HSA/FSA…the new Alphabet Soup of Healthcare

Posted on June 2, 2010 by Dr. Kevin

As a health provider I have seen a huge swing in health care reimbursement in the last few years. The days of $5 co-pays seem to be long gone! A patient came into the office last week with a $45 co-pay, which was laughable due to the fact that his health insurance company only paid $42 per visit. Their co-pay was more than what the company was paying me under contract!!!

In order to offset the sting of high deductibles and co-pays, companies are allowing employees to put pre-tax salary away to pay for these health costs. As of 2010, the limit is $5000. This is typically called an FSA (Flex Spending Account)or an HSA (Health Saving Account)…is there a difference? Yes, a big one!

First please let me explain some basics. You decide that over the course of a year it is reasonable that you are going to spend $3,000 on health care. You tell your employer, during open enrollment, and they begin deducting money out of your check…PRE-TAX! That could be a huge savings if you are climbing into the high tax bracket.

Let’s say you have a $2000 deductible on your plan and your company has graciously agreed to pay this for you. You would receive an HSA card that you would use to pay down your deductible. This card is a SAVINGS account and that is an important distinction, you get to keep this money from year to year.

Now instead of a $2,000 deductible, your employer has decided to raise the co-pays in order to keep the monthly payments down. You go to your local chiropractor, think me, and are shocked when I tell you that your co-pay for today is $30. In order to offset this sting, you have told your employer to put $1000 away for you for these exact expenses. This would be called an FSA. Here is the kicker, at the end of the year, whatever you don’t spend…you lose, the money goes back to your company!!

Most companies today are making it easier and easier to use these funds. In the old days, you would have to send in receipts and wait for a check. Now these companies are issuing debit cards that allow you to charge your account directly saving you a lot of hassle.

If you are unsure of the benefits or want to learn more about HSA and FSA accounts please visit here and the IRS will be happy to get into more details.

Please do not forget, if you have money in an FSA at the end of the year, get out there and spend it or it will be gone forever!

Word of the Day: Telomere

Posted on January 28, 2010 by Dr. Kevin

Telomeres are the little white ends

What if I told you one of the most important words in your health vocabulary should be telomere. Let me give you a quick definition and you should immediately understand what I am talking about. A telomere is the end of a chromosome. These specialized structures are involved in the replication and stability of linear DNA molecules.

Wait….what?

In all seriosness, anti aging experts now believe that telomeres may be the key to staying young and more importantly staying healthy. What the experts now know is when the telomere shortens the cell it is living in dies. This is important in that cell death can lead to serious disease as well as pre mature aging.

The experts are now focusing creating therapies to lengthen already shortened telomeres or even better yet, how to prevent them from shortening in the first place.

What have they found works well in preventing telomere shortening….Exercise. Research shows that people who exercise have less erosion of their telomeres than people who are healthy but are not very active.

Last post I encouraged people to get out and vote. This post I am encouraging you to just plain get out and get moving….your telomeres are depending on it.

Get out the Vote!

Posted on January 11, 2010 by Dr. Kevin

First off, please accept my apologies for the space between posts. Between the holidays and the start of high school hockey I have slacked here…no more I promise. For those of you who are interested I coach a high school hockey team and you can follow our progress either through our website (www.ccchsboyshockey.com) or follow us on twitter where we live update the games between periods (www.twitter.com/cchsboyshockey).

While I have always refrained from talking politics in the office, I feel very passionately about the upcoming Massachusetts state election on January 19th, 2010. The two candidates are:

Martha Coakley www.marthacoakley.com

Scott Brown, www.brownforussenate.com

This election will be crucial in the health care debate.

Ms. Coakley in a word is for the health care plan that is being voted on, while Mr. Brown in a word is against this plan.

While I don’t judge and do not want to turn this into a political debate, I would encourage everyone to take a few minutes out of their day and research both the pros and cons of the current health care plan that is being proposed.

