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[Dec 26, 2013] For Fitness, Intensity Matters By GRETCHEN REYNOLDS

Dec 25, 2013 |

This year, exercise science expanded and fine-tuned our understanding of how physical activity affects our brains, joints, hearts, and even genes, beginning before birth and continuing throughout our lifespans, which can be lengthened, it seems, by exercise, especially if we pick up the pace.

This year's fitness news, as a look back through 2013's Phys Ed columns shows, was variously enlightening, validating (if, like me, you never bothered cooling down after a workout anyway), and practical (D.I.Y. concussion testing, anyone?). It was also occasionally deflating, at least if you hoped that barefoot running invariably would reduce the risk of injury, gentle exercise would quash your appetite, or training for a marathon would automatically exempt you from being a couch potato.

But the lesson that seemed to emerge most persistently from the fitness-related studies published this year was that intensity matters, especially if you wish to complete your workout quickly. The most popular column that I wrote this year, by a wide margin, detailed "The Scientific 7-Minute Workout," a concept that appealed, I have no doubt, because the time commitment was so slight. But the vigor required was considerable; to gain health benefits from those seven minutes, you needed to maintain a thumping heart rate and spray sweat droplets around the room.

Almost halving the time spent exercising was also effective, a later and likewise popular column showed. In that study, out-of-shape volunteers who ran on a treadmill for a mere four minutes three times a week for 10 weeks raised their maximal oxygen uptake, or endurance capacity, by about 10 percent and significantly improved their blood sugar control and blood pressure profiles.

The results undercut a common excuse for skipping workouts. "One of the main reasons people give" for not exercising is that they don't have time, said Arnt Erik Tjonna, a postdoctoral fellow at the Norwegian University of Science and Technology, who led the study.

But they emphasize, too, the potency of hard effort. The volunteers ran at 90 percent of their maximum aerobic capacity for those four minutes, a level that is frankly unpleasant. But, in four minutes, they were done.

There were other hints throughout the year that exerting yourself vigorously may have unique payoffs, compared with less strenuous exercise. In a study that I wrote about a few weeks ago, for instance, people who walked briskly, at a pace of 17 minutes per mile or less, generally lived longer than those men and women who strolled during their walks, at a pace of 20 minutes per mile or slower, although the study was not designed to determine why the intensity of the exercise mattered.

And in September, I wrote about two studies showing that strenuous exercise blunted volunteers' appetites after workouts more effectively than longer sessions of easy exercise did. The studies were small, though, and involved only young-ish, overweight men. Whether the results are applicable to other people, including those of us who are not male, requires additional experiments. I expect to be covering the results in 2014.

Meanwhile, other studies that I wrote about this year emphasize how pervasive the impacts of any amount and type of exercise can be. One of my favorite experiments of 2013 detailed how rodents that ran on wheels for several weeks responded far better to stressful situations than sedentary animals, in large part, it seems, because their brains contained specialized cells that dampened unnecessary anxiety. At a molecular level, the runners' brains were calmer than those of their sedentary lab mates.

But perhaps the most remarkable studies of the year examined the effect of exercise on our DNA. In several experiments, which I wrote about in July, scientists found that exercise reshapes genes in human cells, changing how atoms attach to the outside of individual portions of our DNA. As a result, I wrote, the behavior of the gene changes. In one of the studies, researchers found that six months of moderate exercise profoundly remodeled genes related to the risk for diabetes and heart disease. But for those of us too impatient to wait six months, the other study found that a single session of bike riding altered genes in volunteers' muscle cells. The effects showed up whether the pedaling was easy or strenuous, but, in line with so much of this year's exercise science, were more pronounced when cyclists rode vigorously.

Still, for everyone, as one of the scientists told me, the studies are an important and inspirational reminder of "the robust effect exercise can have on the human body, even at the level of our DNA."

[Nov 30, 2013] Statins by Numbers By JASON KARLAWISH

Nov 29, 2013

Experts Reshape Treatment Guide for Cholesterol (November 13, 2013)

In his book "Moneyball," Michael Lewis chronicled how the Oakland A's, in order to identify the best predictors of a winning baseball team, used a highly formulaic, statistics-driven approach in place of the traditional assessments of coaches and managers. This month, in a similar spirit, the American Heart Association and the American College of Cardiology issued new, numerically driven guidelines for the treatment of cardiovascular disease.

