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Clifford Raabe Weiss, M.D.

Medical Director, The Johns Hopkins Center for Bioengineering, Innovation and Design (CBID)
Associate Professor of Radiology and Radiological Science

https://www.hopkinsmedicine.org/profiles/results/directory/profile/0015953/clifford-weiss

In part for these same reasons rheumatoid arthritis weight gain cheap voltaren 100mg overnight delivery, it is much easier to present pseudoscience to the general public than science rheumatoid arthritis white blood cells discount 50mg voltaren otc. Pseudoscience speaks to powerful emotional needs that science often leaves unfulfilled arthritis in neck and hips buy generic voltaren 50 mg on line. At the heart of some pseudoscience (and some religion also zostrix arthritis pain relief cream stores 100mg voltaren with amex, New Age and Old) is the idea that wishing makes it so rheumatoid arthritis diet reviews best purchase voltaren. How seductive this notion is arthritis rheumatoid treatment natural buy voltaren with amex, especially when compared with the hard work and good luck usually required to achieve our hopes. The enchanted fish or the genie from the lamp will grant us three wishes anything we want except more wishes. In some countries nearly everyone believes in astrology and precognition, including government leaders. But the psychic spoonbender and extraterrestrial channeller Uri Geller hails from Israel. High French officials, including a former President of France, arranged for millions of dollars to be invested in a scam (the Elf-Aquitaine scandal) to find new petroleum reserves from the air. An estimated 100,000 fortune-tellers flourish in Japan; the clientele are mainly young women. Australian peace-keeping forces in Haiti rescue a woman tied to a tree; she is accused of flying from rooftop to rooftop, and sucking the blood of children. The soporific homilies of its founder and spiritual leader, the Maharishi Mahesh Yogi, can be seen on television in America. Seated in the yogi position, his white hair here and there flecked with black, surrounded by garlands and floral offerings, he has a look. At each relinquishing of civil controls and scientific education, another little spurt in pseudoscience occurs. Leon Trotsky described it for Germany on the eve of the Hitler takeover (but in a description that might equally have applied to the Soviet Union of 1933): Not only in peasant homes, but also in city skyscrapers, there lives alongside the twentieth century the thirteenth. Under Communism, both religion and pseudoscience were systematically suppressed except for the superstition of the state ideological religion. It was advertised as scientific, but fell as far short of this ideal as the most unself-critical mystery cult. Critical thinking except by scientists in hermetically sealed compartments of know ledge was recognized as dangerous, was not taught in the schools, and was punished where expressed. A stunning decline in life expectancy, increasing infant mortality, rampant epidemic disease, subminimal medical standards and ignorance of preventive medicine all work to raise the threshold at which scepticism is triggered in an increasingly desperate population. For a time he was funded by the army and the secret police, but when his invention was found to be a scam he was arrested and imprisoned. The government of China and the Chinese Communist Party were alarmed by certain of these developments. On 5 December 1994, they issued a joint proclamation that read in part: [P]ublic education in science has been withering in recent years. At the same time, activities of superstition and igno rance have been growing, and antiscience and pseudoscience cases have become frequent. Therefore, effective measures must be applied as soon as possible to strengthen public education in science. The level of public education in science and technology is an important sign of the national scientific accomplishment. It is a matter of overall importance in economic development, scientific advance, and the progress of society. We must be attentive and implement such public education as part of the strategy to modernize our socialist country and to make our nation powerful and prosperous. Its causes, dangers, diagnosis and treatment are likely to be similar every where. Here, psychics ply their wares on extended television commercials, personally endorsed by entertainers. For the chief executives of major corporations, for financial analysts, for lawyers and bankers there is a species of astrologer/ soothsayer/psychic ready to advise on any matter. Some portion of the decision-making that influences the future of our civilization is plainly in the hands of charlatans. If anything, the practice is comparatively muted in America; its venue is worldwide. While vast barriers may seem to stretch between a local, single-focus contention of pseudoscience and something like a world religion, the partitions are very thin. A wide variety of solutions are offered, some of very limited worldview, some of portentous sweep. In the usual Darwinian natural selection of doctrines, some thrive for a time, while most quickly vanish. Devotionalism and cheap psychology on one side, and arrogance and dogmatic intolerance on the other distort authentic religious life almost beyond recognition. Sometimes I come close to despair, but then I live tenaciously and always with hope. There is the possibility for religion and science to forge a potent partnership against pseudo-science. Proprietary feelings are of course offended when a scientific hypothesis is disproved, but such disproofs are recognized as central to the scientific enterprise. The precision and retention of our motor skills may, however, give us a false sense of confidence in our other talents. But if we are capable of a little courageous self assessment, whatever rueful reflections they may engender, our chances improve enormously. It is enormously easier to present in an appealing way the wisdom distilled from centuries of patient and collective interrogation of Nature than to detail the messy distillation apparatus. But so beautiful was it in heaven that the man who looked in over the edge forgot everything, forgot his companion whom he had promised to help up and simply ran off into all the splendour of heaven. I was gripped by the splendour of the Universe, transfixed by the prospect of understanding how things really work, of helping to uncover deep mysteries, of exploring new worlds maybe even literally. This book is a personal statement, reflecting my lifelong love affair with science. The plain lesson is that study and learning not just of science, but of anything are avoidable, even undesirable. We have also arranged things so that almost no one understands science and technology. We might get away with it for a while, but sooner or later this combustible mixture of ignorance and power is going to blow up in our faces. Whenever our ethnic or national prejudices are aroused, in times of scarcity, during challenges to national self-esteem or nerve, when we agonize about our diminished cosmic place and purpose, or when fanaticism is bubbling up around us then, habits of thought familiar from ages past reach for the controls. In a Universe tens of billions of light years across and some ten or fifteen billion years old, this may be the case forever. It counsels us to carry alternative hypotheses in our heads and see which best fit the facts. This kind of thinking is also an essential tool for a democracy in an age of change. Except in pure mathematics nothing is known for certain (although much is certainly false). Moreover, scientists are usually careful to characterize the veridical status of their attempts to understand the world ranging from conjectures and hypotheses, which are highly tentative, all the way up to laws of Nature which are repeatedly and systemati cally confirmed through many interrogations of how the world works. Humans