Managing your health, pain, medications, and health care costs




Buying drugs and procedures
smartly, cheaply, safely

Tip No. 1: Most physicians do not have a clue how much various drugs cost (and may have an incentive/​encouragement to prescribe the pricier ones). Let them know what you know and what you can afford.
GoodRX Stop paying too much for your prescriptions. Compare prices and find coupons to save up to 80%.
PharmacyChecker.com Compare drug prices among reputable online pharmacies.Find the best drug prices from verified overseas online pharmacies, vetted by the physician who runs it for quality. Order no more than a three-month supply.
Attention, Shoppers: Prices For 70 Health Care Procedures Now Online! (Jay Hancock, Kaiser Health News, 2-25-15).
Generic Drug Prices Are Declining, But Many Consumers Aren’t Benefiting (Charles Ornstein, ProPublica, and Katie Thomas, New York Times, 8-8-17) Outcry has been building over the rising cost of brand-name medications, but the price of generic drugs has been moving in the opposite direction. The stock prices of generic manufacturers have tumbled, but many consumers aren’t paying less at the pharmacy counter.
The Myth of Drug Expiration Dates ( Marshall Allen, Pro Publica, 7-18-17) Hospitals and pharmacies are required to toss expired drugs, no matter how expensive or vital (or that they routinely give you way more than you need). Meanwhile the FDA has long known that many remain safe and potent for years longer. Part of Pro Publica's Wasted Medicine series.
Facebook Live: The Prescription Drug Pricing Pipeline (video, Kaiser Health News, archived 30-minute conversation with knowledgeable journalists). Who contributes to what you pay at the pharmacy? Why are prescription drugs so expensive in the United States? In this Facebook Live, KHN’s Julie Appleby talks with Stephanie Stapleton and answers readers’ questions about the prescription drug pricing pipeline and the industry stakeholders who have a role in what you pay.
Tracking Who Makes Money On A Brand-Name Drug (Julie Appleby, Kaiser Health News, 10-6-16) A diagram of what Julie and Stephanie discuss in previous entry.
Sounds Like A Good Idea? Regulating Drug Prices ( Julie Rovner and Francis Ying, Kaiser Health News, 7-11-16)
Save Money on Meds: 9 Tips for Finding the Best Prescription Drug Prices (Consumer Reports, 3-8-17) Prices can vary widely from store to store, even in the same town. The trick is to shop around. Look at the price comparison chart.
Buying Cheaper Drugs Online (Anahad O'Connor, NY Times, Ask Well, 11-11-13)
Drugs, Big Pharma, conflicts of interest, and why U.S. patients pay too much for medication
Best Buy Drugs campaign (Consumer Reports)
CR Price Reports (Consumer Reports' "bluebook" surveys of national and local fair prices for brain MRI, breast augmentation, breast reduction, chest x-ray, colonoscopy, complete blood count, comprehensive metabolic panel, fetal ultrasound, hip replacement, hysterectomy, knee arthroscopy, knee replacement, laminectomy, lap-band surgery, laparoscopic cholecystectomy, liposuction, rhinoplasty, septoplasty, tubal ligation, TURP (transurethral prostatectomy), and vasectomy.
CVS Health Is Sued Over 'Clawbacks' of Prescription Drug Co-Pays (Jef Feeley and Jared S Hopkins, Bloomberg, 8-9-17) CVS Health Corp. was sued by a California woman who accused the drugstore operator of charging customers co-payments for certain prescription drugs that exceed the cost of medicines. CVS, the largest U.S. pharmacy chain, overbilled consumers who used insurance to pay for some generic drugs and wrongfully hid the fact that the medicines’ cash price was cheaper. Woman says she paid $166 for medicine that actually cost $92. Chains worked with benefit managers on billings, suits say.
I Got the Wrong Drug. And a $2,500 Band-Aid. (Josh Max, Opinion, NY Times, 7-15-17)
5 signs your doctor might be an overprescriber (Consumer Reports, 9-28-16) Too often, patients get unnecessary medication.
Finding the Right Pharmacy (Consumer Reports, Jan. 2014) 10 reasons why you may want to switch drugstores
Costco’s Prices for Generic Medications as of October, 2013
Buying Prescription Drugs From Canada: Legal or Illegal? (ElderLaw Answers)
VIPPS (VIPPS information and verification site of the National Association of Boards of Pharmacy) Enter a site's URL to verify if it meets industry standards.
Find a VIPPS online pharmacy (National Association of Boards of Pharmacy)
Ratings for hospitals, doctors, surgeons, home health agencies
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Shopping for vitamins, supplements, and "natural products"

Have you noticed that the price for your vitamins and supplements has been rising? The Food and Drug Administration (FDA) does not regulate the safety and sale of nutritional supplements. Because they're classified as food products, not medicines, they aren't regulated by the strict standards governing the sale of prescription and over-the-counter drugs.
Knowing What’s Worth Paying For in Vitamins Lesley Alderman, NY Times, Patient Money, NY Times, 12-4-09) Use only what you need: "Popping too many vitamin pills is not only a waste of money but can be bad for your health. Talk to your doctor about what added vitamins or minerals you might require; you can ask for a blood test to learn what you might be lacking." A multivitamin will not provide the level of a vitamin you may be deficient in. If your doctor recommends a specific supplement, like omega-3, ask in what form you should be taking it. Find a reputable source. "Purchase your vitamins from well-known retailers that do a brisk business and restock frequently, whether that’s Costco or Drugstore.com." Price may not indicate quality."ConsumerLab.com says it has found a few patterns that consumers may find helpful. Products sold by vitamin chains tend to be more reliable than drugstore brands, and Wal-Mart and Costco’s vitamin lines are usually worth considering. In a recent test of multivitamins, ConsumerLab.com found that Equate-Mature Multivitamin 50+ sold by Wal-Mart was just as good as the name brand Centrum Silver, but at less than a nickel a day is half the price."
ConsumerLab.com. Among sources ConsumerLab.com recommends for buying vitamins, supplements, and "natural products" (but check their site!):
---eVitamins
---Lucky Vitamin
---Swanson Vitamins
---iHerb
---VitaCost
Check the price at your local store against prices for the same product on Amazon. They are often notably higher at the vitamin shop I have frequented.
Supplements Can Make You Sick (Jeneen Interlandi, Consumer Reports, 7-27-16) Dietary supplements are not regulated the same way as medications. This lack of oversight puts consumers' health at risk.
Vitamin B.S. (Cari Romm, The Atlantic, 2-26-15) How people came to believe the myth that nutritional supplements could make them into better, healthier versions of themselves. From an interview with Catherine Price, the author of Vitamania (for which I've seen two different subtitles: "How Vitamins Revolutionized the Way We Think About Food" and "Our Obsessive Quest for Nutritional Perfection").
What Heart Patients Need to Know About Herbal Supplements (Lauren Friedman, Consumer Reports, 3-2-17) A new study says they may be an especially risky choice for patients taking heart meds

Liver Damage From Supplements Is on the Rise (Lauren Cooper, Consumer Reports, 5-19-17) Green-tea extract and bodybuilding pills pose a particular risk, study finds
The Truth About Calcium and Vitamin D Supplements (Lauren Cooper, Consumer Reports, 7-27-16) Consumers take them to strengthen bones and prevent fractures. Do they work? "Taking daily calcium pills can increase bone density in people over 50 years old by 1 to 2 percent—not enough to prevent fractures. That’s according to a review of 59 randomized controlled trials, published last year in the British Medical Journal. “That small gain is not worth the risks, including an increased likelihood of heart disease, kidney stones, and gastrointestinal problems,” Lipman says."
"The best way to get that calcium is to eat calcium-rich foods including milk, cheese, and yogurt. Good sources of vitamin D are mushrooms, eggs, fortified milk, soy beverages, and salmon. Our bodies also make vitamin D when our skin is exposed to sunlight, so our experts suggest getting 10 minutes of sunshine per day. Exercise is important, too. “Weight-bearing aerobic activities, such as walking and dancing, may slow bone loss."
15 Supplement Ingredients to Always Avoid (Consumer Reports, 3-21-17) These supplement ingredients can cause organ damage, cardiac arrest, and cancer: Aconite, caffeine powder, chaparral, coltsfoot, comfrey, germander, greater celandine, green tea extract powder, kava, lobelia, methylsynephrine, pennyroyal oil, red yeast rice, usnic acid, yohimbe. A useful chart with "claimed benefits" vs. "risks."
4 Supplements to Question After Age 50 (Lauren Cooper, Consumer Reports, 12-16-16) Who might need folic acid, calcium, iron, and vitamin E supplements, do they do what is claimed, and what problems might there be with them (for whom).
Fish Oil Supplements May Not Help Prevent Heart Disease (Sally Wadyka, Consumer Reports, 3-14-17) Those who already have certain forms of heart disease may benefit, though, a new report finds. "One thing most heart disease experts do agree on: The best way to get the protective benefits of omega-3s is to eat fish rather than take fish oil supplements.Salmon, sardines, mackerel, and other fatty fish, have the highest amount of omega-3s, and are low in mercury. Fish may be protective, says Lipman, not just because of its omega-3 content, but because it is a lean source of protein, low in saturated fat, and rich in other nutrients.:
‘Natural’ Sleep Supplements Carry Serious Safety Concerns (Ginger Skinner, Consumer Reports, 12-29-16) There's little research to suggest melatonin and valerian work, plus the popular supplements come with clear risks
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Fighting drug price gouging and making drugs more affordable

