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E-Cigarettes — Helpful, Risky, or Both?

By Mark A. Kelley, MD |4/9/18
Founder, HealthWeb Navigator

Walking down the street, sometimes I see people who appear to be strolling in a cloud. These folks are wrapped in vapor they inhale from e-cigarettes — a practice called vaping.

Vaping devices first emerged in the late 1990s. They feature a battery-powered heating element that heats up liquid nicotine to create an aerosol, which is free from the toxic byproducts of cigarette combustion. In theory, this device could make it easier and safer for smokers to kick the habit.

As a pulmonary physician, I wince when I hear about people voluntarily inhaling any foreign substance. We are already exposed to more environmental toxins than we realize, and adding something else seems unwise. However, quitting smoking is extremely difficult. Most remedies have been only slightly effective at best. Could vaping help?

After a decade or more of scientific studies, we know a few facts about e-cigarettes, although many questions still remain. Here are the key points:

1. The e-cigarette market is growing. Several studies have shown that between 2010-2013, the use of these devices had more than tripled to include 7% of the U.S. population. Most users are young and/or former smokers. About one-third have never smoked before. Nicotine is highly addictive which is why smokers have difficulty stopping. Vaping is popular among high school students, and their teachers fear that this will lead to cigarette smoking and other addictive habits.

This effect has been observed in a few studies but the trend is unclear. In 2015, the e-cigarette use rate among high school students declined from 16% to 11%. However, there is some evidence that e-cigarette use in high school students is a risk for taking up cigarette smoking.

2. E-cigarettes are safer than regular cigarettes. Both e-cigarette vapor and cigarette smoke contain nicotine, but only cigarette smoke has the harmful products of tobacco combustion. For that reason, most experts consider the e-cigarette to be safer than a regular tobacco cigarettes. However, in both cases, inhaled nicotine stimulates the cardiovascular system. It is unknown whether this effect has long-term consequences such as heart disease or hypertension.

3. E-cigarettes may help smokers quit — but the effect is small. The vast majority of e-cigarette users are current or former smokers. Based on research surveys, these patients are either trying to quit smoking or at least reduce their cigarette consumption. Many studies have compared e-cigarettes to other methods of smoking cessation such as nicotine patches, counseling etc. These studies have been inconclusive. A panel of experts recently suggested that e-cigarettes may slightly improve smoking cessation but the magnitude of the effect is small.

4. It’s too early to know all the risks of using e-cigarettes. These devices expose the user to liquid nicotine and chemicals that create the vapor. The chemicals involved with vaping — propylene glycol and glycerol — when heated, are known to produce carcinogens and compounds that irritate the airways. The exact risk from this exposure is currently unknown, though it is thought to be much lower than that of a regular cigarette. Therefore, for a smoker, switching to the lower risk e-cigarette is a good trade-off. But for non-smokers, using an e-cigarette introduces potential risk for lung disease and cancer. Outbreaks of asthma have already been reported in association with vaping.

5. E-Cigarettes are regulated differently around the world. The World Health Organization has called for strict regulatory control of e-cigarettes by keeping them away from non-smokers and minors. Some countries have banned the devices altogether.

In the U.S, many initially opposed these devices, presuming that they would lead to an increase in cigarette smoking. Some of this fervor has died down and is now focused on minors. At the moment, most states prohibit the sale of e-cigarettes to minors — the same policy as for cigarettes.

The FDA’s new director, Dr. Scott Gottlieb, has taken a fresh approach this problem. The FDA has established a program to fight nicotine addiction by reducing levels in tobacco and other products. Included in this mandate is continued surveillance of the safety and public health effects of e-cigarettes.

If this program is implemented, the role of e-cigarettes in public health may become clear. Ideally, e-cigarettes will rescue smokers from their habit — without recruiting new ones.

Of course the e-cigarette industry has other plans. Although some vaping devices carry a hefty price tag, overall vaping is relatively cheap and safer than cigarettes to boot. The industry is using those facts to leverage the market. Analysts predict that the vaping industry will see annual growth of 20% over the next decade with worldwide revenues of $50 billion by the next decade.  Most of those dollars will come from the industry’s best customers — Americans and Europeans.

