Friday, April 30, 2010

When Doctors are Owners, Surgery Goes Up

More and more physicians are owners in surgi-centers, imaging facilities and GI labs.  Some have labeled these ownerships as the "triple dip" because the doctor collects a professional fee as well as the facility profits and the investment value.  A study by John Hollingsworth, MD, a Robert Wood Johnson Clinical Scholar,  shows this creates a potential conflict of interest.  The study showed doctors that invested in outpatient surgery centers performed on average twice as many surgeries as doctors with no such financial stake.

The study looked at all patients in Florida who underwent 5 common procedures including cataract excision, colonoscopy, knee arthroscopy, myringotomy (placing tubes in the ear), and carpal tunnel release.  They compared surgery use among the owners and looked at before and after they acquired the ownership.  They also compared with physicians who didn't own a facility.

They found the physician investors operated on twice as many patients as the non-owners.  They also increased their surgeries after they became owners in the enterprise.

Dr. Hollingsworth reports that the number of surgery centers has increased nearly 50% over the last decade and physician investors is the big driver.  Physicians have a stake in 83% of these facilities.  The physicians who own surgi-centers say they provide better service, have improved room turn-over times, avoid the hospital bureaucracy and have more control over their practice lives.

Since surgery and procedures are large drivers of rising health costs, isn't it time to take a good look at these relationships?  I know doctors who make more on their facility investments than they do practicing medicine.  In California, hospitals are eager to partner with physicians in these investments because the hospitals know the business will leave them if they don't.  Fifty percent of something is better than 100% of nothing and the doctors control the patient care business.  But these centers can also cherry pick the healthiest patients and the easiest surgeries with the most profit margin.  Because they operate under different rules, they do not have to accept uninsured people or take Medicaid payments.  They use the local hospital for those surgeries.

The incentives seem pretty screwed up to me.


Reference: Health Affairs, Vol 29, No. 4, April 2010

Wednesday, April 28, 2010

Gene that Regulates Pain

I've often wondered about people's pain threshold and why some people seem to experience more pain than others.  New research reported in the Proc Natl Acad Sci USA, shows that a rare mutation in a gene (SNC9A) that encodes a protein in a type of sodium channel is associated with disorders of either excessive pain or insensitivity to pain.  Those with a rare allele that is found in about 10% of patients had a single nucleotide polymorphism that caused the patients to report higher pain than those without the allele.

(A single nucleotide polymorphism is a DNA sequence variation that can create a copying error for proteins that change how a gene works and can be the site of certain disease processes)

Researchers found that pain scores from patients with sciatica and phantom limb pain were higher if they had the rare allele and even healthy women were more likely to have lower pain thresholds if they had the mutation.  Additional experiments showed that inactivation of sodium channels is slower in cells with the rare allele.

Pain is subjective and often difficult to treat.  Developing drugs that target the sodium channels might be useful in treating pain.

Healthy Senior Inspiration

Thanks to KM for turning me on to this inspirational 73 year old grandmother who runs marathons, trains with weights and has a passion for helping other women reach their peak conditioning also. She started at age 56 when she realized she didn't like the way she was looking in a bathing suit. She adamantly denies using performance enhancing drugs or special supplements. She does take Vitamin D and runs about 80 miles a week.

Hats off to this amazing woman. I am inspired for sure.

Monday, April 26, 2010

Primary Care shortage Predicted to Worsen



The new reform law which is called the Patient Protection and Affordable Care Act (PPACA) will be a huge disappointment to the millions of previously uninsured people who finally purchase insurance policies when they try to find a doctor. Primary care physicians are already in short supply and the most popular ones have closed practices or long waits for new patients. Imagine when 2014 hits and all of those patients come calling. Who is going to be available to treat them?

It takes 8-10 years for an under supply of physicians to be corrected because physicians have to go through medical school and residency. There has been no up swing in physicians choosing primary care specialties for years and, in fact, the shortage is predicted to be 46,000 full time physicians by 2025 (Association of American Medical Colleges). Now add millions of new patients, baby boomers reaching Medicare and you have a disaster in the making.

I have been sounding this alarm for at least 10 years as I saw what our lack of policy and attention has done to primary care. Comprehensive Internal Medicine is one of the hardest lines of medicine. Patients are complicated, the work is long and arduous and primary care doctors save the "system" millions of dollars. Why it has not been recognized and rewarded in the United States is a mystery...especially when every other industrialized nation has build their health care policy on primary care.

