Very interesting article in American Medical News (Nov. 26, 2007) on the recent introduction of a health care gift card.  It’s no secret that gift cards are a wonderful way for retailers to siphon more money from consumers using a variety of methods.  First and foremost, is the fact that only about 90% of gift cards are actually redeemed.  Considering that gift cards are an billon-a-year industry, we’re talking about billion given to retailers without any merchandise being delivered.  Quite a gift.
Second, a variety of less scrupulous gift card vendors assess various fees, especially cards issued by malls and credit card companies.  They’re basically charging a fee to spend money.  Third, once people enter stores to redeem the gift cards, they’re prey to the expert marketing efforts at work, meaning that often times they spend more than the value of the gift card.  Finally, some gift cards expire, meaning that the retail establishments get to keep the money free and clear.
One would ask, then, why not just give/use cash?  Frankly, I don’t have a good answer for this particular question.  It certainly seems easier.  I remember the days when I’d get a Hanukkah card from my grandmother with in it and consider it a king’s sum.  I could only spend up to and I could spend it in increments, all at once, or not at all, without fear of it losing any significant value.  No muss, no fuss.  Of course today I’d ask my grandmother for Euros, but that’s another story.
So what possible role could gift cards play in the current health care system?  The company advancing this idea is Highmark – a health care conglomerate that includes a Blue Cross/Blue Shield carrier, a dental insurance company, a provider of managed care vision benefits, an eyeglass frame designer (fancy that!), and a processor of Medicare claims, amongst other businesses.  According to the AMNews article, Highmark believes that these healthcare gift cards can be used for everyday health expenses.  Naturally there’s a fee (.95) for the privilege of loading the card, and it can be used for things as small as co-pays to things as large as medical equipment or gym memberships.  Naturally, Visa has a hand in it as well, meaning that there are additional fees.  In this case, a .50-per-month fee if the card isn’t used for more than nine months. 
Clearly it’s a gimmick, and one that will surely enhance the bottom line of two large companies by sucking additional health care dollars out of the pockets of consumers.  Heaven forbid those dollars should actually go to the physicians and nurses who make a living out of delivering medical care, right?  After all, Visa and Highmark executives need to be paid for their innovation and leadership.  Besides, the .2 million that Kenneth R. Melani, Highmark’s president and CEO makes hasn’t put him into the billionaire range, and that’s clearly not acceptable.
Jennifer Offenberg, PhD, an assistant professor of economics at Loyola Marymount University in LA says, it best: “It’s a little mysterious why they [the patients] would bay 5 for 0.  I don’t understand it.”
Neither do I.  (Source: Blog, MD)

Since Kevin has been so kind as to let me borrow his blog for a while, I’d like to ask you all for a favor. Can you help me understand more about “most favored nation” clauses, common to insurance contracts? I’ll be meeting with my states legislators soon and I’d like to be well versed. So how about it, any J.D.s and/or M.D.s in the audience? Are they good, bad, or meaningless? Are they the reason that doctors must charge “full” price to cash patients? (Source: Kevin, M.D. – Medical Weblog)

California voters by nearly a 2-to-1 majority would support increasing their state’s cigarette tax by per pack to help raise cash for a state effort to provide health-care insurance to the uninsured, according to the latest Field Poll released on Friday. Reuters Health Information (Source: Medscape PublicHealth Headlines)

“Like Minnesota’s 10,000 lakes, hundreds of millions of dollars worth of options held by former UnitedHealth CEO Bill McGuire remain frozen,” the WSJ’s Law Blog reports today in its inimitable style.
McGuire was ousted last year in an options-backdating scandal, and the fate of his options, which have been valued at well over billion, have made him something of a fixture on the Health Blog. Earlier this month, he agreed to forfeit 0 million of stock-option gains and retirement pay as part of a settlement of a few civil actions.
Most Health Blog readers thought that wasn’t enough, and at least one court may agree.
Calpers, the California retirement giant, still has a lawsuit pending against McGuire and United. The huge pension fund has argued that allowing McGuire to cash in his remaining options — worth some 0 million after tax — would jeopardize its ability to collect a settlement, according to the Law Blog.
U.S. District Judge James Rosenbaum of Minneapolis agreed, ruling that the need to protect a possible judgment in Calpers’s favor outweighed McGuire’s “wish for funds with which to engage in charitable activities and to pursue business interests.”
Bonus billion: Rosenbaum seemed awed by the scale of McGuire’s wealth. “Words such as ‘huge,’ ‘fantastic,’ ‘astounding,’ ’staggering,’ or ‘astronomical,’ do not describe billion,” he wrote. “Such a sum can only be thought of as ‘transcendent,’ or in terms of the gross national product of smaller members of the United Nations.” (Source: WSJ.com: Health Blog)

