Sandeep Jauhar is a cardiologist and the director of the Heart Failure Program at Long Island Jewish Medical Center. He writes regularly for The New York Times and The New England Journal of Medicine. Intern: A Doctor's Initiation is his first book. Information about the book is available at www.sandeepjauhar.com.

Sandeep Jauhar--

An elderly woman was recently transferred to my hospital for cardiac catheterization after suffering a heart attack. Unfortunately, by the time she arrived from another hospital, the time window—about 12 hours—for getting benefit from angioplasty, had elapsed. Angioplasty, the procedure that uses tiny balloons and coils of wire called stents to open blockages in the arteries that feed the heart, is the best treatment for a heart attack when performed expeditiously by experienced doctors. The woman is now being treated medically—meaning drugs, but no invasive procedures.

The story of this patient is one we as doctors encounter almost every day: a heart attack victim taken by ambulance to a hospital that isn't equipped to do angioplasty. If she had been brought directly to my hospital, where angioplasty can be performed 24 hours a day, the damage to her heart could have been averted, adding years to her life. But it would have required a degree of coordination and oversight that many ambulance fleets in New York and across the country currently lack.

There is ongoing vigorous debate in the medical community over how acute heart attacks, the quintessential medical emergency, should be treated. With a million cases in the United States every year, acute heart attacks are a major public health problem, and how this debate is settled is bound to have important public health implications.

In Ottawa, Canada, paramedics are specially trained to recognize heart attacks and transport patients to designated angioplasty labs. According to a recent study in The New England Journal of Medicine, the time to treatment is nearly half as long as for patients transferred from emergency rooms (1 hour vs. 2 hours)—and there is a trend toward a survival benefit.

Doing the same thing in the U.S. may prove difficult. Coordinating ambulance fleets in major U.S. cities is a gargantuan task, in part because a large number—30 percent in New York City, for example—are privately owned. A proposal is currently being discussed that would require ambulances in New York to transport patients with heart attacks directly to angioplasty centers, rather than to the nearest hospital. This might seem like a no-brainer, but the project is controversial. Are paramedics knowledgeable enough to recognize acute heart attacks? Money and politics are also in the mix. Smaller hospitals, for example, don’t want to give up the revenue from heart-attack cases.

Paramedics have already learned to take trauma and burn victims to specialized hospitals. Heart attack victims deserve no less, and many more lives are at stake. Many doctors, myself included, are hoping this demonstration project gets underway this year.

Doctors Learn On Patients

A Doctor Shortage In The United States?

Jaci Rae is known as The Queen of More Green. She is the author of several books including this week's Bestseller at Amazon 5 Meals For $5. Other books she's written: Shop For a Day With Jaci Rae, How To Get Almost Anything For Free, and Winning Points With The Woman in Your Life One Touchdown at a Time. Jaci Rae, who was raised in poverty and knows the value of a dollar, can show you that it doesn't have to be a struggle. Recently Jaci Rae went on a shopping spree and filled an entire truck, inside and out for under $400. Jaci is currently working on a Ph.D.

Jaci Rae--

Health care is a grave concern for most American’s today. With the rising costs of everyday living, most American’s are not able to buy health insurance or at the very least, under-insured. How can we cope with the rising costs of health care?

Most families simply forgo a trip to the doctor and hope the ailment goes away. However, there is help. You can get your health care for a lot less than you think you can and in some cases completely free.

Before I share the resources that can help, check your monthly budget and find out if you can afford at least catastrophic health insurance. If you cannot, do not despair.

Here are a few resources that you can contact to find out how to receive free check-ups and health care.

1. Free vision and eye health exams and glasses. Apply through Salvation Army, Catholic Charities, Lion’s Club or United Way.

2. HRSA (U.S. Department of Health and Human Services Health and Resources Services Administration. HRSA supported health care centers let you pay only what you can afford and it is based on your income, even if you do not have health insurance.  Go to their website to find a clinic near you. http://ask.hrsa.gov/pc/

3. The American Foundation for Vision Awareness (AFVA) http://www.opt.indiana.edu/students/org/afva.htm

4. California Children’s Services

Children's Medical Services Branch Office MS 8100
Phone 916-327-1400   Fax 916-327-1106  
Genetically Handicapped Persons Program MS 8105
Phone 800-639-0597   Fax  916-327-1112  
Newborn Hearing Screening Program MS 8103
Phone 877-388-5301   Fax 916-323-8104      Email nhsp3@dhs.ca.gov

5. California Optometric Association

6. Central American Medical Outreach http://www.camo.org/ Phone 504-662-2118 or 504-662-3570 Email camohon@yahoo.com

7.  Healthy Moms Healthy Babies Phone 800-994-6610  Fax 630-792-5636

The following agencies you will need to type their names in Google as there are hundreds around the country and no one office is centralized.