may crave absolute certainty; they may aspire to it; 30 Science and Hope they may pretend, as partisans of certain religions do, to have attained it. But the history of science by far the most successful claim to knowledge accessible to humans teaches that the most we can hope for is successive improvement in our understanding, learning from our mistakes, an asymptotic approach to the Universe, but with the proviso that absolute certainty will always elude us. The most each generation can hope for is to reduce the error bars a little, and to add to the body of data to which error bars apply. The error bar is a pervasive, visible self-assessment of the reliability of our knowledge. Imagine a society in which every speech in the Congressional Record, every television commercial, every sermon had an accompanying error bar or its equivalent. But when we pass beyond the barrier, when the findings and methods of science get through to us, when we understand and put this knowledge to use, many feel deep satisfaction. I know personally, both from having science explained to me and from my attempts to explain it to others, how gratifying it is when we get it, when obscure terms suddenly take on meaning, when we grasp what all the fuss is about, when deep wonders are revealed. In its encounter with Nature, science invariably elicits a sense of reverence and awe. The very act of understanding is a celebration of joining, merging, even if on a very modest scale, with the magnifi cence of the Cosmos. So are our emotions in the presence of great art or music or literature, or of acts of exemplary selfless courage such as those of Mohandas Gandhi or Martin Luther King Jr. You can go to the witch doctor to lift the spell that causes your pernicious anaemia, or you can take vitamin Bl2. Yet has there ever been a religion with the prophetic accuracy and reliability of science? Then simply pick the one that in a fair comparison works best (as opposed to feels) best. If different doctrines are superior in quite separate and independent fields, we are of course free to choose several but not if they contradict one another. Far from being idolatry, this is the means by which we can distinguish the false idols from the real thing. That openness to new ideas, combined with the most rigorous, sceptical scrutiny of all ideas, sifts the wheat from the chaff. If you examine science in its everyday aspect, of course you find that scientists run the gamut of human emotion, person ality and character. So in preparing to defend their theses, they must practise a very useful habit of thought: they must anticipate questions. They have to ask: where in my dissertation is there a weakness that someone else might find? You find university colloquia in which the speaker has hardly gotten thirty seconds into the talk before there are devastating questions and comments from the audience. Scientists do not seek to impose their needs and wants on Nature, but instead humbly interrogate Nature and take seriously what they find. We are constantly prodding, challenging, seeking contradictions or small, persistent residual errors, proposing alternative explanations, encouraging heresy. We give our highest rewards to those who convincingly disprove established beliefs. Years after launch, billions of miles from Earth (with only tiny corrections from Einstein), the spacecraft beautifully arrives at a predetermined point in the orbit of the target world, just as the world comes ambling by. Newtonian physics is valid over a wide range of conditions including those of everyday life. It is a splendid and justly celebrated accomplishment of the human mind, but it has its limitations. Two very dense pulsars in orbit around each other are predicted to radiate copious quantities of gravitational waves, which will in time slightly alter the orbits and rotation periods of the two stars. Not only were they willing to challenge General Relativity, they were widely encouraged to do so. As it turns out, the observations of binary pulsars give a precise verification of the predictions of General Relativity, and for this Taylor and Hulse were co-recipients of the 1993 Nobel Prize in Physics. Beyond the test of everyday living, who is systematically testing the circumstances in which traditional religious teachings may no longer apply? Take, for example, the recipro cal electrodynamic action of a magnet and a conductor. The observable phenomenon here depends only on the relative motion of the conductor and the magnet, whereas the cus tomary view draws a sharp distinction between the two cases in which either the one or the other of these bodies is in motion. For if the magnet is in motion and the conductor at rest, there arises in the neighbourhood of the magnet an electric field with a certain definite energy, producing a current at the places where parts of the conductor are situated. In the conductor, however, we find an electromotive force, to which in itself there is no corresponding energy, but which gives rise assuming equality of relative motion in the two cases discussed to electric currents of the same path and intensity as those produced by the electric forces in the former case. They suggest rather that, as has already been shown to the first order of small quantities, the same laws of electrodynamics and optics will be valid for all frames of reference for which the equations of mechanics hold good. That there is such a place as the centre of the Universe, and that the Earth sits in that exalted spot was once obvious. At the end of all this work, through careful experimentation, the idea is found to be worthless. So the physicist discards it, frees his mind from the clutter of error, and moves on to something else. In all uses of science, it is insufficient indeed it is dangerous to produce only a small, highly competent, well rewarded priesthood of professionals. It is why so many graduate students in science and engineering at American graduate schools still the best in the world are from other countries. The corollary, one that the United States sometimes fails to grasp, is that abandoning science is the road back into poverty and backwardness. For the first time in human history we are able to secure a real understanding of some of these matters. Science confers power on anyone who takes the trouble to learn it (although too many have been systematically prevented from doing so). Science thrives on, indeed requires, the free exchange of ideas; its values are antithetical to secrecy. Both demand adequate reason, coherent argument, rigorous standards of evidence and honesty.

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To know that what is impenetrable to us really exists rheumatoid arthritis mouth sores order voltaren overnight, manifesting itself as the highest wisdom and the most radiant beauty arthritis pain glucosamine chondroitin discount voltaren express, which our dull faculties can comprehend only in their most primitive forms—this knowledge does arthritis in neck cause headaches discount 50 mg voltaren with amex, this feeling rheumatoid arthritis lyme disease 50 mg voltaren with visa, is at the center of true religiousness arthritis diet exercise purchase voltaren 100mg line. In this sense and in this sense only arthritis in dogs joints buy 50 mg voltaren, I belong to the ranks of devoutly religious men. Paper presented at Annual Meeting of the American Psychological Association, New York, 1995. Controlled trial of homoeopathic potency, with pollen in hayfever as model, Lancet, 2 (8512), 881–886, 1986. Commentary on: healing, energy and consciousness: into the future or a retreat to the past? However, here the nonthermal electromagnetic therapies will be approached as a subfeld of energy medicine. Research on the effects of externally applied electromag netic forces has proceeded in a piecemeal manner. Research from conventional biochemistry has focused on investigations of possible cellular mechanisms, while clinical trials