Perhaps the question "Do we need healthcare reform" is more than a bit rhetorical. Just about anyone who has had a significant interaction with our health care system (with or without the benefits of health insurance), is likely to conclude that reform is needed -- even if only to fix the broken and inefficient system for determining what is covered and who should pay how much for each service. Those less fortunate who have no health insurance would certainly benefit from reforms that lead to universal coverage.

The current discussions and proposals for healthcare legislation prompted me to summarize my own thinking on why we need healthcare reform, and record those thoughts here.

Healthcare costs are damaging our global competitiveness
The current US healthcare payment system is unsustainable, causes economic harm, and is damaging America’s ability to compete in the world marketplace -- GM and Chrysler are just the tip of the iceberg. As Craig Barrett said when he was CEO and Chairman at Intel,
"...if you are interested in U.S. competitiveness, as I am, then you have to say that healthcare is the biggest boat anchor, the Achilles heel going forward. We need to do something … If you continue along the current track... every job that can be moved out of the Unites States, will be moved out of the United States because of healthcare costs." [keynote address to HIMSS, Sep 26, 2006]

We are leaving key segments of our population uncovered for healthcare
Despite the largest per capita spending on healthcare of any nation in the world (now over $8000 per person per year, consuming over 17% of our GDP), we leave large segments of our population uninsured for healthcare treatment. At any point in time, about 45 million people have no coverage. An astonishing 86 million people in the U.S. were uninsured at some point during 2007 and 2008, and 66 million were uninsured for at least 6 months during that 2 year period. [http://www.familiesusa.org/assets/pdfs/americans-at-risk.pdf]. Huge inequities also exist because health insurance can be canceled when an illness causes a job loss, and chronic or past illnesses cause health insurance to be unaffordable.

We rank poorly on measures of effectiveness of our healthcare system
We are in last place among 19 industrialized nations on deaths that could have been prevented with better healthcare. On the most recent comprehensive analysis of the quality of our healthcare system, we averaged a score across 37 performance indicators of 65 out of 100, where a benchmark score of 100 has been achieved by best practices within the U.S., or in other nations. [Results from the National Scorecard on U.S. Health System Performance, 2008, http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2008/Jul/Why-Not-the-Best--Results-from-the-National-Scorecard-on-U-S--Health-System-Performance--2008.aspx]. The reasons for this performance are complex - it is also true that for a variety of conditions (for example, heart attack and breast cancer), if you have health insurance, then your survival appears to be greater in the U.S. that it is in other countries with advanced healthcare systems (for example, Canada).

The current system of delivering and paying for U.S. healthcare is incredibly inefficient, because it spends inordinate amounts of money, and fails to provide basic and needed services for a large segment of the population. The need for healthcare reform is acute, and the Obama administration has said it believes any reform package must necessarily address all of these problems.

Why haven't we fixed this crazy system already?
Unfortunately, there is a reason that reform efforts over the last 30 years have failed. The complexities of figuring out viable reforms include:
-It is not economically possible to add coverage to the uninsured using the current system to deliver care.
-The current healthcare players (EG, insurance and pharmaceutical companies, and healthcare providers) will resist powerfully any changes to their current business models.
-The public is susceptible to media messages that will portray any proposed change as a government takeover of private healthcare, or a taking away of existing rights and access to care. The current media bias in reporting of the benefits (and weaknesses) of other countries' systems of healthcare is striking.

Competition in healthcare versus universal coverage
There is a strong business sentiment to harness market forces to improve efficiency in healthcare. For example, Health Savings Accounts exist to encourage people to make cost-efficient decisions in their healthcare spending. Unfortunately, people have few resources to assess the quality of care they will receive and to make judgments about cost-effectiveness - although it is clear how to select the lower cost options. Unfortunately, when life is threatened or severe pain is involved, most people stop paying attention to the cost of healthcare services, and want only the best possible and immediately available care.

A bigger problem with the increased use of market forces to drive personal choice in healthcare is that such systems must allow people not to buy if the price is too high. So people of low or modest means are more likely to choose not to be covered or not to purchase expensive care. This is dramatically at odds with the expectation that people should not die or suffer serious consequences because they have no access to needed healthcare.

Is there a solution?
Based on our history and legislative traditions, and the acknowledgment of same by our current administration, it does seem that any reform that has a hope of making it into law will be incremental rather than transformative, and will build on the existing parts of our healthcare patchwork. The challenge will be to combine market-driven or incentive-based mechanisms that drive real reductions in cost with a subsidized option for healthcare coverage for those who currently cannot afford it (or choose not to purchase it).

The viable solutions to this problem will likely include reform or regulation of private health insurance companies, a public insurance option that forces economic efficiency on the private insurance companies (and that allows some to fail), plus financial incentives to providers that lead to improved quality and efficiency.

