Ante Up for Concierge Medicine? Three Key Questions and My Decision

As I've mentioned, I face a decision: whether to continue with my longtime internist now that he is converting to concierge practice, a subscription-based arrangement available for a $1,500 annual fee. If you haven't already, you may well need to make a similar choice soon. More and more internists, especially senior doctors, are shifting to concierge medicine.

It hasn't been an easy decision. But I've benefited from your blog comments, emails, phone calls, and personal chats. In making my decision, I focused on the three questions:

1. Can I Afford It?

This is the threshold issue. Fortunately for me, it's the easiest question to answer. Yes, I can afford it.

For many others, this issue isn't so easily dismissed. Coughing up an extra $1,500 or more every year can be difficult. And remember: under these arrangements, you will still pay the usual charges for all office visits.

Those who can't afford it will need to find another doctor at a time when there is already a shortage of internists. That squeeze will only get tighter when the Affordable Care Act ("ObamaCare") offers medical insurance to about 30 million people who are now uninsured.

2. Are the Extras Worth the Fee?

"There's little value added. It's a rip-off." That was the assessment I got from an astute, knowledgeable friend . . . and I'm inclined to agree. Here are some of the "extras" I'd get as my internist's brochure described them:

• An expanded physical of up to 90 minutes. One of the many things I like about my internist is that he already allows plenty of time to talk about my health concerns and offer advice. I don't need more time. Nor do I think I need more tests as part of my physical. Many health authorities are questioning the need for annual physicals. A Danish research team found no benefit to the risk of death or serious illness among apparently healthy people who had general checkups compared to those who did not. The American Academy of Family Physicians itself has recommended against routine annual EKG screenings of asymptomatic patients -- a screening I've been getting every year as part of my annual physical. Sounds like my "less is more" mantra applies here.

What Hospitals Charge and What Medicare Reimburses: HUGE Variations

On May 8, the Centers for Medicare and Medicaid Services released some eye-opening information: A) the amounts that hospitals across the country charge for medical procedures, and B) the amounts that Medicare reimburses to those hospitals. The big story here: the vast differences among the “A” figures, and the similar discrepancies among the “B” numbers.

It’s a broad study of 2011 data from 3,300 hospitals, and tracks the costs associated with the 100 most frequent procedures and treatments, including joint replacement, gall bladder removal, and coronary operations. To avoid odd “one-offs,” hospitals had to have performed a particular procedure at least 11 times for their prices to be included in the study.

As far as I know, it’s the first time that consumers who CAN plan ahead have the opportunity to “comparison shop.” For people on Medicare or covered by private policies, these numbers don’t affect us too much; we make hospital choices based on other factors, like reputation, convenience, or affiliation with our own doctors. But for people without insurance – millions of Americans who need to pay the bills themselves -- this new information can be very helpful.

What Hospitals Charge
Here’s just one example from an excellent New York Times article from May 8: “In one hospital in Dallas, the average bill for treating simple pneumonia was $14,610, while another there charged over $38,000.” That higher price is 2.6 times MORE than the other. Why?

Promising New Paradigm for Testing Alzheimer's Drugs May Also Work for Other Age-Related Diseases

Yesterday we reported on the curcumin-based compound J147, which looks like the most promising drug candidate in the pipeline to treat Alzheimer's disease. It was developed by scientists at the Salk Institute for Biological Studies using a novel approach that may signal a new way of researching AD and other neurodegenerative disease-fighting drugs.

No question: a new approach IS needed. So far, Big Pharma has had little success with AD drugs, or with my own concern -- Parkinson's drugs.

Previous studies demonstrated that several compounds including J147 can prevent or delay onset of AD-like symptoms in young mice. But that methodology doesn't exactly address the issue for people, who typically experience symptoms before being diagnosed.

Salk Institute researchers therefore used older, AD-engineered mice, whose symptoms were already advanced. Treating these mice with J147 improved their memories in several tests. Examinations of their brains showed decreases in proteins associated with cell death, and increases in proteins that form the connections responsible for learning and memory. Yesterday's post provides more info about J147.

Curcumin-Based Drug That Reverses Alzheimer's in Mice Is Ready for Human Trials, But . . .

A curcumin-based drug that can stop, even reverse, Alzheimer's symptoms is ready for human clinical trials, according to Salk Institute researchers. This development may be the most promising to date in a search that has challenged the best brains in medical research. But Big Pharma has declined to fund the human trial.

The initial report  on the Salk study came out over a year ago. Earlier this week, an update appeared in the online journal Alzheimer's Research and Therapy.

The scientists' follow-up study used an experimental design that separates this research from most of the work being done on Alzheimer's.