I went and saw the movie Juno recently. I absolutely loved it. The one liners, cutdowns, and internal commentary of Ellen Page as the title character, Juno, is flawless. She created the character and played her as if it were second nature. I recommend that everyone go and check this movie out as soon as possible. I must say, though, that Michael Cera as Bleeker was likely the most awkward and uncomfortable character I’ve ever seen. His character in Superbad was equally awkward. Granted, that’s what the director wanted for these characters, but while he was on screen, the awkwardness he portrayed made me fidget in my seat.
 -=+=-
On the pharmacy front, I recently had an uncomfortable and irrational encounter. This tank of a woman came in and requested a transfer of her Paxil CR from a nearby Walgreens to my pharmacy. I thought nothing of it, and we got it filled up with no problems. However, the insurance card she presented and we put in was not accepted by my pharmacy. When the lady came in to pick it up, she was told 100 bucks or whatever that mess of a SSRI costs. She, of course, was livid.
I told her that we didn’t accept the plan. She told me I was a misinformed liar (which is rather contradictory, right?). “I talked to my employer and they gave me a list and your pharmacy was listed as a provider.”
“Do you have a copy of that with you? It could have been a typo. We’ve never accepted this plan. Walgreens paid a lot of money to be the only pharmacy that accepts this plan in this area. And, as far as I’ve been told, that’s how it still is — and has been for the last five years.”
“I don’t have a copy of the letter with me. But, I know you’re on it, and you’re going to take it.” [Condescendingly]
“Well ma’am, now you are misinformed. These computer communicate in real time with the computers ran by you insurance provider. They say we don’t take it, and therefore, won’t pay for it. The only way you can leave here with this medicine today is by paying cash. If they are in the process of adding us, and that takes place in the next week to ten days, we can reimburse you.” [Of course, I said this like a huge dick]
“This is ridiculous. You’re an idiot. I want to talk with the store manager.” [yelled – of course]
“I’m sorry to say, but the store manager has no control over the pharmacy. He can’t help you. However, I want to help you, but the fact of the matter is, I can’t help you.” [I said this really nicely, because I know that I can’t help her regardless of how badly I wanted to]
“Fine, I’ll just call your corporate headquarters. I’m sure they’ll be interested in knowing that you are refusing to fill my prescription.”
“I’m not refusing you service. I’ve got your prescription filled….here it is right here. What I’m telling you is that we are not contract with your insurance. We cannot just give this 0 prescription away. I’m sure if you called my coorporate headquarters and told them the entire story, and not just the part about you leaving here without a prescription, they’d apologize for not being contracted — but they’d go on to tell you that we have no control over that here. Walgreens has cornered the market, and there’s nothing you , I, my boss, or my bosses’ boss can do about it.”
“You need to find a new job — you’re not very good at this one.” [This is the second time some fuckhead has told me this in a week because they didn’t get their way when a situation came up that was completely out my control — fuck this fat bitch!]
“You’re wrong. I’m good at this. You’re just not good at listening or understanding that certain things are out of the realm of control of workers. Do you yell and make a scene towards the cashier at McDonalds when the McRib is taken off the menu? I mean, he could call up the CEO and say he wants it back on the menu…but, that’s kind of futile isn’t it? Anyway – what do you want me to do here to help you, keeping in mind that there is no humanly possible way for me to bill this to your insurance provider?”
“Just transfer it back to Walgreens – I know I’m never coming back here again!”
“Sounds good to me! Happy New Year.”
As she left, I acted like I was calling Walgreens immediately. Right when she got around the corner, I hung up. She can wait for an hour or two at the WAG. That’s her punishment for being an irrational bitch from hell. [PS - I’m aware that this was unethical, unecessary, and crossed even my line…but I’m a dick…I get mad AND I get even…] (Source: The Angriest Pharmacist)

Above, Cynthia Barton Rabe’s description of outsiders brought in to companies to encourage innovation.

Rabe’s 2006 book, “Innovation Killer: How What We Know Limits What We Can Imagine ? And What Smart Companies Are Doing About It,” elaborated on her term.

Too bad about the way too long title.

Anyway.

Janet Rae-Dupree’s December 30, 2007 New York Times essay on innnovation began, “It’s a pickle of a paradox: As our knowledge and expertise increase, our creativity and ability to innovate tend to taper off.”

Her interesting piece explored reasons why and possible solutions; it follows.

Innovative Minds Don?t Think Alike

It’s a pickle of a paradox: As our knowledge and expertise increase, our creativity and ability to innovate tend to taper off. Why? Because the walls of the proverbial box in which we think are thickening along with our experience.

Andrew S. Grove, the co-founder of Intel, put it well in 2005 when he told an interviewer from Fortune, ?When everybody knows that something is so, it means that nobody knows nothin?.? In other words, it becomes nearly impossible to look beyond what you know and think outside the box you?ve built around yourself.

This so-called curse of knowledge, a phrase used in a 1989 paper in The Journal of Political Economy, means that once you?ve become an expert in a particular subject, it?s hard to imagine not knowing what you do. Your conversations with others in the field are peppered with catch phrases and jargon that are foreign to the uninitiated. When it?s time to accomplish a task ? open a store, build a house, buy new cash registers, sell insurance ? those in the know get it done the way it has always been done, stifling innovation as they barrel along the well-worn path.

Elizabeth Newton, a psychologist, conducted an experiment on the curse of knowledge while working on her doctorate at Stanford in 1990. She gave one set of people, called ?tappers,? a list of commonly known songs from which to choose. Their task was to rap their knuckles on a tabletop to the rhythm of the chosen tune as they thought about it in their heads. A second set of people, called ?listeners,? were asked to name the songs.

Before the experiment began, the tappers were asked how often they believed that the listeners would name the songs correctly. On average, tappers expected listeners to get it right about half the time. In the end, however, listeners guessed only 3 of 120 songs tapped out, or 2.5 percent.

The tappers were astounded. The song was so clear in their minds; how could the listeners not ?hear? it in their taps?

That?s a common reaction when experts set out to share their ideas in the business world, too, says Chip Heath, who with his brother, Dan, was a co-author of the 2007 book ?Made to Stick: Why Some Ideas Survive and Others Die.? It?s why engineers design products ultimately useful only to other engineers. It?s why managers have trouble convincing the rank and file to adopt new processes. And it?s why the advertising world struggles to convey commercial messages to consumers.

