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Want to Avoid Unnecessary Antibiotics? Be Careful What Time of Day You See Your Doctor

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Too often, people with viral illness leave the doctor’s office with prescriptions for antibiotics. That’s a real problem. Antibiotics don’t treat viruses, often cause side effects, and when taken too often, lead to drug resistance.

So when you have a bad cough and go to the doctor, you should hope to see someone who is careful not to prescribe unnecessary antibiotics. Oh yes, and you should see that doctor early in the morning, or first thing in the afternoon, or you risk the chance that fatigue will cause your physician to prescribe an antibiotic you don’t need to take.

That’s the conclusion drawn by Jeffery Linder and colleagues, after they analyzed data from 23 primary care clinics in the Boston area. Disturbingly, Linder and colleagues found that doctors prescribe unnecessary antibiotics with frightening frequency, almost regardless of the time of day.

(To read the rest of this article, please visit Forbes.)

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Bait and Switch: The Sneaky Way Your Employer Just Passed Healthcare Costs onto You

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If you get health insurance through your job, beware: you might be picking up more of the cost of your medical care than you realize. With increasing frequency, employers are directing their workers to the kind of high deductible, high out-of-pocket insurance plans that leave workers financially responsible for a surprising portion of their healthcare expenses.

Not long ago, having insurance coverage meant your costs were largely covered. Americans could count on their employers to offer health insurance plans that covered the vast majority of their healthcare expenses. What’s more, employers even chipped in generously to cover a good chunk of people’s monthly premiums. As a result, Americans with good jobs could live their lives unafraid that they would be financially devastated by an unexpected acute illness.

But this generosity came at an increasingly unaffordable cost for American companies, with the price of health insurance threatening their bottom line. In response, companies have looked for ways to get their workers to pick up more of the tab.

Enter high out-of-pocket health plans.

On the surface, these plans look like bargains, because they cost less each month than other plans. When signing up for insurance, many people are attracted to these plans, knowing they will have less of their take home pay diverted to an insurance company. But then they discover that even a minor illness can turn that bargain to a burden.

(To read the rest of this article, please visit Forbes.)

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Everyone Agrees Obamacare Prices Have Been Rising Rapidly (But Everyone Is Wrong)

(Photo by Joe Raedle/Getty Images)

It has been well publicized that premiums for Obamacare insurance plans have been rising at a disturbing rate. Local news is filled with reports of 21.5%36.3% and even higher price hikesPresident Trump complained in February that Obamacare premiums “have increased by double and triple digits,” even remarking that premiums in Arizona “went up 116% last year alone.”

If the cost of buying insurance were really rising this rapidly, we’d have a reason for bipartisan agreement that the Obamacare insurance experiment is a failure. But the rise in Obamacare premiums isn’t even close to the magnitude we are hearing about from reporters and politicians. And it is not because of fake news or dishonest discourse. It’s because everyone is looking at what’s for sale rather than what’s being sold.

Not sure what the heck I’m talking about? Then consider the Nike Mag 2016, a sneaker touted as “sensing the foot and lacing itself,” because, you know, it is so exhausting to tie your own shoes. Nike made less than a hundred pairs of these battery-powered, motor-driven sneakers, which now sell for an average of $26,000 a pair.

Suppose, for purposes of illustration, that before the Mag came to market, Nike had five lines of basketball shoes on the market. They sold for an average price of about $200. Then in 2016, it brings out the Mag. If healthcare reporters and politicians commented on these shoes, they would tell you that Nike prices have risen more than 2,000%. That’s because they’d be calculating the average price of Nike’s shoe offerings, as if people bought an equal number of each type of shoe. If you have five varieties priced at around $200 and one that’s priced at $26,000, you’ll have an average price of over $4,000.

But that’s an insane way to describe the price of Nike basketball shoes. To know how much their basketball shoes cost, on average, we need to know what shoes people actually buy. With hundreds of thousands of people buying the $200 sneakers and a handful of people buying $26,000 sneakers, the average price of Nike’s shoes won’t be much more than $200.