• Pregnancy Resource Center Free Health Clinic
• County Health Services Agency
• Venereal Disease Clinic
• AIDS Program
• Blood Pressure Clinic

• The American Cancer Society Phone: 800-ACS-2345 or 866-228-4327 for TTY
• The American Heart Association Phone:  800-AHA-USA-1 or 800-242-8721
• The American Lung Association Phone: 212-315-8700

Side bar:  If bill collectors from overdue medical bills that you cannot afford are harassing you, there is a way to help either lower the bill, or in a very urgent and final effort, stop the harassing calls permanently. 

The first thing to do is call up the medical provider and ask them for a discount. Work out a deal where you agree to pay so much per month ($10 - $25) in exchange for a lowered bill. Medical offices do not want many defaults on their hands.

It costs their company a lot of money in administration fees as well as collection agency fees. Most will lower your bill by 25% - 75%. I used to work in medical billing and I know from personal experience.

If that does not work and you are already in collections, write the collection agency and tell them very firmly that they may not contact you ever again and you do not want to hear from them ever again via certified mail with signature return on it.

They will not bother you anymore after that. I have that on good authority directly from an attorney I spoke with today for this article. However, that will result in problems with your credit rating, so try to get the bill lowered and work out a payment plan.

People With Lower Incomes, Lower Education Level, Have Higher Death Rates

It's Time For Deep Health Care Reform

Yesterday my home received a phone call from the American Red Cross, asking for my 16-year-old son, who has recently become a blood donor.  Taking a message from their solicitor, I learned that the Red Cross is offering $10 gas cards in return for blood donations.  Should my underage son be encouraged to sell his blood for a gas card?

The American Red Cross states that every two seconds, someone in the United States needs blood. "But only 5% of the eligible US population donates blood in any given year.  Healthy donors are the only source of blood."  Such as my son, who is also a member of his local high school Red Cross chapter.

Blood transfusions are needed for cancer patients, blood disorders, those with sickle cell, anemia, and other diseases.  Blood is also necessary in emergencies, like after an automobile accident.  5 million people in the United States receive blood transfusions every year.

The American Red Cross encourages donors to give, and give regularly, "like eating at your favorite restaurant."

The Top 10 Reasons To Give Blood:

• Free juice and cookies
• You will weigh one pint less after donating
• It's easy and convenient--taking up only one hour of time, there are many donor centers around the country
• You have a surplus of blood
• You can avoid lifting heavy objects as long as you wear a bandaid afterward
• You will feel better about yourself
• You will help ensure that there is blood available when someone needs it--you never know when
• Blood is something you cannot buy
• You may help save a life
• It is the right thing to do.

In addition, I'll add that in college I began to give blood, for free.  It helped me overcome my fear of large needles.  To qualify as a blood donor, the American Red Cross site says that a younger donor must be at least 17-years-old or older, weigh at least 110 pounds, and be in good health.  He probably needs a car too, to spend that gas money on.

Blood Transfusions For Pets?

Were You In The Wrong Place At The Wrong Time?

Unrelenting Anger Causes Disease

Approximately one third of states are not measuring up in the 
fight against cancer by failing to implement laws 
and policies that help people fight the disease, 
according to a new report evaluating state legislative 
activity on cancer policy issues. The report, developed 
by the American Cancer Society Cancer Action Network(SM) 
(ACS CAN) in collaboration with its partner charitable
organization, the American Cancer Society, found that 20 
states reached benchmarks on either none or only one of 
the six legislative priority areas measured in the report.

"With the death rate from cancer continuing a decline 
that began in 1991, we have made great progress in 
the fight against cancer," said Daniel E. Smith, 
president of ACS CAN. "Further progress requires state
legislators to make fighting cancer a priority. 
It's time for all state legislators to do their 
part by enacting state legislation critical to
defeating this deadly disease."