There will be discussion of how we can use prevention as a means to reduce the need for healthcare, but to date, no method of delivering systematic improvement in our healthy behaviors has been offered.

I'm afraid there is a danger that we will end up expanding coverage only incrementally for those who need it most, and we will be tempted to pay for that by reducing payments to providers, without reducing administrative inefficiencies and alleviating both direct and hidden costs of malpractice. True reform and the ability to expand coverage to all who need it will require structural changes that will be politically very difficult to achieve.

In fact, if we do not create a more efficient healthcare system, we will not be able to keep people insured, let alone expand coverage to those who do not have it now. Based on recent speeches by Obama, and on comments made by secretary of HHS Sibelius, it appears that the administration does understand this issue.

I'm hopeful that the recent groundswell of support for reform, including specific support for a public health insurance option, will be sufficient cover to allow our politicians to pass an effective reform plan. My great concern is that the forces lined up against a truly effective and efficient public option could lead to a public option that is by design unable to force cost reductions (such a design for the public option would harm the viability of private insurance companies' current business models). Without cost reductions, we just won't get significantly expanded coverage.

I hope not. It still seems inconceivable that we can leave in place a system that spends more money per person on healthcare than does any other nation, and yet fails to deliver care to such a large number of people who need it.

Today, the Director-General of the World Health Organization raised the Pandemic Alert level to phase 6. This is the highest level for a global pandemic, in response to the extent of spread of this new H1N1 virus (it's now in over 74 countries). The phase 6 level is not in response to any increase in severity. In fact, the Director-General, Dr. Margaret Chan, said in her statement today that

"...the overwhelming majority of patients experience mild symptoms and make a rapid and full recovery, often in the absence of any form of medical treatment... we do not expect to see a sudden and dramatic jump in the number of severe or fatal infections."
(you can read the full text of her statement )

The main reason that this new virus is being taken so seriously is that, compared to typical seasonal flu, there are a small number of more severe cases occurring among young people (under age 25), and a number of fatalities have occurred among people in their 30's and 40's who have one or more risk factors, such as respiratory or heart conditions, diabetes, autoimmune disorders, and obesity. So far in the U.S., just over 2% of confirmed cases have required hospitalization, although that is probably an overestimate, given that most of the milder cases are never confirmed as H1N1 infections.

As I mentioned yesterday, the number of cases in the U.S. has dwindled, and I don't see any cause for panic regarding this pandemic. We are likely to see a worse than usual flu season this fall in the U.S., when the H1N1 virus will return, and the flu is likely to affect more and younger people. It's also true that many of the less well developed nations may suffer more when the H1N1 virus hits, because they have more people with chronic illnesses and fewer resources to treat serious illness.

The good news is that this less severe pandemic is giving the world a chance to exercise the Global Outbreak Alert Network, and the WHO, CDC, and public health services around the world are gaining more experience and practice in how we identify, monitor, and respond to pandemic illnesses - this experience will be valuable when we face the more serious worldwide pandemic illnesses that will inevitably come in the future.

Of course, we still have to watch this virus closely (the current flu season in the Southern hemisphere will tell us a lot about what is likely to happen here in the fall). There is always a chance that this virus will mutate and become more virulent, but there is no sign that has happened so far.

For me, living in California, the exercise we are in now feels a bit like earthquake preparedness. We know the next major event is inevitable, we just don't know when or where it will happen.

It seems the Swine flu, now renamed the H1N1 flu, has petered out in the U.S., with the number of new cases reported on the dramatic decline (although pockets of smaller outbreaks persist). The only concerning feature of this pandemic is that there have been a small number of more serious cases among people under 24 years of age - The good news is that it appears that people over the age of 60, who typically suffer the most from seasonal flu, are in fact less likely to be seriously affected by the H1N1 virus if it returns with greater force in the fall.

This updated Google Flu Trends plot shows that there was only a tiny blip in flu cases at the end of April, compared with the number of seasonal flu cases this past winter.

The WHO may decide to elevate the Pandemic Alert to the highest level (phase 6), but that would be only because this new virus has spread to over 70 countries, not because the virus has shown a more lethal behavior. Interestingly, the WHO criteria for their pandemic alerts are being questioned because they are based only on how wide the distribution of the pandemic is, and do not reflect how severe the pandemic illness is (you can find the details at http://www.who.int/csr/disease/avian_influenza/phase/en/index.html ).

There has been an uptick of cases in Australia and New Zealand, but that is expected at this, the beginning of their flu season. The world will be watching to see how much of a problem the H1N1 virus will be for them this July and August.

Of the 27,737 cases reported to the World Health Organization so far, there have been only 141 deaths. In the U.S, there have been over 27,000 cases identified, with 27 deaths. Compare those numbers to the 200,000 cases and over 30,000 deaths that are attributed each year to the seasonal flu in the U.S. alone!