(To read the rest of this article, please visit Forbes.)

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Make Sure Your Doctor Is Treating You and Not Your Blood Tests

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He came to the ER with chest pain, shortness of breath, and atrial fibrillation with a heart rate of almost 120 beats per minute. It wasn’t a heart attack, and it wasn’t some rare disease. He was emergently ill because his physician overreacted to blood tests, and prescribed a thyroid pill he didn’t need.

If your doctor tells you that your thyroid is underactive—that you have “subclinical hypothyroidism”—do what you can to make sure you don’t receive thyroid medicine that could do more harm than good.

According to an article in JAMA Internal Medicine, the 72-year-old patient described above had gone to his doctor several months earlier, with mild, nonspecific physical complaints. The doctor ordered a blood test, which showed a slight elevation in his TSH, or “thyroid stimulating hormone.” TSH is the molecule your body releases when your thyroid isn’t producing enough hormone. When TSH is elevated, it can be a sign that your thyroid gland is underperforming.

In this patient’s case, even though his TSH level was high, the level of thyroid hormone was normal in his blood. That means his situation isn’t straightforward. Suppose his TSH had been elevated at the same time as his thyroid hormone was low. And suppose that he was also showing specific signs of thyroid problems—maybe he was cold all the time, or had a slowing of his heart rate. This constitution of signs and symptoms would be strongly suggestive of hypothyroidism—that extra TSH in his bloodstream might not be up to the task of prodding his thyroid to do its job. In that case, it would be reasonable for his primary care physician to prescribe thyroid hormone replacement, and see if he got better.

(To read the rest of this article, please visit Forbes.)

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Thyroid Cancer Rates Are Rising for an Infuriating Reason

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The last four decades have witnessed an explosion of thyroid cancer diagnoses in the U.S. People are three times more likely to receive cancer diagnoses now than they were in 1975.

Why? Is it chemicals in the water supply? A side effect of all those childhood vaccines? Or is it because a TV ad convinced people to ask their doctors to check their neck?

I have examined thousands of patients’ necks in my career. I ask them to drink water while I feel the contours of their thyroid for suspicious asymmetries. If I feel anything suspicious, like a lump, I follow up with blood tests and ultrasound exams, to see if my patient is harboring a potentially dangerous growth. Here’s the problem with all that neck checking—there’s no evidence it saves lives. But there is solid evidence that it leads to diagnoses of non-threatening thyroid cancers.

(To read the rest of this article, please visit Forbes.)

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Is Federal Policy Really to Blame for the High Cost of Cancer Care?

(Photo By BSIP/UIG Via Getty Images)

U.S. healthcare costs have been high for decades, outpacing other developed countries since at least the 1980s. But costs continue to rise, and that is causing many experts to ask why. Some people blame federal policies. As an example, they point to reimbursement policies that create incentives for healthcare providers to consolidate. When hospitals merge with each other, or when hospitals buy out physician practices, healthcare providers gain negotiating leverage over insurers, which enables them to negotiate higher prices.

But what evidence do we have that federal policies are to blame for such consolidation?

(To read the rest of this article, please visit Forbes.)

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Want to Prevent Heart Attacks? Perhaps Don’t Try This Behavioral Economics Intervention

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If you experience a heart attack, you are probably going to need to take pills to prevent another such attack. People who take beta blockers, aspirin, or cholesterol pills after heart attacks are less likely to experience a second such attack. (Note: Don’t take any of these pills until you have spoken to your doctor. These medications aren’t for everybody.)

There’s a problem, though. Lots of people don’t take these pills, even after their doctors have prescribed them. Life gets in the way. They forget to take them, or they run out of pills, or they don’t get to the pharmacy for refills.

To increase the chance people will take these important pills, a team out of the University of Pennsylvania created a behavioral economic incentive. The intervention was multipronged. It included enrolling patients in lotteries, which gave them a chance to win money every day they took their pills. It encouraged patients to enlist a friend to help them stay on track taking their pills, a friend who would get notified every time they skipped their medications for a few days in a row.