The recent report measures state policies on six 
priority areas: breast and cervical cancer early 
detection program funding; access to care for the
uninsured; colorectal screening coverage laws; 
smoke-free laws; pain management; and tobacco 
taxes. Failure to address these issues effectively
places barriers in front of those who seek 
proper diagnosis, treatment and care when facing cancer.

None of the states met the a set goal in all six 
policy areas measured in the report.

Alabama, Florida, South Carolina, 
Mississippi, North Dakota, Oklahoma, and Tennessee

"As advocates, we have the responsibility to 
educate our constituents on how to prevent 
and fight cancer effectively," said Laura J. Hilderley,
RN, MS, volunteer chair of the ACS CAN board of 
directors. "But we cannot do it without the 
help of state and local policymakers. ACS CAN joins the
Society in urging legislators to remove those barriers 
that prevent the
proper diagnosis, treatment and care of cancer patients."

"Between July 1, 2007 and June 30, 2008, five states
implemented comprehensive smoke-free laws, protecting 
workers and patrons from the hazards of secondhand smoke 
and ensuring that more than 60 percent of the
U.S. population is covered by such laws.

In addition, 10 states increased their match funding 
for the National Breast and Cervical Cancer Early 
Detection Program, and a number of states created new 
programs to screen uninsured residents for colon cancer.

Five states increased their tobacco taxes, bringing 
to 44 the number of states with tobacco tax increases 
since 2002. Nearly half the country met ACS CAN's 
and the Society's benchmark of raising the tobacco 
excise tax to at least $1.14 per pack of cigarettes. 
Statistics have shown that increasing the cigarette 
tax is one of the most effective ways to reduce
smoking, especially among children. Studies show 
that every 10 percent increase in the price of cigarettes 
reduces youth smoking by 7 percent and
overall cigarette consumption by about 4 percent."

 Other findings detailed in the report:

 -- Only eight states have reached benchmarks in 
providing screenings for breast and cervical 
cancer early detection.

 -- Twenty-five states and the District of Columbia 
have laws that ensure private insurance coverage for 
the full range of colon cancer
screening tests.

 -- Twenty-five states have uninsured rates of 16 
percent (the national average) or higher.

 -- Twenty-seven states met the benchmark on 
cancer pain management policy and practice.

 -- 2008 is the second consecutive year that 
Florida, Tennessee, and South Carolina have not 
hit a single benchmark.

 The report also covers the challenges of ensuring 
access to quality,affordable health care for all Americans. 
This year, more than 1.4 million people in America will 
be diagnosed with cancer and another 565,000 will
die from the disease. Almost 47 million people in 
America are uninsured and more than 25 million are 
underinsured. Countless Americans are needlessly
losing their battle against cancer because they 
cannot gain access to the lifesaving care they need. 
ACS CAN, in partnership with the Society, is
dedicated to ensuring that quality health care 
is available to all Americans. Meaningful reform 
must include adequate, available, affordable,
and administratively simple health insurance 
coverage for all, regardless of health status or risk.

Other issues examined in the report include: 
tobacco cessation services and tobacco prevention 
program funding, nutrition and physical activity,
Medicaid and cancer treatment and high-risk 
health insurance pools.

A copy of the complete report is available online 
at the American Cancer Society.

ACS CAN, the nonprofit, nonpartisan advocacy 
partner of the American Cancer Society, supports 
evidence-based policy and legislative solutions
designed to eliminate cancer as a major health 
problem. ACS CAN works to encourage elected officials 
and candidates to make cancer a top national
priority. ACS CAN gives ordinary people extraordinary 
power to fight cancer with the training and tools 
they need to make their voices heard. For more
information, visit the American Cancer Society.

_{SOURCE American Cancer Society Cancer Action Network}

Senator McCain To Share His Cancer Plan
Texas Holds The Cure To Cancer
The End of Cancer Begins With Everyone Standing Up

Suzy Cohen, R. Ph., is a licensed pharmacist with nearly 20 years of clinical experience. The author of The 24-Hour Pharmacist (HarperCollins, July '07), she is "America's Most Trusted Pharmacist," and has helped millions of patients in various clinical settings, such as retail, hospital, nursing home pharmacies, and through  her nationally syndicated column, "Dear Pharmacist." A former spokesperson for the National Association of Chain Drug Stores, Suzy Cohen is a member of the Institute of Functional Medicine, The Association of Natural Medicine Pharmacists and The American Pharmacists Association. You can subscribe to Suzy's free weekly newsletter or ask her a question at her DearPharmacist website.

