The ratio of workers paying Medicare taxes will drop from 3.3 workers for every beneficiary now, to 2.1 workers for every beneficiary by 2030.

But the Democrats see another great election-year issue. They want to move on prescription drugs with or without a Medicare overhaul. House Democratic leaders have announced plans to force the Medicare drug issue to a vote on the House floor. They intend to override the Republican leadership by launching a “discharge petition” drive. If they can get a simple majority of members (218) in a House that has only a five-vote Republican majority, they can bring the issue to the floor. While their effort is a long shot and there is no way the Republican-dominated Senate would go along if they did get the issue to the House floor, it underscores the Democrats’ desire to make this a big election-year issue.

The pharmacy industry has waded in as well by running a number of television and print ads around the fictional character, “Flo.” Flo has called for an approach favored by many Republicans that creates more private sector prescription drug options for seniors and provides assistance to low-income seniors in accessing them.

The drug companies are really worried about price controls. They have watched as Congress and the administration have repeatedly cut Medicare doctor and hospital reimbursement rates over the past 30 years in order to balance the budget. They want no part of any drug program that is integrated into Medicare and subject to future Congressional and White House price cuts.

The American Association of Retired Persons has also joined the debate. Without endorsing anyone’s specific plan, AARP issued 10 principles with which they can examine the various proposals. AARP believes a drug plan should:

Be part of a Medicare-defined benefit package. (This would be similar to the Clinton/Gore and Bradley approach, but likely at odds with the direction in which Republicans appear to be headed, which generally relies on more private sector options.)

Include a government contribution generous enough to yield an affordable premium, and an attractive benefit design that is responsive to beneficiaries’ needs.

Allow beneficiaries to keep their current coverage if desired and should not cause employers to drop coverage.

Give enrollees access to drug therapies and reduce medical errors and mismedication.

Contain subsidies for low-income beneficiaries and utilize some of the predicted federal budget deficit to pay for the plan.

We really won’t have a prescription drug debate in Congress until the Republicans can agree on a leadership approach. The House Republican leadership has appointed a task force to develop a response to the Clinton/Gore Democratic approach to the prescription drug issue. They are expected to outline a proposal later this spring.

With prescription drug costs rising at 15 percent per year, and with seniors using an average of nine to 12 prescriptions per year, the lack of a comprehensive drug benefit within Medicare is a huge issue for the elderly population. A recent study conducted by a University of Maryland researcher for the Commonwealth Fund, a private foundation that supports independent research on health and social issues, found that:

About half of all seniors have prescription medications coverage — 52.7 percent of Medicare beneficiaries had continuous outpatient drug coverage in 1996.

In 1996, 28.4 percent had no coverage (almost 20 percent had coverage for some period in 1996).

Those with insurance who had fair or poor health had an average of 36.7 prescription transactions in 1996, compared to 27.2 transactions for those with no coverage.

Beneficiaries with fair to poor health spent an average of $732 in drugs on 1996.

Thirty-seven percent of Medicare beneficiaries with annual incomes of less than $10,000 did not have drug coverage in 1996 (many were likely eligible for Medicaid coverage). For those with incomes over $30,000, 28 percent had no drug coverage.

The Clinton/Gore administration, as well as presidential candidate Bill Bradley, recognized this issue by proposing new Medicare drug programs. The Clinton/Gore plan would pay for half of a senior’s drug expenses up to an annual cap, have a monthly premium and cost $118 billion over 10 years — to be taken from projected budget surpluses. That has led to a number of alternative programs to be introduced in the Congress.

Republicans have generally been skeptical of any new and costly programs being added to a Medicare program expected to become insolvent by 2017 if major changes aren’t made. It is not that the Republicans don’t favor a solution. Many believe that the overall Medicare problem must be solved before any new entitlements are taken on.

Representative of the Republican attitude is Sen. Bill Frist, R-Tenn. As he put it, “Laying a huge expensive proposal … on top of a system that is going bankrupt… is unacceptable to people such as myself.” He went on to say that passing a drug benefit without first making the needed reforms would be “terribly destructive” to the program.

Republicans point to Congressional Budget Office projections that predict:

Medicare expenditures will grow 4.5 percent in 2000, and 9.1 percent in 2001.