If vaping becomes widely used, we may learn that it is safe. But we can’t rule out the opposite outcome either. Widespread vaping across large populations may introduce us to new diseases that could have been prevented.

There is a high cost for ignoring such potential risks. Just ask any patient who has suffered from the toxic effects of asbestos, second-hand smoke, or radon exposure.

U.S. Health Leads the World in Costs, Technology, Not Much Else

By Mark A. Kelley, MD |3/28/18
Founder, HealthWeb Navigator

Why is U.S. health care so costly compared to other developed countries? A recently published report provides some insights.

In a study of 11 countries, Harvard researchers found that while the United States has the highest health costs relative to its GDP, its use of services is average. More specifically, the U.S. ranks lower than nearly every other country in doctors’ visits, hospitalizations, hospital days, and consultative services.

The difference is that the U.S. uses more expensive technologies with high numbers of surgical and cardiovascular procedures and imaging studies.

Other sources of high costs include brand-name drugs and administration of insurance programs. And while the U.S. has fewer physicians per capita, our physicians earn more than counterparts in every other nation.

With fewer doctors, hospitalizations, and office visits, one might conclude that U.S. health care is poor. In some respects, that is true. The U.S. has a low life-expectancy and high maternal and infant mortality compared to other wealthy nations.

One explanation is that the U.S population is larger and more geographically and economically diverse compared to its peer countries. As the Harvard group explained, if the state of Minnesota were compared to a similarly prosperous European country, it could hold its own. In contrast, Mississippi, a poorer state, would rank much lower.

The message is that if you cannot access the U.S. health system due to income or distance, your wellbeing is at risk. The ACA tried to fix this problem by expanding insurance eligibility with federal support. Surprisingly, some states whose citizens would have benefitted refused to cooperate.

The Harvard report suggests two remedies for curbing health care costs: price control of new brand-name drugs and curbing the proliferation and costs of new technology. These ideas are not new—as the famous economist Uwe Rinehart once wrote, “It’s the prices, stupid.”

Some countries like Great Britain and Canada have taken measures to control such costs. But little has been done in the U.S.

What we are left with is a dysfunctional system that creates high costs, expensive drugs and technology, and lacks a stable national health insurance plan. Is it any surprise the U.S. healthcare system has been ranked last among developed countries?

Worse, we may soon have another embarrassing statistic to report—medical bankruptcy. As healthcare costs continue to rise, many patients can’t afford to pay their medical bills. A recent study revealed that many patients deal not only with hefty hospital bills, but also lost wages and even unemployment when they are ill.

It’s also important to remember that medical bills remain the number one reason for bankruptcy in the United States.

Four years ago, experts in medical bankruptcy grew tired of seeing families lose their homes because of medical debt. They founded a nonprofit organization called RIP Medical Debt (RMD) to solve this problem.

Like a mortgage, some medical debt is discounted and sold on the open market as a commodity. In some cases, the debt can be purchased for pennies on the dollar. The buyer then owns the debt and recovers whatever payment they can.

RMD purchases such debt and then raises donations to settle the account. For example, a donation of $100 can settle a debt of $10,000. A donation of $15,000 can retire $1M of medical debt. Over four years, the organization has retired millions of dollars of debt for patients and their families. While I applaud this program, its very existence speaks volumes about the inadequacies of health insurance in the U.S.

As I write this blog, the stock market has fallen dramatically due to the looming threat of trade warfare between the United States and China. If this crisis continues, the price of imported goods will rise for American businesses and consumers. It’s possible that companies may trim their healthcare benefits to cut costs, shifting the burden onto employees through higher premiums and/or higher deductibles. Such changes will nudge many employees even closer to financial ruin if they get sick.

An equally depressing but plausible scenario is that patients will choose to go without routine care because they cannot afford it.

The current national political agenda is aimed at creating more jobs for Americans. Unless those jobs offer adequate health insurance, medical bills will devour wages.

If elected officials are serious about helping Americans, they should stop playing political football with health insurance.

Only a stable single-payer system, similar to Medicare, will keep the average American family secure in times of illness. And armed with the same power of national price control enjoyed by Medicare, such a plan can tackle the escalation of health care costs.

Vitamin Supplements—Cure-All, or Snake Oil?