This cancer patient is devoting his life to making drugs more affordable (Dan Gorenstein, Marketplace, 5-17-17) David Mitchell started a national organization, Patients for Affordable Drugs., to channel the public's growing frustration about high drug prices and campaign to make them more affordable. What makes his organization different to others is that it doesn't take any funding from drug companies. That's significant because most patient advocacy groups do.
The high price of anticancer drugs: origins, implications, barriers, solutions High drug prices harm patients — often directly through increased out-of-pocket expenses, which reduce levels of patient compliance and lead to unfavourable outcomes — and harms society — by imposing cumulative price burdens that are unsustainable. The excessive costs of anticancer drugs have been criticized by >100 experts in
Best Buy Drugs (Consumer Reports free service to help you make smart drug choices based on scientific evidence and expert medical advice).
High drug prices: Don’t let industry excuses go unchecked–or patient voices go unheard (Alan Cassels, HealthNewsReview.org, 5-18-17) price gouging is beyond frustrating for David Mitchell, a D.C.-based consumer advocate who started Patients for Affordable Drugs.
AARP: Why Our Drugs Cost So Much (AARP Bulletin, 5-22-2017)
Lowering the Cost of Prescription Drugs Is One of the Top Health Priorities Across Parties. That's shown in the chart displayed in this story: Kaiser Health Tracking Poll - Late April 2017: The Future of the ACA and Health Care & the Budget (Kaiser Health News, 4-26-17) Six in ten Americans say lowering the cost of prescription drugs is a “top priority” for President Trump and Congress – including majorities of Democrats, Republicans, and independents. "A majority of Republicans, Democrats, and independents favor most of these policy actions with one exception – encouraging people to buy lower-cost drugs by requiring them to pay a higher share if they choose a similar, higher-cost drug, which is favored by less than half of Democrats."
Reference pricing for ‘shoppable’ health care services steers consumers to low-cost providers (Joseph Burns, Covering Health, Association for Health Care Journalists, 8-15-16) "Using reference pricing, Safeway saved $2.57 million over the three years of the study (2011 to 2013). Of that amount, $1.05 million (41 percent) went back into consumers’ pockets, and the remaining $1.70 million accrued to Safeway, the study showed. Also, reference pricing led to a 32 percent drop in the average price that consumers paid for 285 different lab tests."
Why U.S. medical costs are so high
and where the system needs fixing
(key articles explaining the high cost of medical care in the United States -- and asking whether we're getting what we're paying for)
Taking the mystery out of health care prices . A push for transparency in health care pricing.
A new Parkinson’s drug is a long-acting version of a cheap generic. Should it cost $30,000 a year? (Adam Feuerstein, STAT Plus, 8-25-17) If this rings your bell, go to this page: Drugs, Big Pharma, conflicts of interest, and why U.S. patients pay too much for medication. There is no getting around who the main villains are in America's wildly out-of-balance health care $ystem.
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Questioning drug claims and managing medication side effects

The anatomy of a drug website: 5 pharma tactics to be wary of (Michael Joyce, HealthNewsReview, 5-25-17) In brief: 1) Heavy reliance on patient anecdote videos (ironically, using actors more than real patients); 2) Cherry-picked statistics; 3) A financial saving/​support or “Co-Pay Calculator” (implying you don’t have to pay full cost … if you qualify); 4) Quizzes or FAQ sections which encourage you to self-diagnose (at a very low threshold); 5) A call to action = “ask your doctor." "The primary goal of these websites is not hard to spot. They are clearly trying to expand the pool of people who are eligible to be diagnosed with the condition their drug treats." That is, to increase demand for the drug (even among those for whom it is useless).
Cashing in on emotions: How pharma profits from medicalizing the normal spectrum of feelings (Michael Joyce, HealthNewsReview.org, 5-16-17) Nuedexta is the only FDA-approved drug to treat a condition called pseudobulbar affect, or PBA. The drug has its own website, which is a virtual blueprint for the 5 marketing tools I see most commonly used to hook customers (pharma would likely counter they are 5 tools to “educate”).
Tips for analyzing studies, medical evidence and health care claims (HealthNewsReview)
Dose of Confusion About 160 Americans die accidentally each year from acetaminophen poisoning — and about the same number use the drug to commit suicides each year. Two-thirds of parents who brought children under 7 into city emergency rooms did not know the difference between concentrated infant’s drops and other formulations of acetaminophen. At certain doses, acetaminophen can damage or even destroy the liver.
Use Only As Directed (This American Life and ProPublica, Program 505, 9-20-13) One of the country's most popular over-the-counter painkillers — acetaminophen, the active ingredient in Tylenol — also kills the most people, according to data from the federal government. Over 150 Americans die each year on average after accidentally taking too much. And it requires a lot less to endanger you than you may know. We reported this alongside ProPublica. The ProPublica stories (T.Christian Miller and Jeff Gerth, ProPublica, 9-20-13): "About 150 Americans die a year by accidentally taking too much acetaminophen, the active ingredient in Tylenol, federal data from the CDC shows. Acetaminophen has a narrow safety margin: the dose that helps is close to the dose that can cause serious harm, according to the FDA. The FDA has long been aware of studies showing the risks of acetaminophen. So has the maker of Tylenol, McNeil Consumer Healthcare, a division of Johnson & Johnson. Over more than 30 years, the FDA has delayed or failed to adopt measures designed to reduce deaths and injuries from acetaminophen. McNeil, the maker of Tylenol, has taken steps to protect consumers. But over more than three decades, the company has repeatedly opposed safety warnings, dosage restrictions and other measures meant to safeguard users of the drug."
We need to pay better attention to medication side effects (Marlene Beggelman, MD, Kevin MD, 2-22-17) Clinicians often misdiagnose problems caused by medications, especially when patients take multi-drug combinations. Physicians don't actively report side effects from medications and often deny those patients tell them about. When doctors fail to connect symptoms to medications, not only do they fail to help their patients, but they also fail to report the side effects to the Food and Drug Administration. As a result, the FDA is likely underestimating the reactions, leading other doctors and patients to believe some drugs are safer than they are. "Patients may be the most reliable sources to report side effects. In fact, they are often the only information source about reactions to medications. Their observations deserve serious consideration. Federal money for drug research and safety has declined to the point that pharmaceutical companies now fund over 85 percent of all research, medical journal publications and medical conferences, where physicians receive much of their educational information –- a clear case of the fox guarding the chicken coop."
How I almost killed my mom with a simple anti-itch pill "Known for her easy smile, great style and a crazy-early bedtime, [my mom] morphed in less than five hours into a hallucinating, night-walking, screaming basket case, all thanks to one anti-itch prescription pill I gave her for her eczema....One of the many secret aspects of aging is that physical symptoms can mutate like aliens, which plays havoc with all we think we know about healing ourselves or our loved ones. For example, once we hit our 70s or 80s, symptoms of urinary tract infection that most women recognize — fever or a burning sensation when urinating — give way to something known throughout Florida — the state with the nation’s highest percentage of the elderly — as “acting strange.” "Anticholinergics include all kinds of mass-market remedies beyond Benadryl (which is known generically as diphenhydramine), such as Nyquil, Sominex, Advil/​Tylenol PM, the bladder-control prescription drugs oxybutynin (Ditropan) and tolterodine (Detrol), and neck and back pain drugs such as Flexeril. These are all worthwhile medications — for younger people. My 95-year-old mother’s accumulation of daily prescriptions were classic textbook material, beginning with pills for overactive bladder that she had taken from age 69 to 94. A doctor had prescribed that medication years before — without her even being incontinent."
Common anticholinergic drugs like Benadryl linked to increased dementia risk ( Beverly Merz, Executive Editor, Harvard Women's Health Watch, on Harvard Health Blog, 5-23-17) "In a report published in JAMA Internal Medicine, researchers offers compelling evidence of a link between long-term use of anticholinergic medications like Benadryl and dementia. Anticholinergic drugs block the action of acetylcholine. This substance transmits messages in the nervous system. In the brain, acetylcholine is involved in learning and memory. In the rest of the body, it stimulates muscle contractions. Anticholinergic drugs include some antihistamines, tricyclic antidepressants, medications to control overactive bladder, and drugs to relieve the symptoms of Parkinson’s disease."
Magellan Anticholinergic Risk Scale
When the Immune System Thwarts Lifesaving Drugs (Gina Kolata, Health, NY Times, 5-15-17) "The body’s immune system produces antibodies, blood proteins, in order to attack molecules the body recognizes as alien, often carried on viruses and bacteria. But antibodies also are deployed against other foreign substances, and this may include drugs given to patients." With several serious medical conditions, patients sometimes develop antibodies to the drug that might save them and perhaps to other drugs that the immune system might see as foreign. Understanding the cause of these antibodies would be valuable "if you could say, 'This one patient out of 20 should not take this drug.’” Also, "drugs that might have been abandoned could be developed for the patients who can tolerate them."
Do Best-Selling Drugs That Calm Stomachs Damage Kidneys? The Answer’s Unclear. (Sydney Lupkin and Pauline Bartolone, Kaiser Health News, 5-17-17) Recent research has linked proton pump inhibitors, or PPIs, such as Nexium and Prilosec to serious side effects, including chronic kidney disease. The risk of chronic kidney disease is as much as 50 percent higher in people who’ve taken the drug compared with those who’ve not — although no causative link has been proven and manufacturers like AstraZeneca insist they are safe. Although their labels recommend limiting treatment to a few weeks or a few months, it’s not uncommon for patients to take the heartburn pills for years--producing sales worth many billions of dollars a year for pharmaceutical companies.
Learning About Side Effects (Food & Drug Administration)
Daily Med (National Library of Medicine, NIH) Go to the Daily Med website, enter a drug name, click on the name when it appears, and scroll down to Adverse Reactions.
MedWatch Online Voluntary Reporting Form (U.S. Food & Drug Administration) Here is where both doctors and patients can report serious problems with human medical products including drugs.
What are the possible side effects of a drug and where can I find the most current information about my drug? (FDA)
What is a Serious Adverse Event (FDA)
MedShadow (blog about Balancing Drug Risks and Benefits)
Physician response to patient reports of adverse drug effects: implications for patient-targeted adverse effect surveillance. (BA Golum et al., Drug Safety, on PubMed, 2007)
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Sites providing information about much hospitals charge

