Issue: 45

October: A Great Nobel Prize in Physiology or Medicine!!
I was especially pleased by this year's awardees: William Campbell of the United States, Satoshi Omura of Japan, and Youyou Tu of China. Tu is only the 12th woman in 116 years to win the prize in Medicine and the fifth Chinese citizen to win a Nobel of any kind. The three were recognized for their work on natural products that have saved millions of human and animal lives! 
A natural product is a chemical produced by nature, like penicillin, and then developed into a medicine. Nature is a very, very creative chemist!
Everyone knows the amazing story of Alexander Fleming, a British scientist and Nobel laureate. A pack-rat by nature, Fleming let his petri dishes pile up in the corner of his laboratory. When it finally came time to clean up, he noticed that some of the dishes were contaminated with mold and that the surrounding bacteria had died.  He figured that the mold made something that killed bacteria. He was right!  After much work, penicillin was identified, produced in bulk by American pharmaceutical companies, and used to save the lives of countless WWII GIs.
Fast forward to the present. Campbell, working at the Merck Research Laboratories in Rahway, NJ, was interested in treating roundworm infections. In the tradition of Fleming, he asked whether organisms grown from soil might make an antibiotic capable of killing the pests. Looking through the microscope, his staff finally found an extract that paralyzed the wriggling worms. After much work, the active ingredient was identified and called "avermectin." Merck scientists learned how to make and manufacture avermectin and a number of derivatives, leading to a number of important products for protection of livestock and domesticated animals such as HeartGard� for dogs. It was later found that ivermectin, a derivative of avermectin, cured River Blindness, a horrible worm infection that has blinded thousands of victims in Africa, Latin America, and Yemen. Former President Jimmy Carter has championed the cause to eradicate the disease with ivermectin supplied gratis by Merck. I had the pleasure of knowing Dr. Campbell during my years in the Merck Rahway lab. He was quiet and unassuming and universally respected by his colleagues for his monumental achievement. In my practice, I have used ivermectin to cure lice and scabies - it is very safe and very effective!
But the story gets better! The soil organism that produced avermectin came to Rahway, NJ, from __________ (Ans: Japan!). Satoshi Omura, the Japanese awardee, was famous for traveling the world and scooping soil samples into his pants pocket before returning home. He cultured many different species of Streptomyces from the soil samples and shared them with Merck. Streptomyces were already known to produce streptomycin, the antibiotic discovered by Selman Waksman at Rutgers University for which he received the Nobel in 1952. Streptomycin is credited with closing the sanitariums for tuberculosis. Merck's relationship with Omura and his Kitasato University made the discovery of avermectin possible!  We need to learn the lessons taught by this great example of international cooperation!
Now comes the great discovery of Youyou Tu!  You have heard of the antimalarial known as quinine, a natural product isolated from the bark of the chinchona tree, and the first important medicine to cure malaria. It was first discovered by the indigenous peoples of Peru and Bolivia and brought to Europe by the Jesuits. GIs in Vietnam came down with chloroquin-resistant malaria. Tu and colleagues found a natural product that killed these chloroquin resistant parasites, called artemisinin. Don't try to pronounce it! It works and so far, resistance has been rare!
What to take away from these amazing natural product discoveries? The food and vitamin industries have applied the "natural" label indiscriminately. Please remember that the Nobel was awarded to scientists who did the heavy lifting of identifying the active ingredient. In every case, the complex mixture was analyzed to find the substance with curative properties. Some say that we should use complex mixtures but I suggest otherwise. Unless the manufacturer can point to the active ingredient and demonstrate its medicinal properties, think twice before buying complex mixtures just because they are "natural."
I applaud those who continue to explore nature for new cures. They are the heirs to the wonderful legacy of Fleming! But let's hold them to the exemplary examples of Campbell, Omura, and Tu before we accept their breakthrough claims!