As of now, it appears that the usual recommendation for seasonal flu vaccination will remain in place for this coming fall. The CDC has prepared the way for a second vaccine to protect against the H1N1 virus, should that become necessary.

My main concern is that the media response to the reporting of each case and each death was a bit of a "cry wolf". When the next strain of a truly dangerous virus appears (and it is only a matter of time until that happens), the public may be conditioned to ignore or downplay the early warnings.

On the other hand, the entire exercise was a bit of a fire drill for our federal and state health authorities. And fire drills are a good thing to practice before the real fire happens.

Sources: who.org and cdc.gov

There is quite a buzz about the Swine Flu outbreak that began in Mexico and is now gaining ground in the U.S., especially after the US Department of Health and Human Services declared a public health emergency, and the World Health Organization (WHO) declared yesterday that the swine flu outbreak had reached "phase 5", worldwide pandemic status.

The reports of about two thousand hospitalizations and 159 deaths in Mexico led to great concern that this virus may be transmitted easily from person to person, and may cause a high rate of death among those infected. The swine flu is caused by a new strain of the influenza A (subtype H1N1) virus that appears to have made a cross-species jump from pigs to humans. This virus is not the same as the previously identified human strain of influenza A subtype H1N1, and this year's influenza vaccine does not protect against it.

The concerns about a global pandemic from a new influenza virus are real -- the 1918 "Spanish flu" (H1N1) pandemic killed at least 50 million people globally (some estimate up to 100 million died from it), and the death rate was more than 10% of those who fell ill. That pandemic killed more people than died during all of World War I, and more than died during the four years of the "Black Death" or bubonic plague, from 1347-1351.

Over the past decade, we have identified a new and even more lethal subtype of an avian influenza virus, the "bird flu (H5N1)." A great concern driving a fear of impending global pandemic is that if the bird flu mutated and became easily transmittable from person to person, it could lead to literally hundreds of millions of deaths worldwide.

So will the swine flu cause a major deadly global pandemic? The truth is that we don't yet know the biology of this new virus and the clinical behavior of the infection it causes. So far, it has shown that it can travel from person to person, but there are no signs that it is substantially more lethal than the previously known causes of seasonal influenza. Of over 100 reported cases in the U.S. as of today, there has been only one death of a toddler in Texas who had traveled to Mexico. Probably more important, we are at the end of the usual flu season, so the seasonal factors that lead to enhanced influenza spread are not with us (The seasonal cycles may be due to climate, indoor heating, patterns of congregation , and so on).

You can see the patterns of influenza in the online tool "Flu Trends" :

(from http:// www.google.org/flutrends/)

The Flu Trends application is a great resource to help understand the patterns of influenza outbreaks in the U.S., and to see where we are in the annual flu season cycle. This graph shows that there is no evidence (yet!) of a widespread pandemic of people with respiratory illness in the U.S., although there is for the first time today a barely visible flattening of the usual downward trend. This tool may provide the best real time measure to monitor this outbreak and see how widespread the influenza pandemic becomes.

I do think the swine flu will likely spread and will cause many people to fall ill, and that it will kill many more - but we should compare the number of these deaths to the over 30,000 deaths that we usually see each year from influenza in the U.S. We don't yet know that this virus will come anywhere close to that number. It's challenging to predict the course of a new and relatively unknown virus, but I'm quite hopeful that the outbreak will not turn into a major deadly pandemic within the U.S. in the next few months. On the other hand, even if this outbreak does die down quickly, we are likely to see a return of this virus in the next fall flu season.

What can I do to avoid getting the swine flu?
The recommendations for each of us are simple. Wash your hands regularly, and especially after shaking hands with others. If you come in contact with someone who is suspected of having swine flu, then see your doctor and ask about taking antiviral medications, either seltamivir (Tamiflu) or zananavir (Relenza). You should suspect someone of having swine flu if they have a respiratory illness (fever, cough, sore throat, runny nose, congestion) and were in contact with someone thought to have swine flu or traveled to an area where there was an outbreak of swine flu (e.g., Mexico city).

If you do develop a fever and symptoms of a respiratory illness, see your doctor to discuss whether you should start antiviral medications, and ask your family members and close contacts to do the same. If you are sick, stay home from work or school, and avoid crowded places, such as theatres, clubs, subways, airplanes, and shopping malls! Also, if you are caring for a child, don't give aspirin or PeptoBismal, as these may increase the risk of Reye's syndrome.

Above all, don't panic. So far we haven't seen any reason to be more fearful of the swine flu than we are of seasonal flu during the regular flu season.

Here are some resources that you may find helpful if you would like to learn about the swine flu virus and the potential for a widening outbreak of influenza in the U.S.