How Much Hospitals Charge For the Same Procedures (New York Times)
Hospital Compare (Centers for Medicare & Medicaid Services, a consumer-oriented website that provides information on how well hospitals provide recommended care to their patients)
Hospital Ratings and Reports (The Leapfrog Group) How transparency is driving leaps forward in hospital care in this country. Hospitals across the country demonstrate their commitment to transparency and quality improvement through the Leapfrog Hospital Survey.
Guidestar (a major source of information on nonprofit organizations, including nonprofit hospitals)
Pro Publica's Nonprofit Explorer. Database provides summary data for nonprofit tax returns and PDFs of full Form 990 documents, including those for most nonprofit hospitals.
Ratings for hospitals, doctors, surgeons, home health agencies, nursing homes (invaluable information, available publicly--be a smart patient and check things out!)
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Finding prices for medical procedures

These resources are useful, but rarely if ever give you the complete cost of procedures. For a fuller understanding, read Elisabeth Rosenthal’s book An American Sickness: How Healthcare Became Big Business and How You Can Take it Back.
ClearHealthCosts (bringing transparency to the health-care marketplace by telling people prices for medical procedures and items -- using crowdsourcing in the few cities where it operates)
FairHealth. Consumers: Estimate your healthcare costs, dental or medical.
Healthcare Bluebook. Never overpay for healthcare again. Join the Fair Price Revolution.
Medibid (reducing healthcare costs through competitive bidding--a helpful site if you have a high deductible health insurance plan)
See also
Taking the mystery out of health care prices
How much does a colonoscopy cost? From $600 to over $5,400 (Jeanne Pinder, ClearHealthCosts, 7-20-14)
How much will that cost/​did that cost? Part 1 of a series on billing (Jeanne Pinder, ClearHealthCosts, 10-30-16)
Is it cheaper to pay cash than to use your insurance? Maybe. (Jeanne Pinder, ClearHealthCosts, 12-22-14)
How much does a mammogram cost? The takeaway on billing, from our WNYC partnership (Jeanne Pinder, ClearHealthCosts, 7-1-13) Mentions resources for those who are not insured.
Reforming the U.S. healthcare system.
Understanding the issues health care reform should address
Organizations serious about reforming U.S. healthcare.
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Managing medications, tests, procedures, and treatments

Genetic testing fumbles, revealing ‘dark side’ of precision medicine (Sharon Begley, STAT: Reporting from the frontiers of health and medicine, 10-31-16) 'Enthusiasm for precision medicine, from the White House down to everyday physicians, is at an all-time high. But serious problems with the databases used to interpret patients’ genetic profiles can lead to “inappropriate treatment” with “devastating consequences,” researchers at the Mayo Clinic warned on Monday....“This is the proverbial dark side of genetic testing and precision medicine,” said Ackerman. Because databases that companies use to interpret DNA tests are riddled with errors, “we’re starting to see a lot of fumbles,” with patients told that a DNA misspelling is disease-causing when it actually isn’t....That raises the very real concern that some people treated with “precision” approaches will be misdiagnosed and given useless or even harmful treatment.'
Genetic test costs taxpayers $500 million a year, with little to show for it (Casey Ross, STAT, 11-2-16). Unnecessary medical care is estimated to cost the United States between $750 billion and $1 trillion dollars a year, accounting for nearly a third of its overall spending on health care. Wasteful testing is one of the primary drivers of those costs. In the case of inherited thrombophilia, said Dr. Christopher Petrilli (a University of Michigan hospitalist who coauthored the study cited), doctors appeared to be complicit in the waste — possibly due to fear of litigation or simply a shared desire to get the answers for their patients. “You can explain to them that getting a test is not going to change therapy and that it’s just going to lead to more anxiety, unclear results, and more testing,” said Dr. Nitin Damle, president of the American College of Physicians.
Pros and cons of various medical tests, treatments, habits for cardiovascular problems
The cold facts about colds and flu (Consumer Reports article on the difference between a cold and the flu and how best to treat them)
Does Biotene cure dry mouth? (Stephanie Watson, HowStuffWorks, Oral Care Products) Dry mouth, a lack of saliva despite drinking fluids, can be caused by different health conditions and treatments. Does this product relieve the symptoms?
A Prescription for Confusion: When to Take All Those Pills (Paula Span, NY Times, 12-18-15)
Preventive Care (Publichealth.org). Under Resources , find curated links to journals, open courseware, research and professional organizations, and awareness campaigns on addiction, aging, cancer, environmental health, heart disease, HIV/​AIDS, infectious disease, maternal and child health, mental health, nutrition, obesity, poverty, and sexual abuse.
Maybe You Should Rethink That Daily Aspirin (Maanvi Singh, Shots, NPR, 4-27-15) "Aspirin thins the blood and can help prevent blood clots that can clog blood vessels and cause strokes and heart attacks. But long-term use of the drug also increases the risk of ulcers, gastrointestinal bleeding and bleeding in the brain. "Everyone agrees that for people who have already had a cardiac event, the benefits outweigh the risk," pharmacologist Craig Williams says. But for most other people, the chance that aspirin will prevent a first heart attack is about equal to the chance that it will cause harmful side effects, research suggests."
Dental amalgam or resin composite fillings? (helpful Delta Dental explanation)
Autism and the Agitator (Frank Bruni, NY Times Op Ed, 4-21-14) For much of the past decade, Jenny McCarthy has been the panicked face and intemperate voice of a movement that posits a link between autism and vaccinations. "When did it become O.K. to present gut feelings like hers as something in legitimate competition with real science?"
When More Medicine Isn't Better (Leana Wen, Huff Post blog, 8-11-13)
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Medications, tests, procedures, and treatments to question or avoid

"Don't cling to a mistake just because you spent a lot of time making it."

Choosing wisely (Evidence-based advisories on various medical procedures, produced by Consumer Reports, working with the ABIM Foundation). You can download a pdf of all specialty society lists of procedures to avoid. Two examples follow:
Five Things Physicians and Patients Should Question (American Academy of Hospice and Palliative Medicine, Choosing Wisely, an initiative by the American Board of Internal Medicine Foundation and Consumer Reports, to alert doctors and patients to problematic and commonly overused medical tests, procedures and treatments)
1. Don’t recommend percutaneous feeding tubes in patients with advanced dementia; instead, offer oral assisted feeding.
2. Don’t delay palliative care for a patient with serious illness who has physical, psychological, social or spiritual distress because they are pursuing disease-directed treatment.
3. Don’t leave an implantable cardioverter-defibrillator (ICD) activated when it is inconsistent with the patient/​family goals of care.
4. Don’t recommend more than a single fraction of palliative radiation for an uncomplicated painful bone metastasis.
5. Don’t use topical lorazepam (Ativan), diphenhydramine (Benadryl), haloperidol (Haldol) (“ABH”) gel for nausea.

Five Things Physicians and Patients Should Question (American Geriatrics Society, Choosing Wisely)
1. same as above
2. Don’t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia.
3. Avoid using medications to achieve hemoglobin A1c <7.5% in most adults age 65 and older; moderate control is generally better.
4. Don’t use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia, agitation or delirium.
5. Don’t use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present.