?I have a DVD remote control with 52 buttons on it, and every one of them is there because some engineer along the line knew how to use that button and believed I would want to use it, too,? Mr. Heath says. ?People who design products are experts cursed by their knowledge, and they can?t imagine what it?s like to be as ignorant as the rest of us.?

But there are proven ways to exorcise the curse.

In their book, the Heath brothers outline six ?hooks? that they say are guaranteed to communicate a new idea clearly by transforming it into what they call a Simple Unexpected Concrete Credentialed Emotional Story. Each of the letters in the resulting acronym, Succes, refers to a different hook. (?S,? for example, suggests simplifying the message.) Although the hooks of ?Made to Stick? focus on the art of communication, there are ways to fashion them around fostering innovation.

To innovate, Mr. Heath says, you have to bring together people with a variety of skills. If those people can?t communicate clearly with one another, innovation gets bogged down in the abstract language of specialization and expertise. ?It?s kind of like the ugly American tourist trying to get across an idea in another country by speaking English slowly and more loudly,? he says. ?You?ve got to find the common connections.?

In her 2006 book, ?Innovation Killer: How What We Know Limits What We Can Imagine ? and What Smart Companies Are Doing About It,? Cynthia Barton Rabe proposes bringing in outsiders whom she calls zero-gravity thinkers to keep creativity and innovation on track.

When experts have to slow down and go back to basics to bring an outsider up to speed, she says, ?it forces them to look at their world differently and, as a result, they come up with new solutions to old problems.?

She cites as an example the work of a colleague at Ralston Purina who moved to Eveready in the mid-1980s when Ralston bought that company. At the time, Eveready had become a household name because of its sales since the 1950s of inexpensive red plastic and metal flashlights. But by the mid-1980s, the flashlight business, which had been aimed solely at men shopping at hardware stores, was foundering.

While Ms. Rabe?s colleague had no experience with flashlights, she did have plenty of experience in consumer packaging and marketing from her years at Ralston Purina. She proceeded to revamp the flashlight product line to include colors like pink, baby blue and light green ? colors that would appeal to women ? and began distributing them through grocery store chains.

?It was not incredibly popular as a decision amongst the old guard at Eveready,? Ms. Rabe says. But after the changes, she says, ?the flashlight business took off and was wildly successful for many years after that.?

Ms. Rabe herself experienced similar problems while working as a transient ?zero-gravity thinker? at Intel.

?I would ask my very, very basic questions,? she said, noting that it frustrated some of the people who didn?t know her. Once they got past that point, however, ?it always turned out that we could come up with some terrific ideas,? she said.

While Ms. Rabe usually worked inside the companies she discussed in her book, she said outside consultants could also serve the zero-gravity role, but only if their expertise was not identical to that of the group already working on the project.

?Look for people with renaissance-thinker tendencies, who?ve done work in a related area but not in your specific field,? she says. ?Make it possible for someone who doesn?t report directly to that area to come in and say the emperor has no clothes.? (Source: bookofjoe)

I was out to dinner with 3 of my Med School classmates a few months ago to celebrate being done with some class or another. In true Philly style, it was a BYOT (T is for TEQUILA) so that the restaurant wouldn’t have to pay the outlandish Pennsylvania liquor taxes, and it was also cash only so (presumably) at least part of what we paid could go under the table to avoid paying Philly income taxes. The soft corn tortillas with orange-glazed pork that I was munching on were delicious, especially in combination with the margarita that I was sipping, which was the restaurant’s specialty. Every so often, one of us would dip a crispy tortilla chip into the freshly made guacamole sitting in the tureen in the middle of the table. We all commented that the food was as good as all the hype had indicated. One of my friends lamented that the next course was only two weeks long, and that meant that our respite from studying would be woefully short this time. “What am I going to do?” she cried, “I have so much I have to do this week!” Fred’s birthday was tomorrow at Absinthe, and then her friend was coming to town from Cleveland to visit, and she was planning on taking her to Le Lan. “I’ve heard the fusion French-Vietnamese food they sever there is phenomenal,” she said. We all nodded in agreement. I had been there with my parents a year ago to celebrate after my white coat ceremony and it had been fantastic. The conversation topic turned to health insurance. Our student coverage had changed this year, and now generic drugs cost and brand name cost . “Oh my god! I just don’t know how I’m going to be able to afford my medications this year!” we all complained. “It’s SO expensive now! What do they expect us to do, STARVE? I mean, for the ,000 we pay per year for health insurance, it should cover SOMETHING.” I nodded in agreement. It really sucked now that every month I now had to pony up to cover my medications. And my friend had to pay almost 0 every month to cover her’s! It was unbelievable! Our stipends and loan allowances were WAY too low to cover all of our expenses. “Well, I just cut my pills in half and take half of what I’m supposed to so that 1 month will last for two months, and it seems to work,” one friend commented. “I’ve never had a problem with anything since I started doing that a few years back. It’s just too expensive! I simply can’t afford to take the full dose every day.”My other friend chimed in. “Did you go to that meeting about how student medication costs are going through the roof? We’re planning on staging a protest next week. The administration just can’t keep screwing its students like that!”I couldn’t blame her. It really did suck. And what did they expect us to do? We were poor! It was going to be years before we started earning real money as doctors. And some of us had so much debt! The bill came. 0 for the four of us. Not bad. Philly may be a small dirty city with astronomical crime rates and an inflated cost of living, but the restaurants are good quality and reasonably priced. We paid the bill and walked out of the restaurant.A homeless black man sat in his wheelchair by the Wawa on our walk home. His toothless gums flapped incomprehensibly at us as he jingled his styrofoam cup at us, muttering something about racism. There was a cardboard sign next to his chair that read, “Veteran, Need Money for Food!” We shook our heads as we made a wide arc around him, knowing that he really just wanted money to spend on his diet of liquor and drugs. It was such a pity that some lives turned out so sadly. Being poor really sucks. (Source: The long road to medical school)