By Mark A. Kelley, MD |2/15/18
Founder, HealthWeb Navigator

Vitamins and other over-the-counter supplements are extremely popular in the United States. In fact, it’s estimated that Americans spend $21 billion on these products every year—a few billion dollars more than NASA’s entire annual budget.

Over the last century, there has been extensive research to understand the importance of vitamins and minerals in maintaining good health. Essential vitamins and minerals are chemicals that our bodies cannot manufacture on their own. Usually they’re introduced to our bodies by the food we eat.

There are some great stories surrounding the discovery of certain vitamins and minerals. Three centuries ago, sailors on long voyages often became very ill, many of whom died. The cause was lack of vitamin C in their diet, a condition known as scurvy. To provide vitamin C, these sailors were given limes to eat on the voyage. Miraculously the condition disappeared.

Another example comes from the early twentieth century, when patients were mysteriously dying from anemia despite an adequate diet. Studies showed that they lacked a protein that is necessary to absorb vitamin B12. When the patients were given vitamin B12 by injection, their anemia vanished.

Over time medical science has learned much more about how vitamins and minerals keep us healthy. Yet even in this era of health supplements, the average person still wonders, “What should I be doing to maintain good health?”

Below, we’ll look at a few of the consensus recommendations for vitamin use based on clinical studies to date.

Are Vitamins and Supplements Necessary?

For a healthy person, a well-balanced diet will supply the necessary minerals and vitamins. A balanced diet should include fruits, grains, vegetables, protein, and some dairy products. These foods have the right nutrients that our bodies are designed to absorb to keep us healthy.

Folic acid supplement during pregnancy has been shown to reduce neural tube (spinal) defects in infants. This major advance may save many infants from a lifetime of disability.

Strict vegans may need vitamin supplements. A completely vegetarian diet may lack vitamins B12 and D, and the patient may require oral supplements to correct these deficiencies. The same approach applies to anyone on a poor or restricted diet.

Vitamin D may require some supplement. Vitamin D is necessary for bone growth and strength and comes from two sources. The first is from food, and the second from our skin, which produces vitamin D in response to sunlight. Low vitamin D levels can be seen in patients whose diets are poor or who rarely go out in the sun. For this reason, many experts advise oral vitamin D supplements for older patients who may be at risk for osteoporosis or bone fracture.

Multivitamins are safe, but usually aren’t necessary. Patients with poor diets or digestion may benefit from multivitamins or other supplements. However, for an average person, the consensus is that these products are unnecessary. Nonetheless, multivitamin doses are generally modest and likely won’t harm healthy patients who want to use them within the usual recommended doses.

Beware of high doses of certain vitamins. High doses of the following vitamins can cause lasting damage to your health:

• Vitamin A: Birth defects, osteoporosis, increased cardiac mortality

• Beta-Carotene: Lung cancer

• Vitamin C: Kidney stones

Based on current research, there is no evidence that supplemental vitamins or antioxidants prevent or improve the outcomes of cancer or cardiac disease.

Vitamin and mineral supplements can sometimes be helpful. But for those of us who take prescription medications, they can also cause dangerous interferences. This field is complex, and the science behind it is constantly evolving. Before taking any supplements, it is wise to consult your physician and discuss what is best for you.

An internist and pulmonologist, Dr. Kelley is a faculty member at Massachusetts General Hospital and Harvard Medical School.

A Permanent Vaccine for the Flu?

By Mark A. Kelley, MD |2/5/18
Founder, HealthWeb Navigator

The current flu season is the most severe in nearly a decade. In a typical year, influenza causes 3 to 5 million cases of severe illness, and anywhere from 290,000 to 650,000 deaths around the globe.

But this year may be even more worse because the flu vaccine has been only 10-20% effective in preventing the flu—less than half its usual protection.

The flu virus mutates rapidly, so creating an effective vaccine is largely a game of chance. The process requires scientists to decide in advance which strains they think will be the most prevalent each flu season. That decision determines how the flu vaccine is manufactured, a process that takes about six months.

This year the H3N2 virus emerged unexpectedly. It is particularly nasty and tends to be more resistant to flu vaccines.

The flu virus, particularly type A, can also blend its genes with other viruses, including those infecting animals like pigs and birds. These changes produce new surface coatings on the virus, which pose a major challenge for our body’s defenses. If our immune system recognizes a virus from a previous infection or vaccine, it can quickly kill it. However, new forms of the virus are hard to recognize and can make it difficult for the immune system to react quickly. Such a delay can be deadly if it allows the infection to gain a foothold.