For the Elderly, Medical Procedures to Avoid (Paula Span, New Old Age, NY times, 10-23-13)
Drugging dementia: Are antipsychotics killing nursing home patients? (David Martin, America Tonight, Aljazeera, 3-11-15) Antipsychotic drugs are approved for patients with bipolar disorder or schizophrenia, not for dementia. They are often given to dementia patients, because when they are zonked out, they are easier to control. A body of research has shown "a correlation between lower staffing levels and higher use of antipsychotics."
Beers Criteria for Potentially Inappropriate Medication Use in Older Adults (American Geriatrics Society, based on evidence-based recommendations. See additional material.

Doctor Groups Issue List of Overused Medical Tests (Laurie Tarkan, Well, NY Times, 2-21-13)

Doctor Panels Recommend Fewer Tests for Patients (Roni Caryn Rabin, Health, NY Times, 4-4-12) Nine medical specialty boards plan to recommend that doctors perform 45 common tests and procedures less often, and to urge patients to question these services if they are offered (for example, EKGs done routinely during a physical, even when there is no sign of heart trouble, M.R.I.’s ordered whenever a patient complains of back pain, and antibiotics prescribed for mild sinusitis

Conflicts of interest associated with drugs and medication (Health Care Reform and Medical Error and the Affordable Care Act, links to key articles on the subject, on Pat McNees website)

When Demented Patients Receive Feeding Tubes (Paula Span, NY Times, Health, 5-9-11). Do not use feeding tubes for patients with advanced dementia.

Ratings for hospitals, doctors, surgeons, home health agencies
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The truth about private screening tests

Annual physicals and health care screening tests Physicals, yes--just not annually. Definitely get a physical when something is wrong.
A Check on Physicals (Jane Brody, Well, 1-21-13) A 'Danish team noted that routine exams consist of “combinations of screening tests, few of which have been adequately studied in randomized trials.” Among possible harms from health checks, they listed “overdiagnosis, overtreatment, distress or injury from invasive follow-up tests, distress due to false positive test results, false reassurance due to false negative test results, adverse psychosocial effects due to labeling, and difficulties with getting insurance.”'
Which screening tests are worth getting? , sidebar to story Annual physical exam is probably unnecessary if you’re generally healthy (Christie Aschwanden, Washington Post, 2-8-13).
Private health screening tests are oversold and under-explained (UK physician Margaret McCartney, The Guardian, 9-17-14) The message in this article for the UK is equally valid for the USA: "Health screening can cause more harm than it prevents, so companies have a duty to provide full information to customers." Life Line Screening markets its for-profit tests without providing fair information and an evidence base for taking them. She provides examples and links, particularly to PrivateHealthScreening: What to Think About When You’re Thinking About Screening Tests. (Click on and read all the links there.) Links below (via Gary Schwitzer) get more specific. Unless your doctor recommends them, there are reasons to think twice about screening tests for which you receive marketing material--say, for aortic aneurysms.
Screening For Asymptomatic Carotid Artery Stenosis (PDF, Agency for Healthcare Research and Quality, Evidence Synthesis No. 50)
Screening Asymptomatic Adults With Resting or Exercise Electrocardiography: A Review of the Evidence for the U.S. Preventive Services Task Force (Annals of Internal Medicine, 9-20-11)
Effect of Screening on Ovarian Cancer Mortality (JAMA, The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial, June 8, 2011)
The UK NSC policy on Osteoporosis screening in women after the menopause (Systematic screening in postmenopasual women is not recommended.)
Liver function tests in patients with computed tomography demonstrated hepatic metastases (Springer, 1989) "Although liver function tests (LFTs) (enzyme levels) are inexpensive and simple to perform, they failed to detect a significant number of patients with liver metastases."
Incidental Findings on Brain MRI in the General Population (New England Journal of Medicine, 11-1-07). "Incidental brain findings on MRI, including subclinical vascular pathologic changes, are common in the general population. The most frequent are brain infarcts, followed by cerebral aneurysms and benign primary tumors. Information on the natural course of these lesions is needed to inform clinical management." See full discussion.
"Preventive health screenings" that are hardly a Life Line (Dr. Kenny Lin, Common Sense Family Doctor, 2-7-11)
How Doctors and Patients Do Harm (Tara Parker-Pope, Well, NY Times, 4-20-12). "That was the beginning of Otis Brawley becoming a loudmouth in the prostate cancer screening debate. We’re making promises to patients and making them think we know things we don’t know and making money off of them. There is a subtle little corruption in medicine. We’re selling chemo to people who don’t need it, giving prostate screening when it might save lives, but we make them think it definitely does..."
Articles about screenings (Covering Health, Association of Health Care Journalists).
Iowa hospitals drop controversial mobile testing firm ( Tony Leys, Des Moines Register, 9-5-14). University of Iowa Health Alliance plans to stop using HealthFair, "a mobile heart-testing company that has been accused of 'fear-mongering' to induce healthy people to undergo scans of their hearts and arteries." This came about after the advocacy group Public Citizen called for an investigation and a halt to recommending tests for most patients. "Such widespread screenings are not recommended by medical experts because each of the six tests either benefits only appropriately selected high-risk patients or has not been scientifically shown to provide any clinically meaningful benefit to anyone.
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Telemedicine and virtual medical visits

More Than Half of Kaiser Permanente's Patient Visits Are Done Virtually (Kia Kokalitcheva, Fortune, 10-6-16) "For the first time, last year, we had over 110 million interactions between our physicians and our members," said Tyson, adding that 52% of them were done via smartphone, videoconferencing, kiosks, and other technology tools. "What were now seeing is greater interaction with our members and the health care system," said Tyson. "They're asking different questions, they're behaving more like consumers, and medical information now is becoming a critical part of how they're making life choices."
Telehealth back in the spotlight (Covering Health, Association of Health Care Journalists, 8-7-17) Lack of reimbursement for telehealth has for many years been an impediment to adoption.Three proposed initiatives would remove some longstanding roadblocks to wider adoption of telehealth services. One proposal would eliminate the state-by-state licensure requirement for telehealth delivery for all federal programs, including Medicare (so the patient wouldn't have to be in the same state as the doctor). The proposed Evidence-Based Telehealth Expansion Act of 2017 would waive current Medicare restrictions on telehealth coverage as long as it saves money. The proposed CHRONIC Care Act of 2017 would offer accountable care organizations and Medicare Advantage plans greater flexibility in reimbursement for telehealth services, and eliminate geographic restrictions for telestroke service payments.
Get Your Checkup by Phone or Video (Beth Howard, The Investing Revolution, US News, 8-26-16) "When 11-month-old Jack Causa's eyes became red and developed a yellow discharge last winter, his mother Izzy immediately recognized the problem: pinkeye. Because the pediatrician's office was closed, she used a service called Teladoc, provided through her health benefits, to reach a physician on her smartphone....Teladoc is one of several services, including MDLIVE, American Well, and Doctor on Demand, offering secure access to a doctor anytime, anywhere to anyone with a smartphone or tablet. "
Choice, Transparency, Coordination, and Quality Among Direct-to-Consumer Telemedicine Websites and Apps Treating Skin Disease (Jack S. Resneck Jr, MD, et al., JAMA Dermatology, 5-1-13) Telemedicine has potential to expand access to high-value health care. Our findings, however, raise concerns about the quality of skin disease diagnosis and treatment provided by many DTC telemedicine websites. Until improvements are made, patients risk using health care services that lack transparency, choice, thoroughness, diagnostic and therapeutic quality, and care coordination. We offer several suggestions to improve the quality of DTC telemedicine websites and apps and avoid further growth of fragmented, low-quality care.
Charlotte patients take control of their medical records, doctor visits with virtual care (Karen Garloch, Charlotte Observer, 12-20-14) After downloading a new app to her iPhone, within minutes Beth Straeten was talking face-to-face with a physician assistant. As Straeten described the poison ivy rash on her arms, PA Dimple Joshi sat across town at Carolinas Medical Center-Pineville, in front of two computer monitors. On one, Joshi could see Straeten and on the other she could read Straeten’s medical record. This has been called medicine’s “Gutenberg moment” by Dr. Eric Topol, one of the nation’s leading cardiologists. Much like the printing press liberated knowledge from control of the elite class, Topol says digital health technology is poised to democratize medicine in ways that were unimaginable until now. “It goes from being the doctor’s medical record to being the patient’s medical record,” said Dr. R. Henry Capps Jr.
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Managing hospitalization and after