- A great starting point for information about swine flu is the WellPage on this topic, which lists the articles from the HealthBlogger network, and also shows valuable links in the Trusted Web Resources and News sections: http://www.wellsphere.com/wellpage/swine-flu

- HealthCentral has created a special page on the Swine flu at http://www.healthcentral.com/cold-flu/swine-flu.html

- Daily updates of progress of the outbreak are issued by the Center for Disease Control (CDC) at http://www.cdc.gov/swineflu/

- You can find a comprehensive and understandable summary of the virus causing this illness on the World health Organization website: http://www.who.int/csr/swine_flu/swine_flu_faq.pdf

I recently found an interesting blog called InspirePossibility.com that I thought would make a great addition to our Happiness Community. I was pleased when the author of this blog, Mark Susnow, responded to my invitiation to join the HealthBlogger Network by email:

"Thanks for your email and sharing with me your vision of making a difference in the world. I would be honored to part of your community"

Mark followed up his acceptance with a phone call, and we had a chance to connect. I was impressed with the peaceful enthusiasm he emanates. It seems he felt unsatisfied as a litigation attorney, and turned to music, yoga, and meditation to balance his life. In 2000, he gave up his established practice, and has since then found greater meaning in his life as an Executive and Life coach, helping others and working to "inspire others to find more fulfillment and success in their life"

I must admit I found his energy and enthusiast uplifting. I'm looking forward to the publication of his next book: "Dancing on the River…Finding Joy and Meaning in the Midst of Success", which is scheduled for release later this year.

For now, I'm pleased to share this article from one of his recent newsletters:

6 Secrets for Finding More Joy and Meaning in the Midst of Success.
by Mark Susnow

You might have your own definition of success. Success is more than making money. Success is more than being recognized in a career. It’s about being happy. It’s about liking who you are. It’s about having loving relationships. But if you are successful in a career and don’t have time to share your success with loved ones, you are missing out on one of the joys of life. With your busy lifestyle, you wonder how you can find that balance.

1. How you start your day sets the tone for the day. If you start the day in a hurry it’s extremely difficult to slow down. What I have seen is that most people wake up in the morning--rush out of the house, trying to make an appointment or deadline. Underneath their concern that they won’t be able to get it all done, is an underlying anxiety. Perhaps you feel the same way. You sometimes wish you had a magic wand that could make things different.”

Although there is no magic wand there is a morning practice that if implemented can change your life. After you wake up and before you do anything else, take 10-15 minutes for reflection. Perhaps you already have a meditation practice. If you don’t, just sit still and pay attention to your breathing.

After ten minutes or so, begin to focus on what you are grateful for. Perhaps there might be only a few things that you can think of in the beginning, but once you make this part of your daily practice, you’ll realize how blessed you are. By focusing on what you are grateful for, you shift your focus from what’s wrong about your life to what’s right. It’s an amazing practice, which has the power to transform your life.

Then by wondering about what the highlight of your day might be, you create a positive expectation as the day progresses. Briefly scan what you have to do during the day with that focus in mind. Of course you’re always open to those pleasant surprises… those moments of grace that uplift your spirit. It might just be for a moment or two but you are totally present in that moment.

2. Learn how to recognize and know your VOJ. The VOJ is that voice of judgment that drives you nuts. You would give anything to silence it for a few minutes. The sooner that you can recognize your VOJ, the sooner you can become free of the hypnotic spell that can last a lifetime if you don’t do anything about it. Doubting and self-criticism become the norm. But the doing is a different type of doing. It’s just noticing when the VOJ raises its voice. Simply by recognizing it, you break the spell. I have found that giving this voice a name is most effective in breaking the spell. I call my VOJ, Ralph. This is a lifelong challenge so don’t be discouraged if it doesn’t happen overnight.

3. Self-Acceptance is the next secret. Let’s be honest with ourselves. There are certain things we can’t change about ourselves. We can’t change who are parents are. We can’t change our country of origin. We can’t change all of the injustices in the world. We can try. But we can change, although challenging, how we think about ourselves and our circumstances. And we can change, although challenging, how we think about our bodies. Even though we are our own worst critics, our work is to accept those things that we don’t like about ourselves. It’s the acceptances of these attitudes and beliefs that is so freeing.

4. Introduce positive self-talk (VIP) into the conversation. Now that you are more familiar with those voices and patterns that have been running your life, it’s time to listen to a new voice that needs to be nurtured and cultivated. It’s a voice if honored and respected can change how you think about yourself. I call this voice your VIP. It’s the voice of Inspiration and Praise that we don’t listen to or hear enough. That voice, that I call Buddy is my inner champion. When I think that I shouldn’t have felt the way I did about something that happened or that I shouldn’t have acted in a certain way, Buddy sends me a few words of encouragement. He says to me, “you’re doing great. You handled that well.”