Compared to vaccines for polio, smallpox, and measles, the current flu vaccine falls considerably short:

• It offers limited protection that changes year to year.

• It does not provide lifelong immunity.

• It is unlikely to protect against more dangerous strains of flu like the 1918 pandemic that killed 50–100 million of the world’s population.

Can we produce a better and more effective flu vaccine? The short answer is yes—but only if we have the will to do it.

Scientists have known that certain parts of the flu virus do not change their genetic profile. These areas hide from our immune system. A more effective vaccine would expose and target those areas so that our immune system can always recognize the virus and eliminate it. Other approaches include reengineering some of our own cells to look like the flu virus and making the immune system better prepared to reject it.

These and other innovations are aimed at developing more effective and predictable protection against the influenza virus. Although it will likely take years and considerable funding to develop, the costs are paltry compared to the estimated $8.4 billion in lost productivity every year in the U.S. resulting from the flu. A new vaccine that uses modern technology and offers better protection would be a bargain.

Influenza has plagued mankind for centuries. Every winter, this disease reappears around the world. It may spread even more rapidly with population growth, international travel, and urbanization.

There are reasons to be optimistic about a new vaccine. In this era of “precision medicine,” the science of virus biology has advanced far beyond the 70-year-old technology used for the current vaccine. If the nations of the world choose to accept this challenge, we may be able to protect millions of people who suffer or die from influenza every year.

An internist and pulmonologist, Dr. Kelley is a faculty member at Massachusetts General Hospital and Harvard Medical School.

Are Allergies Preventable? You May Be Surprised

By Mark A. Kelley, MD |1/30/18
Founder, HealthWeb Navigator

Chances are you or someone you know has experienced an allergic reaction at some point. The statistics are eye-opening:

Allergies affect as many as 30% of American adults and 40% of children in the U.S. An estimated 20% of Americans have hay fever; about 4% of children and adults have a food allergy; and 10-20% of children and 3% of adults have significant skin allergies. Also common are allergies to dogs and cats.

Thankfully medical science can prevent and even eliminate some of these conditions. But how?

Our immune system is finely tuned to recognize and repel invaders, especially bacteria and viruses. An allergy develops when the body’s immune system detects a foreign protein and reacts to its presence.

Take the example of pollen. Most people have no problems with pollen. However, anyone with seasonal rhinitis (like me) suffers through the pollen season with a runny nose and cough.

Peanuts are the source of another common allergy. Most people have no problem with peanut products, but for others, peanut consumption can be dangerous. When exposed to a peanut product, these patients can develop serious breathing problems within minutes. Without treatment, this reaction can lead to life-threatening shock.

Of course, the best defense against an allergy is to avoid exposure to the agents that trigger it. Never eat peanuts if you are allergic; stay away from grass and flowers in pollen season; and give away your pet if you are allergic to it.

But sometimes these steps are impractical. For the peanut allergy, any food can be risky because peanut products are common in many foods. In pollen season, staying inside may be impossible if you work outside. As for a cat or dog allergy, patients are very reluctant to part with their pets.

Another way to fight an allergy is to “teach” the body to be more tolerant to allergens. The key is to introduce the offending proteins to the immune system in very small doses. This therapy of “allergy shots” has been around for decades. Small injections of the offending allergy protein (like ragweed) tone down the immune system so that any future reaction produces minimal symptoms. This approach is called “immunotherapy.”

For decades, this tolerance-building approach has been widely used for common allergies such as pollen and animal dander. With new technology, the allergens can now be delivered more easily, either under the tongue or orally, instead of by injection.

New evidence suggests that tolerance develops naturally in early childhood. From birth to about 4 years of age, the immune system seems to have a learning curve about how and when to react to allergens like animal dander and peanuts.

It was once thought that if children had less exposure to allergens, they wouldn’t be as likely to develop an allergy. For years, parents were advised to keep peanuts and other complex food away from children until the age of four. Similar advice pertained to exposure to pets.