For sure there are no easy answers. While most people would agree that more people under insurance care is better, others would ask how are we going to pay for this. These are all issues that you should research before you head to the poll on the 19th.

Given how close the health care vote is sure to be, many national political pundits believe that the winner of the Mass election may be the swing vote in whether or not this plan gets passed, it is imperative that we get out and show not just the state, but the entire country that we care and are passionate about electing our leaders.

Please do your homework and get out and vote on the 19th!

Case of the Month October 2009

Posted on October 26, 2009 by Dr. Kevin

Mrs. X presented to the office with bilateral carpal tunnel.

First a little background. Carpal tunnel is a common term for pain in the wrist. For many years it was assumed that because the pain was in the wrist, then the problem was originating in the wrist. Chiropractors have worked to show there may be other factors that influence the pain in the wrist, including neck misalignment, muscle spasm and joint misalignment.

Back to the patient. Mrs. X reported no significant history of trauma. She did report that she spent between 8 and 1o hours at the computer, with about half of that on a laptop. When asked to reproduce her work position I noted there was significant leaning forward with a lot of slumping of the shoulders.

Examination showed significant restrictions in the neck and muscle spasm in the shoulders and forearms. X-Ray exam showed a 7 degree curve in the neck, where 45 is ideal and 36mm of forward head carriage.

After going through my findings with Mrs. X I suggested a 5 visit trial where I would get to see how she responded to the care and she would determine if this course of care was for her. Care consisted of neck and midback adjustments, extension traction and trigger point therapy. After evaluating the wrists, I made the decision to not mobilize the wrists as I judged they were already moving well.

On the first visit I asked Mrs. X to rate the pain in the wrists, it came in at a 7. I adjusted Mrs. X, had her stretch and worked on the muscle spasm in the forearms. This went on for 5 visits.

At the beginning of the fifth visit, Mrs. X reported her wrist pain had improved to a 3!!! As excited as she was about this, her objective changes were what was getting me fired up. The muscle spasm in the forearms was significantly better, the restrictions in the neck were clearing up and I was even seeing a change in her posture.

This is a classic example of the pain being in one area but the problem located in another area.

If you would like to see a research report that shows chiropractic as effective as taking a bunch of pain killers for carpal tunnel click here. Please remember, what we did with Mrs. X involved no drugs, which for sure saved some wear and tear on the liver, stomach, etc.

Can We Trust the FDA?

Posted on October 13, 2009 by Dr. Kevin

The Food and Drug Administration (FDA) is a federal agency in the Department of Health and Human Services established to regulate the release of new foods and health-related products. Health related products includes but are not limited to medicine, cosmetics, supplements, and even certain veterinary products. Their mission is to be responsible for ensuring that foods are safe, wholesome and sanitary; human and veterinary drugs, biological products and medical devices are safe and effective; cosmetics are safe; and electronic products that emit radiation are safe.

In a nutshell, we trust them to have our back when new products hit the market.

There have always been whispers that the FDA was ignoring the risks of artificial sweeteners, that they had been bought off by the companies that produced and used them. MSG was another one that people have forever said the FDA is looking the other way despite mounting evidence that it may not be all that great for you.

Most of these claims were written off to conspiracy theorists with nothing better to do…..until now.

The FDA recently came out and admitted that 2 senators and 2 representatives from New Jersey placed undo influence on the FDA to approve a knee operation patch made by the company ReGen Biologics, which happens to be located in New Jersey. The well wishing senators claim that the money that was donated to their coffers, around $26,000, had nothing to do with the pressure they put on the FDA, they were merely looking out for a constituent company.

Here is how it went down. The agency’s scientists for years unanimously ruled that this device was unsafe due to a high failure rate, forcing the patient to have another surgery. A clinical trial of the device failed to show that it worked any better than routine surgery. That should have been the end of it, however, the agency managers overruled the scientists and approved the device for use.