These guidelines recommend that doctors no longer use a patient's LDL cholesterol level to decide whether to prescribe a cholesterol-lowering statin, and instead rely on the results of a web-based "risk calculator" - the Omnibus Risk Estimator - that determines a person's chances of suffering atherosclerotic cardiovascular disease in 10 years.

Into the Omnibus Risk Estimator you enter nine variables, including age, sex, total cholesterol and systolic blood pressure, and the estimator returns your 10-year and lifetime risks of stroke, heart attack or death from cardiovascular disease. With these data, you and your doctor decide whether to invest in a lifetime of daily therapy with a statin pill.

This is a revolutionary shift. Once upon a time, medicine was a discipline based on the nuanced diagnosis and treatment of sick patients. Now, Big Data, networked computers and a culture obsessed with knowing its numbers have moved medicine from the bedside to the desktop (or laptop). The art of medicine is becoming the science of an insurance actuary.

It is also becoming big business. The developers of the World Health Organization's FRAX calculator, which calculates your 10-year risk of major osteoporotic fracture, licensed it to General Electric, a manufacturer of bone-density measurement devices.

What is the problem with grounding medical practice in the cold logic of numbers? In theory, nothing. But in practice, as decades of work in fields like behavioral economics have shown, people - patients and doctors alike - often have a hard time making sense of quantified risks. Douglas B. White, a researcher at the University of Pittsburgh, has shown that the family members of seriously ill patients, when presented with dire prognoses, typically offer quite variable understandings not only of qualitative terms such as "extremely likely" but also of quantitative terms such as "5 percent." We like our numbers, but despite our desire for better information and an ethic of "informed consent," we don't know how to use them.

Far more worrisome is where the numbers come from. Until the last decade or so, estimates of risk came from a doctor's head. Now the numbers often come from a machine, which makes them seem objective and credible. But like Dorothy confronting the Wizard of Oz, we need to look behind the curtain. It seems that anyone with a Big Data set and a statistics software package can develop an algorithm, give it a user-friendly interface, and behold: Your future is foretold. It's fast. It's simple. But it's opaque, and it may be wrong.

The Omnibus Risk Estimator is one of many available cardiovascular disease risk calculators. When you enter a patient's data into them, you get a disturbingly wide range of results. Depending on which algorithm you use, you may need a lifetime of statin therapy. Or not.

Why the variation? Because the data sets used to develop the calculators themselves vary widely, and often are derived from populations that do not resemble that of the patient in question. This flaw is most pronounced when a calculator developed in one country is applied to patients in another country, where habits, health care and genetics can substantially differ. But it can be a problem even within a country. Over time, people and their habits change. The Framingham, Mass., of 1980 is not the Framingham of 2010. In general, people these days smoke less, gain more weight and take more medications. Numbers themselves may be precise, but the information they convey can be erroneous.

Calculators like the Omnibus Risk Estimator are simply tools, or devices, akin to the hip prostheses and pacemakers doctors implant in their patients. They are designed well, or they aren't. But unlike other medical devices, which must undergo standardized testing and unbiased review and monitoring by the Food and Drug Administration, these risk calculators are developed with little regulatory authority over their design and use. There needs to be better oversight.

But even if professional and public action ultimately set higher standards, and even if we can get the numbers right, we must be mindful that these are calculators whose results prescribe patented, expensive drugs to millions of people. We have only to recall the successes of the Oakland A's to know that whoever controls the numbers wins.

Jason Karlawish is a professor of medicine, medical ethics and health policy at the University of Pennsylvania.

[Nov 08, 2013]

The idea is put a small table on already existing table and add keyboard stand.

[Aug 11, 2013] Study Ties High Blood Sugar To Dementia

August 11, 2013
A study published last week in the New England Journal suggests that blood sugar levels may be a more important indicator than previously realized for non-diabetics: high blood sugar levels were linked by the study's authors with increased risk of dementia (summary free; full article paywalled). The study followed more than 2,000 elderly participants, and found a positive correlation between blood glucose levels and development of dementia, both for patients with and without diabetes.