Recent research has changed this thinking. New studies have shown that infants introduced to oral peanut extract before the age of one have much lower rates of peanut allergy. In other studies, children who grow up around domestic animals and pets have much lower rates of animal allergies and hay fever. This research suggests that childhood exposure to some allergens teaches the immune system tolerance and reduces the likelihood of developing some allergies.

Most mild allergies are easily treated and prevented. However, others are more serious, their therapies more complex. It is wise to discuss any allergies with your doctor and, if necessary, consult an allergy specialist.

An internist and pulmonologist, Dr. Kelley is a faculty member at Massachusetts General Hospital and Harvard Medical School.

If You’re Considering Psychotherapy…

By Kay O’Laughlin, Ed.D. |1/25/18
Licensed Psychologist

Some of the reasons people start psychotherapy might surprise you. The most obvious reasons for seeing a therapist include:

• Relationship problems

Overwhelming sadness or depression

Grief over death or other serious losses

• Intense anxiety

Thoughts of hurting oneself or others

But people also choose to see a therapist when they feel stuck or lost. For example, having no sense of direction about a career path or feeling that something is missing from life.

Others decide to talk to a therapist when they realize they are using addictive behaviors to cope with stress and it’s not working. The addiction may be overeating, overusing alcohol, misusing drugs, or even compulsively over-exercising. Of course, the trap is that such behaviors create new problems instead of solving the old ones.

Therapy helps to identify negative thought patterns, misperceptions, and unhelpful behavior patterns—and then make plans for changing them.

You may wonder what therapy is and whether it really helps. Psychotherapy is generally known as “talk therapy,” though today many therapists incorporate specialized approaches such as cognitive-behavioral techniques, EMDR, guided imagery, mindfulness, and forms of deep relaxation.

Interestingly, research tells us that the most crucial factor in successful therapy is a positive connection between the client and therapist, meaning that the client feels the therapist both understands and empathizes. The American Psychological Association reported major research showing that 50% of people in therapy improved noticeably after eight sessions, and 75% improved noticeably by the six-month point. In recent years numerous rigorous studies have shown therapy has positive effects on one’s overall health and immune system.

So, in a nutshell, therapy helps most people who give it a try.

Therapists include psychologists, psychiatrists, psych nurse practitioners, social workers, pastoral counselors, and licensed mental health counselors. All of these disciplines involve licensing at a state level. Your insurance company keeps a list of providers in their network, but you should also ask whether they cover out-of-network therapists. Your doctor may be familiar with local therapists and able to recommend someone in particular.

If you need medication, a psychiatrist or psych nurse practitioner can prescribe. They may also do talk-therapy, but some prefer to work in conjunction with therapists from other fields. Often primary care doctors are comfortable with first-level medication for anxiety and depression.

All therapists help clients deal with relationship issues and solve problems. When you first meet a therapist, notice whether that person actively listens to you, seems to understand, and helps you formulate a roadmap of where you want to go and how to get there. You should feel comfortable and safe in the office environment.

One of the benefits of therapy is having time during a week devoted solely to you—how often does that happen in your busy life?

Often, people who are nervous about starting therapy soon find themselves looking forward to each session. One of the biggest surprises for many clients is how much they enjoy therapy and the sense of growing strength, clarity, and focus. I tell my new clients that the work may be intense at times, but along the way we’ll also find humor and reasons to laugh.

Are you considering talk therapy as an option? Check out these websites to help you find a therapist online.

Hospitals Take Aim at Generic Drug Companies

By Mark A. Kelley, MD |1/22/18
Founder, HealthWeb Navigator

In a previous blog, I mentioned how the prices of many generic drugs have skyrocketed. In some cases the price of a single pill has increased over 500%.

But help may be on the way. Recently several large and respected non-profit hospital systems indicated that they will “fire a shot across the bow” of the generic drug business. That would be a game-changer.

Why has the price of generics skyrocketed?

Some large drug companies have purchased (or outcompeted) generic drug manufacturers. This has created a monopoly for some widely used and long-standing products, such as the EpiPen and the albuterol inhaler. In effect, the companies can set whatever price the market will bear. In many cases, the market (i.e patients) has no choice but to accept these prices since no one else makes the drugs.

As if that strategy were not enough, some analysts have suggested another motive. By raising the price of generics and controlling the supply, monopolies could also introduce new “copycat” drugs that resemble the generics and are protected by patents. Both of these maneuvers could improve the stock market value of these drug manufacturers.