have concentrated on treatment for conditions already defned from the biochemical medical perspective. European developments in naturopathic and homeopathic medicine have evolved a range of therapeutic approaches using electro stimulation; however, the conventional medical community has rejected the possibil ity of these approaches, assuming no biochemical mechanisms could be affected by such weak electrical processes. Innovations and evidence are accumulating in con ventional medicine and biophysics that increase the plausibility of electrotherapeu tics that use very subtle effects. Differences in national cultures and stark contrasts among research and therapeutic traditions have kept these communities of practice separated and continue to create tasks for translation and interpretation of knowledge for those wanting to engage in both the study and practice of electrotherapeutics. Integrative medicine can bridge these very different worlds, fostering understanding between them. It is widely accepted that the skill of the surgeons are major factors in clinical results. Similarly, with the highly personalized and indi vidual approach of many integrative medical practices, the skill and infuence of the practitioner may be accepted as a major factor in the healing process. An exclusive focus on objective endpoints can miss or ignore other effects, such as subjective symptoms. Effcacy refers to what a treatment can do under ideal circumstances; effectiveness indicates what a treatment does do in routine daily use. Effectiveness addresses clinical results in everyday use, for particular individuals. Studies of effcacy may ignore the results of those individuals who have nega tive outcomes far different from the majority of the study population. Conventional medicine, based in biochemistry, is typically interested in cause and-effect relationships between underlying mechanisms of illness, treatments designed to alter those mechanisms, and the observed results for the patient. Linear cause-and-effect approaches usually try to identify the simplest possible causal mod els. These methods have been highly successful for medicine in acute conditions and for diseases caused by microorgan isms, when individual causes can be objectifed and eliminated or repaired immedi ately. Alternative medical approaches may use more complex systems models, with multiple factors and multiple levels of highly interactive and iterative relationships, rather than linear causal connections. Research methods can be developed that describe interactive and multiplicative processes. An example of one such method is recursive partitioning, which uses statistical models specifcally designed to identify interactive effects of large numbers of causal factors acting simultaneously (Institute of Medicine, 2005). Individualization of therapy to a unique combination of patient characteristics is a core concept. Studying clinical outcomes is the only way to evaluate such complex systems of interaction, and the descriptions of the treatments and patients must be rich enough Energy Medicine 233 to capture salient dynamics. By defnition and theory, these treatments cannot be standardized in the same way in which drug treatments are standardized by sub stance, dose, and route and timing of administration. Randomized controlled trials, using isolated variables, are not appropriate for clinical assessments of such highly individualized treatments (Institute of Medicine, 2005). Nonetheless, effectiveness studies can be conducted on individualized therapies using practical clinical trials (Tunis et al. Controversy attends integrative medical investigations because different research and clinical traditions begin from very different worldviews and assumptions. For instance, Western biochemistry focuses on specifc molecular processes at the level of the cell, while acupuncture focuses on balancing large-scale energetic fows among the body’s subsystems. A detailed and full critique of the widely varied approaches in integrative medicine is beyond the scope of this present discussion. Here, some biochemical and biophysical theories that suggest quite subtle energetic processes are present in the body will be surveyed—beyond the dynamics expected from bio chemistry at states of thermodynamic equilibrium. Biochemistry is based on an understanding of the fow of energy that drives chemical reactions. When applied to chemistry, thermodynamics (literally meaning the power of heat) uses statistical descriptions of the behavior of large ensembles of molecules to predict the behavior of chemical syntheses. Physical properties of mol ecules can be combined to express internal energy, and thermodynamic potentials are used to describe the conditions necessary for equilibrium and spontaneous pro cesses. Thus, thermodynamics describes how cellular biochemical systems respond to changes in their surroundings. New models in biophysics emphasize cooperative electrical activity of highly ordered ensembles of elements, at all scales of physiology: cells, tissues, organs, organ systems, as well as the whole body. These new insights can form theoretical bridges between some of the different medical traditions. For instance, acupuncture and homeopathy have plausible electromagnetic modes of action when viewed from the perspective of these new biochemical and biophysical models. After surveying these theoretical constructs, we will look further at some clinical applications of electromagnetic devices that claim to be using these subtle energetic processes for therapeutic beneft. Stimulus voltages are typically in the range of 10 to 100 V, and currents range from 10 to 100 mA, supplied from electrodes 234 the Scientifc Basis of Integrative Medicine in contact with the skin. Current fow in diathermy involves complex processes, so patient observations of perceived heating and the rates of applied power are used to guide these therapies. As the oscillations decay, kinetic energy is distributed among surrounding molecules, increasing their motion— which is heat. More heat will be produced in tissue that conducts more easily, making the specifc absorption rate greater. Diathermy is effective for heating deep muscle tissue because current fows more easily in muscle than in fat. The fundamental frequency often is delivered in pulses, which are more effective for producing charged particle oscillation. The power applied during therapy is thus a combination of pulse amplitude, duration, and frequency. Typical peak pulse amplitudes range from 100 to 1000 watts, in pulse durations of 25 to 400 msec and with the average power in the current delivered to the patient being a few watts (McMeeken and Stillman, 2002). Because this stress response can be triggered by both heat and weak electromagnetic felds, the thermal and non thermal thresholds can be directly compared. According to biochemical tenets of conventional medicine, weak electromagnetic signals are not expected to interact with metabolic processes because the thermody namics of biochemistry seem to require that thermal noise in the tissues would swamp such weak signals. In contrast to these expectations, acupuncture and homeopathy expect extremely weak signals to have profound effects for shifting physiological Energy Medicine 235 processes. The mechanisms of action for some models of acupuncture, described later in this chapter, include the minute electrical potentials of a few milliamperes provided by bimetallic battery potentials in the needles. In laboratory research and in some clinical devices, very low-power electromagnetic felds are used to change physiological processes. For a wide range of conditions, benefts have been shown from stimulation in the 50 to 70 Ghz microwave spectrum, using low intensities ranging from a few mW/cm2 down to a few µµW/cm2, when applied at acupuncture points associated with the effected organ systems. The small area of the stimulation makes the total power applied miniscule, when compared