The FDA’s report said that its Office of Legislation began receiving calls from members of Congress in December 2007 complaining about its review of the device, and the office’s director “described the pressure from the Hill as the most extreme he had seen.”

With all this pressure from the Congress the FDA caved and approved a device that does not appear to work. The San Antonio Spurs, of the NBA, orthopedic physician Dr. David R. Schmidt said he was involved in the original clinical trial of ReGen’s Menaflex device and concluded that patients did not benefit. He said he was surprised that the FDA approved it.

In January, the Government Accountability Office concluded that it was long past time that the agency demanded that manufacturers prove that all complex devices are safe and effective before being approved for sale.

What should we make of this? Do we need more oversight? Do we really want politicians placing calls to the FDA to approve things that shouldn’t get approved?

Hopefully in the future these agencies can stay above the fray of campaign finance and rule on things as they see fit.

Doctors Getting Paid To Market Drugs

Posted on October 5, 2009 by Dr. Kevin

Drug Marketing

A while back I wrote a post on a drug company, Eli Lilly, using ghost writers to write favorable articles and having doctor’s sign their names to them as if they had written them. You can read that here. At best it is a murky situation.

Recently, Eli Lilly was back in the news here in Boston, when the Boston Globe reported that at least 60 area doctors received more than a half million dollars in speakers fees.

A very common practice in the drug industry is to hire physicians as speakers , provide them with the literature on the drug they are marketing, and turn them loose speaking on behalf of the company that hired them.

Imagine the difference in credibility between a drug salesman and a renowned doctor. When that doctor, whom may be at the top of their field, speaks people will listen. The drug companies know this and have very smartly used the doctor’s credibility to help them push drugs through these talks. The question I have is this: Hasn’t that doctor become nothing more that a glorified drug salesman? Is their credibility now under fire? I think it has to be and I am not alone in those thoughts.

Mass General researcher, Eric Campbell found out that 16% of all US doctors and 25% of hospital department heads belong to one speaking bureau or another. Mr Campbell is quoted as saying, “Academics who want to be drug salesmen should go be drug salesman. But don’t do it under the shroud of academia.’’

Everyone from politicians to other physicians are voicing concern that these company paid doctors cannot give unbiased information, whether that may be downplaying the side effects of a drug or not talking about the generic equivalent which would cost less.

What do these doctor’s whom are paid this money say? They claim they vet all information and would only present material that they believe in, even if the company is the one providing the material. They also claim these talks are great ways to educate other doctors about new drugs. Although one doctor did admit he was doing the talks in order to cover his children’s college tuition.

The public is starting to wake up to this and put pressure on these companies to disclose their financial relationship with doctors. To their credit Eli Lilly released a list of all their paid speakers. Good for them, it is nice to see that the much asked for transparency is starting to become reality.

Because of this debate and other problems – pharmaceutical firms have paid millions in fines for illegally marketing medications – companies are under political pressure to disclose their financial relationships with doctors. Lilly is one of the first companies to publicly release a list of paid consultants and speakers.

In January the FDA reported they were fining Eli Lilly 1.4 billion dollars for illegally marketing a drug. That is a lot of money until you realize that Eli Lilly did 20.38 billion in sales in 2008.

The drug they are getting fined over….in 2006 did 4.7 billion in sales.

Now let me ask you this, if I told you I would let you market a drug to 4.7 billion in sales, but if you get caught you would have to pay a fine of 1.4 billion would you take that deal? Darn right you would.

Paying doctors to market drugs needs a complete overhaul. We need to be demanding complete transparency. Good for Eli Lilly to be the first one to do it, let’s hope it keeps going.

Could the Sun Help You Fight the Flu?

Posted on September 28, 2009 by Dr. Kevin

Vitamin D, a powerful, natural antibiotic

Skin cancer is a huge topic of concern for lots of people. As someone who is, shall we say, pigment challenged, I make a point to use sunscreen when I am out and will try to avoid spending too much time in the sun in the middle of the day. While this is for sure keeping my skin healthy, is it helping me with the flu?