The issue is that prescription drugs operate in a market that does not include the patient. Health insurance companies negotiate drug prices and then pass them on to employers and their employees. Compared to hospital costs, most generic drugs are minor costs for the employer. Furthermore, through deductibles, any new drug costs can be passed on to the patient.

Federal regulation might seem like be a good way to solve this problem. Most other developed countries set drug prices for their national health programs. However, Congress has historically forbidden the federal government to set drug prices for Medicare. Regulating the pharmaceutical industry seems unlikely.

What can a hospital consortium do? The hospital industry spends billions of dollars on drugs to treat patients in the hospital and in ambulatory practice. Most insurance plans pay hospitals a fixed price per hospital admission. If drug prices rise, either the insurance company must pay more or the hospital loses money. Lately the drug prices have jumped, especially for generics.

On the ambulatory side, the scenario is no different. Hospitals with outpatient practices are under increased pressure to reduce costs. Among the largest is prescribed drugs.

Another problem for hospitals is the shortage of many commonly used drugs whose patents have expired. Companies simply are not interested in keeping high inventories to meet the challenges of demand.

A nationwide hospital consortium could have tremendous market leverage since these facilities care for millions of patients. Currently, the consortium has enrolled 300 hospitals. That market power could be used to negotiate reasonable prices with the pharmaceutical industry. However, such a plan is complicated and might face legal and regulatory challenges.

The other option is for the consortium to create a nonprofit company that makes generic drugs and sets fair and reasonable prices. That is bold move that would create a true free market. Generic drugs account for almost 80% of all prescribed medications.

Rather than rely on for-profit manufacturers, hospital systems and their patients would have access to the same drugs at lower prices. In effect the providers would eliminate the middleman by controlling the supply of most drug products.

It is unclear how this proposal will evolve because it threatens the status quo. There is sure to be opposition—but not from patients. They will root for any plan that protects them from more out-of-pocket spending.

We need to reduce health care costs and, for once, here is an approach that offers an innovative and sensible solution for patients everywhere.

It’s an idea whose time has come.

Why Everyone Should Get a Flu Shot (Yes, Even You)

By Mark A. Kelley, MD |1/15/18
Founder, HealthWeb Navigator

According to the Centers for Disease Control, we are in the midst of a significant flu season. Headlines tend to amplify danger, but when it comes to the flu, there is reason to worry. After all, the 2012-2013 flu season killed an estimated 56,000 Americans.

Influenza is highly contagious. Even those with mild symptoms can infect others in the first day of their illness. And once the flu virus is in the community, it can spread quickly.

There are two viruses that cause influenza: Type A and B. Type A changes its molecular appearance frequently. That means a strain that caused an epidemic one year may not be the next year’s culprit.

Sometimes a new flu strain emerges that is particularly aggressive and has a higher mortality rate. These frequent changes in the flu virus mean that humans cannot develop long-lasting immunity to its infection.

The solution is to provide a new vaccine each year that protects against the strains of virus that seem most likely to cause a new epidemic. But that prediction is imperfect. It takes six months to develop the vaccine, and in that time the targeted viruses may mutate. Some years, the vaccine hits the target and provides excellent protection. In other years—the aim is not as good.

For most healthy people, the flu is usually an inconvenient sickness from which they recover. But there are exceptions. Even healthy people can die from the flu.

Who’s At Risk and Why?

Children are particularly at risk, as are the elderly, pregnant women, and those with chronic illness. These groups account for most of the flu-related deaths every year.

So what makes the flu so deadly?

Research suggests that the flu virus can overwhelm those with weakened immune systems. Normally, our immune system fights off infection pretty well. But for children—whose immune systems aren’t fully developed—and adults over the age of 65, the immune system loses some of its effectiveness. Patients with chronic disease and pregnant women are especially susceptible to the additional stress.

These weaknesses allow the flu more time to invade the body before the immune system can stop it. The most common complication is pneumonia, which can lead to other infections elsewhere. These series of events can also lead to organ failure, long hospitalization, and even death.

Thankfully medical science is able to create the flu vaccine, reducing the flu-risk for millions of Americans.