Anonymous Coward

Re:Proves Bloomberg correct. (Score:1)

1) High Fructose Corn Syrup, the thing used in just about everything is a mixture of about 55/42% fructose and glucose respectively.

2) Fructose is almost immediately metabolized by the liver into glucose, once it leaves the small intestine.

So, it's basically the same damn thing to the body anyway.


Brain diabetes (Score:4, Informative)

This is particularly interesting because alzheimer's is now thought, by many researchers, to be a form of "brain diabetes."

There are clinical data which demonstrate that alzheimer's can be reversed to some extent with medium chain triglycerides, which are absorbed by cells directly and provide energy which isn't dependent on glucose uptake.

See: [] and [] for more info.


So imbalanced body chemistry leads to problems? (Score:2)

Okay, so perhaps it is over-simplifying the over-all issue and doesn't recognize the increased understanding of what affects what in what ways. It's important, so I'm not going to discount that value.

But the short of it is always this:

1. The body is a chemical machine. It needs good balance. When people screw with it too much beyond its tollerance, it's bad. We know this already. We hear "balanced diet" all the time. Trouble is, "balanced diets" are mostly a lie and because of human diversity, what is balanced for one person isn't balanced for another. 2. People are constantly trying to cut the head off of the body when it comes to illness. If it's "mental illness" they want to blame something mental. If it's something else, they want to blame the body in some way. It's as if this "blood brain barrier" is a thing that people believe contains the soul and spirit of a person. "Magic" right?

It's just not like that. We're all machines through and through. We know chemicals can affect our mood, our judgement, our response time, out ability to think clearly and some would say even enhance our thinking on some ways (I disagree, but okay...) We know we can affect our minds with chemicals and yet we STILL want to believe the mind is separate from the body.

Everyone needs to stop thinking this. Everyone. Laymen, Medical professionals, Police, Justice, Welfare services, Employers and more. Just Everyone.

I see this as completely obvious. Other people still cling to their ideas which are simply and demonstrably wrong.


This wouldn't surprise most diabetics (Score:1)

I was an undiagnosed Type 2 for a very long time, and since diagnoses it's become clear to me that brain function and mood are very closely tied to my blood sugar levels.

Undiagnosed I would experience bouts of temper or melancholy that came from nowhere in particular, and these have been mostly eliminated since I started to medicate.

When sugars a low it's very hard to think at all, you can't concentrate, and it's hard to coordinate movement. Those that think lows can be cured by simply eating chocolate haven't drunk 10 pints of beer and then tried to find a source of sugar in a three bedroom house!

When sugars are high you can be hyper for a time, before you begin to lose control of your body temperature and the slightest thing can send you into a rage.

Uncontrollable rage is very common indeed in teenage diabetics.

[Jul 26, 2013] US Healthcare Costs a Global Outlier and Monument to Crony Capitalism

I think the Big Pharma/Health and Big Finance sectors have similar cartel like structures where a few large companies dominate the field, exercising considering political power and the ability to obtain subsidies and protections from the system while fending off regulation and price restraints.

There are others of course, like the energy field from exploration to distribution, often known as Big Oil, but which now includes natural gas and electric energy production and distribution.

The recurring myths of the efficient market and 'free trade' are exacting a heavy toll on the general public and the real economy. They provide ideological cover to a favored elite that is acting in the manner of a privileged and extractive aristocracy while beguiling many with the allure of easy money.

The concentration of ownership in the media has become an inhibiting and directing influence in public discourse that is hard to miss.

The current recovery fueled corporate perks and ZIRP for the financial sector, a fine example of 'trickle down' economics, will be remembered as one of the great policy errors of modern economic history. They pretend ignorance, they feign helplessness, and they know. But they are getting paid not to act effectively, and even not to see, but to spin some fantasy.

They 'feel your pain.' They just do not do anything substantial about it. Even a second term president can still talk as though he is a recently arrived outsider, critiquing the actions of some predecessor and a corrupt system in which is he barely involved.

These are not leaders. They are like modern CEO's, professional organizers and managers, who talk a great game about their accomplishments but, when the truth comes out, posture that they stand outside the very system for which they have long held the ultimate responsibility.

But even worse are those who make little pretense to justice and goodness and moral principle, preferring to appeal to the darkest impulses, the fears and hatreds of a society. Their actions betray their words.