The sun is a huge source of Vitamin D, a key vitamin for health that is not readily available in the diet. Yes you can get get some Vitamin D from drinking milk, however, the amount is so paltry it is almost a waste of time.

Recently there was a study published in Nature Journal where a group of scientists from UCLA confirmed two recent studies the showed we have a naturally occurring steroid hormone that in short is a powerful antibiotic. This antibiotic increases the body’s production of a certain protein that is instrumental in destroying the cell walls of lots of bad stuff, including the flu virus. Oh the name of this steroid hormone, yes Vitamin D.

Ever notice that tons of people get sick in the winter? Ever wonder why? What do we do in the winter, we stay inside. We limit our exposure to sunlight.

The elderly die much more in the winter than in the summer, is this a coincidence?

So what do we do about it?

There are several options. First is spend a LITTLE time in the sun. 15 minutes a day every other day will do the body a ton of good. If you can do this, most likely you won’t need anything else. If getting outside is not an option, diet is the next step. Food high in Vitamin D include…well nothing you really want to eat, let’ s be honest here. If you are willing to ingest a bunch of cod liver oil, well let’s say you are a better person than I am.

Lastly you can go the supplement way. Just a word of caution there is a small chance that you can overdo it with the supplements, although a recent expert had this to say, “Worrying about vitamin D toxicity or Overdose of vitamin D is like worrying about drowning when you are dying of thirst.”

If you choose to go the supplement route, make sure you check with your doctor as to any contra-indications that may be present. There is discussion as to how much you should be taking. Most agree that 2,000 units per day is a decent amount. Make sure that you look for vitamin D3, or cholecalcifero if you are shopping for it.

Any questions? Leave me a comment and I will see if I can help you.

If You Try My Free Cream I Will Make You 7 Feet Tall!

Posted on August 10, 2009 by Dr. Kevin

You cannot go anywhere on the web without seeing these crazy ads.

Learn this one rule and lose 3 pounds tomorrow!
Learn how this Boston Mom got whiter teeth!

I never thought anything about them until a couple of patients came in this last month and had fallen prey to these shysters.

If you are unfamiliar with internet marketing, it can be a world of sleazy, bait and switch scammers. The key component to these programs is offering you a free trial that is really never free. You pay a very modest amount for shipping and handling, somewhere between $1.95 and $7.95. If you agree to this they got you.

In the super fine print you are agreeing to spend a lot of money for a product that at best is of questionable

snake-oil-cables effectiveness. Here is a sample of the fine print on one of the weight loss flogs (fake blog):

Start your FREE Trial today and we will send you a full 30 day supply of the xxxxx Acai Weight Loss System dietary supplements. Just pay $3.95 in shipping and processing. You will have 14 days to try the xxxxx Acai Weight Loss System dietary supplements and discover why they are the perfect weight loss dietary supplements for you. If you like how our dietary supplements help reduce body fat, boost metabolism and control your appetite, do nothing. At the end of your free trial period you will be charged the discounted price of $79.95If for any reason the dietary supplements are not for you, call xxxxxx Acai Customer Care toll free at 1–xxx–xxx–xxxx within your 14 day free trial period to cancel. Then simply return the product (even if it is empty!) and you will NEVER be billed any additional amount. No commitments, no hassles.

Plus, if you decide to keep the xxxxx Acai Weight Loss System dietary supplements, you will receive FREE acceptance in Club xxxxx Acai and will receive a fresh supply of the xxxxx Acai Weight Loss System dietary supplements approximately every 30 days at the same low price of $79.95, plus $3.95 for shipping. You can cancel anytime by calling xxxxx Acai Customer Care. No risk, no obligation, cancel any time!