Medicare outlays will grow at an average annual rate of 6.9 percent, well in excess of the average growth projected for the economy — 4.5 percent per year for the same period.

Medicare enrollment will increase by 17 percent over the next 10 years.

Friday, June 29 — Vice President Dick Cheney announced today he has a new heart problem — an irregular heartbeat that may require the installation of a pacemaker as soon as tomorrow.

Cheney made his surprise announcement during a hastily called news conference at the White House. Since the 2000 presidential election, he has had two heart procedures. He suffered what doctors called a “mild” heart attack in November, his fourth, during which a stent was implanted in a coronary artery. That artery was reopened and widened in March, when he experienced chest pains again.

Cheney says that his doctors assured him the new procedure won’t keep him off the job. “There’s no reason why either the procedure or the device that’s being implanted should in any way inhibit my capacity to function as the Vice President,” he says.

Cheney, 60, says the rapid heartbeat was detected when he was put on a monitor for a day and a half two weeks ago. He says he had no symptoms. “I’m oblivious to these incidents when they occur,” he says.

Cheney will check into George Washington University Hospital in Washington, D.C., tomorrow for tests to determine whether a defibrillator is needed. If it is, he says, he will have what he calls a “pacemaker plus” implanted. The device is an implantable cardioverter defibrillator, which detects abnormal beats and restores them to normal.

Putting in a defibrillator is “a very low-risk business,” says Dr. Spencer King, an Atlanta heart specialist and past president of the American College of Cardiology. “The fact that Cheney had previous coronary artery work would not cause the implantation to be substantially more risky.”

“Having one or two seconds of rapid heartbeat is not that unusual,” King adds. “Most people have extra beats, and if that just happens for one or two seconds and goes away, it’s a totally benign thing.”

But if the rapid beats last longer, there is a problem, King says. “Some people have a whole string of rapid heartbeats that do not stop, and that can cause symptoms like dizziness or even fainting. If that occurs, you may have to correct it. And one of the methods, even more effective than drugs, is the implantation of a device similar to a pacemaker that detects the rapid heart beat and then corrects it automatically.”

“Frankly, this doesn’t sound like there’s any immediate danger at all,” King adds. “It’s kind of like a missile defense shield — if they decide to do it, it’s a prophylactic thing.”

At his news conference, Cheney described the procedure as “an insurance policy.”

“I feel fine,” he added.

Dr. Sidney Smith, chief science officer for the American Heart Association, agrees that getting a defibrillator is a “relatively minor procedure. It’s not a big operation and you wouldn’t be going into an operating room and having your chest opened.”

“An incision is made in the skin and a small pocket is created,” Smith explains. “A very tiny battery is placed in the pocket and a catheter is routed to the heart and the battery is connected to the defibrillator.”

Cheney may not even need the defibrillator, Smith says. “He could go into the lab, have the test and they won’t be able to stimulate or induce a rapid heart beat. So they may not put in the device. The test is very important.”

It’s not unusual for someone who has had a heart attack to develop heart beat irregularities, Smith adds. “People who have some scarring on the heart tissue from previous heart attacks can develop some rapid heartbeats,” he says.

Cheney’s history of heart trouble is almost as long as his career in public service. He suffered his first heart attack in 1978, when he was 37 years old. He had another one six years later, and underwent bypass surgery in 1988 after sustaining his third.

Cheney has been on a strict diet and exercise regimen to cut his risk of additional attacks. However, patients who experience such problems early have a much worse outlook than those who suffer heart episodes later in life, experts say.

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A panel of expert advisors to the US Food and Drug Administration (FDA) voted 10 to 7 on Thursday to endorse a proposal that would expand the agency’s current policy of deferring donors that spent six months or more in the United Kingdom to include the entire European continent.

The proposal would also expand its present deferral policy to include people that spent three or more months in the UK between 1980 to 1996 and people who spent six or more months on any European-based US military instillation south of the Alps.  For those military bases north of the Alps, the panel endorsed the deferral of people that spent six or more months there between 1980 through 1990.

