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Month Year Issue No.
In This Issue
Healthcare Reform
My Take and Summary
The Travails of Tylenol?
You may want to think twice especially before treating children with it. 
Flu Update
H1N1 is still around and the seasonal flu has yet to appear. 

Here is the latest edition of our email Newsletter. 
My Take on Healthcare Reform
Healthcare Reform
A number of patients have asked me my opinion of the current healthcare legislation before Congress and so I will take this opportunity to get on my soapbox. I, like President Obama, believe that access to quality healthcare is a right and not a privilege.  Anybody who views our current system as excellent is rather uninformed.  It is overly expensive for what we , the consumers, get. I, as you doctor, used to be free to order any test I had wanted to and order it as often as I liked even if it were unnecessary. For example, you as a patient, could get an MRI even if it wasn't going to add to the quality of your care. Eventually, that kind of a system runs out of the money needed to pay for the basics. While the perverse incentives of the system aren't going to change much with the current legislation I believe it will be laying the groundwork for such a change in the future.
The Friday  Dec. 25 Globe had an excellent table explaining the basic aspects of the Hose and Senate versions of the bills. Here are some important points-
1. Approx. 95% of Americans will be covered (83% now).
2. Insurance will largely be through employers but a public option (House) or national insurance exchanges (Senate) will be available for those without employer availability.
3. Purchasing insurance will  be mandatory but there will be subsidies for family of 4 earning less than $88,000.
4. Seniors will eventually have all their medication covered without a  'doughnut hole' (a level at which no drugs are covered).
5. You will not be able to be denied healthcare as a result of a pre-existing condition.
6. Long-term Care insurance will be available on a national level ( a major innovation) and it will be voluntary.
7.  Abortions - House bill more restrictive than Senate but neither will change the status quo for those with current insurance.
8. Cost- About $900 billion over 10 years.
9. Funded through various taxes and cuts to some Medicare/Medicaid programs. Seniors will  see an improvement in their plans as preventive services will be covered for the first time and there will be elimination of the 'doughnut hole'.  The House bill focuses on taxing families earning over $1 million/year  whereas the Senate increases Medicare payroll taxes.  
Massachusetts already has a plan that covers almost as many people as the proposed plan and indeed was a model for the current plan. There are, of course, aspects of the national plan (esp. those highlighted) that would be an added benefit to us. Employers and some residents masy also get federal tax breaks too.
Eventually, in my opinion, we will need to go to some sort of national system that is similar to Medicare (but more tightly managed). Medicare has approx. 3% in overhead costs compared to 10-20% for private heath insurers.  But without controls on services costs will continue to increase in the out-of-contol manner that they have. In short, I believe that the current healthcare reform legislation that has been put forward in the two separate bills in the House and Senate will be a big step forward for the country. It will not bring universal coverage to all Americans but it will get us closer to that goal.
The Travails of Tylenol 
Tylenol (acetaminophen) is widely used in our society and that may be about to change somewhat. An FDA advisory panel in July voted to recommend the reformulation of products a containing Tylenol so that 650mg be a maximal single dose and not 1000mg. There is concern that some people are damaging their livers by taking limitless quantities of tylenol and mixing them with other prescrition medications and/or alcohol. Still, Tylenol is considered amongst the safest medications when taken in standard recommended quantities. Up to 4000 mg per day is probably safe for most people even though the maximum recommended daily dose may be lowered too.
There have been a few kinks in the armor that have come to the fore in recent years though. A few years back it became clear that Tylenol can affect the potency of warfarin  (a common 'blood thinner') especially when taken in dosages over 2250 mg.  Also, a recent study from the Czech Republic showed that giving Tylenol to children at the time of immunization caused a decrease in the immunogenicity (effecvtiveness) of the vaccines.  And perhaps more importantly, a very large worldwide study of Tylenol usage in children showed that there was an increase in the incidence of asthma in children who received Tylenol (the more Tylenol - the higher the risk for asthma). Are there implications for adults as well? Does tylenol have an effect on our immune system?
I'm not saying that you should never take Tylenol. I think that the only message here is that the philosophy of taking as little unnecessary medication as possible is always advisable. (Of course, always take medication that I prescribe :) ).
Flu Update 
Sneezing boy
As of this writing, the H1N1 flu outbreak is still going on but it is on the wane. Some 25% off the population has gotten it and most have fortunately had a mild attack.  If you have significant shortness of breath or seem to be getting worse after having been improving then please call the office. We are in general not prescribing antivirals unless you are chronically ill. Currently we do not have any more H1N1 vaccine for those over 49 years of age. Any parents of children under 10 years of age who did not get a booster dose should contact the office as we did set aside some of the intranasal immunization for them. (BTW, I would like to hear from you if you did not receive a call from us on this matter as you should have already been notified).
We unfortunately did not get any seasonal flu vaccine this year even though it was preordered 1 year ago. I'm rather bitter about this as the vaccine manufacturers thought it more fitting to supply pharmacies with the vaccine and thus make it available to low risk people while higher risk folks sometimes had to scrounge around for it. On the bright side, there is a chance that there will not be much seasonal flu this year as a result of the H1N1 boxing it out. But this cannot be predicted with certainty, so high risk patients (over 65, those with diabetes, heart or lung disease and the immunocompromised) should still get vaccinated if possible.