to a process like microwave diathermy. Biological effects of very weak electromagnetic felds also are found in laboratory research. Ross Adey’s laboratory, identifed cellular processes i n wh ich spe cifc f re quencies produced ma x i mu m ef fects (Adey, 1981, 1988). Applied weak felds can have strengths approximating the Earth’s magnetic feld, which is about 50 µT or 5 G. The energy available from these felds is much smaller than the characteristic energies of chemical reactions and much less than would be conventionally expected to induce motion in charged particles with molecular masses. In laboratory studies, the parameters of these felds—frequency, amplitude, waveform, and duration of application—have been shown to be very specifc to the observed effects. Recognition of physiological sensitivities to exogenous electromagnetic felds arose from observing interaction with internal, endogenous electrical processes. An example of endogenous electrical control processes is the piezoelectric properties of bone that employs electromechanical control to determine which cells become osteoclasts or osteoblasts. The piezoelectric forces induced by walking and mechani cal support direct continual remodeling of bone to provide optimal structures, by regulating cellular processes with electrical effects (Marino and Becker, 1970). Robert Becker’s profound work in the twentieth century, on the role of electrical currents in growth, regeneration, and repair, is now well accepted, although he was initially castigated for pursuing fanciful theory (Becker, 1972, 1974; Becker and Seldon, 1985). Today, bone repair stimulated by electrical currents—in older practice, using electrodes inserted directly into the injury, and in newer less invasive procedures, using induc tion of electrical microcurrents by magnetic felds—is common practice for frac tures with delayed unions (Lavine et al. Detailed clinical research in orthopedic biophysical stimulation has identifed specifc cellular processes responding to particular forces. Osteogenic activity can be promoted by selective pathways at the cell membrane depending on the physical forces applied: 1. Inositol phosphate by mechanical stimulation As these models of cellular action continue to develop, therapy modalities and doses can be refned and directed toward particular situations (Brighton et al. Electromagnetic processes in the skeletal system have been extensively character ized. Basic research on cells in cultures, animals, and clinical studies have refned specifc information for frequency, amplitude, waveform, orientation, and exposure required to activate specifc processes in specifc cells (Bassett, 1989). Processes prompted by bioelectromagnetic signals have been identifed in cascades of inter actions taking place from the cell surface into the cytoplasm and on into the cell nucleus and genes, where selective transcriptional and translational effects have been identifed (Brighton et al. Although soft tissue healing of chronic wounds supported by electrical cur rents has been extensively studied, therapeutic applications are not yet widely used (Cukjati and Savrin, 2004). Endogenous wound-induced electric felds guide the cel lular movements that close wounds. Externally applied electrical felds can affect orientation, migration, and proliferation of cells with key roles in healing, such as fbroclasts and keratinocytes. Negative electrode positioning on the wound surface has antimicrobial effects and is useful in initial stages of treatment. When low-frequency pulsed electric currents are applied locally, both electrodes are positioned on surrounding healthy skin. Pulsed low-frequency current increases partial oxygen tension (p02) around the wound, so benefts appear to derive from improved microcirculation. Energy Medicine 237 Ca n d i d a The si The s f o r We a k el e C T r o m a g n e T i C fi e l d in The r a C T i o n s Various components of cells may be potential sites for interaction with low-power, nonthermal and nonionizing energy: intracellular structures. The microtubule cylinders can produce piezoelectric and elec tropiezo effects, responding selectively to resonant frequencies. This stored energy can then be passed to other molecules, used in biochemical processes, or degraded into waste heat. Smith has sug gested that frequencies in the infrared not absorbed by mitochondrial cytochromes can be absorbed by cytochromic constituents of the cell membrane, effecting direct changes in calcium ion fux at these sites (Smith, 1991a, 1991b). Goodman and colleagues have repeatedly reported electromag netic-induced genomic changes, particularly the expression of heat shock stress proteins, using both pulsed magnetic felds and sinusoidal magnetic felds (Goodman et al. It remains to be seen whether the gene expressions are a direct effect or are mediated by other dynamics. The movement of sodium, potassium, and calcium ions drive important functions in cell regulation. Movement in response to feld effects can modify the ion distribu tion, changing cell activity (Frohlich, 1988). Ross Adey’s research group was among the earliest to focus on the cell mem brane as a site of interaction with pulsed magnetic felds at particular frequencies, amplitudes, and waveforms. Adey proposed that specifc magnetic feld effects at the membrane could enhance communications with hormones, antibodies, and neu rotransmitters. He demonstrated that an initially weak trigger could have prompt, large amplifcation by enhancing membrane communication processes. Further, amplitude or pulse modulations of frequencies in the radio frequency and micro wave spectrum trigger cellular effects, while the same frequencies will simply pass transparently through tissue as an unmodulated carrier wave (Adey, 1981, 1988). As mentioned, based on the concept of thermal noise, a number of physicists and physical chemists have rejected the possibility that static and low-frequency mag netic felds can cause biological effects (Muchsam and Pilla, 1996; Pilla et al. Bianco and Chiabrera provided an elegant explanation for thermal noise appearing to drown out any weak electromagnetic signals. Using the Lorentz– Langevin model, they clearly showed that the force applied by a magnetic feld on a charge moving outside the binding site is negligible when compared to the back ground Brownian motion and it would then seem that such applied forces should have no signifcant effect on binding or transport at a cell membrane (Bianco and Chiabrera, 1992). The modeling by Bianco and Chiabrera does not, however, exclude other possible mechanisms for weak signal effects because the feld interactions need not be outside the molecular binding sites. Some interesting work using calmodium shows calcium bound in the molecule to exhibit hopping between two energy states— driven by the noise (Markov, 2007; Pilla et al. Physicists and some engineers have continued to propose microthermal, rather than nonthermal processes for the biological membrane effects (Astumian et al. Pr o C e s s Co n T r o l a n d mag n e To s o m e s Binhi and Rubin (2007) recently have criticized assumptions of the so-called thermal threshold or thermal noise paradox. They reject the assumptions that electromagnetic feld effects must be power processes. They propose that signals controlling magnetic Energy Medicine 239 resonance conditions infuence the probability that a process will proceed rather than acting with the power of an either/or trigger. By modifying the electromagnet envi ronment, subtle signals may shift the tendencies for cellular activities, rather than turning such activities on or off. Binhi and Rubin also offer magnetosomes, biological structures that are sensitive to magnetic fux, as another candidate for a mechanism of biological sensitivity to very weak magnetic forces. Bacteria use magnetosomes for orientation in the magnetic environment, and some bird species navigate using the Earth’s magnetic feld, pos sibly relying on magnetosomes.