The panel’s decision was based upon surveillance reports showing that mad cow disease has now spread throughout Europe. In the late 1980s, the disease primarily afflicted cattle herds in the UK. Cases have since been reported in various European nations, including France, Portugal and the Republic of Ireland.

Mad cow disease, or bovine spongiform encephalopathy (BSE), afflicts cattle. The occurrence of mad cow disease in Europe has become a major concern in the US because scientists have linked BSE to a fatal new variant of a human condition called Creutzfeldt-Jakob disease (CJD), which causes the brain to waste away. About 100 people, almost all of them young adults in the UK, have been diagnosed or have died of variant CJD (vCJD).

At present, there is no evidence that the disease can be spread from person to person by blood transfusions. So far, all of the documented cases in Europe have been associated with the consumption of tainted meat. However, animal studies have established at least a theoretical risk.

The panel’s decision primarily was due to an FDA risk analysis, in which the agency concluded that the expanded deferral policy would lead to a 91% reduction in the overall risk of transmission if the disease can be spread through blood transfusions.

“Proper targeting can reduce the total risk by more than 90%, while decreasing the donor supply by only 5%,” testified Dr. Alan Williams, director of the FDA’s Division of Blood Application, before the panel.

But the panel’s recommendation is also likely to cause some controversy due to the potential affect on the nation’s overall blood donor numbers.  While the FDA policy would reduce the theoretical risk of Americans contracting mad cow disease, blood banks say it could also have a very real impact on existing patients.

For instance, the FDA’s proposed policy could reduce the blood supply in the New York City area by as much as one third, jeopardizing patient safety in an area of approximately 18 million people, testified Susan Waltman, a senior vice president of the Greater New York Hospital Association.

The FDA’s proposed policy would also have a major impact on the availability of plasma derivatives, which already are in short supply, added Dr. Michael Busch, a professor of laboratory medicine at the University of California in San Francisco and a vice president of the Blood Centers of the Pacific.

“I ask the committee to step back and consider where the slippery slope of deferral policies regarding vCJD will end,” Busch said, while expressing concern that the deferral policy would perpetuate the illusion regarding the association between the emergence of vCJD infections in Europe and blood transfusions.

Still, the proposed FDA policy also enjoyed a certain measure of support.

In fact, the American Red Cross said it would voluntarily adopt in September an even more stringent deferral policy, under which it would defer anyone that spent three or more months in the UK since 1980 and six or more months in any European country.  Under this policy, the Red Cross said it would also defer anyone that received a blood transfusion in the UK.

“The American Red Cross believes that safety does not have to be compromised to achieve availability,” said Jacquelyn Fredrick, a senior vice president of the American Red Cross.

And in the end, the majority of the expert advisors to the FDA agreed.

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A new strain of an antibiotic-resistant bacterium that causes urinary tract infections in women has suddenly appeared in widely separated communities in the United States, raising the possibility of widespread contamination of food, researchers report.

The Escherichia coli strain has been isolated from women with urinary tract infections in California, Michigan and Minnesota, reports a team led by Dr. Lee W. Riley in the latest issue of The New England Journal of Medicine. Riley is a professor of epidemiology and public health at the University of California at Berkeley. The strain is resistant to the trimethoprim-sulfamethoxazole combination commonly used to treat E. coli infections and has a genetic fingerprint different from other resistant strains, the researchers report.

“This one is different from other groups of E. coli that are traditionally associated with urinary tract infections,” says Riley. “We provide evidence that this drug-resistant strain might be spread by food.”

The emergence of the new strain in three different geographic areas points toward “one or more contaminated products ingested by community residents,” the journal report says. Contaminated foods have been responsible for community-wide outbreaks of intestinal infections caused by a different strain of E. coli that is designated 0157:H7, the report says.

The public health implications of the finding could be important. The new strain accounts for a startlingly large percentage of antibiotic-resistant E. coli above what normally would be expected in the areas where it has been found.

“If it were not for this clone [strain], the overall level of resistance in the Berkeley population we studied would be 12 percent,” Riley says. “Because of this clone [strain], it is 22 percent. In Minnesota, a related strain accounts for a similarly large proportion of antibiotic-resistant infections.”