Tomorrow I'll describe the study's methodology, and the Salk scientists' suggestion that Big Pharma has been on the wrong path for drug discovery. But today, let's look at the follow-up study's findings about the curcumin-based drug and Alzheimer's.

Progression of AD Halted in Very Old Mice
No available drug can stop the progression of Alzheimer's disease. But the Salk researchers now believe their curcumin-based compound can do just that.

It's a bold claim, but rigorous experiments on laboratory mice have held up, revealing the great promise of J147, the new curcumin-based product. The initial 2011 report on J147 showed that it could improve memory in AD-affected mice. Researchers demonstrated that J147 prevented disconnections in the brain's synapses, which in turn halted the ravages of the disease.

Cranberries and Lemons: Powerful Cancer Fighters?

On May 10, Dr. Michael Greger released a video on his NutritionFacts.org site about the impact of 11 popular fruits on the growth of human liver cancer cells in a petri dish.

I had to wonder -- if veggies with edible nicotine can prevent Parkinson’s disease, as I mentioned in yesterday's post – can fruits fight cancer cell proliferation?

In a nutshell, here’s what Greger found:

• Plain water had NO effect on the cancer cells. 
• Pineapples, pears, oranges had negligible impact. 
• Peaches at high concentration reduced cancer growth by about 10%. 
• Bananas and grapefruit reduced cancer growth by about 40%. 
• Red grapes, strawberries, and apples – even at half doses – cut cancer growth up to half. 
• Lemons and especially cranberries dramatically cut cancer growth, even with tiny doses. 

Can the Peppers Peter Piper Picks Prevent Parkinson’s?

Perhaps.

Eating foods with small amounts of nicotine – like peppers and tomatoes – MAY reduce the risk of developing Parkinson’s disease, according to a study released May 9 in the Annals of Neurology journal.

Dr. Susan Searles Nielsen -- with colleagues from the University of Washington / Seattle -- recruited 490 patients newly diagnosed with PD. For controls, they enlisted another 644 unrelated people with no neurological issues.

All study subjects answered questions about their dietary histories and tobacco use. For this investigation, tobacco use was defined as having ever smoked more than 100 cigarettes, or regular use of cigars, pipes, or smokeless tobacco.

The Solanaceae Family of Flowering Plants
Results showed reduced risk of Parkinson’s disease among people with increased consumption of foods from the flowering plant family Solanaceae, which includes peppers (red, green, yellow), tomatoes, and potatoes. Those edible plants contain small amounts of nicotine . . . not surprising since tobacco is also a Solanaceae family member.

Aging and Gardening and Me

Gardening gives me great pleasure, but it wasn't always that way.

During my working days (and weeks and years), I puttered in the garden now and then, but bike riding was always my first choice for weekend activity. If the weather wasn't good for biking, it wasn't good for gardening either. 

When I retired (1/1/1995) and had more spare time, I gradually began to spend more time gardening. Then the huge hackberry tree that had dominated (and shaded) our backyard died. I loved that tree. To console myself, I hired the wonderful Janet Gaskin of Landscape Design to completely redo the backyard. We did away with the grass lawn, planted three big river birches, installed a pond with waterfall and stepping stones, and created the lovely oasis I've enjoyed ever since from the screened back porch, where I can be found whenever the weather permits. 

When age and Parkinson's forced me to retire the bike, gardening took over as my prime outdoor activity.

Three New (Unapproved) Drug Applications for Parkinson's

We haven't talked about Parkinson's for a while. Time to check in on recent news.

Three recent drug therapies show promise for people -- like me -- with Parkinson’s. The findings were presented in late March at the annual meeting of the American Academy of Neurology in San Diego, CA.

DROXIDOPA for Dizziness when Standing Up
About one fifth of the one million Americans with PD experience light-headedness when they stand up, a result of rapid blood pressure drops. Patients’ autonomic nervous systems fail to produce adequate amounts of the hormone norepinephrine when their postures change.

Dr. Robert Hauser, professor of neurology and director of the University of South Florida Parkinson's Disease and Movement Disorders Center in Tampa, studied 225 people who shared this problem. Half of those subjects received droxidopa (still unapproved in America), which the body converts into norepinephrine. The other group received a placebo.

After ten weeks, the droxidopa group had experienced a “two-fold decline” in lightheadedness and dizziness, and fell lest often.

TOZADENANT to Combat the “Wearing Off” of Levadopa
Hauser studied 420 patients who regularly experienced a decline (“wearing off”) in the effectiveness of their levadopa therapy. Subjects on average encountered about six hours of “off time” every day as a result of the wearing off effect of levadopa.