When thousands of new primary care doctors are needed to care for our population, doesn't it seem foolish to cut residency training slots and pay specialists 2 to 4 times as much? Some suggestions at this late hour are to use nurses or physician assistants to fill the gaps. Others have suggested shortening the residency time. Both are terrible ideas for our population as medicine is becoming more complicated, not less.

I watched as Anesthesiology and Radiology became the most sought after residencies. I don't think there was a sudden interest in putting patients to sleep or reading X-rays in the dark all day. When I was a senior resident an anesthesiology friend encouraged me to switch immediately to Anesthesiology. He said "You'll work 1/2 the time and make 4 X the money." He was right and I saw what happened in the years to follow.

What can we do today?
  • Increase primary care residency program slots effective 2011 at teaching hospitals and pay more for those programs to increase.
  • Enact forgivable loans for all medical students who choose primary care and practice it for at least 5 years. You can't enslave people forever.
  • Raise the Medicare reimbursement by...oh let's say 40%. Even that may not be enough to turn this ship around. The inequities are just too large.
  • Allow even higher reimbursement for primary care doctors who practice in rural communities or under served areas. The pressures in those areas are magnified and should be rewarded.
  • Develop true systems of care where physicians treat the most complicated patients and nurse practitioners handle routine care.
It is time to quite admiring the problem and get to work solving it.

Sunday, April 25, 2010

Preterm Childbirth Caused by Physicians



Babies born between the 34th and 36th week have more complications and the cost in the U.S. is $26 billion annually. These children have more risk of death, cerebral palsy, cognitive impairment or respiratory problems. In the United States, nearly 13% of infants are born before they reach 37 weeks gestation. According the the Society for Maternal-Fetal Medicine (SMFM), that rate is much higher than other developed nations and physicians may be partially to blame for the early deliveries.

Some of the reasons may be older moms or the increased use of artificial productive technology and multiple births. But they are finding that some physicians are choosing to deliver between 34 and 37 weeks even when there is no clear medical indication. SMFM analyzed data of 250 late preterm births and found that the indication for these early deliveries did not meet accepted medical indication in 20% of the cases. Another study from Columbia University Medical Center showed similar results that deliveries were performed without an indication supported by evidence.

Of all the specialties, Obstetricians have the most at stake in caring for patients. They actually have two patients, the mother and the child. There is nothing more heartbreaking than a "bad baby"...the term we use for a terrible maternal outcome and the Obstetrician is usually blamed if the baby does not come out perfect. It is no wonder that they want to deliver the child at the first signs of problems (hypertension in the mom, anxious parents).

Review of all preterm deliveries should be performed by the quality committee at the hospital. These are usually physicians in that specialty who can understand the thought process that was used by the physician. Education can be instituted if the doctor is delivering outside of guidelines. We need more internal controls and patient safety reviews to understand the role that medical interventions play in preterm deliveries.

Thursday, April 22, 2010

The Uvula


That thing that hangs down in the back of your throat is called the Uvula. Like any tissue, it can get inflamed or infected and swell. This photo shows uvula edema. (or if you are a Brit it is called uvular oedma)

This patient was hospitalized for acute pancreatitis and developed difficulty swallowing and a sore throat. He had been vomiting repeatedly and that may have been the cause of the swelling. Other causes are infection, inhalation injury, an adverse medication effect or allergy.

The treatment is antibiotics if infection is suspected and corticosteroids to reduce the swelling. This patient's symptoms resolved without treatment.

(Case from Consultantlive
)

Wednesday, April 21, 2010

New York Senator Steals from Community Health Clinics


Citizens are outraged at the New York State Senate majority leader, Pedro Espada, Jr (Democrat), who has been charged with stealing more than $14 million from nonprofit health care clinics and using that money for apartments, Mercedes-Benz, meals, vacations and campaign expenses. Mr. Espada founded the organization and stacked its board with relatives and Senate employees. The foundation board includes two uncles, his sister's boyfriend and two daughters-in-law along with 5 past or current members of his staff.

According to the New York Times, it appears the looting has been going on for years and an outside accounting firm noted in 2007 that they were directed to ensure that Mr. Espada and his family were paid before any other financial obligations were met, including the clinics rent and utilities. The clinics failed to pay hundreds of thousands of dollars in payroll taxes, even as it handed out millions of dollars to Mr. Espada. The non-profit clinics received their financing from federal and state governments (Medicare, Medicaid). Our taxes!

