I want this insurance!

Some self-insured companies are using “medical tourism” to save money while providing excellent care at accredited foreign hospitals. Here’s an example: an employee of Ashley Furniture Industries needed a knee replacement. Her company arranged for her to go to Galenia hospital in Cancun for the surgery and to stay at the Sheraton hotel next to the hospital for ten days while she was undergoing post-op physical therapy. A highly trained orthopedic surgeon from the US traveled to Cancun to perform the operation. Here are the highlights:

• The orthopedist stayed less than 24 hours and received $2,700—three times what he would have received from Medicare.
• The surgery in Mexico cost $12,000. The average cost in the US is $30,000 but is often double or triple that amount.
• The standard charge for a night at Galenia hospital is $300. In the US the average cost is $2,000 a night.
• The implanted knee device costs $3,500 at Galenia. The cost for the same device in the US is  $8000.
• The patient paid no co-pay or deductible. In fact, she received $5000 from her employer and all her travel costs were covered.

Ashley furniture has sent about 150 of its employees to Cancun or Costa Rica, saving the firm $3.2 million in health costs since 2016. Even after paying for the medical services plus the incentive payments, the company pays about half the cost it would pay for care in the US.

Following the treatment at Galenia, the patient had this to say: “It’s been a great experience. Even if I had to pay, I would come back here because it’s just a different level of care—they treat you like family.”

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Remember thalidomide?

In the 1950s and early 60s the drug was given to pregnant women as a cure for nausea. Unfortunately, it caused severe birth defects in their children, most notably truncated or missing limbs. Because of the dire consequences of this drug, in 1962 the government enacted the Kefauver-Harris amendment to the Federal Food, Drug and Cosmetic Act, which requires drug makers to satisfy the F.D.A. that their products are safe and effective before they go on sale. (I was kind of blown away by the fact that, before 1962, drugs could be sold without any data to support their claims of efficacy.)

Anyhow, the more than 100,000 drugs already on the market needed to be reviewed. To streamline the process, if the drugs’ components had been deemed to be safe and effective, they could be used under specific conditions without further review. But about a third of the drugs have still not undergone the final review process. That is, hundreds of over-the-counter drugs have not yet been determined to be safe and effective. Sunscreens are one of these.

Beginning in 1997, scientists discovered that oxybenzone, the chemical that filters out UV rays, does not stay on the surface of the skin but is absorbed. It has been found in urine and breast milk. (The CDC found that 97 percent of sunscreen-users’ urine samples contained the chemical.) At the same time, there’s never been any indication that sunscreen chemicals are harmful to humans, and evidence has shown that sunscreen can prevent skin cancer. Still, because sunscreens have not been studied (too many variables!), we don’t know about long-term effects—whether sunscreen use, for example, plays a role in infertility or anything else.

I use sunscreen on my nose sometimes to prevent it from getting any redder than it already is. I’ve had plenty of skin cancers and am plagued by actinic keratosis, which are supposedly pre-cancerous (but have never turned into cancer). Even so, I rarely use sunscreen, mostly because of the bother. My husband has never used it and has never had skin cancer or actinic keratosis. Perhaps a study is called for.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Diets and supplements for cardiovascular health: Not

Long-term trials (277 of them) on 992,000 people have pretty much shown that adhering to special diets and taking supplements are of no benefit to your cardiovascular health:

• Low fat diets, including avoiding saturated fats, doesn’t help heart health. (I’ve been saying that all along.)
• Eating a Mediterranean diet is also not beneficial. What’s the big deal about “whole grains” anyhow?
• As a rule, supplements, including fish oil, vitamins, and antioxidants, don’t help much. Apparently folic acid helps people in China, where there’s a deficiency. On the down side, the study did find that taking calcium with vitamin D increases the risk of stroke, probably because these supplements increase clotting and hardening of the arteries.
• Reduced salt helped a few people, but was certainly not beneficial across the board. Some people are sensitive to salt; others are not. As doctor Eric Topol says, “maybe salt restriction really is beneficial for some, but we haven’t defined the people yet that would drive that.”

People are different. I have a friend who passes out if she eats strawberries; another who becomes ill by eating onions; another who is allergic to artichokes. Certain cancer medicines help some people but not others. All medicines affect people differently. Then there are your gut bacteria, which vary a great deal among people and which affect not only your physical health but also your mental health. Unfortunately, researchers haven’t nailed down ways to determine what foods or medicines are either beneficial or toxic to you specifically. For now you’re stuck with trial and error.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

We’re stuck with superbugs

Superbugs are bacteria that have become resistant to antibiotics. Bacteria become resistant because their rapid rate of reproduction (every twenty minutes) makes possible a high number of random genetic mutations. Thus, an antibiotic may kill plenty of bacteria, but not those whose mutations have rendered them immune to the drug.  The most well known of these is Methicillin-resistant Staphylococcus aureus (MRSA). MRSA originally appeared in intensive care units, among surgical patients, causing pneumonia and bloodstream infection from catheters. Now it’s become more widespread outside of hospitals. Other bacteria have also become resistant to antibiotics.

Some statistics:

• It costs $35,000 to treat MRSA; chance of death is over 20 percent.
• The number of people dying each year from resistant microbes is at least 1.5 million.
•  Antibiotics from human and animal waste end up in our drinking water, which makes for even more drug-resistant bacteria.
• Farm animals are routinely fed low doses of antibiotics; over 70 percent of medically important antibiotics in the US are sold for use in farm animals.

Drug companies are not knocking themselves out to discover new antibiotics—it’s not commercially attractive to them. We need to conserve those viable antibiotics we have. In other words, limit unnecessary use. Good luck with that.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.