• Medicare’s Physician Compare tool lets you know whether your doctor accepts Medicare and takes assignment.
What You Need to Know When You Go to the Hospital: Before, During, After (Caring Collaborative, Transition Network, 2011)
Advance directives, POLSTs, living wills, health care (medical) proxies. In brief (but there is a whole section here): The health care proxy part of the advance directive designates the person who has the authority to make medical treatment decisions for you should you be unable to (say, you've been in an accident and are in a coma). The living will (identifies the types of treatment you do and do not want at the end of your life-- stating your wishes about life-sustaining medical treatment if you are terminally ill, permanently unconscious, or in the end-stage of a fatal illness. The living will part of the advance directive expresses your wishes but it is NOT a medical order. Before you undergo a procedure or surgery it may be even more important to be sure your medical team has a copy of your MOLST, or POLST. The POLST form (aka MOLST, POST, MOST, ETC.) is a medical order--that's the one they're supposed to obey in a medical emergency or a life-threatening situation. Go here for a fuller explanation and links to places where you can get forms for these documents.
Slammed with a Huge ER Bill from an Out-of-Network Doctor or Hospital? Now What? (Sandra Levy, HealthLine, 10-22-14) An increasing number of insured patients are stunned when they receive humongous bills from hospital emergency rooms and “contracted” physicians that are out of their insurance network. You assume, when you go to an in-network hospital, that everyone treating you is in-network ... There is a tiny paragraph [on admission forms] that says, ‘We may use outside doctors that are not part of your network and you are responsible..’ 'Pat Palmer, founder and CEO of Medical Recovery Services, told Healthline that in the past year and a half, she’s seen an increase in hospital ERs using the services of “contracted physicians” or “traveling docs,” as well as outside labs and radiology services. These doctors and services are contracted by the hospital, but they are out of a patient’s insurance network.' Palmer advised patients to inform the ER personnel, and write on the admission form, that you want to be notified of any provider that is not part of your insurance program, or not in-network. When negotiating with the provider, inform them that you never engaged their services directly; someone else engaged their services on your behalf, said Palmer. “Unless they have a signed document from you that you are agreeing to pay them anything they asked for, you want the bill adjusted to what the insurance is allowing,” said Palmer. Read this very practical piece in full!
My friend Ina suggests writing this on any form you sign: "Notwithstanding any other provisions contained herein it is hereby stipulated the patient or other person signing this document is not responsible for any costs, fees or other charges not covered by patient’s insurance policies. Patient will only pay co-payment amounts when approved by patient’s insurance policy companies."
How To Fight For Yourself At The Hospital — And Avoid Readmission (Judith Graham, Kaiser Health News, 9-1-16) This new column explains what older adults and their families can do to avoid hospital readmission. Kaiser Health News columnist Judith Graham writes: "Everything initially went well with Barbara Charnes’ surgery to fix a troublesome ankle. But after leaving the hospital, the 83-year-old soon found herself in a bad way. Dazed by a bad response to anesthesia, the Denver resident stopped eating and drinking. Within days, she was dangerously weak, almost entirely immobile and alarmingly apathetic. “I didn’t see a way forward; I thought I was going to die, and I was OK with that,” Charnes remembered, thinking back to that awful time in the spring of 2015. Her distraught husband didn’t know what to do until a long-time friend — a neurologist — insisted that Charnes return to the hospital."
When You Need a Home Health Aide (Orly Avitzur, Consumer Reports)
Diagnosis: Unprepared (KHN) Hospitals can be hazardous places for elderly patients, who are at increased risk of falling, drug-induced injury and confusion.
But as the nation’s senior population grows, many facilities are ill-equipped to address their unique needs. Kaiser Health News visited hospitals around the country, reviewed data and interviewed dozens of patients, family members and health providers to document the extent of the problem and highlight possible solutions.
Read the stories in this series:
Elderly Hospital Patients Arrive Sick, Often Leave Disabled (Anna Gorman, KHN, 8-9-16)
Geriatric ERs Reduce Stress, Medical Risks For Elderly Patients (Anna Gorman, KHN, 8-23-16) Geriatric emergency rooms, which are slowly spreading across the country, provide seniors with more expertise from physicians, nurses and others trained specifically to diagnose and care for the elderly, researchers said.
Elderly Patients In The Hospital Need To Keep Moving (Anna Gorman, KHN, 8-16-16) “People walk in the door of a hospital and think it’s OK to stay in a bed. It’s not,” said Middlebrooks. The Affordable Care Act explains some of the reluctance by staff at many hospitals to get patients moving, experts say. Under the law, hospitals are penalized for preventable problems, including falls. Researchers believe that hospital staffers, to ensure their patients don’t fall, often leave them in their beds. The impact of remaining so sedentary in the hospital can be devastating for older patients: It is puts them at greater risk for blood clots, pressure ulcers and confusion. Immobility hurts older patients more than younger ones, in part because the elderly are generally weaker, have less bone density and are at higher risk of falling. Ironically, keeping a patient in bed, which is often intended to prevent falls in the hospital, can increase their risk of falling after they are discharged, experts said.
‘America’s Other Drug Problem’: Copious Prescriptions For Hospitalized Elderly (Anna Gorman, Kaiser Health News, 8-30-16)
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Reducing medical costs

Guroo.com, which "shows the average local cost for 70 common diagnoses and medical tests in most states...based on a giant database of what insurance companies actually pay." Guroo is produced by the Health Care Cost Institute. See KHN story: Attention, Shoppers: Prices For 70 Health Care Procedures Now Online! (Jay Hancock, Kaiser Health News, 2-25-15).
Surprisingly Little Evidence for the Accepted Wisdom About Teeth (Aaron E. Carroll, The New Health Care, NY Times, 8-29-16) There’s good evidence that brushing twice a day with fluoride toothpaste is a good idea, especially with a powered toothbrush. For children, there’s good evidence that the use of fluoride varnish or sealants can be a powerful tool to prevent cavities. The rest? It’s debatable; we don't have good studies. With flossing, which is cheap and easy, it still might be worth doing. And fluoride is important.
5 Tips for Handling Early-Year Medical Expenses (AP, NY Times, 2-5-15) Which refers to:
---Co-Payment Assistance Organizations (Patient Access Network Foundation)
---Partnership for Prescripton Assistance (PPA)
In Medicine, the Power of No (David Leonhardt, NY Times, 4-6-10) Americans tend to think more healthcare is better healthcare, says Leonhardt, but " it also has big downsides, including the side effects and risks that come with unnecessary treatment." For example, we overuse CT scans (radiation), " Caesarean births have become more common, with little benefit to babies and significant burden to mothers. Men who would never have died from prostate cancer have been treated for it and left incontinent or impotent. Cardiac stenting and bypasses, with all their side effects, have become popular partly because people believe they reduce heart attacks....unnecessary care causes a lot of pain and even death." (See Berwick on Medical Errors.) So let's start reducing unnecessary care. "Learning to say no more often will be a three-step process." (1) Learn more "about when treatments work and when they don’t." The Institute of Medicine says the most promising areas for research into what's necessary include prostate cancer, inflammatory diseases, back pain, hyperactivity, and CT scans vs. M.R.I.’s for cancer diagnosis. (2) Give patients the available facts about treatments. When patients are given information about potential benefits and risks, they can weigh the risks and benefits and may choose the less invasive option. (3) Change the economics of medicine, to reward better care rather than simply more care--so "doctors who provide good, less expensive care won’t be financially punished as often as they now are."
Cost Conundrum: What a Texas town can teach us about health care (Atul Gawande, New Yorker, 6-1-09)
CAPHIS 2013 Top 100 List: Health Websites You Can Trust
PatientAssistance (helping patients get medication). See list of Top 50 drugs
CountyRxCard (up to 75% discount on all FDA-approved drugs at 56,000 pharmacies nationwide)
Be a Prepared Patient Center for Advancing Health, CFAH)
6 Ways to Lower a Massive Medical Bill (Lacie Glover, The Fiscal Times, 6-16-14)
How to Catch Costly Errors on Your Medical Bills (Lacie Glover, The Fiscal Times, 6-8-14)
30 Ways to Cut Health Care Costs (Kimberly Laskford, Kiplinger, April 2011) How to pay the lowest price without sacrificing quality.
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Good e-resources for patients/​consumers/​patient advocates and e-patients

Kaiser Health News (thorough coverage of medical news)
PubMed (reliable information for consumers, providing good basic understanding of specific diseases, with literature searches and references to articles that provide a state of the art overview
ePatient Dave (a voice of patient engagement). See The New Life of e-Patient Dave "In 2007, supported by an extraordinary team of family, friends, and medical staff, I stomped the snot out of a nasty cancer that was on its way to killing me. I've since learned that the way I did it has a lot in common with the advice of the "e-patients" movement, so I've changed my blogger name from Patient Dave to e-Patient Dave."
e-patients.net (because providers can't do it alone)
Kevin MD (doctors' voices blog)
• On Symptom Checkers: e-Patient Dave's "A Turing Test for Diagnosis: BMJ evaluates online symptom checkers" ( BMJ 2015;351:h3480). See also Tools to diagnose symptoms online often get it wrong, study finds (Boston Globe).
Health Net Navigation Never trust a librarian… unless you want good information.
Health videos (Medline Plus)
Medical Encyclopedia (Medline Plus)
Medical Dictionary (Medline Plus)
Patiient Empowerment (About.com)
New America Media (collaboration of 3,000 ethnic news organizati0ns in US) with special sections such as Paul Kleyman's Ethnic Elders or posts on Health.
Journal of Participatory Medicine
Empowered Patient (Elizabeth Cohen's column, CNN)
Not Running a Hospital (Paul Levy, former CEO of a large Boston hospital, shares thoughts about hospitals, medicine, and health care issues)
The Health Care Blog
Blogs and news for science and medical writers (Writers and Editors)
Geek Doctor (life as a healthcare CIO)
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Patients sharing info and opinions about health care services