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Narendra Singh i) Presented on 8th May arthritis in the knee cap buy discount voltaren online, 2015 an invited talk on “Research Publication in High Impact Factor Journal: A key to transforming higher education” in “NationalSeminar on Transforming Higher Education in North-East India” held on 8th May 2015 at Thoubal College rheumatoid arthritis diet natural remedies cheap voltaren 50 mg without a prescription, Thoubal arthritis xiphoid process order voltaren 100mg mastercard. B) Non-parametric Test (Wilcoxon Matched pairs arthritis of the hip purchase 100 mg voltaren with visa, Mc Nemer’s test) x) Presented on 26th Oct gouty arthritis feet purchase cheap voltaren online. B) Determination of Sample Size (Applied aspect) xii) Delivered the following two lectures on 26th Nov types of arthritis in back cheap voltaren online visa. A) Measurement Technique: Formation of Scale & Score, B) Measurement Technique : Test of tools. Narendra Singh was invited as subject expert of Statistics in “the 10 Day Manipuri Terminology Building Workshop” conducted by Department of Language Planning & Implementation. Detais of Seminar/Conference/Workshop attended: International: World Congress of Nephrology at Taipei, Taiwan attended by Prof. Brojen Singh attended Indian Society of Nephrology conference at Gurgaon in December 2013. Publications of the Unit: i) Successful Pregnancy Outcome in a Patient Suffering from Chronic Kidney Disease V undergoing Chronic Ambulatory Peritoneal Dialysis a case report Ind. Vol 25, Aug 2013 pp 27-28 ii) Changing epidemiology of community acquired acute kidney injury in developing country; analysis of 2405 cases in 26 yrs from Eastern India, Clinical kidney journal (International),April-20136(2): 150-155. Extracurricular activities/achievement: a) Prof Aribam Devadutta Sharma is continuing as the Hony. The purpose of such a knowledge network goes to the very core of the country’s quest for building quality institutions with requisite research facilities and creating a pool of highly trained professionals. Chandabadani Devi Staff Position: i) Professional – 3 ii) Semi Professional – 6 iii) Others – 12 Statistics of work progress: i) No. Staff Position: i) Physical Instructor – 1 ii) Attendant – 1 iii) Chowkidar – 1 th th 3. Reproduction in whole or in part is strictly prohibited without the express written permission of the publisher. For new subscriptions or renewals to Easy Health Options™ newsletter, please call 1-800-523-5593 or e-mail subscriptions@easyhealthoptions. All material in this publication is provided for information only and may not be construed as medical advice. Readers are advised to seek advice from competent medical professionals for their individual health and medical needs. The information and opinions expressed in this publication are believed to be accurate and sound, based on the information available to the author. Cardiovascular disease refers to heart disease (coronary artery disease) and diseased blood vessels of other critical body organs, such as the brain (cerebral vascular disease). That means more than 64 million Americans suffer from cardiovascular disease, and 1. With the risk of having heart disease after age 40 being a whopping 49 percent for men and 32 percent for women, we all must take a serious look at what we are doing for heart health. The 1992 Bogalusa Heart Study that was published in the American Journal of Cardiology definitely woke up the nation. Over a period of just a few years, researchers did post-mortem evaluations on 150 persons ages six to 30 years who died accidentally and were considered disease free before death. They measured the amount of plaque build up inside the wall of their aorta, the main artery carrying blood away from the heart. To their surprise, they found extensive plaque build up among these young “disease-free” individuals. The amount of atherosclerosis ranged from 1 zero to 71 percent of the inner lining surface area from each aorta they examined. This was news to the world that atherosclerosis develops far sooner than previously thought. And it is now known that it highly corresponds with eating foods that incite inflammation. There are many differing strategies for the prevention of cardiovascular disease, and there are even more strategies for its treatment. And once this disease has taken its toll, there is little one can do to bring back function of an organ that has been severely damaged. Yet there remains a serious lack of knowledge about what causes this disease, how to prevent it, and the safe, natural treatments that are available. With the danger imposed by this diseased state, it is no longer satisfactory for you to remain unaware of how and why this and other chronic diseases develop. Such naiveté encourages unhealthy lifestyles, which are at the root cause of cardiovascular disease. Thinking you have little to no control over your health and your genetic predisposition is a completely false notion, yet this is the prevailing mindset of American adults today. Worse, the public at large is not taught what to do, nor inspired sufficiently to act on knowledge to make a difference with their long-term health. The health authorities (government, physicians, and pharmaceutical companies) have grossly misled Americans—and have no effective plan to correct the fatal path most are on. Introduction G 3 Additionally, there is no uniform education in America that fully addresses the causes of cardiovascular disease, which can be reversed with knowledge and application. It is time each family learns the principles of true health on their own, and takes their health into their own hands. You and your family deserve to know what factors contribute to cardiovascular disease (much the same factors behind most all other chronic illnesses as well). What must a person really know—and do—to prevent cardiovascular disease with reasonable certainty? Also, what reasonable treatment options are there, both from conventional medical wisdom as well as the natural, non-surgical, non-pharmaceutical ones? The focus of this report is to answer these questions and get you onto your path of health, happiness, and fulfilled longevity. They bear the force of each heartbeat and therefore must be strong enough to endure approximately 100,000 heart pulsations daily—that’s more than 36 million times each year. The walls of arteries must also be flexible and adjust for varying pressures due to the heart’s variation, gravity changes from bodily positioning, body and blood fluid volume changes, and even variations in blood thickness and acid-base status. Flexible arteries are healthy, while thickened or hardened walls without elasticity are the result of atherosclerosis. The outer layer of your arteries, the adventitia, is a flexible connective tissue that surrounds the next layer—the elastic smooth muscle. The muscle provides the contractile strength to expand and contract with each heartbeat. It is here where damage can occur, leading to clot formation, calcium deposition, and finally, atherosclerotic plaque. Understanding the process of how athero sclerosis develops will give you insight into the many causes and triggers of this disease, which are important to know so you can prevent them. It begins with small areas of damage to the endothelium or as a dysfunction that then causes the endothelium to act like it has been damaged. This allows cholesterol molecules and other proteins in the blood to get inside the endothelium to the basal lamina with a scarring effect, thus setting up for further buildup of plaque. Cholesterol molecules become modified so they are sticky and get incorporated into larger molecules such as immune complexes. These modified cholesterol molecules get digested by fighter white blood cells (an immune reaction) and this leads to further inflammation inside the vessel wall. Smooth muscle cells and the fat-laden, white blood cells make up what is called a “foam cell. This forms a cap over the site of injury, to which calcium accumulates to form a strong bone-like material (the “bricks”). This complex array of foam cells, lipid accumulation, and calcification is called atherosclerotic plaque. Plaques typically become unstable as they grow and rupture, exposing them to the contents of the blood. Clotting proteins and fat accumulate around the ruptured plaque, resulting in a larger clot to which calcium attaches and the plaque grows inside the vessel wall. Large clots and large plaques can easily block the flow of blood to the heart wall muscle causing an acute heart attack. Causes of Atherosclerosis So what kinds of things play a causative role in this process of endothelial damage and dysfunction? Let me list several known causes of dysfunction: Infections I Hidden bacterial infections such as Chlamydia Pneumoniae and Helicobacter Pylori. Oxidative stress Endothelium I Free radical