It takes conscious effort and resolve to cultivate your VIP. As you learn to trust and listen to it, how you feel about your life will shift.
Our work is to create more points of light that inspire us and make us feel good

5. Make time for the Jollies. So here we are again with another new phrase. No I haven’t lost my mind.
We all have our share of challenges that concern us from time to time; some more challenging than others. Some of us feel overwhelmed by all that we are faced with.
Even though life might be like that for you, there are still a lot of things that have given you joy at one time or the other. They might be little things that you have forgotten about.
Lately I have made time for tennis. I forgot how much fun playing tennis is. The same thing for dancing. Going dancing is always a lot of fun especially as I get better. The Jollies is taking the time to do what gives you joy. So when I say make time for the jollies…I mean make time for what gives you “joy.”
Those things that you have to do or that you are concerned about, don’t go away. Even when your “to do” list has plenty of things on it and you still have loose ends in your life, still make time for the jollies whatever they are for you. In the beginning it might take effort, but it wlll have a profound effect on the quality of your life.

6. Smile and laugh a little bit more than yesterday. Most of us are too serious. I was certainly that way. Once you accept those things about yourself that you used to be embarrassed by, there is no question that you will be lighter.
And isn’t that what it’s all about--becoming lighter.

When I was younger I thought about becoming enlightened. Enlightenment was the carrot that kept me going on my spiritual quest. With family and career my focus shifted. Even though I stopped thinking about enlightenment it still popped up from time to time. So I have come up with my definition that works for me. It means to “lighten up.” When you do, you have less stress, better health and more fun. I’m not suggesting for you to go out there and perform standup comedy, but see what happens if you tell a joke once in a while. Becoming more playful is a worthy challenge and a gift to all who are in your presence.

I'm saddened to tell you that a young and beautiful member of the HealthBlogger network recently passed away. Shawndra Turner was just 32 years old when she lost her very valiant and courageous battle with colon cancer. Shawndra wrote an inspired blog (Shawndra's Blog) that chronicled her journey, and demonstrated what an incredible spirit she has.

In her last posting on March 3, she wrote "Thank you all for your continuous support you give my family. I believe it is getting closer to the end of this journey and we are going into it blindly, trying not to fear but to give up our control and take it day by day … love you all. Shawndra" She received love and support from her husband Douglas and young daughter Ella, and many other family and friends who helped her on this journey.

Her husband Doug posted on her blog:
"A recording of [Pastor Les Beachamps's] "rememberance" of Shawndra may be downloaded as an MP3 file from Shawdra's remembrance (Right-click on the link and choose "save link as". Here's a free media player to play it -- http://www.winamp.com/) "

Shawndra's family asks that any contributions be made to Solace House, 8012 State Line Road Suite 202, Shawnee Mission, KS 66208, a center for grieving children and their families.

Dr. Richard Keller, the coroner in Waukegan, Lake County, IL, keeps an active blog "Live from the coroner's office" where he provides very interesting posts about life (and causes of death). His position as coroner gives him insights into the changing patterns of the causes of death.

Recently, he has posted on such topics as
- the rise in heroin-related deaths and how this may be related to higher concentration of heroin sold on the street
- the difficulties an uninsured 20-something man had in getting a much needed (but non emergent) operation on his broken leg
- problems associated with non medical use of pain relievers
- and a suggestion for an improvement to the Wellsphere Tip of the day widget (thanks, Dr. Keller!)

I thought this post on why we should pay attention to the basics of diet and exercise was a story worth repeating.

Heart attacks don’t only attack ‘old folks’
by Dr. Richard Keller

Shocked, concerned, dismayed, I’m not sure what word to use.

In the last couple of weeks we have had 3 folks in their 30s die due to heart disease. Granted they were overweight and had histories of hypertension, but seeming so young to have life-threatening (life ending) heart disease. Most of the time you don’t think of heart disease killing at such a young age.

What is going on? These folks, for the most part, didn’t access our healthcare system for personal of financial reasons (that can be hard to sort out, not being able to talk with the person involved in the decision making). Apparently, they weren’t able, for whatever reason, to make life style changes to impact the obvious risk factor with diet and exercise. Folks need to know the health decisions you make at any age (even when you are young) can, and does, impact your longevity.

Do what you can to not die before your time. Make good choices.

Dr. Dominic Gaziano is a wellness practitioner based in Chicago. He calls himself "The Feel Good Health Guy, Health and Wellness Expert." His background in Internal Medicine guides his recommendations and advice for his patients, which he provides to help them find a path to wellness. He offers helpful pointers, tips and advice on the TV show he created "Health & Lifestyles Weekly." What's more, he now authors a great blog at feelgoodhealthnow.com where he shares his insights.