The phony board approved the Senator a $9 million severance package, which far exceeds the clinic's net assets, leaving the network insolvent.

Good work by attorney general Cuomo for filing a civil suit, but his is one we should track and make sure it is more than window dressing. A civil suit is fine, but criminal charges are warranted for this outrageous theft. No plea bargaining allowed...jail him and throw away the key.

Tuesday, April 20, 2010

Aspirin for Migraine Headache


There are many expensive and complicated treatments for people who suffer from migraine headaches but a new literature review shows that a single dose of 1000mg aspirin is effective for more than half of all patients. Compared with placebo, aspirin reduced associated symptoms of nausea, vomiting, photophobia (lights) and phonophobia (sounds) and made severe or moderate pain into no pain after two hours in 24% of patients. Fifty two percent of patients reduced severe pain to no worse than mild pain by 2 hours after taking the aspirin and headache relieve was sustained for 24 hours more often with aspirin than placebo.

For patients who have migraine associated nausea, adding metoclopramide aka Reglan (an old fashioned medicine that can even be used in pregnancy) to aspirin significantly reduced nausea.

This study, published in the Cochrane Database of Systematic Reviews, is good news because it shows that inexpensive over- the -counter medication can help a large group of migraine sufferers. A normal size aspirin is 325mg and most folks don't take more than 2 at a time. For people with migraine headaches, it is worth trying 3 at a time to see if it will abort the pain.

Sunday, April 18, 2010

Surgeon Removes His Own Appendix



You gotta love the British Medical Journal for their report of a surgeon in a remote area of the Antarctic who did emergency surgery on himself. Russian Leonid Ivanovich Rogozov was the only doctor on an expedition ship whose mission was to build a new Antarctic polar base island in 1961. The sea had frozen over and the 12 explorers were alone at the base when the 27 year old team doctor developed fever, chills and symptoms of acute appendicitis. Transportation was impossible and there was no way to get any help.

As his condition worsened and he grew weaker, he knew he would need to operate on himself. The other guys on his team helped by sterilizing the bedding and getting instruments ready. In the event Rogozov lost consciousness, he instructed his team how to inject him with drugs using syringes he had prepared and how to provide artificial ventilation.

Rogozov chose a semi-reclining position and elevated the lower half of his body at a 30 degree angle. He disinfected his skin and used procaine as a local anesthetic. He then make a 10-12 cm incision as his team mate held a mirror for him to see. After 30-40 minutes he needed to take short breaks because of general weakness and dizzyness. Finally he removed the severely infected appendix. He then applied antibiotics directly into the wound.

His teammates were close to fainting and wanted to leave but they stayed. Rogozov himself was calm and focused on his work, but sweat was running down his face and he requested his forehead to be wiped. Afterward he reflected that "after I gave myself the first injection, somehow I automatically switched into operating mode, and from that point on I didn't notice anything else."

The surgery took 1 hour and 45 minutes.

The day after the operation his temperature was 38.1 and he described his condition as "moderately poor." He continued taking antibiotics and after 5 days his temp was normal. Within two weeks he was able to return to his normal duties.

A year later the team left Antarctica and Rogozov returned to his work at the clinic. He never returned to the Antarctic and he died 39 years later.

The British Medical Journal says Rogozov's self operation was probably the first one undertaken in the wilderness, out of hospital settings, with no possibility of outside help.

Saturday, April 17, 2010

Good Aspects of Heath Care Reform Bill


The large health care bill has some very good elements in it that should help the average American. One is a provision that will kick in in 2011 that says all health insurers will need to spend 85% of the premium dollar on actually providing care. This means people may actually receive benefits they pay for. What a concept! Before you worry too much about WellPoint and United Health Care, remember that insurance companies make most of their billions in profit by investing your premium dollars. Spending 85% on actual health benefits still leaves them with massive profits.

Reuters reports that the insurance industry is already beginning to game the system and WellPoint has already reclassified more than half a billion dollars of administrative expenses as medical expenses. By shifting accounting practices, these corporations think they can get around the new rules.

Senator John Rockefeller says, "This new data makes clear that too many health insurance companies are still putting profits before people, and they have a lot of work to do to meet the consumer protection requirements of the health care reform law by the end of this year."