Why You Should Get the Flu Vaccine

Here are some quick facts about this live-saving vaccine:

1. The flu shot reduces flu-related adult hospitalization by 57%, and as much as 70% in the elderly. For children, the flu vaccine reduces mortality by a whopping 65%.

2. Even if you get the flu, the vaccine will reduce the length of illness and reduce the risk of complications. And you will likely get back on your feet sooner.

3. The flu vaccine helps you protect others. If you are a healthy young or middle-aged adult, you will likely survive the flu—but you will also expose the rest of your family to the virus. Vulnerable family members are more likely to have complications from the flu, and have higher risks of hospitalization and even death. No one wants to expose loved ones to such danger.

The flu vaccine comes with little risk and protects all of us, particularly our children, the elderly, and those with health challenges. If you are healthy, the flu may not pose a great danger to you. But if you pass the virus on to someone who is vulnerable, it may threaten their life.

That alone is a good reason to get a flu shot every year.

Should I Get the Shingles Vaccine?

By Mark A. Kelley, MD |1/11/17
Founder, HealthWeb Navigator

I have seen more and more friends and patients who have suffered with shingles. For no apparent reason, a very painful rash appears, most often on the chest or abdomen. The rash eventually disappears but the pain can last for weeks.

Fortunately, this condition can be prevented.

What Causes Shingles?

Shingles can’t be “caught,” and you can’t get shingles if you’ve never had chickenpox. Both chickenpox and shingles are caused by the varicella zoster virus.

In chickenpox, the virus spreads through the body because the patient has no immunity to it. Once immunity develops and controls the virus, the patient recovers.

However, some of the virus hibernates in our nerve cells, locked away by our immune system. As we age, our immune system is not as effective in keeping the virus in check.

For some folks, the zoster virus emerges and spreads along the nerve cells, causing them to become painfully inflamed. The result is a localized rash that resembles chickenpox. Weeping fluid from the rash contains live zoster virus and can cause chickenpox in anyone who has never been exposed to zoster, such as infants.

With shingles, the body usually fights off the virus successfully. However, it takes a long time for the inflamed nerves to settle down and for the pain to subside. Ask anyone who has had shingles and you will be impressed with how disabling the pain can be.

Roughly 1 in 4 adults will develop shingles at some point during their lifetime. Those odds increase with age.

In a healthy person, shingles is usually not life-threatening, but it can lead to chronic pain or, if it affects the eye, can cause blindness. More serious complications, including death, can occur in patients whose immune systems are weakened by anti-inflammatory drugs, chemotherapy, or chronic disease.

What Are My Options?

Currently there are two injectable vaccines that can prevent shingles.

Zostavax is a single injection that delivers a weak form of varicella zoster. That exposure awakens the immune system to quickly fight off the virus. This vaccine prevents shingles in about 50% of patients, but that protection is only good for about 5 years. However, for immunized patients who develop shingles, the vaccine reduces the severity of the symptoms.

Shingrix is a new vaccine that was engineered to look like the zoster virus to our immune system. Since it is not a real virus, it cannot cause any infection. The vaccine requires two separate shots and may be more effective than Zostavax. In numerous trials, the Shingrix vaccine has protected over 90% of elderly patients from shingles for about 8 years. Zostavax, on the other hand, has protected only half of similarly aged patients. Shingrix is approved by the FDA but will not be available until later this year.

Is the Shingles Vaccine Right for Me?

The CDC’s current recommendation is that every adult over the age of 60 should be immunized with Zostavax, whether or not they have had chickenpox. The reason is that most American adults have antibodies to varicella, suggesting they were once infected with the virus. There has been no consensus on whether to recommend periodic booster shots. Younger patients with immune systems weakened by disease or treatments may also be considered for the vaccine.

These recommendations may change to favor the newer vaccine Shingrix, because it appears to be more protective. No formal policy has yet been published, although one is expected later this year.

The retail price for both vaccines is about the same. The single shot of Zostavax costs about $220, and the two shots of Shingrix together are estimated to cost about $240. Insurance or discount coupons may cover some or all of this cost. It pays to check with your insurance company and shop around.

I think the shingles vaccine makes sense for most patients over the age of 60. It substantially reduces the risk of developing a very painful condition that can last weeks. We now have one—and soon two—safe, effective vaccines.