If you click on a couple of these ads you notice a running theme. With the exception of a few personal twists thrown in the stories, pics and even comments on the flog are identical. Here is the running theme:

Personal story of how the mom gained all her weight, almost all blamed having kids
They all tried a bunch of different diets, need I tell you none of them worked, try to hide your shock
Picture of them at their heaviest, right before they tried the magic potion; of course they throw in a picture of how fabulous they look now, after taking the magic potion
Every one of them just happened to tune into Oprah on the day that Dr. Oz spoke of the Acai berry
Saw Dr. Oz the next day on TV talking about another product that would also help lose weight
They all like Dr. Oz and Oprah, so much in fact they all wrote about it; here is the writing from 3 of these flogs, does anything strike you as similar here?

I liked Oprah and Dr. Oz because they themselves were not trying to peddle some product themselves. Oprah and Dr. Oz was trying to get the public understand the health benefits simply taking either an Acai berries or a Colon Cleanse supplement pills. And Rachael Ray did it herself!

What I most like about Oprah and Dr. Oz is that they were not promoting a specific product. They really just wanted to get the word out about the health benefits of using Acai berry and Colon cleanse supplements.

I liked Oprah and Dr. Oz because they themselves were not trying to peddle some product themselves. Oprah and Dr. Oz was trying to get the public understand the health benefits simply taking either an Acai berries or a Simple Cleanser supplement pills. And Rachael Ray did it herself!

Hopefully by now I have convinced you these sites are scams. Not only is the site a scam, the product does not work as advertised. It has gotten so out of control that both Dr. Oz and Rachel Ray have had to come out with statements that they do not endorse these products and their lawyers are going after the scammers.

If you do any sort of google search you will see tons of sites out there with people telling how they couldn’t get rid of the charges. Some even had to go as far as switching bank accounts as some of these companies are not located in the US and are not subject to our laws.

Wait, Dr. Kevin, those flogs all had tons of comments that were universal in their love for the product. Umm yeah, those comments are fake and if you go to any number of the sites, you will see identical comments. This has gotten so out of control that the FTC is now stepping in and dropping the hammer on these sites.

Lastly, if you have been scammed by one of these sites please contact your bank/credit card and see what they can do. If you are insistent on trying one of these products and they ask for your bank account information including routing and account number…..never ever give them those, you will be changing bank accounts shortly and that is a pain.

If after all this you still need to try one of these products, do yourself a favor and go buy a Visa gift card and use that for your trial. If you like the product you can switch to something else after a period of time, that way you are protected in case you don’t like the product and don’t want to go through the hassle of canceling.

Please remember, if it sounds to good to be true it almost always is, except for when hear about how awesome I am. That is the 100% truth!!!!

I Am a Bottled Water Fan!

Posted on August 4, 2009 by Dr. Kevin

Sugar

I know that bottled water is totally not vogue right now and I may be angering some of you with my stance on it, however, I am a huge fan of bottled water. Please let me explain before you scorch me with emails and comments.

Recently, RTI, a non profit research group, health economist Eric Finkelstein offered a blunt message for lawmakers trying to revamp the health care system: “Unless you address obesity, you’re never going to address rising health care costs.”

Dr. Thomas Frieden, director of the US Centers for Disease Control and Prevention, wrote in April in The New England Journal of Medicine, “Sugar sweetened beverages may be the single largest driver of the obesity epidemic.’’

Last year 26 percent of beverages consumed were soda.

The average 20 ounce soda has 17 teaspoons of sugar in it. 17 teaspoons!!! That is an insane amount. Try this; place 17 teaspoons of sugar in a bowl and look at how much sugar is in there. I did it and was horrified.

I don’t think anyone would argue with me that there is no way it is good for you to consume that much sugar in one drink. Please keep in mind that the average person will drink a couple of these a day!!

Last year we as a country spent $147 billion on obesity. For an obese person that adds up to over $1400 per person per year in additional medical costs. The two biggest diseases linked to obesity are heart disease and diabetes.