molecules are generated by Smooth muscle cell cigarette smoke, radiation, and metal infiltration into the endothelium toxicities (such as mercury). Increased blood turbulence I Increased turbulence of blood flow from thickened blood damages the endothelium, triggering more inflammatory chemicals and clotting factors. More important than maintaining low cholesterol is to minimize the other causes of inflammation that trigger the above causes. For example, poor health habits and normal aging both appear to damage the endothelium such that the endothelium boundary is broken, inflammation begins and abnormal platelet aggregation occurs, and subsequently atherosclerotic lesions form in response to this arterial wall injury. In this report, I will be covering in detail the various health habits that cause inflammation with a focus on how to reverse this disease. Likewise, there are nutrients known to help maintain a 4 5 6 healthy inner arterial lining. It is no coincidence that nutrients which suppress chronic inflammation also protect the endothelium. An Inside Look at the Heart And the Damage from a Heart Attack Your heart is surprisingly small. Your heart’s primary purpose is to pump blood and nutrients 24 hours a day to your more than 300 trillion cells. Your heart contracts and relaxes approximately 100,000 times each day, pumping about 2,000 gallons of blood. Your entire circulatory system is comprised of your heart and the vessels that carry blood from your heart to all other organs and tissues. It also includes your lungs and the veins that carry blood from your lungs back to the heart. And finally, it includes all the other deep and superficial veins, which carry blood back to your heart. If all your blood vessels were laid end-to-end they would measure nearly 75,000 miles—twice the circumference of the earth. Anatomy and Physiology of the Heart the amazing power behind the ability of your heart to continuously beat as described above is its electrical power. It has its own generator of electricity, called the “pace-maker” or sinoatrial (S-A) node, which is located at the top of the right atrium imbedded in the muscle. And from the A-V node, the electrical pulsation spreads throughout the specialized muscle fibers of the heart and valves in a coordinated fashion so as to create a contraction. This contraction creates a perfect sequence so that each chamber of the heart keeps the blood flowing in one direction only. The two weaker chambers, called atria, and the strong muscular-walled chambers, called ventricles, each have a valve that prevents the back flow of blood. You can imagine that when either a valve or the wall of a ventricle gets weak, it wouldn’t take long to cause the symptoms of light-headedness, shortness of breath, or even pain in the chest. Thank goodness for the talented cardiovascular surgeons today that can repair Understanding Cardiovascular Disease, Heart Attack and Stroke G 7 valves, reconstruct vessels, and even transplant Inside the Heart a failing heart! Then there is the regulation and inter connection of your heart with your other Superior organs. For example, the heart is slowed during vena cava Aorta Pulmonary times of relaxation, feeding, or breeding. The artery specialized nerves called the parasympathetic nerve system control this behavior. There are different nerves called the sympathetic nerve Right Left system that cause it to speed up or beat atrium atrium stronger in times of stress, exercise, changes in blood volume, changes in body temperature, and changes in body positioning. There is also a delicate balance of the three main mineral electrolytes that keep Right muscles contracting: Sodium, potassium, and ventricle calcium. Several disease states are known to affect these minerals in the body to the point Left where the heart’s electrical activity and muscle ventricle pumping ability threatens failure. You deserve to know something about the arteries to the heart muscle itself, called coronary arteries. The three main vessels are the right coronary, the left anterior descending, and the circumflex artery. Blockage anywhere along these vessels can cause ischemia (lack of oxygenated blood) and result in damage to the muscle known as myocardial infarction. This can make it weak and vulnerable for pump failure, or can even cause wall motion abnormalities to the point that it goes into “fibrillation,” which can be lethal within minutes if not reversed. In 2001, fibrillation was responsible for more than 39 percent of all deaths in the U. Heart Attack Symptoms It is not enough just to say that chest pain is the symptom of a heart attack. Because there are a number of other symptoms and signs that may be present that you may miss if you only consider chest pain. Pulmonary Embolism A clot which travels to the lungs from the heart or extremities is known as a pulmonary embolism. Signs and symptoms of pulmonary embolism can be: I Sudden shortness of breath, typically, but not necessarily during exercise I Pain that can mimic a heart attack—pain in your chest, shoulder, arm, neck, jaw or back. The pain is usually sharp but may be aching, and becomes worse with deep breathing or with coughing, bending, or stooping. I Blood in the sputum from coughing I Rapid heartbeat (tachycardia) I Wheezing I Leg swelling (a deep vein clot may be the source of the embolus) I Clammy or pale skin (from lack of oxygen to your body) I Lightheadedness, fainting, anxiety, or weak pulse may also be present the Brain and What Happens During a Stroke Now that you have a fairly in-depth understanding of atherosclerosis in the heart vessels, you also know how vessels in the brain become diseased. Stroke is the leading cause of adult disability Understanding Cardiovascular Disease, Heart Attack and Stroke G 9 in the U. Approximately 750,000 Americans have a stroke every year and 150,000 Americans die from it. Brain tissue gets starved of oxygen and nutrients, resulting in any one of the signs and symptoms of stroke.

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Tom is a high-risk patient arthritis qualify for disability discount voltaren online visa, and he received his colonoscopy at a hospital outpatient center arthritis diet and exercise buy voltaren 50mg on-line. During the colonoscopy his doctors discovered 2 adenomatous polyps tricompartmental arthritis definition buy voltaren 100mg on-line, which were removed patellofemoral arthritis definition purchase voltaren 50 mg amex, and a lesion suspicious for colon cancer medication arthritis in hands order voltaren. In March arthritis pain with fever best 100 mg voltaren, Tom had colectomy surgery to remove the lesion and surrounding tissue, and a lymphadenectomy to test if the cancer had spread. In April and May, Tom received chemotherapy, and supportive care drugs, like anti-nausea medication, to ease side effects. Tom fnished his treatments in May and began post-treatment follow-up, including regular doctor’s visits and blood tests. Colorectal Cancer Medicare Tom had health insurance coverage through Medicare and the total health care costs for Tom’s Medigap. Medicare and Tom’s Medigap and Medicare Part B—$122/month Part D plans paid the vast majority of these Medigap (Policy F)—$415/month costs—$123,057. If Tom had been uninsured, he would have been responsible for all of these Medicare Part D—$64/month costs,** and may have been required to pay them Tom’s highest total spending came in April up-front before treatment. Even though Tom is and May ($1,284 each) when some of his no longer in active treatment he will still require chemotherapy and supportive care drugs were regular follow-up visits with his oncologist and paid for through his Medicare Part D plan. In * Note that these costs only include cancer treatment, and do not include total Tom paid $600 in premiums every month. Her primary care doctor told her the scan was positive for a large mass in her left lung, and referred her to a pulmonologist. Because the cancer was too widespread, surgery and radiation were not treatment options. She also had special genetic tests on her tumor which showed she was not a candidate for targeted therapy or immunotherapy. She also had a consultation with a palliative care specialist to discuss her goals and treatment impact on her work and family, and received supportive care drugs to ease side effects. In May, Kathy went to the emergency room and was hospitalized for trouble breathing. Kathy and her doctor decided to try a second-line treatment, as her chemotherapy was not working. The immunotherapy worked to keep her cancer from spreading and maintained her quality of life, so Kathy continued the treatment and monitoring through the end of the year. Throughout the course of her treatment, Kathy saw several doctors and specialists, including her primary Lung Cancer care doctor, a pulmonologist, a medical oncologist, a palliative Individual Market Plan care