His blog includes articles on "Feel Good Fall Tips", "Fall Flu Shots", "Arthritis and Diet", "Holiday Health Tips", and the following article promoting February as American Heart Month:

American Heart Month During February
by Dr. Dominic Gaziano

Did you know that February is American Heart Month, and not because of Valentine's Day? Every year, the President has issued a proclamation to this effect, to help raise public awareness of heart disease. Even though most people associate heart disease with men, it's also the leading cause of death among women.

In 2009, an estimated 785,000 Americans will have a new coronary attack, and about 470,000 will have a recurrent attack. About every 25 seconds, an American will have a coronary event, and about one every minute will die from one
Cardiovascular diseases, including stroke, are our nation's No. 1 killer.

To urge Americans to join the battle against these diseases, since 1963 Congress has required the president to proclaim February "American Heart Month."

The American Heart Association works with the administration to draft and sign this annual proclamation.

During American Heart Month, thousands of volunteers visit their neighbors. Their goal is to raise funds for research and education and pass along information about heart disease and stroke.

The chance of developing coronary heart disease can be reduced by taking steps to prevent and control factors that put people at greater risk. Additionally, knowing the signs and symptoms of heart attack are crucial to the most positive outcomes after having a heart attack. People who have survived a heart attack can also work to reduce their risk of another heart attack or a stroke in the future. For more information on heart disease and stroke, visit CDC's Division for Heart Disease and Stroke Prevention.

This week, I'm delighted to introduce you to a blog that helps to inform on the topic of age-related macular degeneration (AMD), a common cause of progressive blindness in seniors.
Irv Arons worked as a consultant to the optometry and opthalmology industry, and published a newsletter, Executive Laser Briefing, until he recently retired. He now contributes through his blog, where he posts timely and informative information about AMD for others to learn about this condition that all too often robs the elderly of their vision.

Irv's most recent posting informs us about all the current clinical trials that are underway that address AMD:

AMD Update 3: Current Studies for Treating Macular Degeneration
by Irv Arons

In its upcoming February 25th issue, Ocular Surgery News presents a table of ongoing clinical trials for treating age-related macular degeneration. I have reproduced the table below.

For more information on any of these, or the 186 current open trials for treating age-related macular degeneration, please go to Clinical Trials.gov. By using the “Refine Search” tab, and putting in the name of any of the trials listed in the table into the search box, you should be able to gain more information about each.

(By right-clicking on the table image and opening in a new tab or window, a larger more readable version will appear.)

I am very excited by the merger of Wellsphere and HealthCentral and the possibilities it creates for members of our vibrant Health Blogger Network to reach a larger audience and get more recognition for their blogs. As a health blogger, a caregiver, and a physician, I'm thrilled to be able to expand our positive impact and make a bigger difference in the lives of people who need it most.

Please take a moment to read through a message of welcome from Chris Schroeder, HealthCentral’s CEO, and Ron Gutman, Wellsphere’s Founder and CEO, on what this new partnership means, and the opportunities ahead.

Geoff
--

Dear Wellsphere Community Members, Health Mavens, and Health Bloggers,

Earlier today HealthCentral, a leading publisher of over 35 websites for individuals facing specific health challenges, announced that it has acquired Wellsphere.

This is an incredibly exciting moment for every contributor to HealthCentral’s and Wellsphere’s communities, and for the 10 million health consumers who, each month, seek and find powerful information and invaluable support from each of you. Our communities offer unparalleled insight, practical advice, and inspiration for people who want to live better and fuller lives.

HealthCentral has built, and will continue to build in partnership with you, welcoming and supportive communities – places that reflect the natural respect between people in need, and each of you, who share incredibly moving experiences in service of a greater good. Through our new relationship, your perspectives will now reach millions more health consumers in powerful new ways. Over the years, HealthCentral has built strong relationships with its many distinguished contributors – many of whom independently operate personal blogs or communities – and it has a reputation of working openly and honestly with its community members. We will carry this spirit of partnership as we move forward together, to build new opportunities for and with you, to recognize uniquely powerful voices and the collective chorus of your wisdom.

If you have a question about your relationship with Wellsphere, or the meaning of Wellsphere’s new association with HealthCentral, please e-mail us at community@wellsphere.com .

We welcome your ideas, your suggestions, and your concerns, and look forward to building with each of you, a uniquely welcoming place for everyone who comes to us for help and for hope.

Sincerely,

Christopher M. Schroeder, CEO, HealthCentral
Ron Gutman, Founder and CEO, Wellsphere

I'm delighted to share with you some exciting news from Wellsphere. Here are the details from our CEO, Ron Gutman:
------------------------
Dear members, writers, and users,

It is my pleasure to share with you some very exciting news: Wellsphere has merged with HealthCentral to create the world’s premiere online health technology company, the second largest organic online health enterprise, and the number one network of online health communities!