The finding is important for two reasons, says Dr. Walter E. Stamm, professor of medicine at the University of Washington School of Medicine and author of an accompanying editorial.

“First, it is a demonstration of the continuing development of antibiotic resistance,” Stamm says. “It is also possible that there might be a potential single source of this organism, possibly in food.”

Further tests to determine the breadth of the outbreak are needed, as are studies of possible sources of the infection, Stamm says. Riley says he is trying to determine that source.

Whatever the source, “it is probably a very likely thing that the overuse of antibiotics plays a role in the emergence of such resistant strains,” Stamm says. His editorial says it is “yet another example of the ongoing global problem of antimicrobial resistance.”

That problem is due not only to medical overuse of antibiotics, Riley says. The food industry also uses a lot of antibiotics, he says. “Half of all the antibiotics used in the United States is given to animals as growth promoters. Many of the drug-resistant organisms that humans get are ultimately derived from drug-resistant strains in animal reservoirs.”

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It is possible to live and deal with sarcoidosis. This disease is treatable. No matter how bad or scary it seems.

I was diagnosed in January 1996 with sarcoidosis. I have good days and bad ones. Sometimes it is a bumpy ride but it is one I am glad that I have had. I was always healthy until this. I didn’t have a clue as to what it would like to not be a healthy person. It has given me a new perspective on things and taught me a little more tolerance. I think it has made me a stronger person. I consider sarcoidosis my best friend. I know that probably has means I need a padded room and one of those cute little white coats with the arms that fasten behind the back. But it is with me 24 hours a day, 7 days a week. I bathe, eat, sleep, and do my living with it. Under those circumstances it is better to treat like a friend. Anything just doesn’t make sense.

My next few articles will deal with defining sarcoidosis; all the terms that goes with it, and experiences of dealing. I am also planning on discussing things like medical testing and procedures, insurance, finding a good doctor. There are all kinds of resources available if we just look.

Angioplasty isn’t necessarily the only solution for a diabetic with heart disease. The findings of this new study show that the old, reliable use of medications for a diabetic with heart disease is often the best choice.

Often heart disease will cause death in a diabetic, but you should know that angioplasty isn’t right for everyone. For some, medication can be used to reduce the blood pressure and ease the load on the heart.

So what is the best way for a diabetic to treat heart disease?

In the past, doctors have usually suggested angioplasty surgery for clearing the arteries of a diabetic with heart disease. Angioplasty uses a balloon pushed through choked arteries and is a very expensive remedy. Although using angioplasty is generally safe, in a very small percentage of cases, death or heart attack both during and after surgery can occur. Occasionally bypass surgery is needed because the artery closes down during the surgery.

This study found that a diabetic can be treated for heart disease with medications if the disease isn’t severe. Angioplasty includes the risk of heart attack, as much as 5% of the time, but despite this, often a diabetic with heart disease and their doctor will choose surgery as the quickest option for repair. Things often go wrong for a diabetic if they have other complications due to the diabetes, such as kidney disease. The risk is highest for the elderly, women, and people with other health problems.

Heart Disease Treatment for Diabetics: Medications

If you are a diabetic with heart disease, you can feel eased because there are several medications that will work for you. To lower your risk of heart attack and lower your cholesterol, statins are available.

A diabetic can use ACE inhibitors to treat heart disease and lower blood pressure. According to the findings of the study, a diabetic can be successfully treated for heart disease with medications, which will lower the risk for heart attack and death due to the heart disease, just as well as with angioplasty.

So if you are a diabetic with heart disease, what is the truth about successful treatment?

If your heart disease is severe, angioplasty is often necessary but if it isn’t, medications can often safely treat the symptoms. Only your doctor can determine which choice is right for you.

The main parts of your blood pressure are your heart and arteries. Each time you have a heart beat, blood is sent into the arteries to circulate in your body. The average heart beats about 66 to 70 times per minute. The force that the blood flow exerts against the arterial walls is what is known as “blood pressure”.

The upper part of the arm inside the elbow is where blood pressure is typically taken. The brachial, a main artery, is located in the hollow of the elbow. The brachial artery is the artery that carries oxygenated blood away to the muscles and cells from your heart. A sphygmomanometer is a blood pressure cuff that is placed on the upper part of the arm, inflated, and a stethoscope is used on top on the brachial artery.