The lack of serious reform, in large part because of the partnership between Big Money and Washington's new political class, and the dormancy of the progressive impulse, will eventually stress the fabric of society to the limit. And then change will come.

Read the entire story here.

[Jul 25, 2013] The 80 Percent Rule for Retirement - By Dave Bernard

Jul 12, 2013 | Yahoo! Finance/U.S.News & World Report LP

If you do yoga, you might sometimes feel the urge to push yourself beyond what you find comfortable. You probably remember being able to easily complete a pose and hold it indefinitely not that long ago. Now when you attempt it, you may be surprised to feel an unfamiliar tightness or pain.

This is the time to listen to your body rather than a well-intentioned instructor who may try to push you too far. For those of us getting along in years, we may want to change our fitness mantra from "no pain, no gain" to "don't overdo it." Instead of pushing at 100 percent effort, we may now want to take it down a notch to 80 percent.

As we age it becomes important to accept we may not always be able to do everything we could when we were younger. What was easy at 20 can be challenging and sometimes even risky to attempt at 70. There will always be daredevils of all ages who push the limits of safety and sometimes common sense. But as a whole, along with aging comes an increased awareness and hopefully respect for the limitations that begin to creep into our lives.

The 80 percent rule can apply to more than just yoga. Here are some situations when it makes sense to slow down in retirement:

Exercise. During our second act, we are no longer the same 20-something who pushed himself to the brink of exhaustion during workouts. But we can still live full, exciting and eventful lives in retirement. By realizing we cannot do all we used to, we can still grab for life's possibilities and avoid hurting ourselves.

Sports. Accepting limitations can be particularly difficult for ex-athletes. You can probably still picture yourself in your prime. Back then, you probably could have held your own in today's world of insanity workouts. But today, unless you exhibit a bit more caution and restraint, it is not uncommon to go too far and hurt yourself. Equally bad, the recovery period for older physiques can stretch on far beyond what it took when younger.

Travel. Imagine finding yourself in a wonderful new international city with tourist attractions galore, but you only have two days before your itinerary takes you to your next destination. Rather than run yourself ragged, you may want to temper your pace. Pick a few of the sites you most want to visit and build your day around that. Throw in some time in a local cafe, maybe enjoy some time on a park bench admiring the flowers in bloom and walk the neighborhoods to experience their personality and local flavor, appreciating all they have to offer at a slower pace. You do not need to race around at 100 percent all the time to make the most of your travel experience.

Time commitment. Now that you have free time in retirement, you may find your presence in demand from family and friends. But if you commit every free moment to some activity or social event, you may find your days beginning to blur together. Making time to pursue your individual passions and interests can be an important ingredient to a successful retirement. Whether you decide the appropriate mix for you is 80 percent helping others and 20 percent relaxing or some other proportion, some formula that helps balance your time in retirement can add to the satisfaction you realize.

Work. Some retirees continue to find meaning and genuine satisfaction in the work they do. These lucky folks may choose to include work as part of their retirement life. However, for most retirees the ideal work arrangement is not a full-time endeavor. Consider cutting back your work hours or only taking on the projects you truly want to be part of.

Dave Bernard is the author of "I Want To Retire! Essential Considerations for the Retiree to Be". Although not yet retired, he focuses on identifying and understanding the essential components of a fulfilling and meaningful retirement. He shares his discoveries and insights on his blog Retirement-Only The Beginning.

mustangmach • 3 days ago Report Abuse
What they should really emphasize for the 80% thing, is that the unreasonable monetary figures for 'comfortable retirement' are based on assumptions that you consume 100% or more of your current income.

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[May 27, 2013] Ask Farnoosh Best Ways to Negotiate Medical Bills

Yahoo! Finance

Medical bills can be intimidating, to say the least. With so many confusing line items and multiple bills arriving from a single hospital visit, it's not always clear how costs get calculated. "There's so much outsourcing done by hospitals and often more than one entity associated with a single visit and the resulting bill," says health care advocate and nurse Michelle Katz. "Hospital bills have a professional component and a technical component. Typically, your hospital will submit their bill, the professional component, but then there are all these outsourced technical charges. For example, an anesthesiologist, radiologist for X-rays, lab work, etc.," she says.