It will take a lot of surveillance to make sure health insurers actually do what the law says. It's about time that consumers are being protected.

Thursday, April 15, 2010

Insurance Companies Invested in Fast Food Stocks


A new article published today in the American Journal of Public Health shows that U.S., Canadian and European insurance firms hold $1.88 billion of investments in fast food companies like Jack in the Box, McDonald's, Burger King and Wendy's/Arby's Groups. Both Health Insurers and Life Insurers have substantial holdings in these companies.

One just needs to read "Fast Food Nation" or watch the documentary "Food, Inc." to understand the negative impact of processed foods on the health of our country. The evidence is so compelling that the new Health Reform legislation is requiring fast food and chain restaurants to disclose calorie counts on their menus. Ironically, the new legislation will also add millions of customers to the health insurers.

The authors of the study write, "The health bill just enacted in the Washington will likely expand the reach of the insurance industry. Canada and Britain are also considering further privatization of health insurance. Our article highlights the tension between profit maximization and the public good these countries face in expanding the role of private health insurers. If insurers are to play a greater part in the health care delivery system they ought to be held to a higher standard of corporate responsibility."

It is going to be up to each of us, individually, to make choices about health. Don't expect corporations to do the right thing.

Wednesday, April 14, 2010

Head Lice



It's the phone call every grade school parent dreads..."Come and pick Johnny up from school. He has lice". Before you scream "Ewwww" and hang your head in shame, you should know that head lice are a very common problem. In fact, only the cold is a more common communicable disease that affects school age children. The medical term for head lice is Pediculosis capitis.

This tiny insect is smaller than a sesame seed and feeds on the blood from your scalp. It is not a sign of bad personal hygiene and lice are spread through personal contact or sharing pillows, hats or other personal belongings. They are human parasites and do not live on pets. They don't have wings so they cannot fly and they don't have hind legs to jump.

The first photo above shows a scalp with an infection from scratching and tiny nits that are clinging to the hair shaft. Nits are the eggs of lice and they take 7-10 days to hatch. It takes another 7 days for the louse to mature and lay more eggs. During this time they are feeding on the scalp blood but they are so tiny it is often hard to see them.

What if you find head lice? You do not have to spray bedding or furniture and that would be toxic. Vacuuming and washing bedding and plush toys is all that is needed. You do not need to shave the head and that can be much more traumatic to the child than having lice. Over the counter lice shampoos generally do the trick and are used one week apart to make sure all of the hatched eggs are treated. The nits should be combed off of the hair shaft with a fine tooth comb and rubbing olive oil in the hair before coming makes it easier to get the nits off. There is no need to treat other family members unless lice or nits is found on them. A close inspection is needed of the hair shaft with special focus behind ears and at the neckline.

We coexist with many parasites and insects and lice are just another nuisance that humans deal with.

Tuesday, April 13, 2010

Announcing The Winner


The Winner of the EverythingHealth Made From Earth giveaway contest is...drumroll....
Country Midwife. She had an advantage because I am partial to women who work all night bringing life into the world and she has a painful spider bite.

The other entries were also good and there will be more healthy contests in the future.

Congratulations, Country Midwife. Please contact me with your name and mailing address and you will receive a full size Rosehips Face Serum to make you beautiful after a hard night's work.

(Lisa, it would be nepotism for you to win...I'll buy you one)

Monday, April 12, 2010

Surprises About Emergency Room Use


If you think the overcrowding in Emergency Rooms across the country is because of uninsured, think again. A new study in the Annals of Emergency Medicine reports that of patients who are frequent users (over 4 times a year) of Emergency Departments, the uninsured represent only 15% of those frequent users. Also the frequent ED users were more likely than occasional users to have visited a primary care physician in the previous year.

They also found that most patients who frequently use the ED have health insurance and the majority of users (60%) were white. These findings contradict the widely held assumption that frequent users are minorities or illegal immigrants without insurance.

It is no surprise that frequent ED users tended to be sicker than occasional users and were more likely to be transported by ambulance. Chronic conditions like renal failure, COPD, asthma and sickle cell disease where common along with "pain". In urban areas like Boston and San Francisco, alcohol related visits and psychiatric conditions led to more frequent visits.

The principle reasons given by patients for using the ED included quick service and ability to receive free care. Most patients had Medicare or Medicaid as their primary insurer.