ClearHealthCosts
Costs of Care (Twitter thread). See especially GODMeDS
DocGraph. We bring healthcare data into the open.
ePatient Dave. A voice of patient engagement. See, for example, New Orleans investigative reporters expose health cost craziness, with ClearHealthCosts
PatientsLikeMe. By actively involving people in their own care, we're changing lives…
Rock Health. The first venture fund dedicated to digital health. We support companies improving the quality, safety, and accessibility of our healthcare system.
Smart Patients. An online community where patients and their families learn from each other.
uBiome. SmartGut is the first sequencing-based clinical microbiome screening test. With SmartGut, you and your doctor can gain valuable insights to better understand what’s going on inside your gut and then take steps to feel better.
Asthmapolis, now Propeller, moves beyond asthma
Crohnology. A Patient-Powered Research Network that allows any patient to contribute to research for the cure. Currently focused on Crohn's & Colitis. What if we could learn from the collective experience of patients everywhere?
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Basic healthcare explanations: How things (in the body) work

Antibodies: Friend & Foe (Thomas Packard, Healthcare in America,12-29-16)
You Should Appreciate Germs (Bill Gates, GatesNotes, 3-26-17) Gates talks with British journalist Ed Yong about his book I Contain Multitudes: The Microbes Within Us and a Grander View of Life. "Yong makes clear that only a tiny fraction of microbes have the ability to make us sick. There are approximately 100 species of bacteria that cause infectious disease in humans. But there are hundreds of thousands of species that live peacefully, symbiotically within us, primarily in our gut. Microbes help us digest our food, break down toxins, guide our physical development, protect us from disease, and even speed human evolution. We are utterly dependent on them." “We have been tilting at microbes for too long, and created a world that is hostile to the ones we need,” says Yong. What we're doing wrong: overusing anti-bacterial soaps and sanitizers, antibiotics (“A rich, thriving microbiome acts as a barrier to invasive pathogens,” writes Yong. “When our old friends vanish, that barrier disappears [and] more dangerous species can exploit the … ecological vacancies.”) We don't give our children enough micronutrients (not available in pizza!) "The list of disorders that have been linked to disruptions in the microbiome includes Crohn’s disease, ulcerative colitis, irritable bowel syndrome, colon cancer, obesity, type 1 diabetes, type 2 diabetes, and Parkinson’s disease. "
Blood tests and results, explained
Blood Pressure Monitors (those validated as reliable, dabl Educational Trust)
Types of blood tests (National Heart, Blood, and Lung Institute, NHBLI)
Risk Assessment Tool for Estimating Your 10-year Risk of Having a Heart Attack (NHBLI)
Questions and Answers on Cholesterol and Health with NHLBI Nutritionist Janet de Jesus, M.S., R.D. (NHBLI)
Testosterone (This American Life, Program 220, 8-30-2002) Stories of people getting more testosterone and coming to regret it. And of people losing it and coming to appreciate life without it. The pros and cons of the hormone of desire.
Fighting the Plague: A Story of HIV/​AIDS (Thomas Packard, Healthcare in America, 12-2-16)

Mapping the Secret Lives of Human Cells (Daniela Hernandez, WSJ, 4-6-17) What does a human cell look like? That is somewhat of a mystery because most current cellular models are static and based on limited data, according to scientists from the Allen Institute for Cell Science in Seattle. Until recently researchers lacked the tools to assess cells and their tiny internal structures, known as organelles, in real time on a large scale, they say.
In Giant Virus Genes, Hints About Their Mysterious Origin (Rae Ellen Bichell, Shots, NPR, 4-6-17) Viruses are supposed to be tiny and simple — so tiny and simple that it's debatable whether they're even alive. They're minimalist packets of genetic information, relying entirely on the cells the infect in order to survive and reproduce. But in 2003, researchers identified a new kind of virus that that turned scientific understanding of viruses upside down, and tested the boundary of what can be considered life.

Thanks to Kaiser Health News (http:/​/​khn.org/​.
Many of the links posted on this website I became aware of through Kaiser Health News, which I highly recommend. You can subscribe here..
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Making wise medical choices, decisions

Choosing Wisely (Consumer Reports and the American Board of Internal Medicine (ABIM) Foundation) Helps consumers/​patients choose care that is truly necessary, is supported by evidence, and doesn’t duplicate tests or procedures already received.
Consumer Health Choices (Consumer Reports, free resources for more sensible healthcare decisions)
Preventing Overdiagnosis (winding back the harms of too much medicine)
Right Care Weekly (Lown Institute)
Modifying use of some prescription drugs may reduce fracture risk in older adults (Liz Seegert, Covering Health, AHCJ, 9-13-16) Some fragility fractures – those that occur at standing height – may be preventable by modifying a patient’s prescription drug regimen. 21 drug classes have been associated with increased fracture risk. These include commonly prescribed medications such as antidepressants and antacids.

Diseases and conditions
Diseases and conditions (PubMed Health, alphabetical)
Blood disorders (National Heart, Lung & Blood Institute)
Infectious Disease Information, A to Z (CDC National Center for Infectious Diseases)


For your medical reference shelf


The Body Clock Guide to Better Health by Michael Smolensky and Lynne Lamberg
The Cornell Illustrated Medical Encyclopedia: The Definitive Medical Home Reference Guide (Weill Cornell Health Series) by Antonio Gotto
The Johns Hopkins Complete Home Guide to Symptoms & Remedies by Editors of The Johns Hopkins Medical Letter Health After 50
The Johns Hopkins Consumer Guide to Medical Tests: What You Can Expect, How You Should Prepare, What Your Results Mean by Simeon Margolis
Know Your Body: The Atlas of Anatomy by Emmet B. Keefe
Mayo Clinic Family Health Book, 3rd edition, by the Mayo Clinic
Mosby's Manual of Diagnostic and Laboratory Tests by Kathleen Pagana and Timothy Pagana (this is especially helpful in interpreting lab test results)

Many diseases and conditions are listed on this website (with links) under Coping with chronic, rare, and invisible diseases and disorders . When you reach a blog about a particular condition, look along the right side of the page and you'll usually find a "blog roll," listing other resources on the same subject. Some will provide more reliable information and insights than others, but patient-written blogs (which may certainly contain misinformation) often provide practical insights into how to live with a disease or condition (psychologically and otherwise).
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Books about how healthcare professionals train, think, and act

An Uncertain Inheritance: Writers on Caring for Family edited by Nell Casey. Wonderful writing, excellent insights into the complexities both of caring and of being cared for, during an illness.
An Unquiet Mind by Kay Redfield Jamison (about manic depression).
Better: A Surgeon's Notes on Performance by Atul Gawande
Complications: A Surgeon’s Notes on an Imperfect Science by Atul Gawande
How Doctors Think by Jerome Groopman
How We Die by Sherwin Nuland (excellent descriptions of exactly how the various body systems fail, when they fail -- a primer even for healthy readers)
Illness as Metaphor: AIDS and Its Metaphors by Susan Sontag
In the Country of Hearts: Journeys in the Art of Medicine by John Stone
Just Here Trying to Save a Few Lives: Tales of Life and Death in the ER by Pamela Grim
Life Disrupted: Getting Real About Chronic Illness in Your Twenties and Thirties, by Laurie Edwards
The Man Who Mistook His Wife for a Hat and Other Clinical Tales, by Oliver Sachs
The Measure of Our Days: New Beginnings at Life's End by Jerome Groopman
Medical Detectives, by Berton Roueche
Second Opinions: Stories of Intuition and Choice in the Changing World of Medicine by Jerome Groopman
Unholy Ghost: Writers on Depression, ed. Nell Casey
You: The Smart Patient, An Insider's Handbook for Getting the Best Treatment, by Drs. Michael F. Roizen and Mehmet C. Oz, with the Joint Commission (one of a series by the charismatic Oprah favorite, Dr. Oz, and the knowledgeable Dr. Roizen)
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MANAGING PAIN