First, triple check your bills – especially your hospital statements. Eight out of 10 hospital bills contain errors, increasing the bills by an average 25%, according to a survey by the Medical Billing Advocates of America. To avoid getting overcharged, track all your tests, medications, and check them against your medical file which you can get from your hospital's billing office. If you spot an error, send them a letter in writing requesting to fix the mistake and keep your insurer notified by giving them a copy of all documentation. Check for erroneous dates, as well, says Katz, another red flag that some of the calculations are wrong. Watch out for double billing, too. "If you see a charge for the same amount three or four times, often that's the result of what I call 'fat fingers,'" she says.

And before a medical procedure, speak with your doctor about cost-saving alternatives or how you may be able to reduce your bill. Your physician has a fiduciary responsibility to help you meet your medical needs by not only prescribing you the right medicine, but also making sure your budgetary needs are met. "Your doctor will be your best advocate in making sure you're handled carefully by the billing department and may be given a deal," says Katz. And best to come into that meeting after having done a little pricing homework. "You can actually shop around in preparation for a hospital visit," says Katz. You can find fair pricing estimates for common procedures and surgeries at

From there, ask your provider to beat or accept that rate.

[Apr 28, 2013] Did Novartis Violate Its Corporate Integrity Agreement


Twice this past week, the US Department of Justice filed lawsuits alleging Novartis paid kickbacks to boost prescriptions and caused federal healthcare programs to pay for medicines based on false claims. One complaint seeks damages and civil penalties for corrupting the dispensing process with multi-million-dollar 'incentive programs' that targeted doctors. The other involves kickbacks in the form of rebates and discounts to at least 20 pharmacies in exchange for switching transplant patients from rival medicines to its Myfortic immunosuppressant treatment (back story).

The allegations have a familiar ring, given that the feds have made similar charges against many drugmakers over the past decade. Payments and 'lavish' dinners given to doctors, for instance, were purportedly kickbacks to speaker and attendees to induce them to prescribe different Novartis meds. However, the feds say some programs never actually occurred or doctors never spoke about the drug at issue. Some presentations were made on fishing trips off the Florida coast or at a Hoosters restaurant. Just imagine the intense focus on a slide presentation under such circumstances (you can read the legal filings in the latest lawsuit here and here).

And Novartis did not scrimp on the doctors, either. The drugmaker "frequently" treated them to expensive dinners hosted at high-end restaurants, according to the feds. For example, a dinner for three, including the speaker, at a Washington, DC, restaurant cost $2,016, or $672 per person. Novartis also paid a $1,000 honorarium to the speaker for this program. One of the two attendees had attended the same program a short time earlier. At another program held on Valentine's Day in 2006, Novartis paid $3,127, for a meal for two at a West Des Moines, Iowa restaurant, or $1,042 per person. But as the lawsuit alleges, the return on these indulgences was worth the investment.

But there is more to this story. Novartis, as Preet Bharara, the US Attorney in Manhattan points out, Novartis is a repeat offender. He was referring to a case three years ago in which Novartis paid $422.5 million in penalties and pleaded guilty to a misdemeanor to resolve criminal allegations for improperly promoting its Trileptal epilepsy med and several other drugs (see this). As a result of that settlement, the drugmaker signed a five-year Corporate Integrity Agreement, which required establishing an internal compliance program and reporting violations, among other things (read more here). The CIA was signed in September 2010, yet both lawsuits allege various infractions occurred afterwards.

Consider this contention made by the feds:

"Even after entering into the corporate integrity agreement, Novartis's compliance program failed to prevent kickbacks from being paid in conjunction with Novartis's speaker programs. No individual at the company was tasked with examining its speaker program data to determine whether the programs were used for an illegitimate purpose. Furthermore, although instances of speaker program abuse were reported to Novartis, sanctions were generally mere slaps on the wrist. In some cases, sales representatives who violated Novartis's own speaker program policies were nevertheless promoted. Even after September 2010, Novartis continued to conduct bogus speaker programs that were simply vehicles for paying kickbacks to doctors in the form of honoraria and expensive meals."