Consult your physician to see if and when the shingles immunization is right for you.

Radiology Imaging Tests: The Basics

By Carla Dellaporta |12/8/17
Director of Education, NeedyMeds

You’re out walking your dog, enjoying the fresh air and holiday decorations, when suddenly — bam! Down you go on a patch of black ice. Standing, you realize you can’t put weight on your ankle.

The doctor says she’s not quite sure how bad the damage is. To get a better idea, she wants to schedule what she calls a “radiology imaging test.”

Say what now? Isn’t radiology like, nuclear?

Medical jargon gets thrown around left and right these days. Thankfully this one’s pretty simple. “Radiology” is the branch of medicine that relies on technology to diagnose or treat diseases. And “imaging” means the technology involved to take pictures inside your body.

So your doctor is saying she needs to get a better picture—literally—of what’s going on inside you.

There are many radiology tests out there. They differ in terms of the technologies used to produce images of your body. Some common radiology tests requested by doctors include:

X-ray: Uses a small dose of radiation.

CT scan: Combines multiple X-ray images.

Ultrasound: Uses high frequency sound waves.

MRI: Uses magnetic fields and radio waves.

From 2000-2010, imaging services and costs grew at twice the rate of other healthcare technologies. One reason why may be what’s called “defensive medicine.” This term refers to doctors prescribing or recommending unnecessary tests to protect themselves from potential malpractice lawsuits.

A recent study estimated that unnecessary medical tests cost the U.S. nearly $7 billion dollars annually. Overly cautious medicine is a common practice that, unfortunately, comes at the patient’s expense. Don’t rush to get a test without having a clear idea of what your options are and whether or not you can afford treatment.

Below, we’ll cover some questions to ask before scheduling your radiology imaging test. That way you’ll know you’re getting the best bang for your buck.

Questions to Ask Your Doctor Before Scheduling the Test

Do I need this test? You’ll want to understand why you need a scan and how the results will change your course of treatment. If the doctor can’t justify how the results of the test would change the treatment course, then you probably can do without it. No use in wasting time or money on unnecessary tests.

Are there safer alternatives? A CT scan exposes you to much more radiation than a standard X-ray. An MRI, on the other hand, doesn’t use radiation at all. Because radiation can potentially cause DNA damage, you want to limit your long-term exposure. Ask whether there are any lower-radiation but still effective options.

How much will this test cost? Imaging fees vary widely between hospitals, private facilities, geographic location, etc. Always ask for the bottom line cost before scheduling a test. Keep in mind, there’s something called a “global fee” you’ll want to be aware of. This fee charges for the test itself as well as the professional interpretation of the results. Being aware of the global fee ensures you won’t be blindsided when the bill arrives.

How long before I get the results? Radiology test results are generally read on-site by a trained radiologist. However, it’s the doctor who usually delivers those results to the patient, and a variety of factors will influence when you’ll receive them. Ease your mind by asking up front how long this process will take. Consider calling if you haven’t received your test results after five days.

Some Final Cost-Saving Tips

Confirm which location(s) your health insurer considers in-network and how much they cover. Few people know that most of the time, imaging tests cost more when performed at a hospital rather than private facility. Contact your health insurance company directly to find out which facilities they consider in-network. By staying in-network, you won’t have to pay the for the full price of care. There’s a reason you have health insurance—let your insurer help cover the costs!

Ask for a cash discount or sliding scale payment plan. Paying out-of-pocket doesn’t mean you’re doomed to pay up-front and in-full. Most healthcare centers will work with your financial situation, but first you have to ask. A payment plan is a much more reasonable choice compared to putting the total fee on a credit card. You wind up paying a lot more money in interest if you can’t pay off your credit card bill immediately.

Check the credentials of the imaging facility. You know you can trust a facility if it’s been accredited by the American College of Radiology. That means the center has undergone a rigorous evaluation process led by experts in the imaging field. Generally, accreditation can tell you if the center’s radiologists are experienced, and whether or not the center’s equipment and staff meet/exceed nationally accepted standards. Obviously you want the best care for your money.

To learn more about the field of radiology imaging, our reviewers recommend RadiologyInfo.org as a great introductory resource. This website explains the various forms of medical imaging including their indications, complications, and relevant tips for patients undergoing tests. Read our full review for more information.

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