Managing ordinary (not chronic) pain

Pain (MedlinePlus)
• See full separate section on Managing chronic pain
Beyond pills and shots: Pain patients seek other options (Felice J. Freyer, Boston Globe, 12-30-16). Part of a series on chronic pain.
Pain Relievers: Understanding Your OTC Options (FamilyDoctor.org)
Pain Relief: What You Need to Know (Consumer Reports, 4-28-16) 125 million people are in pain, spending some $300 billion on pills, pot, procedures, and natural ‘cures’ to find relief, but are they worth it?
Pain Management: Which Treatment Is Right for You? (Consumer Reports, 4-28-16)
Addictive Pain Medication: How to Protect Yourself (Theresa Carr, CR, 4-28-16) Many painkillers can be highly addictive
Try This Instead of Drugs to Treat Neck and Shoulder Pain (CR, 4-28-16) Strengthening weak neck muscles with exercise and applying heat can alleviate the pain
How to Get Rid of Lower Back Pain (Consumer Reports, 4-28-16) If you don't feel better after four weeks, see a doctor because it could be another condition, like osteoporosis
Best Ways to Treat Joint Pain (CR, 4-28-16) Stiff or swollen joints can result in pain, especially first thing in the morning and after resting. Here's what you can do to ease it.
Is Supercooling the Body an Effective Therapy? (Dina Fine Maron, Scientific American, 10-31-16) The market for cryotherapy "devices is beginning to burgeon in the U.S., with sports teams snapping them up to condition their players, and spas and wellness centers installing them for clients looking to relax, lose weight and fight signs of aging....Yet the science behind these devices is decidedly lackluster. In July the U.S. Food and Drug Administration issued a warning stating that there is no evidence these technologies help to ease muscle aches, insomnia or anxiety or provide any other medical benefit. Instead, it said, they may cause frostbite, burns, eye damage or even asphyxiation. In a statement to Scientific American the agency added, 'The FDA has not approved or cleared any whole-body cryotherapy devices, and we do not have the necessary evidence to substantiate any medical claims being made for these devices.'”
Acetaminophen Is the Best Pain Reliever for Heart Patients (Orly Avitzur, Consumer Reports, 6-19-16) "Tylenol is a good choice for those needing relief from the physical pain caused by osteoarthritis in the joints or from headache pain and who also have heart troubles such as high blood pressure, heart failure, heart attacks, chest pain due to narrowed coronary arteries (angina), or stroke. Using acetaminophen is a much safer bet than most over-the-counter pain relievers like ibuprofen (Advil and generic) and naproxen (Aleve and generic)....That’s because acetaminophen is unlike other common, over-the-counter pain medications, like ibuprofen and naproxen, which can aggravate high blood pressure, and in turn raise a person's risk of having a heart attack. "
Tension Headache Treatment and Prevention (CR, 4-28-16) A few simple steps like drinking water and doing neck exercises can relieve your pain
Speak Up: What You Should Know about Pain Management (Joint Commission)
Chronic Pain Medicines (FamilyDoctor.org).
When Pain Remains (Jerome Groopman, New Yorker, 10-10-05) What should patients do when doctors can't figure out how to diagnose or treat reflex sympathetic dystrophy (RSD), reclassified in 1994 as complex regional pain syndrome (CRPS), the hallmark of which is excruciating pain.
When Pain Remains: Q & A (sidebar to the Groopman piece on CRPS). What should patients do when doctors can’t figure out how to treat their suffering?
How OxyContin's Pain Relief Built 'A World Of Hurt' WHYY's Fresh Air interviews Barry Meier, author of A World of Hurt: Fixing Pain Medicine's Biggest Mistake (Kindle single)
Neuroplastix Change the Brain; Relieve the Pain; Transform the Person. Read the book free online.
The disturbing reason some African American patients may be undertreated for pain (Sandhya Somashekhar, Wash Post) African Americans are routinely under-treated for their pain compared with whites, according to research. Whites are more likely than blacks to be prescribed strong pain medications for equivalent ailments. Unconscious stereotypes about African Americans likely contribute to this problem, as well as physicians' difficulty empathizing with patients whose experiences differ from theirs.
Ways to Reduce Pain Naturally
Who Has a Right to Pain Relief? (Rebecca Davis O'Brien, The Atlantic, 8-18-14). The legal, medical, and pharmaceutical industries have all struggled to locate the line between analgesia and drug abuse.
Keith Wailoo on the politicization of pain (Book TV, C-Span, 3-3-15) Professor Keith Wailoo talked about his book, Pain: A Political History, about the politicization of treating pain in the U.S. since the 1950s. How do we decide who is or is not (really) in pain and how to treat that pain. Is chronic pain a disability that should be compensated? Are we exercising compassion in treating pain or creating a generation of dependents. It's the judges, not the doctors and not the scientists, who make significant decisions about pain. (Listen, watch, or read transcript.)
Pain: A Political History by Keith Wailoo. A "well-rounded discussion of the politics of pain and pain relief in post WW II America." Wailoo examines how pain has defined the line between liberals and conservatives from just after World War II to the present. From disabling pain to end-of-life pain to fetal pain, the battle over whose pain is real and whose pain deserves relief has created stark ideological divisions at the bedside, in politics, and in the courts -- and the interests and arguments of media, politicians, and medical professionals often work against the voice of the individual suffering pain. What about managing pain in end-of-life care?
Kratom Users Say Ban Will Lead to More Drug Abuse (Pat Anson, Pain News Network, 9-20-16) Kratom is a safe and surprisingly effective treatment for chronic pain and a wide variety of medical conditions, according to a large new survey of kratom consumers. Many say banning the herbal supplement will only lead to more drug abuse and worsen the nation’s opioid epidemic. (An online survey of 6,150 kratom consumers by Pain News Network and the American Kratom Association was conducted after plans were announced by the U.S. Drug Enforcement Administration to classify two chemicals in kratom as a Schedule I controlled substances.)
Why Banning the Controversial Painkiller Kratom Could Be Bad News for America's Heroin Addicts (Maia Szalavitz, Vice, 1-20-16) "It sounds like the perfect drug. At low doses, it's stimulating, like a strong cup of coffee; at higher doses, it's sedating and kills pain. And it's a legal, natural plant that has been used in Asian medicine for centuries. Indeed, a growing number of Americans are finding it to be a useful alternative to heroin and prescription pain relievers. But of course, there's a catch. Like the opioid drugs it is used to replace, this stuff can be addictive, and it can also cause serious nausea. Unlike other opioids, however, it seems to have an extremely low overdose risk, which has caught the eye of people working to fight the record high level of overdose deaths."
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Managing chronic pain


Beyond pills and shots: Pain patients seek other options (Felice J. Freyer, Boston Globe, 12-30-16). Part of an invaluable series, specific titles for which can be found here (read 5-piece limit for free): Boston Globe series on chronic pain. See, for example, Doctors are cutting opioids, even if it harms patients (Freyer, 1-3-17) as well as other stories on opioids, and When Chronic Pain Is a Child's Companion, among several important stories.
What is TN? (Facial Pain Association). "Trigeminal neuralgia (TN) is considered to be one of the most painful afflictions known to medical practice. TN is a disorder of the fifth cranial (trigeminal) nerve. The typical or “classic” form of the disorder (called TN1) causes extreme, sporadic, sudden burning or shock-like facial pain in the areas of the face where the branches of the nerve are distributed – lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. The pain episodes last from a few seconds to as long as two minutes. These attacks can occur in quick succession or in volleys lasting as long as two hours. The “atypical” form of the disorder (called TN2), is characterized by constant aching, burning, stabbing pain of somewhat lower intensity than TN1. Both forms of pain may occur in the same person, sometimes at the same time."
Home remedies for alleviating sciatica pain (McNees blog, 4-2-16) The piriformis muscle is a small muscle located deep in the buttock (behind the gluteus maximus). It starts at the lower spine and connects to the upper surface of each femur (thighbone). It helps to rotate the hip and turn the leg and foot outward. It sits under deep layers of fat and muscle in your buttock, so if you sit a lot and don't move around, those muscles get compressed. Get up from that chair and move around more! Meanwhile, here are some suggested remedies.
Dr. John Sarno on healing lower mid-back pain, sciatica, psoas pain ' (20/​20 segment, YouTube). (Basically, "It's all in your head." -- that is, he says that's often true AFTER you have ruled out physical problems. Your brain protects you from negative emotions by referring them to your back.). Or read his book: Healing Back Pain: The Mind-Body Connection. A lot of people seem to have been helped by this book. Goodreads: " John Sarno, MD, at the NYU School of Medicine discovered in the 1970s that back pain was not coming from the things seen on the imaging, such as herniated discs, arthritis, stenosis, scoliosis, etc. Pain was coming from oxygen reduction through the autonomic nervous system due to elevated tension levels, but had been errantly linked to the "normal abnormalities" seen on MRIs and X-rays. Most physicians refused to believe his findings even though his success rate in healing the most troublesome of pain-cases was well above theirs. Dr. Sarno labeled the disorder TMS, or tension myoneural syndrome, currently being called The Mindbody Syndrome." (From a review of Hanscom's book, below).
Healthcare Hashtag Project, a free open platform for patients, caregivers, advocates, doctors and other providers that connects them to relevant conversations and communities. Thousands of patients talk about diseases weekly in "chats" on Twitter.
Giving Chronic Pain a Medical Platform of Its Own (Tara Parker-Pope, Well, NY Times, 7-18-11) What doctors don't know about chronic pain. “Having pain that is not treated is like having diabetes that’s not treated,” said Ms. Thernstrom, who suffers from spinal stenosis and a form of arthritis in the neck. “It gets worse over time.”
New Pathways to Overcome Chronic Back Pain (listen to podcast of back surgeon David Hanscom, author of Back in Control: A spine surgeon's roadmap out of chronic pain, on Show 972 of "The People's Pharmacy"). "According to Dr. David Hanscom, a leading spine surgeon, back pain can be overcome, but surgery is frequently NOT the best choice. People with chronic back pain may need to overcome their anger and anxiety and use an integrated approach to build new neural pathways that circumvent the pain. Some of the best tactics include finding a way to play as well as a way to confront anger and find forgiveness." From Goodreads: "Steve tells his compelling story of a 30-year battle with pain and ultimate healing after discovering Dr. Sarno's work. After Steve healed he began receiving hundreds of emails, calls, and letters, asking for his help--too many to respond to, so he decided to write his experience down in a book." See the Goodreads comments on book."This is a more readable book than Sarno's, says one reader.
Hurting All Over (Jerome Groopman, New Yorker, 11-13-2000) With so many people in so much pain, how could fibromyalgia not be a disease?
Biofeedback: A High-Tech Weapon Against Migraines (Sue Russell, Healthymagination 7-18-11)
Migraine Treatment, Prevention & Relief (CR, 4-28-16) Tips on how to treat—and even prevent—this common type of pain
Chronic Lyme and other tick-born diseases ("When the doctor gets sick, the journey is double-edged," by Pamela Weintraub, Psychology Today, in 3 parts)
Pains (Janice Lynne Schuster and the Pain Project). Many articles, including
--An Unwelcome Guest: Living with Chronic Pain (Schuster, Disruptive Women in Health Care, 12-15-14)
--Draft of the National Pain Strategy has been published to the Federal Register (PAINS Project, 4-2-15) the National Institute of Neurological Disorders and Stroke (NINDS) Office of Pain Policy today published a notice soliciting public comment on the draft National Pain Strategy.
--In pain? (Some resources. Janice Lynne Schuster's site.)
Complex regional pain syndrome (CRPS, Mayo Clinic staff)
Complex Regional Pain Syndrome fact sheet (National Institute of Neurological Disorders and Stroke
Chronic back pain
Dancing with Pain (one approach to pain relief)
For Grace. Resources for Women in Pain.
How to Cope with Pain website (breathing and relaxation exercises, guided imagery,etc.--includes favorite how-to-cope-with-pain submissions
Living With Pain That Just Won’t Go Away (Jane E. Brody, NY Times, 11-6-07)
Quality of Life Scale , a measure of function for people with pain (pdf, American Chronic Pain Association)
The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing, and the Science of Suffering by Melanie Thernstrom
The Permanent Pain Cure: The Breakthrough Way to Heal Your Muscle and Joint Pain for Good by Ming Chew with Stephanie Golden
Reflex Sympathetic Dystrophy Syndrome Association (RSDSA), promotes public and professional awareness of Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy (RSD)
The Psychology of Pain: It’s Not What You Think (Stan Goldberg's interesting and informative essay)
Chronic pain not only hurts, it also causes isolation and depression. But there’s hope. (Rachel Noble Benner, Wash Post, 1-12-15)
One in 3 women could potentially be spared chronic pain after breast cancer surgery (Medical Press, 2-25-15)
Here’s What’s Wrong With How US Doctors Respond to Painkiller Misuse(Maia Szalavitz, Substance.com, 1-13-15).
New Report Details Uphill Battle to Solve the U.S.'s Pain Problem (Bob Roehr, Scientific American, 7-1-11) The Institute of Medicine reveals a "blueprint" for relieving Americans' pervasive chronic pain.
Opioid Misuse In Chronic Pain Patients Is Around 25%, New Study Shows (CJ Arlotta, Forbes, 4-1-15)
Opioids: addiction, overdose, treatment, and recovery (addiction to heroin, cocaine, crack, and other illegal and addictive painkillers--and addictive prescription drugs)
Managing ordinary (not chronic) pain
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Organizations associated with pain management and relief