Or not.Here is a fascinating article from Jacob Sullum at Reason, reviewing two new books out about obesity (see the links at the bottom for the books). Here are three excerpts from this fascinating article:Gina Kolata says losing weight is nearly impossible. Brian Wansink says it?s easy. But they don?t really contradict each other, because they?re talking about different kinds of weight loss.Although their new books offer very different messages for dieters, Kolata and Wansink share a suspicion of collectivist responses to the ?obesity epidemic.? Both writers are intensely interested in the question of why people weigh as much as they do, but they do not leap from research findings to policy prescriptions aimed at making us thinner by restricting our choices. At a time when almost every discussion of weight in America seems to end with a list of things the government should do about it, their restraint is commendable….Kolata?s discussion of obesity research suggests that false hope is not limited to people trying to lose weight. Scientists too are perpetually reaching for a weight loss key that always seems just beyond their fingertips: the right diet, the right drug, the right hormone.Kolata?s main explanation for the failure of these efforts is that people are genetically programmed for a certain weight range, which varies widely from one individual to another. Twin studies indicate that genetic differences account for something like 70 percent of variation in weight. ?The body?s metabolism speeds up or slows down to keep weight within a narrow range? of ?20 to 30 pounds,? Kolata writes. While losing 20 or 30 pounds would count as success for most Americans whom the government considers overweight, it would be just a start for the study subjects on whom Kolata focuses.The idea of predetermined weight ranges is consistent with much everyday experience: People tend to return to a particular weight after gaining a few pounds from holiday overeating, for example, or after losing pounds during an illness. It also jibes with the complaints of people who say they easily gain weight while friends can eat whatever they want and stay thin….Despite their differences in tone and focus, Kolata and Wansink are equally unenthusiastic about proposals by fat warriors such as Yale obesity expert Kelly Brownell to reshape Americans by reshaping our ?food environment? through propaganda, censorship, taxes, and regulation. Kolata says there?s no reason to think the government knows how to make people thinner. She notes that even well-funded, intensive efforts aimed at slimming down captive audiences of schoolchildren have produced disappointing results, making proposals such as restricting cereal commercials, banning soda machines from schools, and distributing federally funded fruit to students look even lamer.Wansink, for his part, says labeling and education don?t make much of a difference, and ?we cannot legislate or tax people into eating Brussels sprouts.? I was one of the few physicians way back when “Big Tobacco” was being vilified, to point out to my collegues that smoking was a choice made by individuals and that teaching those individuals that they were simply the victims of evil businessmen who wanted them to get lung cancer would be non-productive. But it has become clear that the tobacco insanity–i.e., telling people they are not responsible for the choices they make and blaming business– has opened the door to further absurdities, such as big government-types telling us what and how much to eat; that we must exercise; we must do this, we must do that blah blah blah.Can the goal of these do-gooders be any clearer that this quote from a recent Mark Steyn blog post:Bigshot eco-panjandrum lays down the law:Hillman, senior fellow emeritus at the Policy Studies Institute, says carbon rationing is the only way to ensure that the world avoids the worst effects of climate change. And he says that the problems caused by burning fossil fuels are so serious that governments might have to implement rationing against the will of the people.”When the chips are down I think democracy is a less important goal than is the protection of the planet from the death of life, the end of life on it,” he says. “This has got to be imposed on people whether they like it or not.”Think about the implications of that last sentence, and understand exactly what kind of society Hillman–and by extension, the fat police–are advocating.Of course, I constantly encourage individuals to be responsible in their personal choices — but I never forget that it is their choice, not mine. Notwithstanding the fact that there certainly are some people with physiological and biological defects which result in severe, morbid obesity requiring serious and long-term medical intervention; most run-of-the-mill obesity and overweight is a matter of genetic programming combined with personal lifestyle choices. I have nothing against people who want to lose weight to look and feel better. Go for it! The underlying societal problem, it seems to me, is not obesity, per se; it is that. as we as a society increasingly demand that government take over health care insurance (e.g., medicare, medicaid, etc.) and pay for health care, we have opened the door to justifications to intrude on our everyday personal choices–like what to eat.This is by far a greater threat to our individual liberty than anything ever written in the Patriot Act but there is hardly a word spoken against this sort of obscene violation of our personal freedom, and it is promoted relentlessly by the political left.In 2004, Ed Hudgens, wrote an excellent essay on this very subject, which I have kept in my files:OBESE MEDICARE AND FATHEADED POLITICIANSIn the mid-1990s I used to argue against the war on tobacco as follows: Supposedly 400,000 individuals die each year because of smoking. (It’s closer to 200,000; the government fakes the numbers, but that’s another story.) Since governments pick up many of the health-care costs of people who are sick from smoking, governments claim the right to wage a war on tobacco. But nearly as many individuals allegedly die from bad diets and lack of exercise. By this logic, it will only be a matter of time before you’re limited to two Big Macs per month, potato chips are kept behind the counter and not sold to anyone under 18, and there’s a five-day waiting period to buy Twinkies so government bureaucrats can check your medical records.My reductio ad absurbum is one step closer to surrealist reality, thanks to Health and Human Services (HHS) Secretary Tommy Thompson who has now defined obesity under Medicare as a “disease.” Thompson is on a jihad against extra pounds and expanding waistlines in this country. This change in the Medicare rules undermines freedom on four fronts.First, lots of Americans have unhealthy eating habits. But obesity is not a “disease”; it is the result of poor choices and habits over which individuals have control. Yes, some might be more prone to binge on chips, chocolate or other tasty treats, but the difference between we humans and dumb animals is that we can control our appetites; we can develop the good habits and practices necessary to live healthy lives. To suggest otherwise is to suggest that we are not in control of ourselves and are not responsible for our actions and thus undeserving of freedom.Second, by classifying obesity as a disease, Thompson has created a new, multi-billion-dollar government entitlement, without congressional approval, that will