George Russert:

This is a joke article right? Corporate integrity? There is no corporate integrity anymore. We are in an oligarchy. Corporations do whatever they please and suffer no repercussions any more. Sell bad drugs, spill crude oil, screw with the genetics of our food, add toxic fillers, pay off politicians to start senseless wars for contractor benefit, kill off our youth sent to fight in foreign lands against people who are not our enemies, waste taxpayer money on pork barrel projects and totally useless military hardware like the F-35, alone a looming One Trillion Dollar disaster. Of course thius article is a joke. Imagine, corporate integrity! ROTFLMASO!

Paul Atreides:

Any more? Corporations have never had, and will never have, any integrity!

"The selfish spirit of commerce knows no country, and feels no passion or principal but that of gain." - Thomas Jefferson (1809)

Channing Davis

I am tired of hearing people say how "all corporations are evil / unethical / immoral". Mostly you are either young and inexperienced or older and unseccessful. The reality is the vast majority of companies, especially publicly traded companies, are not only ethical and moral, but they have boards, agreements and governing rules that drive ethical and moral behavior. Without a doubt there are bad business leaders, and generally these executives are eventually forced out of their positions. However, since a publicly traded corporation exists to serve its shareholders, it will focus on developing the best product with the highest profit potential. This approach does not always align perfectly with the needs of the consumer, but overtime the consumer is equally well served.

Let is not forget in America we are capitalists and we do exist, in part, to better our own individual situation. The topic off this article raises an entirely different issue – that is the health and welfare of the general public. There is a delicate balance to strike and the correct response is, perhaps, relying on top income earners to help pay for those in need of care when they are unable to pay themselves. We are a wealthy society in part because of our ability to innovate and not be handcuffed to extreme socialist governance rules. Under that scenario it is likely no one would have access to any life-saving treatments. Our companies are not evil and, at the same time, they are not completely benevolent. Nor should they be.

John McKean

Channing you are either naive, unethical or in denial. I am not "young" but am successful & experieced as an attorney. The vast majority of publicly traded companies have boards that are unethical & have only a profit motive that is unfettered. Their goal is to line their pockets at all cost with out regard to the shareholders, consumers or employees. Believe me when I tell you that I have seen this on numerous occasions. I have served as co-counsel on cases involving corporate fiduciary responsibility. It is ugly. Wake up America!

[Apr 05, 2013] How to handle medical bill problems by Lisa Zamosky

Notable quotes:
"... Most states have laws saying that patients are entitled to an itemized medical bill that details what services and supplies are included in their charges. ..."
"... In 2006, California passed a law to prevent hospitals from collecting more money from uninsured patients than what Medicare or other public programs would pay for the same service. ..."
"... "Once a patient contacts the hospital and shows evidence of their financial situation, state law requires us to offer a discount based on Medicare rates," says Jan Emerson-Shea, vice president of external affairs for the California Hospital Assn. ..."
"... All communications with a provider should be in writing, experts say. Insist that your account be placed on hold until the dispute is resolved to avoid having the bill sent to collections. ..."
"... If you meet with resistance, don't waste time by calling back the customer service line or billing department. Go straight to the top. ..."
"... filing a complaint with your state's department of insurance. ..."
Apr 05, 2013 |

For those with confusing or huge hospital bills, experts advise knowing rights, getting written explanations, turning to the right places for help and filing complaints if necessary.

When Keith Yaskin and his wife, Loren, rushed their 2-year-old son to the hospital with a dangerous infection in his neck, they weren't thinking about how much his care would cost. After his three-day inpatient stay with nonstop intravenous antibiotics, they were hit with $8,900 in charges.

But the toughest lesson for the Scottsdale, Ariz., couple came a month or so later when they began to sort out the hospital bills. Their insurance policy had a $10,000 deductible. So they scrutinized every item, made some calls and had a few surprises.

When, for instance, they asked a medical group they had never heard of why it was charging them $839.25, they said they got no clear answers, just threats if they failed to pay.

After 21/2 months of calls and a complaint to their state attorney general, the Yaskins finally learned that a pediatrician affiliated with the group had treated their son in the hospital. The medical group eventually cut the bill in half.

None of this surprises Pat Palmer, the founder of Medical Billing Advocates of America. "We get feedback from consumers saying that providers are telling them 'We can't give you an itemized statement' or 'You should have asked for it before you left the hospital.'"