Academy of Integrative Pain Management (was American Academy of Pain Management)
American Academy of Pain Medicine
American Board of Pain Medicine (ABPM)
American Chronic Pain Association . Among other resources provided, information about Conditions, A to Z and a free downloadable PDF, ACPA Resource Guide to Chronic Pain Medication and Treatment
American Pain Society
American Society/​of Interventional/​Pain Physicians (ASIPP)
American Society of Regional Anesthesia and Pain Medicine (ASRA)
The Facial Pain Association (FPA) (support for those with trigeminal neuralgia and other neuropathic facial pain conditions). Among publications available from FPA: Striking Back : The Trigeminal Neuralgia and Face Pain Handbook by George Weigel and Kenneth E. Casey (to be updated this year)
Pain Association. Resources include a list of conditions characterized by pain and A Consumer Guide to Pain Medication and Treatment
Pain Relief Network (where chronic pain patients, doctors, and supporters can be heard)
Partners Again Pain (addressing untreated and undertreated pain in America)
U.S. Pain Foundation
National Fibryomyalgia & Chronic Pain Association (NFMCPA)
Pain management forum (MedHelp)
Patients Like Me (sorted by conditions)
American Fibromyalgia Syndrome Association (AFSA)

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The medical use of marijuana


The Medical Use of Marijuana v. The Use of Marijuana for Medical Purposes (Bradley Steinman, American Bar Association,
Gupta: 'I am doubling down' on medical marijuana (Sanjay Gupta, CNN, 3-6-14) Apologizing for having previously spoken against marijuana use, Gupta writes about "emerging science that not only shows and proves what marijuana can do for the body but provides better insights into the mechanisms of marijuana in the brain, helping us better understand a plant whose benefits have been documented for thousands of years. This journey is also about a Draconian system where politics overrides science and patients are caught in the middle."
My Personal Experiences with the Medical Marijuana Business and the Opioid Epidemic (David Meerman Scott, Healthcare in America, 1-4-17) Marijuana is a safer alternative to opioids for pain relief, but you have to jump through hoops to qualify for medical marijuana. A business story that may prove helpful.
Weed (Sanjay Gupta's documentary on medical marijuana)
Marijuana stops child's severe seizures (Saundra Young, CNN, 8-7-13) Much good background information.
To Save Her Daughter, This Mom Became a Medical Marijuana Pioneer On a Facebook group of parents across the world with children with an incurable genetic disorder called CDKL5, one mother in the U.S. described giving her daughter cannabis-based medicines to mitigate the epileptic fits that are a symptom of the disorder. After figuring out the practical aspects of using such medicine for her daughter's condition, a mother in Brazil took on Brazil’s tangled legal system to become the first person in the country’s history with permission to grow cannabis for medicinal purposes. Other Brazilians, mostly parents of children with degenerative diseases, are forced to seek out expensive medical marijuana in clandestine fashion, risking punitive jail sentences if they are caught. The NGO Support for Patients and Research for Medicinal Marijuana (APEPI) pushes for advances in legalization and research permissions.
Medical marijuana (Mayo Clinic) Despite a federal ban, many states allow use of medical marijuana to treat pain, nausea and other symptoms. Is medical marijuana legal under federal law in the U.S.? When is medical marijuana appropriate?
Marijuana as Medicine (Drug Facts, National Institute on Drug Abuse, April 2017) The term medical marijuana refers to using the whole, unprocessed marijuana plant or its basic extracts to treat symptoms of illness and other conditions. The U.S. Food and Drug Administration (FDA) has not recognized or approved the marijuana plant as medicine. However, scientific study of the chemicals in marijuana, called cannabinoids, has led to two FDA-approved medications that contain cannabinoid chemicals in pill form. Continued research may lead to more medications. Because the marijuana plant contains chemicals that may help treat a range of illnesses and symptoms, many people argue that it should be legal for medical purposes. In fact, a growing number of states have legalized marijuana for medical use.
News about Marijuana and Medical Marijuana, including commentary and archival articles published in The New York Times
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Managing pain and improving health with yoga

Yoga overview (National Center for Complementary and Integrative Health)
What the Science Says About Yoga "Current research suggests that a carefully adapted set of yoga poses may reduce low-back pain and improve function. Other studies also suggest that practicing yoga (as well as other forms of regular exercise) might improve quality of life; reduce stress; lower heart rate and blood pressure; help relieve anxiety, depression, and insomnia; and improve overall physical fitness, strength, and flexibility. But some research suggests yoga may not improve asthma, and studies looking at yoga and arthritis have had mixed results." From
Effectiveness of Iyengar yoga in treating spinal (back and neck) pain: A systematic review. (Crow EM, Jeannot E, Trewhela A, Intl J Yoga, on PubMed, Jan. 2015). "This systematic review found strong evidence for short-term effectiveness, but little evidence for long-term effectiveness of yoga for chronic spine pain in the patient-centered outcomes. "
Health conditions benefited by yoga (Timothy McCall, MD, from Yoga as Medicine ), a list followed by links to many references.
Western Science vs. Eastern Wisdom (PDF, Timothy McCall). See also Does Yoga Kill? Yoga, Truthiness and the New York Times, in which McCall argues against New York Times writer William Broad's claims that yoga is responsible for hundreds of strokes per year, the emotional linchpin of his yoga-wrecks-your-body arguments. About which, see next entry:
How Yoga Can Wreck Your Body (William J. Broad, NY Times, 1-5-12) and this follow-up piece: The Healing Power of Yoga Controversy (William Broad, The 6th Floor: Eavesdropping on the Times Magazine, 1-10-13) "Yet, for all the bad news about yoga, I still see the rewards as outweighing the risks. A century and a half of science shows the benefits to be many — and the serious dangers to be few and comparatively rare."
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