bloat an already monstrously obese Medicare program. Let’s remember that when Medicare was created in 1965 the federal government estimated that it would cost billion per year by 1990; instead it cost more than billion that year. Today it costs about 5 billion with another 0 billion going to Medicaid to provide health care for the poor. And let’s remember that in 2003, when the Bush administration proposed its new Medicare prescription drug benefit, it estimated the cost over the first decade at 0 billion. The ink of the president’s signature on the legislation was barely dry when the administration announced that, oops, it had miscalculated; the cost would actually be 4 billion.Third, this new entitlement removes a principal and powerful incentive for individuals to treat their bodies in a responsible manner. If individuals believe the government – read, their fellow taxpayers — will pick up the tab for their poor dietary choices, paying for their Weight Watchers or Jenny Craig, their stomach-stapling surgery or clogged artery treatments, they will be less likely to take their health into their own hands.Fourth, aggressive government diet controls cannot be far behind. With government paying the bill comes government control. As Medicare costs rose in past decades, the feds tried to save money by creating and forcing people into Health Maintenance Organizations that provide poor service, thus harming health. They also fine and even jail doctors for paperwork mistakes in Medicare filings, which are impossible to avoid because of the thousands of pages of incomprehensible Medicare regulations, thus driving many doctors, sick of being persecuted for curing patients, into early retirement.We now can expect the food fascists in this country — those who want to restrict or ban foods of which they don’t approve — to join with the government – the guys with the guns – to make sure you only eat what they want you to eat.Obesity and poor health habits are certainly problems in this country. But the solution lies in true personal responsibility, a sense that one’s life is so important and of such value that one would commit moral treason to one’s self by allowing one’s body to fall into disrepair.A greater threat to the health of our country is the obese size of government, with Medicare the overweight poster child that illustrates the danger to the heart of our liberties. Our biggest problem is not with fat in our waistlines but, rather, in the heads of politicians who want to micromanage our lives. The lesson of HHS’s classification of obesity as a “disease” is that the government should go on a diet, shedding hundreds of billions in needless spending, starting with the entire Medicare program.Amen, brother. Or, should I say, “Amen, Big brother”?The authors reviewed by Sullum suggest that:Many of the health risks associated with obesity may be due to the poor diets and sedentary habits associated with fatness rather than the extra pounds per se. Kolata notes that it?s unclear whether exceeding the government?s recommended weight range is inherently hazardous or whether fat people who become thinner thereby become healthier. Yet scientists who point out such inconvenient facts can expect to be pilloried for failing to toe the party line. Kolata describes the dismay of two researchers at the U.S. Centers for Disease Control and Prevention, Katherine Flegal and David Williamson, at the anger they provoked from their colleagues by suggesting that the death toll the government had attributed to excessive weight was greatly exaggerated.Most of you probably don’t remember how the Center for Disease Control rapidly backpedaled on its OBESITY = DEATH meme back in 2005 when some interesting data came to light. What researchers found was that being UNDERWEIGHT is associated with more deaths than being OVERWEIGHT. Here’s the scoop on that:Apart from this huge downward revision in the numbers of people supposedly dying from fat, there are several things in this study which signal the end of any legitimate linkage between obesity and premature death. First, for the merely overweight with BMI’s from 25-30 there is no excess mortality. In fact, being overweight was “associated with a slight reduction in mortality relative to the normal weight category.” Being overweight not only does not lead to premature death, something that dozens of other studies from around the world have been saying for the last 30 years, but it also carries less risk from premature death than being “normal” weight. In other words the overweight=early death “fact” proclaimed by the public health community is simply not true.Second, for individuals aged 25-59 the risks of premature death from being underweight are substantially greater than those of being overweight and they are also slightly greater than those of being obese. For those aged 60-69 the risk of dying from being underweight is much higher than from being even significantly obese, that is with a BMI > 35. Again, the total number of premature deaths due to obesity is 25, 814, while the mortality attributable to being underweight is 37, 746. If anything this points to an epidemic of not fat but thin caused death.Third, the increased mortality risks from obesity were concentrated in a small sub-section of the population, the morbidly obese (BMI>35), who comprise only 8% of Americans. Yet the obesity hysteria of the public health establishment consistently tells us that 65% of Americans are overweight and headed to an early death.Fourth even the 25,814 deaths per year from obesity needs to be taken not just with a grain of salt but with enough to keep Chicago’s streets ice-free for an entire winter. That’s because the results are in many cases not statistically significant, though the authors don’t mention this. For example, in the 25-59 year old group the confidence interval for increased risk for the obese with BMI’s up to 35 is 0.84-1.72, meaning that we can’t be confident that even for this group there is any increased risk of early death. The same is true for those with BMI’s up to 30. Moreover, the RR figure — the Relative Risk for dying from obesity – is, in the authors’ words, “in the range of 1-2.” This means that there is at the very best a very weak association — notice, not a causal connection — between obesity and death.This is definitely NOT good news for the intrusive nannies who want to control what other people eat; nor is it good news for the a$$holes who hope to cash in on the current fast food victimhood trend.Many obsessive dieters and exercisers that I have met over the years have firmly believed that they had discovered the secret of eternal life. They are encouraged in this belief by the gurus of thin and their legions. How sad for them to discover that death still patiently awaits them, even though they are thin and buff.Which reminds me of several scenes from Woody Allen’s classic 1973 movie, Sleeper:Dr. Melik: [T]his morning for breakfast, uh, he requested something called wheat germ, organic honey, and tiger’s milk.Doctor: Oh yes. Those are the charmed substances that some years ago were thought to contain life preserving properties.Dr. Melik: You mean there was no deep fat? No steak, or cream pies, or hot fudge?Doctor: Those were thought to be unhealthy. Precisely the opposite of what we now know to be true.And, my favorite:Dr. Orva: You must understand that everyone you know in the past has been dead nearly two hundred years.Miles Monroe: But they all ate organic rice! (Source: Dr. Sanity)