(To read the rest of this article, please visit Forbes.)

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A Prick a Day Won’t Keep Your Blood Sugar Away

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When it comes to wreaking havoc on people’s bodies, diabetes isn’t picky, wreaking havoc upon people’s hearts, brains, eyes, kidneys, and peripheral nerves. To forestall such damage, many people with diabetes withstand another kind of bodily harm—they prick blood from their fingers each day to test their blood sugar. For many people with Type 2 diabetes, also called adult onset diabetes, those daily prickings are probably unnecessary. If you have Type 2 diabetes, it’s a good time to ask your doctor whether you can forgo those painful prickings.

In diabetes, people’s bodies lose the ability to tightly control the level of glucose circulating in their bloodstream. (Glucose is sometimes called “blood sugar,” although it is only a cousin of table sugar, sucrose.) When glucose levels rise in the bloodstream, the body normally sends out a cascade of chemicals, like insulin, to corral the molecule: to pull it out of the bloodstream and force it into other tissues. People with Type 1 diabetes, often called juvenile onset diabetes, suffer damage to the cells in their pancreas that secrete insulin. As a result, their glucose levels rise dramatically in response to a meal. Without treatment, many of these patients will suffer severe illnesses or even die from high blood glucose. People with Type 1 diabetes usually need to take insulin, and while closely monitoring their blood sugar adjust their insulin dosages.

People with Type 2 diabetes, on the other hand, usually have functioning pancreases, and without treatment, don’t usually experience life-threateningly high glucose levels after dinner. Instead, their ability to control blood glucose levels has deteriorated, usually because of chronic overweight or obesity, causing their glucose levels to rise more than normal after meals, and stay high for an abnormally long amount of time.

In order to help patients with Type 2 diabetes, physicians have long urged them to check their blood sugar at least once a day, to monitor their glucose levels. When I was trained, I was taught to have people check multiple times a day, so I could show them how to adjust their medications to more tightly control their blood sugar. If a patient had lots of high readings in the afternoon, for example, I might suggest that they increase their morning insulin.

(To read the rest of this article, please visit Forbes.)

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Where You Live in America Determines When You Die

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Debates over income inequality divide liberals and conservatives. In the last few decades, income inequality has soared in the U.S. In the 1950s, the top 1% of Americans brought home about a tenth of the country’s income. By 2012, those 1%’ers accounted for almost a quarter.

Only a minority of Republicans are troubled by these statistics, versus three-quarters of Democrats. We are a nation divided—in wealth and in politics. But perhaps another kind of American inequality can bridge this partisan divide—a life expectancy gap.

Consider the facts. The average life expectancy in the U.S. is almost 80 years. But that average obscures enormous differences based on where people live. In some U.S. counties, life expectancy is close to 90. But in others, people are lucky to live to 65.

(To read the rest of this article, please visit Forbes.)

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How to Tell Grandpa He Is Too Old for Another Colonoscopy

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Cancer screening can save lives: Mammographies reduce the chance women will die of breast cancer; and colonoscopies reduce the chance people will die of colon cancer.

But should my 93-year-old father receive a screening colonoscopy? The test is uncomfortable, carries risks, and costs money. Even more importantly, my dad probably won’t live long enough to benefit from the test. That’s why most medical experts think people like my dad—people unlikely to live another decade—should not receive cancer screening tests like colonoscopies. But how in the heck is my dad’s doctor supposed to deliver this news to him?

My father’s primary care doctor could tell him: “I have good news for you. You don’t need a colonoscopy—you’ll probably die of something else before colon cancer gets you!” But according to recent research, that message isn’t likely to go over well with its audience. The study, out of Johns Hopkins, convened senior citizens and asked them what they thought about conducting screening tests in patients of advanced age. The people told researchers that they understood the concept of stopping testing when people get too old to benefit. But they did not like the thought of doctors telling them that their impending mortality is the reason they will no longer receive such testing. “You’re too old to benefit” is a harsh message.

So what should physicians do?

(To read the rest of this article, please visit Forbes.)

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