Suzy Cohen--

And The Dumberest Award in Medicine Goes To…

Dear Pharmacist,
I know you are a pharmacist who is zealous about natural medicine. So I have to ask you, if you are ever frustrated with all the new medications being promoted? Do you think any of them are useful for us to take? -- KS Tulsa, Oklahoma

Answer: Sure some medications are useful, and very important, like painkillers, heart rhythm drugs, epilepsy drugs, anesthesia and meds used to prevent organ transplant rejection just to name a few. I confess however, that ridiculous stuff does happen in the health industry. So at this time, I’m offering you my First Ever Presentation of Dumb Awards:

Dumb Award: The first ones goes to (drum roll please)…The FDA because they approve recycled drugs. For example, when a prescription medication loses patent, and cheaper generics come onto the market (think of Claritin for allergies), the FDA gets pre$$ure from manufacturers to approve a brand new (and improved?) version of the same drug (called Clarinex). So one drug gets re-birthed into the marketplace with a new name and higher price tag. Cha-Ching!

Dumber Award: We have a tie between birth control pills and Accutane. Let’s start with birth control pills: They prevent pregnancy, of course, but they’re often prescribed to young girls to treat severe acne. The pill has been associated with cancer, heart disease, weight gain, blood clots and stroke. Now for Accutane or “isotretinoin.” It’s been tied to suicide. For real! It has also caused deformities in babies, so today, women of child-bearing are not even allowed to take the drug unless they are also on the pill. I would recommend Clearasil and condoms before I recommended this combination of drugs.

Dumberest Award: (Throw confetti here)… Statins! I don’t think that cholesterol is so bad, and these drugs lower it vigorously. I can’t find one study that proves statins make you live any longer. Inflammation and nutritional deficiencies will continue to damage your heart, even if you have perfect cholesterol. It’s like blowing the smoke out of the house while the fire continues to burn. And statins drugs can cause muscle aches, depression, leg cramps and erectile dysfunction. Dumb or brilliant? Depends what side of the counter you’re on. If you want natural options to prevent heart disease, read Chapter two of my book, The 24-Hour Pharmacist.

Honorary Mention goes to the FCC (Federal Communications Commission) for allowing drug commercials to bombard our airwaves. People used to have to go to the doctor for a diagnosis, now they can just chill out, have a bag of artery-clogging chips and watch TV. Within minutes, you will discover what disorders all of your friends and relatives have… and of course, the newest drug to suggest to them for their bizarre conditions. But tell them not to stress because you also found a way for them to save hundreds by switching to Geico!

Did You Know?
Pau D’Arco supplement or tea may help you with arthritis, diabetes, auto-immune disorders and even cancer.

(This information is not intended to treat, cure or diagnose your condition. Suzy Cohen is the author of “The 24-Hour Pharmacist.” For more information, visit www.DearPharmacist.com)

© 2008 Suzy Cohen, RPh.

Some Pills Make You Pack On The Pounds

Some Medications Increase Skin Cancer Risk

Statins For 8-Year-Olds?

By Richard Schmitz

Society for Women's Health Research

The vast majority of Americans recognize the value of medical research and the importance of human subjects participating in studies. But when it comes to volunteering for research, there’s a lot of hesitation.

Less than 10 percent of Americans have participated in a medical research study of any type, according to a May 2008 survey of more than 2,000 U.S. adults by the Society for Women’s Health Research.

Why they would be hesitant to participate? Many say they don’t have the time. That’s not surprising when you consider that Americans increasingly say the length and quality of their leisure time is on the decline.

Participating in research involves personal sacrifice, including time—time spent traveling to and from a research facility or doctor’s office and time spent participating in the study. 

Thanks to the Internet, there are now opportunities to participate in research online. Some studies, which only need patient responses on their behavior patterns or experiences, can take place entirely online. That’s good news for patients who want to volunteer for research, but feel they can’t because of work, family and other time consuming commitments.

For example, patients are now being recruited for an online study that is measuring cognitive limitations of women breast cancer survivors who return to work. The study is being led by Lt. Lisseth Calvio, M.S., of the U.S. Navy, who is a doctoral student in clinical psychology at the Uniformed Services University of the Health Sciences in Bethesda, Md.

The study is looking for female breast cancer survivors, one to 10 years after primary treatment, such as surgery, radiation or chemotherapy, and women who have never had cancer. The women should be working full time and be between the ages of 18 and 65.