This was originally posted on 8-16-07. I have updated and perfected it on 1-6-08. It’s the longest post on www.TheAngriestPharmacist.com at 2,600 words, but it is completely worth it and should be required reading for all people having a prescription filled. Enjoy!
I take for granted how smart I am, how much common sense I?ve acquired over the years, and how much education I was lucky enough to get. So, for those that are not as *gifted* as the pharmacists and technicians which serve them day-in and day-out, I?ve compiled a list of step-by-step tips to live by when entering, interacting, and dealing with the pharmacy area and staff. (Pharmacists – you can print this out in large quantities and use as a bag stuffer if you so choose)
DROP OFF
1. Take your new prescription to the area labeled ?drop-off,? not the area labeled ?pick-up? or ?consultation.? While I know you want to pick it up eventually, or may have a question, it is not yet filled and first must be dropped off. You will be given the opportunity to ask questions at the pickup window. You can also ask at the drop-off window. If the technician cannot answer your question, s/he can then have the pharmacist come over and help. It?s at this point you should discuss any intricacies of your order. If you want easy open caps, brand name only (for whatever reason you?ve dreamt up ? generics are just as good, FOOLS!), insurance/tax print outs, or additional literature, this is the point in which to request these things.
2. When approaching the drop off, be prepared to answer a few very simple questions about yourself (or the person for whom the prescription is for). These questions are, but not limited to, name, birthday, address, phone number, drug allergies, and up-to-date insurance (see Addendum E). If you are holding an old bottle that merely needs refilled, you should reference step 15. It can be filled in this manner, but you will have to wait ? probably longer than you would like (this may or may not be considered punishment for being inconsiderate). If you had taken 30 seconds to call it in to the pharmacy in advance, you would have saved yourself a lot of trouble and time. You would have also made it easier for the pharmacy staff. If you decide to hand in a bottle at the window for a refill for whatever reason, do not hand the technician tubes of cream or anything that gets ?icky? upon extended use.
3. When the technician or pharmacist gives you an estimate for readiness, bear in mind, the estimate is always the lowest time possible. If he tells you fifteen minutes, that?s if everything goes perfectly. Would you be pleased if he told you two hours? No, but it happens occasionally if something goes awry. Your response should merely be acknowledgement. You should never ever say, ?That long?? or ?Are you serious?? The pharmacy staff is not in the business of making jokes or wisecracks in day-to-day operations. Most take their job very seriously, and remarks like these are never taken well by the staff ? they are downright rude. Make no mistake, if they could fill it in five minutes, they would ? and sometimes that can happen! Take note that there is no visible clock in any pharmacy?J
4. You do not want to wait for your prescription! I know you need to start it today, but leaving a prescription with intentions to come back in one or two hours will have you less likely waiting in the pharmacy well over the time suggested in step 3. Do not tell the technician you are waiting only to subsequently leave. If you do wait for your prescription and ultimately decide to leave, have the courtesy to tell the staff you are leaving. They can then alter the workflow to better serve the customers waiting in the store. You can wait for your prescription in the seating area or shop around the store. Do NOT wait for your prescription in front of the cash register. Do not wait anywhere where you will be ?in the way? ? and never badger the pharmacy staff. It will be filled as soon and as safely as possible. When that happens, we?ll let you know!
PICK UP
5. When attempting to pick up a prescription, give your last name until more information is requested. Every pharmacy is different. Every person working every register in every pharmacy is different. There is no reason for you to give every sliver of information you know out to everyone else standing in line. You do not need to present an old bottle should you be picking up a refill. You can throw those away at home. You also do not need to be arbitrarily sharing your private information with everyone else waiting in line! If the cashier asks you to spell your name or give your birthday, please do it slowly. There?s no reason to blurt it out as fast as possible. Speak slowly and clearly. It?s not a race! Next thing ? Wait your turn. Patiently wait in the line. Don?t cut. Don?t get upset if it?s busy. Businesses do that from time to time ? get a little busy!
PAYMENT
6. After your prescription is rang-out is not the time to present your insurance card. That should have been done in step 2. If you show your card at this time, you will have to wait even longer (depending on the staff?s workload) while the prescription is reprocessed. It could take more time if there is a problem with your insurance that needs to be sorted out with a phone call.
7. Cash or charge, please. Who in the hell still writes checks? Get a debit card if you want to use funds in your bank account.
8. Do not use those damn transfer coupons more than once. They say one per customer. That does not mean one per prescription. It does not mean you can use one from every other pharmacy in the city. In the *Angriest* Pharmacy, these coupons are taken out of my bonus. If every customer uses multiple coupons blatantly against the intentions of the coupon, you are essentially stealing from me. To you, it may not be a big deal ? ten bucks. Nevertheless, if every customer takes a few ?10 bucks? from me, that?s just not fair. See Addendum D for more clarification.
CONSULTATION
9. When you are asked if you have questions, do not immediately blurt out, ?No.? It is not a test. There is no correct answer. Contemplate whether you actually have any questions for your pharmacist ? you (or your insurance) just paid for his time. The only stupid question is one that goes unasked.
10. If your medicine is more expensive than you had planned, do not get angry. Do not yell or make a scene. No one in that building had anything to do with the costs of your prescription except, possibly, you. They can?t change it. They can?t give you a coupon. Do not pull out your insurance card again (should you have missed the opportunity in step 2 and passed up your final opportunity in step 6). You can inquire about the cash price ( doesn?t sound so damn bad when the medicine would cost 0, does it?). You can call your insurance and ask them if there is an error at home. Finally, your pharmacist could potentially contact your doctor for an alternate drug, which may be cheaper ? but your doctor may not wish to do this. In that case, you must call his office and discuss your options with them from your own home.
11. Do not ring up all of your shopping items with your prescription – whether there is a line behind you or not. If you have Band-Aids, that is okay. If you have Band-Aids in addition to 90 other items, that is out of the question. Have some courtesy and utilize the cashiers up front. They are paid to ring you out, whereas the pharmacy is paid to fill prescriptions. Let us all do the job we are paid to do.
12. Thank the cashier or technician ringing you out. If they did not thank you, they could be reprimanded. Wouldn?t you be happier if you were nice?