Wellsphere’s mission has always been to help millions of people live healthier, happier lives by connecting them with the knowledge, people and tools they need to manage and improve their health. Now, together with HealthCentral, we can help tens of millions of people every month!

HealthCentral shares our goal of delivering accurate, condition-specific information to consumers where and when they want it. The comprehensiveness of quality information is what makes the HealthCentral-Wellsphere combination so unique. Combining HealthCentral’s breadth of content and resources with Wellsphere’s technical expertise and the world largest network of leading health writers will enable us to build on our current success on a much broader scale.

Over the past year, Wellsphere has experienced tremendous growth, having grown from less than 100,000 monthly visitors to a current run rate of more than 4 million monthly visitors (yesterday we served more than 160,000 visitors to our site in one day!). At the same time, our Health Bloggers Network has become the world’s number one community of health writers with more than 1800 active contributors serving our users daily. From the early days at Stanford when I put together a multidisciplinary group of students and professors to research ways to help people lead healthier lives, to recently becoming the fastest-growing top consumer health website, we have always focused on listening to our users, improving our products and services to meet their needs, and expanding our reach and impact. Locking arms with HealthCentral will enable us to serve many more people around the world, and provide us with the substantial resources required to sustain our rapid growth. HealthCentral has a strong sales organization and is backed by some of the world’s premier investors (Sequoia Capital, Carlyle Group, Barry Diller’s Interactive Corp., Allen and Co., and Polaris.)

If you are one of the amazing health writers in our network, you may be excited to know that we will continue to empower you and deliver your extensive knowledge, support and inspiration to an even larger audience than before to ensure you receive the recognition you deserve. If you are a Wellsphere member, we will continue to improve your experience as we are now hiring more great people to help us create an even higher quality, quicker, easier to navigate experience on our site, and build new features and functionality to better serve your health knowledge and support needs.

In the words of Winston Churchill: “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning." Here at Wellsphere, we feel that we have successfully completed the first chapter of our book, bringing Wellsphere from a research project to a thriving company that successfully serves millions of people in this country and around the world. We are looking forward to the next chapter in which, together with our new partners we will build the best and most innovative online health company, and work to make a positive impact on the lives of millions of people, starting with YOU!

Ron Gutman,
Founder and CEO

Today's featured Medical Expert is Dr. Angela Gardner, MD, FACEP a remarkable physician who was recently elected president of the Amercan College of Emergency Physicians. As an emergency doc myself, I applaud the commitment to the profession that assuming this leadership role entails. You can read more about her in the press release. Dr. Gardner sets an example for her colleagues by agreeing to be a Health Maven, offering to help others who need answers to their health questions online. The good doctor also helps people directly through her blog. I post here an example of the wonderful advice she offered recently, on the occasion of the New Year. Dr. Gardner is participating in the People's Health Blogger Awards competition, so if you agree that Dr. Gardner deserves your vote, you can vote for her by clicking "Vote Now" here (or just visit Gardner's Gate and click her Vote Now button on her blog!) Do it now, because voting ends on January 31, 2009. 10 Things to do Today by Dr. Angela Gardner

Angela G. http://gardnersgate.blogspot.com/

_____1. Clean out the medicine cabinet.

If possible, relocate the contents to another area of the house. The heat and humidity of the typical bathroom are not good for medications.

_____2. Throw away any prescription medications more than a year old.

Medicines lose their potency and may even be harmful if they are expired.

_____3. Make a list of all medications, including over-the-counter and herbal medicines.

Include the name of the medicine, the strength (mg, units, etc), the prescribing doctor's name, and the way that it is taken (twice daily, at night, with meals, etc.)

_____4. Make a copy of the medication list. Place the list in a clear jar with a lid, and place the jar in the back left corner of the top shelf of the refrigerator.

In the event of an emergency, loved ones and EMS will not have to dig through a pile of paperwork to find the medication list.

_____5. Program an "I.C.E." number in your cell phone.

I.C.E. stands for In Case of Emergency. Program the number of the person that you would like to be notified if you are unconscious or unable to speak. Many EMS, fire, and police departments now look for this number in an emergency.

_____6. Check your thermometer. Does the digital display work?

If you do not have a digital thermometer, get one. They are easy to use, will not shatter, and do not contain mercury.

_____7. Throw away any sunscreen left over from last summer.

Sunscreen ingredients do not have a long shelf life. Using a sunscreen that has been open for a year could result in an unexpected sunburn, and increases the risk of developing a cancer related to sun exposure.

_____8. Replace the batteries in the emergency flashlight in the medicine cabinet.

An emergency flashlight in a known location is important to prevent falls and/or injuries in case of a power outage.