So what does all of this mean? It points to the fact that we do not have adequate chronic care management in this country. It is hard for patients to get in with their physicians when they are sick and they end up receiving care in emergency departments. If they have complicated illnesses, test are often needed and without care coordination in the physicians office it is easier to send the patient to the ED to "get the tests done". Also many patients pay large co-pays or even $thousands of dollars in deductibles if they see their doctor. These fees are often waived if they go to Emergency Departments.

Health care reform can help these numbers or it can make it worse. To make it better, it is essential to support primary care so more can be done in the office. Offices should be open to accommodate working folks and on weekends. This can only happen if we recognize the amount and level of care that physicians can provide in the office and quit short-changing these critical physicians. The concept of "medical home" will work if there are enough resources paid to the doctors so they can utilize nurses and care coordinators. It does no good to use the term "medical home" without paying for the information technology and personnel that are needed to make it work for patients.

Back in the day of capitation I would receive about $95 a year to care for all of the health needs of a patient. (Yes, you read that right...$95 a year). One visit to the ED would cost $1000. I would reflect that that one visit equaled 10 years of my care. It is no wonder that system died a quick death. But it doesn't look like we have learned much as costs continue to rise and patients still have trouble getting the right care in the right place at the right time.

Saturday, April 10, 2010

EverythingHealth Give Away Contest


There may be "no free lunch" but there is a skin serum that is all natural and good for your skin and I'm offering a free give away! I wouldn't offer this to readers if I didn't try it first and love the products. The folks over at "Made from Earth" will send the lucky winner a Rosehip Face Serum and a citrus fresh organic lip balm for free!

Made from Earth is an organic, holistic and healthy supplier of organic body lotions, organic face creams, and, organic lip balms to meet your healthy skin care needs. The selections of healthy lotion and organic creams is extensive and priced right and I tried several of the products myself. They are designed to be absorbed by the skin and do not contain parabens or petrochemicals, which are a group of chemicals that are used as preservatives in other cosmetics and have been linked to cancer.

And the best attribute..they are cruelty free.



So go ahead and tell me why you should win the free Rosehip Face Serum. If you are a guy, you can enter too. Made from Earth products have no artificial fragrance and your skin is important too!

Check out Made from Earth and enter the code "Everythinghealth" and they will send you a free organic lip balm with any order. Free, free, free!

I will announce the winner next week so hit that comment bar now and tell me why you should win.

Thursday, April 8, 2010

Report On The State of U.S. Health


The Centers for Disease Control and Prevention (CDC) issue an annual report on the state of health in the United States. The 33rd edition just came out and has some surprising findings, especially about the use of procedures, tests and medical technology. The life expectancy in the United States is now 77.9 years. Are you over that age? Congratulations, you beat the odds.

Mortality from heart disease, stroke and cancer continue to decline but the leading cause of death for people age 65 and older is still heart disease. The leading cause of death for people age 1-44 is unintentional injuries. I think that includes war, which always takes the young men.

Here are some findings that show how hard it will be to rein in health care costs:
  • The use of MRI, CT and PET imaging soared, especially in physician offices and outpatient departments.
  • Knee replacement surgery for people age 45 and older rose 70% in the last decade. Partial hip replacements increased by 60%
  • Drug-eluting stents were used in 75% of angioplasties. Everyone who has angioplasty seems to get a stent nowdays.
  • Assisted reproduction doubled during the past decade, especially on women over age 40.
  • The use of diabetes drugs for people age 45 and older increased by 50% and statins soared 10-fold.
(Watch Jaimie Oliver's Food Revolution on ABC. This guy is trying to save America.)
  • Out -patient upper endoscopies rose by 90% and colonoscopies tripled.
Mental illness was the 2nd leading chronic condition in adults age 18-44. Since serious mental illness like schizophrenia is not on the rise, could it be that our lifestyles and stress of modern living are affecting our emotions?

If you think about it, lifestyle changes can really impact our lives and our health. Eating healthy, exercising, relaxing, meditating, doing yoga or other fun activities have been proven over and over to be the antidote to modern illness. Stop the wars and put that money into education, school lunches and fun physical education. I know it is utopia but I'd like to see this report in the future if we could accomplish that.