Would anyone argue that all this sugar contributes to obesity? Of course, the beverage companies that produce these drinks may not be on board with the sugar and obesity link.

“It’s counterproductive when you have folks out there trying to single out one particular product as a unique contributor to a problem so complex,’’ said Kevin Keane, senior vice president of the American Beverage Association, which represents the makers of Coca-Cola, Pepsi, and other leading drinks. “You could get rid of soft drinks tomorrow, and you would still have overweight and obese people.’’

It is counterproductive? No one blames ONLY the soft drinks for contributing to obesity but for sure it is a part. Soda draws people’s ire due to how easy it is to consume all this sugar. When you eat food, the body does a decent job of telling you that you are full and it is time to stop eating. Unfortunately when it comes to drinking the body is not as diligent about telling you when to stop, thus leading to consuming many more calories than you actually need.

How many calories are in bottled water??? None.

Now look, you must be socially aware that bottled water is bad for the environment if you throw them away. You must recycle your bottles, not doing so is just flat out wrong. There are also trucking issues related to delivering the water. Even with all of these factors, the side effect of all the sugar people are consuming still makes the bottled water a better choice, in my opinion.

Now we can argue that paying more for water than gasoline is crazy and I would agree. So why not tap water? There are two reasons that I don’t like tap water. The first is the taste. Every town is different, some towns that water taste great and some taste nasty. If the water taste gross I am less likely to drink it.

The second reason is the chemicals that are present in tap water. I am not a huge fan of them. I feel that bottled water companies like Poland Springs® do a good job of filtering their water to reduce the chemicals better than tap water does.

At the end of the day, I am making the case that bottled water, warts and all, is an excellent choice if you are reaching in the cooler at your favorite sub shob.

It for sure beats drinking all that sugar. Wait you want to drink diet soda, don’t even get me started!

Is This Bad Economy a Good Thing?

Posted on July 30, 2009 by Dr. Kevin

Crazy right, how could there be a silver lining in the economy cloud? Well if you are a little older in age and this economy has forced you to rethink retiring, it may be saving your brain.

There is a promising study out of Britain that studied medical records of 382 men whose Alzheimer’s symptoms emerged around age 75. They found that, all other factors being equal, the symptoms were delayed about seven weeks for each extra year the men worked.

It is very perplexing as to why certain people stay mentally sharp and others aren’t. There is some thought that people posses a trait called cognitive reserve. The reserve refers to the brains ability to cope with damage. The more damage, the greater the chance of Alzheimer’s. The theory is the more you expose yourself to mentally challenging activities, things like; education, work, and volunteering, the more reserve you build. The more reserve you have the better the chance you have off fending off memory loss and dementia.

Unfortunately there is not easy answer as to how much is the right amount.

If you are looking to keep active here are some great choices:

Volunteer. There are so many organizations that need your time. This is a win win. You help out a worthy organization and keep your brain charged up. Get more information here…http://www.volunteermatch.org/
Get a pet. Especially if you are alone. There are a lot of studies out that show having someone to care for at home will help with fighting dementia.
Work part time. There are companies out there that would love to have a reliable, nice person working for them

What does not appear to have any benefit are the brain exercise products, often sold as computer based games. A Rhode Island company, reviewed all of the existing trials on such products and concluded in a study published in Alzheimer’s & Dementia this spring that loss of memory was not helped with these products.

Shameless plug. There is some talk that better blood flow to the brain equates to a lower chance of getting a certain type of Alzheimer’s. Chiropractors improve the bio mechanics in the neck area, thus improving blood flow to that region. Is this a cure, most definitely not. Is there a chance it could help….we’ll see.

The one thing that everyone can agree on…get and stay active. Use it or lose it does not apply only to muscles, it appears to also do the brain a lot of good.

What are you or a loved one doing to stay active? Please comment below.

Author Archives: Dr. Kevin