The idea is to discourage patients from asking for the details behind the charges, she said.

Experts offer a range of suggestions for dealing with medical billing problems.

Know your rights. Most states have laws saying that patients are entitled to an itemized medical bill that details what services and supplies are included in their charges.

"You can't be billed if they can't tell you what they are charging for," Palmer says.

Contact the billing department at either the hospital or medical group where you received services, she said. Let them know that you want an itemized bill, and tell them you are aware of your legal right to have it.

Also, a few states have laws limiting how much hospitals can charge patients who pay for care on their own. In 2006, California passed a law to prevent hospitals from collecting more money from uninsured patients than what Medicare or other public programs would pay for the same service.

"Once a patient contacts the hospital and shows evidence of their financial situation, state law requires us to offer a discount based on Medicare rates," says Jan Emerson-Shea, vice president of external affairs for the California Hospital Assn.

Get explanations in writing and take protests to the top. All communications with a provider should be in writing, experts say. Insist that your account be placed on hold until the dispute is resolved to avoid having the bill sent to collections.

If you meet with resistance, don't waste time by calling back the customer service line or billing department. Go straight to the top.

Address a certified letter to the chief executive or chief financial officer of the hospital or medical group explaining that you have tried to resolve billing issues but have hit a brick wall. "The CEO and CFO will take it very seriously," Palmer says.

Get help from your insurer. In the Yaskins' case, both the hospital and the medical group were in their insurer's network and had contracts to provide services at a negotiated discount.

"If you are in network - and this is one of the good reasons to stay in network - you can go to your insurer for help. It has a responsibility to some degree to what happens between you and a contracted physician," says Susan Pisano, spokeswoman for the trade group America's Health Insurance Plans.

Also, ask to make sure you're getting the rate your insurer has negotiated with in-network providers, says Lynn Quincy, senior health policy analyst for Consumers Union, the policy arm of Consumer Reports. Insurers often pass claims through without processing them at the reduced rate. Ask your insurer to re-process the claim if the discount wasn't applied.

Seek help and file complaints. If your bill is large or you're having a hard time making headway, patient advocates can help sort things out. For either a flat fee or a share of the money you save, organizations such as Medical Billing Advocates of America ( and Health Proponent ( can help you fight charges or lower your bill.

If you're being stonewalled by your healthcare provider, and your insurer hasn't helped, Quincy of Consumers Union suggests filing a complaint with your state's department of insurance. In California, patients with HMO coverage can file a complaint with the California Department of Managed Health Care by calling (888) 466-2219 or visiting Californians with PPO coverage should try the Department of Insurance at (800) 927-HELP (4357) or visit If your provider isn't contracted with your insurer, your state's attorney general's office is a place to turn for help.

The Yaskins ultimately enlisted the services of an advocate to help them sort through all their billing questions.

[Mar 02, 2013] Sitting Less Reduces Risk Of Type 2 Diabetes

People at high risk of developing type 2 diabetes can reduce the risk by sitting less and moving around more frequently, rather than exercising regularly.

The finding came from a study at the University of Leicester which indicates that decreasing sitting time by 90 minutes in total each day may result in critical health advantages.

Patients at risk for type 2 diabetes are currently told to do moderate-to-vigorous physical activity (MVPA) every week for at least 150 minutes.

However, the new research, published in Diabetologia demonstrates that individuals should actually be told to decrease their sedentary time. This means that they need to reduce the time they spend moving very little or not all, such as when they are lying down or sitting.

The investigation was led by Joseph Henson and a team from the Diabetes Research Unit, University of Leicester and National Institute for Health Research (NIHR) Leicester Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit (BRU), UK.

The researchers examined patients from 2 reports:

The degree to which MVPA, total physical activity, sedentary time, and breaks in sedentary time were independently linked to cardiometabolic risk factors were observed in people with recognized risk factors for diabetes type 2.

In order to evaluate MVPA, total physical activity and sedentary time, the experts used accelerometers. Breaks in sedentary time were considered a change from a sedentary to an active state.

According to the results, patients with known risk factors for type 2 diabetes recruited from primary care, sedentary time was harmfully linked to 2 h glucose, HDL-cholesterol, and triacylglycerol, independent of confounders that were evaluated.