specialist, and the doctors who treated her in the emergency room. Kathy bought an individual health insurance the total health care costs for Kathy’s lung plan through her state’s marketplace, which cancer treatment in 2016 were $210,067. The premium for her plan was Kathy’s insurance plan paid the vast majority $537 per month, but she qualifed for tax credits of these costs—$203,217. Kathy ended up uninsured, she would have been responsible for paying $272 per month in premiums. Kathy’s highest costs were in January ($3,678) and February ($3,716) when she had multiple As Kathy remained in active treatment for her diagnostic tests and paid 40 percent co-insurance cancer at the end of 2016, her costs will continue for imaging tests and scans, in addition to into future years. She met her maximum out-of-pocket in January, she was once again responsible for limit in February—after that, no cost-sharing was paying cost-sharing until she meets her out-of required as long as she paid her premiums and pocket maximum for the new year. At the end of * Note that these costs only include cancer treatment, and do not include treatment for other conditions that may have developed as a result of the her plan year, Kathy had paid a total of $3,264 cancer treatments and/or any other treatments unrelated to her cancer care, or other preventive services. American Cancer Society Cancer Action Network the Costs of Cancer 13 Key Findings Drug costs vary greatly. Co-pay and co insurance amounts fuctuated based on what Insurance coverage is critical. The scenarios, patients paid a considerable sum out most important factor for these fuctuating costs of pocket for their care but would have paid was whether a treatment was covered under the signifcantly higher amounts if they had not had medical or pharmacy beneft, particularly for drug insurance coverage. For pharmacy beneft ●The cancer patient with employer-sponsored drugs, these patients paid co-pays ranging insurance paid the lowest in monthly from $5 to $100 per drug per month. However, while Medicare and Medigap premiums they paid co-pays (most often $15) and co were high, they were offset by lower cost insurance for drugs covered under Medicare sharing. While the patient with an individual market plan had the highest out-of-pocket costs in each ●The patients with individual market plans had scenario, the patient was protected from even all reached their out-of-pocket maximum by higher overall costs by the maximum out-of the time they were treated with drugs, so they pocket limit. This is why these patients’ out-of did not pay anything out-of-pocket (note that pocket costs were the same in each scenario. Without this maximum in place, particular scenario, represents 29 percent of total these patients would have paid 40 percent co annual income. The following three graphs represent out-of-pocket expenses by month for each of the cancer patients in each insurance scenario. Note that each cancer patient was screened for cancer in January and diagnosed shortly thereafter. American Cancer Society Cancer Action Network the Costs of Cancer 15 Key Findings Medigap makes costs more consistent. In each cancer followed a different pattern than that of the scenario, the patients with employer-sponsored other two types of insurance. Because the insurance and individual market insurance Medicare patient had a Medigap plan, there was experienced the highest out-of-pocket costs protection from co-insurance when utilizing the in the frst 2-3 months after being screened medical beneft. In each case, the Medicare patient were more evenly distributed cancer patients paid large amounts in applicable until the patient began using the Medicare Part deductibles, co-pays and co-insurance in these D pharmacy beneft for oral drugs. This cost months until they reached their co-insurance sharing protection, however, came in exchange for or out-of-pocket maximum. The patient with individual market insurance was diagnosed in January, which was also hit the $6,850 out-of-pocket maximum and was the start of their plan years. Certainly in most only responsible for premiums for the rest of the instances, cancer does not follow this timeline. Cancer patients should expect to pay a large amount of out-of-pocket costs leading up to and directly after a diagnosis, and they should be aware of their maximum out-of-pocket limits and deductibles. In reality, many cancer patients encounter problems that cause delays and complications and further increase their costs. Below are fve common scenarios cancer patients encounter that make their out-of-pocket costs higher than what was modeled in this report. Out-of-Network Charges Payments for out-of-network services do not Insurance plans usually charge less cost-sharing count towards her maximum out-of-pocket limit. In Plans with Signifcant Upfront Costs— nearly every case, going out-of-network is going High Deductible Health Plans to increase costs for the patient. For example, the most popular plan option in She lived in a rural area and an out-of-network the Wisconsin Health Insurance Risk Sharing surgeon was the only one she could see without Plan (the state’s pre-Affordable Care Act high traveling a signifcant distance risk pool, which is often considered one of the Mary’s breast cancer surgery was complicated, most successful programs of its kind) had a and she needed a surgeon with specifc $5,000 deductible. Some patients may delay or abandon follow-up tests or other While Mary’s surgeon was in-network; the care because they can’t afford to meet their anesthesiologist, radiologist or pathologist deductible. If Mary’s surgery was performed at a hospital that was not in her plan’s network she would have received a bill for the full amount of the surgery: $46,400. The frst was a lung cancer screening scan, which After her surgery, chemotherapy and radiation current law requires her plan to cover with no treatments for breast cancer, Mary’s doctor cost-sharing. Mary is part of her evaluation and confrmed her test supposed to take Letrozole for fve years after results. Furthermore, if Kathy a $50 co-pay for this tier of drugs, Mary knew she knew her follow-up scan was going to cost would have to pay $50 every time she flled that her $5,000, she might have delayed the scan, prescription at the pharmacy for the next 5 years. This would likely result in her lung know how much she owed until she got to the cancer progressing even further before it was pharmacy for her frst fll. For the next fve Once a patient meets his or her deductible for years Mary would always be uncertain of what the year, the primary cost-sharing required are she would owe for this medication. Both are fees that the patient pays when a health care service is Non-Covered Treatments delivered or a prescription is flled. Co-pays are Health insurance plans do not always cover every fat fees, usually defned clearly in a patient’s health care service or drug. Cancer patients often treatments, patient out-of-pocket costs increase have trouble fnding out what that total cost is considerably if the patient decides to proceed ahead of time, and therefore cannot predict the with the recommended course of treatment. Health for non-covered services do not count towards insurance plans often use co-insurance for a patient’s out-of-pocket maximum (where certain types of treatment in their medical beneft, applicable), so patient costs for non-covered as well as in the most expensive upper tiers of treatments are unlimited and can add up quickly. After her visit to the emergency room, Kathy Tom’s Medigap plan paid 100 percent of his and her doctor realized her chemotherapy Medicare cost-sharing requirements for hospital was not working, and decided to use a new and physician services (this does not include immunotherapy to try to stop her lung cancer pharmacy costs). Nivolumab is a relatively new drug from paying 20 percent co-insurance for most and is not yet available as a generic. One month’s outpatient and physician services, it came with a worth of Nivolumab for Kathy’s immunotherapy high monthly premium. Kathy could appeal the decision, year: $1,368 year: $14,165 and her doctor could argue that the medication was medically necessary and she had exhausted For a cancer patient in active treatment, the the use of covered drugs to treat her cancer. Note that Tom would have deny coverage, Kathy and her doctor could also been charged 20 percent co-insurance for his go through an external appeals process. Colonoscopies during which polyps are removed are considered diagnostic and not However, if Kathy’s appeals did not succeed and preventive under current Medicare policy. This the plan refused to cover her medication, Kathy often results in Medicare patients who do not would have been responsible for the full cost of have a Medigap plan getting a surprise bill for her immunotherapy—$11,704 every month. The Trade-Offs of Medigap Plans