and teach things like self breast exams and self skin exams among other things. Digital mammography and breast MRI are also question marks as far as the task force is concerned. At present radiology centers are upgrading to digital and that will be the new standard. Skilled radiologists reading the films – whether plain or digital – are still an essential component. In in the last study I read radiologists are still beating the computers in reading digital mammograms. Breast MRIs are expensive and currently used only for high risk patients or as a follow up to abnormal mammograms. Postscript on PAPs Just a couple of days after the USPTF announced their new recommendations the American College of Obstetricians and Gynecologists (ACOG) in a press release announced their own new recommendations that PAP smears can now be delayed until age 21 and only need to be done every couple of years. FYI: These two new recommendations released during the same week were completely coincidental. They were issued by two different and unrelated organizations and are in no way a “conspiracy” to deprive women of health care. For now mammograms are still being covered in the same way by insurance companies they have always been. As for the PAPs, women younger than 21 who are sexually active should definitely see a health professional about their gynecological care every year. Topics for discussion are: birth control options, HPV vaccination, timing of PAP smears, sexually transmitted disease risks and safe sex practices. Bottom line: The best person to take care of you is you. If you’re lucky you have a competent and understanding health professional in the form of a nurse practitioner, physician or physician assistant to help you and advocate for you. If you don’t – see if you can find one. Your comments are welcomed. This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional. Diseases, Cancer, Health Groups, Women 2009-11-20T04:01:43-05:00 http://www.maverickhealth.com/site/how-to-lower-prescription-drug-costs/ http://www.maverickhealth.com/site/how-to-lower-prescription-drug-costs/#When:04:01:55Z I have an idea about how to lower prescription drug costs and save millions (if not billions) of wasted dollars. I know how to decrease confusion and eliminate much of the unnecessary anxiety related to prescription drugs. And I know how to decrease the cost of prescription drugs for individuals. How? Pass a law to make it illegal for drug companies to advertise directly to consumers. Read on see why this is good idea.I have an idea about how to lower prescription drug costs and save millions (if not billions) of wasted dollars. I know how to decrease confusion and eliminate much of the unnecessary anxiety related to prescription drugs. And I know how to decrease the cost of prescription drugs for individuals. How? Pass a law to make it illegal for drug companies to advertise directly to consumers. The Paradox of the American Health Care Consumer I find many of my patients resistant to any drug therapy whatsoever – even if it will prolong their life and reduce their risk of chronic diseases or catastrophic events like a heart attacks or strokes. Yet direct-to-consumer advertising sells these very same patients medications they do not need for conditions they do not have and they come to the office actually asking for them by name. And what do the drug companies get out of it? Billions and billions of dollars from blockbuster drugs is what. Drug companies didn’t begin marketing to consumers until the 1980s. Before that they marketed only the health care professionals – mostly doctors. Today, however, drug companies’ goal is to get patients to ask for a drug – whether they need it or not – because it’s more profitable for the drug companies that way. In the old days they had to convince and then wait for prescribers to decide to use a drug. The only way to create a blockbuster drug is to get people asking for it who don’t even need it. This is a corner of the health care system that really needs reformed but I haven’t heard of any plans to do it. The Cost of Blockbuster Drugs and Direct-to-Consumer Drug Advertising The October 2009 AARP Bulletin printed a list of the 50 Most Prescribed Drugs in 2008 and their cost at the pharmacy. They pointed out that prescription drugs account for 10% of the nation’s total health care costs. And though brand name drugs (versus cheaper generics) make up only 22% of the top 50 drugs they account for 62% of the total expense. The total cost of prescriptions drugs in 2008 was 53.2 billion according to AARP. A recent story on NPR’s Morning Edition reported that drug companies are spending $4 billion a year on direct-to-consumer advertising. NPR reported that Neilson (the company that does TV ratings) estimates there is an average of 80 drug ads every hour on TV. Can you imagine the money that’s costing? But given the money the drug companies are raking in, to them it’s worth it. It’s we consumers who can’t afford it! The problem as I see it is that the more they spend on direct-to-consumer advertising the more they have to rake in to cover their advertising costs. And how do they do that? Higher drug prices, of course. Compare Brand Name Drug Costs with Generic Equivalents Here are just a few comparisons from the AARP Top 50 List with the total cost of brand name drugs (listed first) versus their equivalent generics (listed second). Notice how many extra billions are flowing back to the drug companies just in these few examples. Cholesterol Lowering Medication: Lipitor: $5.88 billion (for 49 million prescriptions) Simvastatin: $1.45 billion (for 60 million prescriptions) Reflux/Heartburn Medication: Nexium: $4.79 billion (for 27 million prescriptions) Omeprazole: $1.15 billion (for 29 million prescriptions) Depression Medication: Lexapro: $2.41 billion (for 26 million prescriptions) Sertraline: $648 million (for 30 million prescritions) High Blood Pressure Medication: Diovan: $1.28 billion (for 16 million prescriptions) No generic equivalent in this drug class Blood Thinner Medication: Plavix: $3.80 billion (for 25 million prescriptions) Warfarin; $317 million (for 23 million prescriptions) Are Drug Companies Serving the Public or Serving Themselves? Finding the right medication for a patient involves correctly diagnosing their condition, knowing their medical history, knowing their drug tolerances and intolerances and then choosing a medication that accomplishes three things: Does not cause side effects. Acheives the desired therapeutic effect. Is affordable. The drug companies argue, “We need these profits for research and development or else we won’t be able to find new cures.” Here’s what I think. I think if they put a complete halt to direct-to-consumer advertising they could use part of the $4 billion they are now spending on advertising to make brand named drugs more affordable. Then they could use the rest to get back to what should be their core business – finding new drugs and new cures. I think they should get out of the advertising business and back into the pharmaceutical business. Anybody out there agree with me? This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional. Rants & Raves, Behaviors, Medication, Health Groups, Women, Men, Elders 2009-11-05T04:01:55-05:00