After controlling for MVPA and adiposity, the results were still significant.

The results were constant across different age groups, demonstrating that the adverse outcomes of surplus sedentary time prevail among young and old adults.

Henson explained:

"These studies provide preliminary evidence that sedentary behavior may be a more effective way to target the prevention of type 2 diabetes, rather than just solely focusing on MVPA. Moreover, sedentary time occupies large portions of the day, unlike MVPA."
The authors added that sedentary time had a more powerful link to many critical cardiometabolic markers, such as HDL-cholesterol, triacylglycerol, and 2 h glucose, as opposed to total physical activity and MVPA, after controlling for each other and other crucial hidden variables.

The novel findings raise concerns about the potential prescription of optimal daily movement for well-being.

Henson concluded:

"Diabetes and cardiovascular prevention programs concentrating solely on MVPA may overlook an area that is of fundamental importance to cardiometabolic health. Along with messages related to accumulating at least 150 min/week of MVPA, which form the cornerstone of diabetes prevention programs, such interventions may be more effective still if individuals are further encouraged to simply sit less and move more, regardless of the intensity level.

This approach requires a paradigm shift, so that individuals at high risk of developing type 2 diabetes think about the balance of sedentary behavior and physical activity throughout the day."

The results coincide with a different study also published this week which showed that sitting for long hours is linked to an elevated risk of developing chronic diseases, such as diabetes, cancer, and heart disease.

How Food Companies Trick Consumers Into Eating Their Unhealthy Products

According to Michael Moss, the Pulitzer prizing-winning reporter and author of the new book Salt Sugar Fat: How the Food Giants Hooked Us, executives at the major food behemoths – Kraft (KRFT), General Mills (GIS) and Nestle – have known for years that the sugar, salt and fat added to their cereals, soups, tomato sauces and hundreds of other food products have put millions of individuals' health at risk. But the quest for bigger profits and a larger share of the consumer market has compelled the processed food industry to turn a blind eye to the dangers and consequences of eating those very products.

Moss' book exposes the inner workings of the food industry and details how these food giants spend millions of dollars to make the food we eat more addictive. After reading his book, which took Moss four years to write and report, one may never want to consume another Cheez-It cracker or Lunchable again.

How do the food giants trick consumers? Moss gives several examples:

Moss says the food companies profiled in his book understand that salt, sugar and fat "are their pillars, their holy grail." These companies employ cadres of scientists "who specialize in the senses" and the industry "methodically studies and controls" the use of salt, sugar and fat.

Even though consumers may think food companies are trying to help their waistlines by offering "low fat" or "low sodium" items, that's not actually the case. Companies will add extra sugar to "low fat" products and "low sodium" offerings tend to have both higher quantities of sugar and fat.

Processed foods are designed "to make people feel hungrier," Moss writes. "The processed food industry has helped foster overconsumption. Salt, sugar and fat are the foundation of processed food."

Rising obesity rates are a global problem. In the U.S. alone, two-thirds of adults are either obese or overweight. The Centers for Disease Control estimate that nearly half of American adults will be obese by 2030. One in six American children is obese today.

Related: Obesity to Cost Taxpayers 'Billions of Dollars': Weight Watchers CEO

Overeating and lack of exercise are the two culprits blamed for weight gain. But cheap food and the general convenience and availability of it have also contributed to the obesity crisis.

Moss provides startling evidence of just how much food people are consuming these days:

The addiction to salt and sugar does not end with consumers. The food giants' "relentless drive" to reach maximum profits at the lowest possible cost has given these companies no incentive to use real, wholesome ingredients. Sugar, for example, not only sweetens but "replaces more costly ingredients, like tomatoes in ketchup to add bulk and texture," according to Moss.

"It costs more money to use real herbs and spices," Moss says. "Economics drive companies to spend as little money as possible in making processed foods. That's the dilemma."

Related: Why We're Fat: It's the Government and Wall Street's Fault: Marion Nestle Says

But food executives need to seriously start examining the consequences of their actions, Moss warns.

"They're coming under increasing pressure from consumers," he argues. "We care more and more about what we're putting into our mouths and bodies. The food industry is...where tobacco was in the 1990s – at the verge of losing the public trust. That's a very dangerous spot for the food industry to be in."


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