While Medicare Parts A and B cover most Medicare enrollees’ hospital and physician services, traditional Medicare has relatively high deductibles and cost-sharing requirements and places no limits on patient out-of-pocket spending, leading 86 percent of Medicare enrollees to purchase some sort of supplemental coverage to help pay cost-sharing. The Medicare cancer patients in this report have enrolled in Medigap policy F, the most popular Medigap plan. American Cancer Society Cancer Action Network the Costs of Cancer 19 Reducing Patients’ Cancer Costs— Public Policy Options Access to Health Insurance and Cancer Treatments the single most important thing policymakers can do to help cancer patients deal with the costs of cancer is to ensure that all Americans— including cancer patients, survivors and everyone at risk for cancer— are able to enroll in comprehensive, affordable health insurance. This clarity enables patients to select the right Ensuring that all Americans are able to afford insurance coverage to meet their needs as well and enroll in quality health insurance coverage as plan for how to cover out-of-pocket costs. Knowing what and how a service or drug is There are many other cost-related factors that covered is especially important for cancer patients affect cancer treatment, patient wellbeing, as many cancer drugs are covered under a plan’s and health outcomes. Cancer patients need medical rather than pharmaceutical beneft and to have insurance plans that cover cancer are therefore not listed on formularies. Unlike treatments, be able to anticipate treatment costs, formularies, medical beneft details can be afford their cost-sharing, and have adequate challenging to access, particularly when it comes access to in-network providers. A 2016 survey by the Kaiser Family Foundation found Cancer patients also have diffculty navigating about a quarter of adults aged 18-64 say they or their plan’s provider network. Several industry someone in their household had problems paying analysts and publications have noted a trend or were unable to pay medical bills in the last 12 toward narrower provider networks, particularly months. Cancer is cited vulnerable to unexpected billing, and patients may 20 American Cancer Society Cancer Action Network the Costs of Cancer have trouble fnding an accessible provider. This is especially true for cancer patients, as cancer A 2012 survey of cancer survivors treatment often involves several different types of specialists. A 2014 analysis by Milliman found that found that one-third of those surveyed many individual market plans include only a limited number (if any) of National Cancer Institute had gone into debt. Americans—including cancer patients, survivors, and those at risk for cancer—have access to health insurance that is adequate, available, affordable and easy to understand. These policies include:43 Ensuring that health insurance is affordable ●Prohibiting plans from using a patient’s pre Ensuring that health insurance is adequate existing conditions or health status to increase ●Requiring plans cover services essential premium rates to quality cancer care, including no-cost ●Providing tax subsidies or other mechanisms prevention and screening, hospitalization, that make insurance affordable for lower specialty cancer care, physician services, income Americans prescription drugs, rehabilitative care, and mental health services ●Instituting maximum out-of-pocket limits for all insurance plans ●Prohibiting annual and lifetime limits ●Expanding eligibility to Medicaid based on ●Requiring plans to cover routine care for income level patients enrolled in clinical trials ●Promoting competitive state insurance ●Requiring plans to have adequate provider markets that incentivize low premiums networks that include access to specialty care ●Protecting patients from unexpected medical Ensuring that health insurance is available bills, otherwise known as “balance billing” ●Prohibiting pre-existing condition exclusions, Ensuring that health insurance is easy to including total denial of policies and excluding understand certain conditions from coverage ●Providing Americans with an easily accessible ●Prohibiting insurance policy rescissions method to shop for individual market coverage (cancellations) ●Increasing health plan transparency so patients ●Ensuring patient protections discussed above are better able to choose the health plan that is are available to all Americans regardless of right for them and plan for their costs their income or the state they live in –Requiring transparency in provider networks ●Providing special enrollment periods that allow Americans with a qualifying event to enroll in –Requiring transparency in formularies, insurance outside of open enrollment including clear information about cost sharing –Requiring transparency in drugs covered under a plan’s medical beneft American Cancer Society Cancer Action Network the Costs of Cancer 21 Prevention and Early Detection Preventing cancer in the frst place or detecting it early is the best way to reduce many costs associated with cancer treatment—patient out-of-pocket costs, health care payer costs, and indirect costs. Medicare policy and removes patient cost In the community setting, one report calculated sharing for all colonoscopies that an investment of $10 per person per year in community-based programs to increase ●Adequately fund evidence-based federal physical activity, improve nutrition, and prevent and state cancer vaccination, screening, and tobacco use could save the country more than control programs; including breast and cervical $16 billion annually within fve years. Analyses of these ●Implement comprehensive smoke-free recommended services fnd that many are cost policies nationwide, which includes ensuring effective and cost-saving. Screening for colorectal comprehensively regulate tobacco products cancer can actually prevent the disease by and marketing detecting and removing pre-cancerous growths. Palliative care has also proven to reduce costs for patients and health care payers. One study of Incentivize advance care planning adult patients with advanced cancer who were admitted to the hospital showed that having a palliative care consultation within 2 days of admission was associated with a reduction in costs up to 33 percent. Increasing access to palliative care increases cost-saving opportunities and augments a patient’s quality of life. Specifc and immediate policy solutions include: American Cancer Society Cancer Action Network the Costs of Cancer 23 Conclusion For the millions of Americans diagnosed with cancer each year the cost of treating the disease can be staggering. Without comprehensive health insurance coverage, cancer patients’ out-of pocket costs would be even higher and millions would be unable to afford the care they need. As policy makers consider changes to the health care system, it is imperative that cancer patients, survivors, and those at risk of cancer continue to have access to adequate, affordable health insurance coverage. Having been diagnosed late in 2015, it became very clear very quickly that I was going to hit my out-of-pocket maximums with my insurance at least three years in a row Since being diagnosed, 28% of [my annual income] has gone to insurance premiums and annual deductibles/out-of-pocket max amounts. Once I pay my other fxed monthly bills, I have approximately $25/day to pay for everything else. Savings, that were once used for unexpected/out of the ordinary expenses like new tires or custom orthotics needed for foot support due to weakening caused by chemo (which are not covered by insurance), has dwindled to almost nothing. State and local health departments, and State programs 16 Kaiser Family Foundation. A Primer on Medicare: Key Facts other than Medicaid); and other public (Medicaid payments About the Medicare Program and the People It Covers. Other also includes on-medicare-what-types-of-supplemental-insurance-do Worker’s Compensation; other unclassifed sources. April 15, Expenses and Percent Distribution for Selected Conditions 2014;120(8):1212-1219. The association of insurance and stage at diagnosis among patients aged 7 Current law requires Americans to maintain health 55 to 74 years in the national cancer database. Insurance 8 For more information about cancer treatment, please visit status and disparities in disease presentation, treatment, Clinical Benefts 10 Note that the scenarios as modeled did not account for any Associated With Medicaid Coverage Before Diagnosis of instances of out-of-network or uncovered care—costs for Gynecologic Cancers. June which would have not counted towards these out-of-pocket 2016;12(6):576-e733. The Affordable price represents mean “charges” from 2014 national Care Act and Cancer Stage at Diagnosis Among Young statistics, representing a non-negotiated rate.

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