John A. Schmidt, MD 
October is Pink! New Recommendations for Mammography from the American Cancer Society!
I am a fan of screening tests including frequent blood pressure measurement, digital mammography, prostate specific antigen (PSA), colonoscopy, bone density measurement (DEXA), coronary calcium score, lung CT for smokers, hemoglobin A1c, and others. Take this simple quiz: A stitch in time saves _____ (Ans: nine!).  An ounce of prevention is worth a pound of ____ (Ans: cure!). True, screens have their problems known as "false positives" and "false negatives." False positive means that the test says "positive" when it should read negative. False negative means the test missed the diagnosis.  Mammography has come under fire because it submits women to lots of uncomfortable tests with lots of false positives. But I ask my patients to consider the alternative: a breast cancer that prematurely ends your life and devastates the ones you love!
Here are the latest recommendations from the American Cancer Society (for women of average risk):
Ages 40-44: should have the choice to start annual breast cancer screening with mammogram if they choose to start.
Age 45-54: should get mammograms every year.
Age 55 and older: switch to mammograms every 2 years or have the choice to continue yearly screening. Continue screening as long as a woman is in good health and is expected to live 10 years or longer.
As you can see, much depends on your risk. To estimate your overall risk of breast cancer, please use the Breast Cancer Risk Assessment Tool provided by the National Cancer Institute. To estimate your risk of having a mutation that may cause breast and ovarian cancer, please visit the Healthy Links page on my website and use the B-RST screening tool.
Medicare Premiums to Rise Dramatically for Some in 2016!
Contrary to popular belief, Medicare is not free to Medicare beneficiaries!! Many taxpayers have been persuaded by the budget hawks in Congress that Medicare beneficiaries get a free ride. Not!! Most Medicare beneficiaries pay monthly for their Part B benefits!  Medicare is actually a subsidy program and it is high time that AARP and the media get the message out to our stingy legislators that they should stop painting Medicare as a free entitlement program!
Because of a quirk in the law that governs Medicare deductions from monthly Social Security checks, most Social Security beneficiaries (about 70 percent) will not be charged with higher deductions for their part B coverage in 2016 (part B covers eighty percent of doctor bills and usually 100 percent of clinical laboratory services.) Why? Because they will not receive a Cost of Living Adjustment (COLA) in 2016. Thus, they are held "harmless" and will not have to shoulder higher deductions next year.  
For everyone else, deductions will increase dramatically. As explained in an article in the October 9 issue of USA Today by Robert Powell, 7 million beneficiaries will see their premiums rise from the current monthly charge of $104.90 to as much as $509.80 per month. The groups affected include individuals who enroll in part B for the first time in 2016, enrollees who are directly billed for their part B premium, current enrollees who pay an income-related higher premium, and dual Medicare-Medicaid beneficiaries, whose premiums are paid by state Medicaid programs.

Medicare Open Enrollment for 2016 is from October 15 to December 7. You must sign up for Medicare three months prior to your 65th birthday. 
Did I mention that Medicare isn't free?
Healthcare.gov Is Back!
The Marketplace, as it is commonly called, opens on November 1 and will remain open until January 31. But don't wait! 2016 plans and prices are available for preview now.Visit the site now to see if you qualify for one of these lower cost, non-Medicare plans or should apply for Medicaid. The Marketplace call center is open 24/7 and can be reached at 1-800-318-2596.
Catholics Need to Speak Out Against Horizon's New Omnia Insurance Plan!
In the wake of Pope Francis' historic and inspiring visit to the United States, we hear that Horizon Blue Cross Blue Shield of New Jersey has excluded most New Jersey Catholic hospitals from their new Omnia insurance network! Where were they when Pope Frances enunciated what it means to be a modern citizen, committed to the advancement of all?
As detailed by Sister Patricia Codey in a guest column in the Star Ledger on October 7, Catholic hospitals serving the poor and marginalized in some of New Jersey's largest cities have been relegated to "tier 2" status. These include hospitals like St. Peters University Hospital in New Brunswick and St. Francis Medical Center in Trenton, hospitals that achieve high grades both in terms of quality and affordability. As Sister Codey points out, patients will be forced to go to other hospitals resulting in a breach in their continuity of care while at the same time making it more difficult for these critical institutions to meet their payrolls and retain their excellent staffs.
This move on the part of Horizon, which has been anything but transparent, confirms that their priorities are guided by profit, not the welfare of those they serve. Shame on them!
Fall reminds us of our predecessors, especially those who worked and suffered to advance the common good. May we be worthy of their tireless efforts and work together, as advised by Pope Francis, to make the world a better place!
Valerie, Morgan, and I wish you a Happy Halloween, holy All Saints and All Souls Days, and a World Series Championship for our New York Mets!!
In This Issue
Nobel Prize in Physiology or Medicine
New Recommendations for Mammography
Medicare Premiums to Rise Dramatically
Healthcare.gov is Back
Catholics Need to Speak Out Against Horizon's New Omnia Insurance Plan
John A. Schmidt Jr., M.D.
 is one of the leading Internists in Monmouth County offering  Medical Home Services.  

"Fall has always been my favorite season. The time when everything bursts with its last beauty, as if nature had been saving up all year for the grand finale." - Lauren DeStefanoWither 
John A. Schmidt Jr., MD
Meaningful Medicine in Your Medical Home
709 Seventh Avenue
Belmar, NJ 07719
Phone:  732-282-8166  
Fax:  732-280-0147 
E-Mail:  [email protected] 
Disclaimer: The articles in Healthy Living are for general information only and are not medical advice.
Discuss all medical concerns and treatment options with your physician.