-=+=- You?ve made it home. What next? -=+=-
13. Take a look at your bottle. Just to be sure, make sure it?s your name on the bottle. Read the drug name and the directions. Nothing should be new to you here. If something doesn?t look or sound right, call the pharmacy and inquire nicely. Read the leaflet should you want any additional information about your medicine. Call the pharmacy where you got the prescription filled with questions ? they have all the pieces to the puzzle. You don?t call McDonalds and ask about Burger King?s menu do you? If they cannot or will not answer your questions, call your doctor and find a new pharmacy.
14. Take your medicine exactly as it says on the bottle – unless directed differently by your doctor. Should that be the case, you need to alert your pharmacy of the change as soon as possible. A new prescription should be attained if you are going to continue taking the medicine ? the bottle should always say exactly how you are taking the medicine.
15. Should your prescription have refills, be sure you call the prescription in to the pharmacy at least 24 hours in advance. This gives them plenty of time to fill the medicine without being rushed. You don?t need to tell a person you want the refill, you can merely punch the number into the automated system with your touchtone phone then hang up.
16. Should your prescription have no refills, but you are to continue taking it longer term, call the prescription in to the pharmacy at least 72 hours in advance (keeping in mind that doctor?s offices are usually closed on weekends and holidays). That gives the pharmacy time to call the doctor?s office and request the refill. The office can then check your records, make a note of the request, and return the call to the pharmacy with authorization. The pharmacy can then get the prescription ready for you to pick up. Feel free to call the pharmacy and speak with someone before making the trip to pick the medicine up to verify it?s ready. Do not be upset if it?s not ready. The pharmacy will make another call if need be. You can also call your doctor?s office and inquire about the refill. Should you run out and refills were not yet authorized, most pharmacies will give you a three-day supply free of charge to hold you over (except on controlled medications). Those tablets will be subtracted from the prescription once it is authorized. Keep in mind, however, that if you run out, have no refills, and the pharmacy cannot give you a few to hold you over, it is your OWN GOD DAMN FAULT! Take some fucking responsibility in your own health care. Don?t hope to ?swing by the pharmacy? on your way to the airport and pickup a refill you didn?t call in that has no refills. Plan in advance, and don?t be a cocksucking asshole.
17. See step 5.
Addendums Not Related to Procedure:
A) Your doctor should talk to you about what medicines you are going to be getting and what they are for. The pharmacist can fill in the blanks and provide in-depth instructions, but you should never get to a pharmacy without knowing at LEAST what drug is on your prescription and how you should take it.
DECORUM
B) Do not yell at your pharmacist. Do not make a scene. Do not talk to him like anything other than your drunken stepfather holding a belt while you just broke something expensive. That is the type of respect s/he should command. Would you tell your physician(s) to, ?kiss my fucking ass you dumb Jew?? I don?t think fucking think so.
C) Do not expect the technicians to be able to answer all your questions off the top of their head. Do not expect the pharmacist to be able to answer all of your questions off the top of his/her head. Books are written for a reason. Your doctor has a palm pilot – so do The *Angriest* Pharmacist.
D) Those on government programs (Medicare/Medicaid) cannot use coupons or vouchers?period. Not policy?LAW
E) Throw away old insurance cards when you get new ones. Keep the new ones on you at all time. It will save you and your pharmacist a lot of time and headaches.
F) Do not argue with your pharmacist over matters with which you know nothing. In fact, if your pharmacist is sure, and s/he tells you such, take their word as fact. S/he may be wrong, but do you think you?re going to be able to prove that with an argument over a counter concerning a matter where you have no higher education, training, or knowledge?
G) After making your purchase, do not rip open the package to see what?s inside like a 5-year old at Christmas. Sure, you may take a look at your prescription while you?re at the pharmacy (just not in the line!). Either way, you should know what?s in the bottle. See Addendum A. Keep in mind though, in pharmacy, we are not in the business of making errors and mistakes. We do it right, and we do it right the first time.
H) You may be ill, but please dress like you are going into public and people will see you?and smell you?so shower as well. If I smelled like I washed ass with dirtier asses, I?d get fired.
I) At no point, anywhere in the entire process or procedure are you allowed to use a cell phone. Your lack of attention could cause serious repercussions for yourself and ultimately your pharmacy. You can make all the calls you want the other 23.5 hours you have in your day in which you are not at the pharmacy.
J) Transfers are a whole new ballgame. The suggestion I offer my friends and family is to just get a new handwritten prescription from your doctor or have the office call you in a new prescription at a new pharmacy if you are going to be on the medicine long-term. Transfers take much longer because it requires perfect timing between two equally busy pharmacists to exchange a lot of information in a short amount of time without interruptions. For this, you CAN drop of the other pharmacy?s bottle. Alternatively, you can call the new pharmacy and give them all the information off the bottle. Your best bet on these is to never plan to get a transfer in less than an hour. This isn?t across the board, but it?s pretty universal in my book.
Above all else, remember this: Pharmacists are there for you because we want to help (or the ones that don?t give a shit cared at one time). Read that again. We want to help you. You must play an active, pleasant, beneficial role, however. You must want to help yourself. Keep in mind though, that if you are a problem customer, we don?t have to help you. In almost every state, pharmacists are not required to fill a prescription if they don?t want to. In some states (like mine for instance), I don?t even need a fucking reason. I can just say, ?No.? Don?t ever be such a problem that your pharmacist has to just tell you to get the fuck out because you?re an asshole. Just be nice, and you can benefit with great pharmaceutical care, I can do my job, share my expertise, and we can create a relationship where we will both benefit.
  Primary Author:
              The *Angriest Pharmacist (Webmaster@TheAngriestPharmacist.com)Supplemental Contributors:
GreenSunFlower (http://greensunflower.blogspot.com)
?Matt?
?Andi?
KnitALot3
IAPharmr
Pharmacy Mike (http://pharmacymike.blogspot.com)
?Katie?
Cathy Lane
Jameed (http://jameed.net)
StressedOutPharmacist
Shalom
IfIHadANickelForEveryTime?Note: There is a rating embedded within this post, please visit this post to rate it.
Note: There is a print link embedded within this post, please visit this post to print it.
Note: There is an email link embedded within this post, please visit this post to email it.
DIGG this site (Source: The Angriest Pharmacist)