Tuesday, April 6, 2010

Corporate Hall of Shame Award

With the United States undergoing the worst recession since the Great Depression and people everywhere worried about the cost of health care and how health care reform will affect them...isn't it great to know that some special corporate execs got a 51% raise in 2009? Angela Braly, the president and CEO of health insurer WellPoint, Inc, got a nice bonus that raised her salary to $13.1 million from $8.7 million the year before.

Now we know where that 25% rate hike by Anthem Blue Cross (a WellPoint subsidiary) went. I guess she deserves the raise since the stock prices gained ground steadily during the year, closing 38% higher. Braly probably deserves the raise for her testimony before Congress about the rate hikes when she claimed the rate hike was because of the soaring cost of medical care and the weak economy. The $2.7 billion dollar profit that WellPoint posted in the final quarter of 2009 certainly justifies her salary.

And it is great to know that Ms. Braly won't need to worry about insurance premiums rising or the cost of travel. The corporate jet and $292,036 in corporate perks will cover any concerns she might have.

Congratulations WellPoint! There is no end to the profits you can continue to earn by insuring our Nation's citizens. Now with Health Reform you will have millions of new customers and your execs can rest easy that their good fortunes will continue.

Monday, April 5, 2010

Is Sexual Addiction Real?


Tiger Woods, Jessie James, Michael Douglas,Wilt Chamberlain (remember him?) are just a few of the celebs who admit to being plagued with "sexual addiction". With rehab centers springing up all over, it would appear this condition is on the rise. But is there really a disorder called "sexual addiction" or is it just bad behavior that finally gets caught? Is sexual addiction equivalent to alcohol dependency or is it just an excuse to be unfaithful?

Experts who treat sexual addiction say it is a compulsive need to seek out and follow a certain type of sexual behavior. Acting out sexually is something the person does to avoid dealing with something else...a coping mechanism that is out of control. It is not really about sex; it is driven by shame.

OK, stop right there. Is it really an addiction? Does the person experience physical withdrawal symptoms if he isn't watching porn or bedding new women? I can understand that some may have an unhealthy obsession with sex but I'm getting sick of the "medicalization" of selfish or bad behavior.

Can we just admit that most men have strong sex drives from the age of...oh about 13 to 90. Certainly there are people that have not developed self control or the ability to have sincere relationships. Others have money and power that makes them feel the "rules" don't apply to them. Some people have compulsions or boredom or too many drugs or too much travel away from home.

Some men (it is almost always men) may just get adrenaline rush from breaking the rules and most neuro scientists agree that we are hard wired for novelty. Could it just be that desire for novelty has become a compulsion?

I think some "sex addicts" just don't think before they are caught. Remember when Jay Leno asked Hugh Grant, "What were you thinking?" and he replied "I did a bad thing" when he cheated on sexy Elizabeth Hurley. At least he admitted HE did a "bad thing" and not that he needed treatment to help him recover from his affliction.

With all of the attention being given to "sexual addiction", it won't be long before we have an expensive new pharmaceutical drug developed to treat it. That's when we will know that a new disease has truly arrived.

Sunday, April 4, 2010

Ten Things You Didn't Know Are In the Health Care Bill


The health reform bill is 1,017 pages long but it contains a lot that will have an impact on Americans. I am one who believes we had to come into the 21st century and join with the rest of the civilized nations in beginning to provide health care to all citizens. You be the judge. Here are 10 things I bet you didn't know know are in the new Health Care Bill:
  1. Menu labeling. Restaurants with over 20 employees must include calorie counts and other nutrition information on the menu.
  2. SWAG reporting. Doctors must report valuable goodies they receive from health vendors.
  3. Right to Pump. New moms must be given space and time to pump. (for large employers over 50)
  4. Research. The bill includes research for post partum depression
  5. Tan tax. There is a 10% tax on tanning booths
  6. Adoption Credit. Adoptive parents receive tax credits to encourage adoption.
  7. Research. The bill includes research for Indian health studies.
  8. Safety. The bill includes required background checks for long term care workers.
  9. Right wing. The bill includes required abstinence education.
  10. Transparency. Employers must show on the W2 what is the employer and employee contribution for health care.
Fox News ("fair and balanced") has said that it's "what you don't know that can hurt you". Fox also said that "42% of doctors said they would quit or retire if Health Care Reform became law". It is time to stop the fear mongering, lies and deception and understand just what this reform will (and won't do) for the American public.

Coffee, Tea and Heart Disease