“The study is trying to verify the best way to measure cognitive limitations,” Calvio said. “A lot of breast cancer patients are expressing changes in their cognitive function. First, how do we measure that?  Once that is determined, we can develop strategies to treat or help cancer survivors.”

Over 80 percent of breast cancer patients return to the workforce within a year of their primary treatment. There is growing evidence that some breast cancer survivors show impaired cognitive performance after treatment, which could impact their ability to resume a normal and full functioning life, including work.

Participants in the study will take a short online questionnaire and a test of memory, attention and organization that takes 60 to 75 minutes to complete. The study can be taken by anyone with a computer and an Internet connection greater than dial-up.

There are advantages of an online study for both the researchers and participants.

“It allows us to cast a wider net and obtain a larger sample size” Calvio said. “Online studies can attract more diverse populations.  People of different backgrounds are going online more and more.”

That’s an important point, considering that residents in rural areas or cities without major medical facilities are less likely to participate in research because of the distance they must travel.

A study published in the July 10 issue of the Journal of Clinical Oncology examines research participation in Maryland and finds the state’s rural and minority residents are underrepresented in federally funded cancer treatment clinical trials. 

“Without adequate diversity, it may be difficult to generalize about trial results because you don’t know whether new treatments or preventive strategies have comparable effects” for different groups of patients, according to Claudia R. Baquet, M.D., lead author of the study and director of the University of Maryland’s Center for Health Disparities Research and Outreach.

As research techniques evolve and computer access grows, the Internet may play an increasing role in closing those gaps.

To find out about other research participation opportunities, including online opportunities, visit http://clinicaltrials.gov/, a Web site from the National Institutes of Health. Information tailored for women about the process of participating in research is available from the Society for Women’s Health Research at http://www.womancando.org/. Individuals can find out if they’re eligible for the breast cancer cognitive function study by answering nine short questions at this Web site: http://cim.usuhs.mil/cancerstudy

The Top Three Hospitals For 2008

The Breast Cancer Survival Manual

A Doctor Shortage in the United States?

RTI International conducted the annual U.S. News & World Report's Best Hospitals rankings, which named Johns Hopkins Hospital, Mayo Clinic and Ronald Reagan UCLA Medical Center as the top three "honor roll" hospitals for 2008. Researchers at RTI collected and analyzed the data and survey information behind the rankings using a respected and well-established methodology, which combined original survey data with secondary analyses of data from various sources, primarily the American Hospital Association and the Centers for Medicare and Medicaid Services. This year's version ranks hospitals in 16 different specialties, ranging from cancer to ophthalmology to geriatric care. The pediatrics rankings were published separately in an issue dated June 9. For the first time, data for all eligible hospitals, not just those printed in the magazine, are available on the U.S. News & World Report Web site. The honor roll includes 19 hospitals that ranked high in six or more specialties. Altogether 170 different hospitals were ranked in at least one specialty. To qualify for ranking consideration, hospitals in 12 of those specialties had to satisfy at least one of three requirements: membership in the Council of Teaching Hospitals, affiliation with a medical school, or offer at least six of 13 important advanced services. Of 5,453 community hospitals in the United States, 1,559 qualified for consideration. Once accepted for consideration, hospitals had to meet a series of progressively tougher standards to be ranked in those 12 specialties. In the other four specialties, where procedures are often performed on an outpatient basis or Medicare data are unavailable, a hospital's reputation with specialized physicians was the only criterion. For consideration within a specialty, a hospital must have performed a significant number of defined procedures, or had to have been recommended by at least one physician in the U.S. News & World Report surveys for any of the past three surveys. Hospitals received a score based on three key components: care-related considerations such as technology and nursing, reputation and mortality. These three components represent the three key aspects of quality hospital care: structure, process and outcomes. Hospitals were ranked by their scores. "We are very happy to continue collaborating with U.S. News & World Report to provide these rankings for consumers," said Joe Murphy, project director and research methodologist at RTI International. "With data on all eligible hospitals now available on the web, the rankings provide an even more useful resource for making comparisons and informing the health care decision process." In addition to compiling the rankings, RTI conducts an ongoing evaluation of the study methodology. More information about the methodology is available at www.rti.org/besthospitals .

Mayo Clinic Trustees Launch Public Phase of $125 Billion Philanthropy Campaign

People With Lower Incomes, Lower Education Levels Have Higher Death Rates