WashingtonCAN released the following press release today. It speaks for itself.

Washington Health Insurance Companies Making Record Financial Gains as Access to Quality Health Care Erodes

New data calls into question industry’s justification for rate-hikes

A Fact Sheet summarizing data is attached. For full report, visit: http://www.nwfco.org/pubs/2008.0110_Insuring.Health.or.Ensuring.Profit.pdf

Seattle, WA ? Washington’s major health insurance companies are making record financial gains, according to a study released today, Insuring Health or Ensuring Profit?: A Look at the Financial Gains of Washington’s Health Insurers.

The study, released today by the Northwest Federation of Community Organizations and the Washington Community Action Network, reveals that the state’s top three insurance companies are benefiting from rising profits and surpluses. Said Julie Chinitz, Health Policy Analyst with the Northwest Federation of Community Organizations, “Unfortunately, the data suggests there’s a mismatch between what’s good for insurance companies and what’s good for the public.”

The cash surplus amassed by the top three insurers ? Regence BlueShield, Premera Blue Cross, and Group Health Cooperative ? more than doubled between 2002 and 2006 from 3 million to over .1 billion.

In 2006, the state’s top three carriers earned a profit of .23 a month on each member, a twofold increase since 2003.

Profits are climbing as the major insurance companies cover fewer people. The number of member months covered by the top three insurers dropped 17 percent from 2002 to 2006, while their profits (net income) skyrocketed from million to 1 million.

At the same time insurance carriers are enjoying increasing profitability, they have dramatically raised rates on individuals. Last year, Regence increased rates as much as 40 percent on individuals. This month, LifeWise, which is owned by Premera, followed suit with a 22.5 percent rate hike.

While the industry has cited increasing health care costs as justification for rate increases, data released today reveals that revenue growth for these insurers’ Washington business is outpacing increases in health care spending. From 2002 to 2006, Washington revenue for the top three increased by 23 percent, while hospital and medical expenses increased only 16 percent.

Betty Halfon, a small business owner in Pike Place Market, saw her LifeWise premium increase more than 40 percent this month. “What angers me the most is that while my insurance company is making paper-thin excuses for raising my rates, they’re amassing record profits,” said Halfon. “If the insurance companies are so flush with cash, my rates should be going down! Instead they’re going through the roof and jeopardizing my financial security.”

The organizations releasing the report recommend increased public oversight of private insurers, as well as a public alternative to private coverage for all state residents.

“Insurance companies compete and profit by avoiding paying for health care, and that’s not what we need for our health care system,” said Deana Knutsen, Board Chair of Washington Community Action Network. “The public needs protection, and I hope our government will step in and provide it.”

###

With over 30,000 members across the state, Washington CAN! is the state’s largest grassroots community organization. Washington CAN! fights for progressive social change at the local, state, and national levels, with a focus on issues that most directly affect the lives of Washington residents. Our mission is to achieve economic fairness in order to establish a democratic society characterized by racial and social justice, with respect for diversity, and a decent quality of life for those who reside in Washington State.

Meanwhile, I’m paying almost 0/month for health insurance coverage through WSHIP, because these insurance companies refuse to insure the people who need them–sick people. That is why they are so profitable–they’ve cherry-picked the health folks and left the sick folks to pay outrageous premiums or go without insurance. (Source: The Assertive Cancer Patient)