A stethoscope helps your doctor figure out two important numbers: your systolic and your diastolic. Systolic pressure is defined as when the heart is beating and places the most stress on the artery walls. Diastolic pressure is defined as when the heart is relaxed and fills up with blood in the middle of beats and there is less stress on the arteries. To illustrate, what is considered normal is a reading of 120/80. The systolic is the number on top and the diastolic is the number on the bottom. These two numbers are important to make a precise measurement of blood pressure.

Blood pressure changes everyday considering the kind of activities you do. Blood pressure will go down if you are seated and blood pressure will go up if you are doing a physical activity. Your mood can be an influence on blood pressure as well. Being nervous and getting excited will make blood pressure go higher. It is necessary to have several readings over time to precisely figure out your blood pressure.

Hypertension is another name for high blood pressure. Having a blood pressure of 140/90 consistently is known as hypertension. High blood pressure might go unnoticed for years without your feeling anything, but while this is going on, organs can be damaged. Hypotension is the name for low blood pressure. Blood pressure readings that are usually between 110/60 and 90/50 are considered low. The difference between low blood pressure and high blood pressure is that there are signs for low blood pressure.

Nearly 33 percent of adults 65 years and younger in America have hypertension, while approximately 66 percent of people over 65 years old have it. Of these, less than half — about one-third — seek medical intervention to control their blood pressure.

Your heart is beating all the time you are alive. Hypertension or hypotension could possibly result in deadly risks. It is important to have your blood pressure taken regularly. Even though the pharmacies have automatic blood pressure machines, they are not totally dependable, but they help you know when it is necessary to go visit a doctor.

Here is some advice on selecting the best ones.

The first rule you must follow when choosing safe medications, is to make sure you comprehend the information on the label. It is amazing how little time people spend reading and fully understanding the tiny print on a non prescription medicine label. The information that appears on a label is normally in a standard format that is similar on all medications. This is how to comprehend the meaning of each piece of information.

How To Read the Label When Choosing a Safe Prescription Medication

Active Ingredient

The active ingredient is the first listed on the drug label, and is responsible for relieving your symptoms. The active ingredient is typically listed together with the amount contained in each pill or capsule. Sometimes over the counter medications might have extra potent ingredients. It’s vital that you have never had a prior experience with an allergic reaction from the active ingredients before trying the medication. If a doubt regarding how the active ingredient works arises, consult with your pharmacist.

Uses

This is found on the over-the counter medication label as the second item. Typically, the label will list each symptom the medication treats. This lets you see if the medication is right for the problems you have. If a particular symptom is not mentioned in this area, do not use the medication to treat it.

Cautions

This segment must be read and followed. It will advise you of foods and products to avoid when taking this medication. For instance, a Tylenol bottle always includes a warning to avoid using it if you consume over 3 glasses of alcohol per day. It also gives directions on whether it is alright to use the medication when you are pregnant, or if children should use it. It is wise to discuss any prescription medications with your doctor or pharmacist before trying an over-the counter medication. Do not combine 2 or more medications without first consulting with your physician.

Directions

This gives instructions on the proper dosage, and at what intervals  you should take the medication. Don’t take more than the amount suggested. Even medications may cause dangerous side effects if taken inadequately. For kids, individual doses are written down if the medication is alright for kids to use. Don’t ever give a child younger than 12 an adult dose of any medication.

Inactive Ingredients

This list includes the ingredients that are in the medication that don’t contribute to relieving symptoms. These consist of preservatives, food dyes, or extra ingredients. If you suffer from any form of food or medication allergy, read this section closely to ensure you are not sensitive to any of the ingredients.

Other Advise

It is necessary to notice when the date expires. As soon as you bring home the latest medication, mark the expiration date so you know when to throw it away. If you experience adverse reactions to an medication, make note of its name, including the active and inactive ingredients it contains, for reference at a later date. Take this information to your physician and pharmacist, and keep a personal record of it.

A consistently accurate reading of the label on over the counter medications will insure a safe choice. It is worthwhile to look at the fine print.

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