_____9. Replace the batteries in ALL of the smoke detectors in the house.

This should be done twice yearly. Replacing the smoke detector batteries on New Year's Eve and the Fourth of July makes it easy to remember.

____10. Have a happy, healthy, and safe new year!

Today's featured Top Health Blogger is Dr. Susan Biali, MD a physician who is a Life Coach, inspirational speaker, and Flamenco dancer! She earned an undergraduate degree in Dietetics (Nutrition) and a doctoral degree in medicine before training in Emergency Medicine. Now, in addition to maintaining a part time clinical practice, Dr. Biali helps others through her work as a Life Coach, wellness consultant, and inspirational speaker. Her byline is "Discover the secrets of Health and Happiness from the Flamenco-Dancing Doctor!" Her background in nutrition and medicine gives her a great ability to help others achieve healthy eating and a healthier lifestyle. I'm looking forward to reading her upcoming book, Your Prescription for Life! Seven Steps to Extraordinary Health & Happiness, to be released by New York's Beaufort Books in January 2010.

Dr Biali publishes her blog at SusanBiali.com, which appears on Wellsphere in the happiness community. She shares her understanding of why we overeat in a post that is fitting for this season of New Year's resolutions.

How to Stop Overeating: Look Good, Feel Better, Forever!
by Dr. Susan Biali, MD

What’s your relationship with food like? From the time I was around ten years old, and my aunt invited me to try my first “diet” with her (eating only grapes – we lasted around six hours), until just a few years ago, I was obsessed with food and the way that I looked. Even though most of that time I actually looked pretty good, I didn't think I would ever be "good enough".

I was recently interviewed about this issue as a panel expert on the national show The Daily: Weekend Edition with Todd Cantelon(www.thedailyweekend.ca ) , and was floored when my beautiful friend (and co-producer of my upcoming show), Stephanie, commented on-air that she’s felt awful about her body her entire life, even in her twenties, when she performed as a (no-doubt-drop-dead-gorgeous) go-go dancer! That illustrated to me, yet again, that the way we feel about our bodies, and ourselves, is an internal phenomenon that often has nothing to do with reality, or the wonderful version of “you” that so many other people see and appreciate.

The same goes for dieting. On the outside, we may try out some new weight loss fad, or promise ourselves that we’re going to stick to a new “diet”, but our enthusiasm disappears after a few days and we find ourselves right back in old habits. We fail because we don’t understand what’s really going on inside of us. We don’t understand our relationship to food, our ideas about weight loss, and why we can’t succeed with this goal. Most diet programs don’t properly address our behaviors and beliefs around food, and they also aren’t designed to be sustained for life.

From the age of ten through twenty, I dieted obsessively. At its worst, I counted calories all day and panicked if I couldn’t find a restaurant option that was “low fat”. I hit bottom the day I bought a sandwich at the deli at work. They didn’t have my usual whole wheat, and had to use multi-grain bread with sunflower seeds. I was so worried about the extra fat in the seeds, that I hid myself in a bathroom stall, and picked them out, one by one.

Shortly after, my boyfriend (of two weeks) told me that he’d break up with me if I didn’t get some help. He gave me the card of the dietitian that his sister, who suffered from anorexia, had been seeing. I went to see her, and he broke up with me anyway! But I’m convinced that he was sent into my life, just to give me that card.

The dietitian informed me that at the rate that I was exercising (long daily workouts), and given the minimal calories I was eating, I was sure to be hugely suppressing my metabolism , and actually making it more likely that I would gain weight, not lose it. She made me a bet that I will never forget:

“I want you to leave my office today, and eat whatever you want, whenever you want, but follow one rule. If you follow this, I bet you that you will not gain a pound and you will equalize out to your perfect weight. This is the rule: only eat when you’re truly hungry, and stop when you’re full”.

I only saw her one more time – to tell her that she’d been right. Today, I actually weigh slightly less than I did back then, seventeen years ago - and I only weigh myself approximately once every three to five years! I don't even own a scale.

Every now and then I “forget”, or more accurately, ignore, her rule (for example, on vacation in Italy), and my clothes start to get tight. Whenever I notice that, I start following the rule again, and go for a bit longer walks. That’s it, works like a charm.

I had to use the rule as a defense this Christmas season, in the face of over-indulgent holiday celebrations with Armando’s family in Mexico. These days, I don’t worry much about weight anymore, but I do know from multiple similar experiences that eating too much rich food, particularly white-flour-based foods, cheese, and chocolate, makes my face horribly puffy, ages me more quickly, makes me sluggish and irritable, and causes my skin to break out. Yet it still can be so hard to resist, or stop!

So many times in the past few weeks I would be sitting at a post-dinner table, feeling full and happy, but staring down a banquet of desserts and goodies. I would be so tempted, almost to the point of pain, to fill my plate with several of them and then go back for seconds. On multiple occasions, it helped so much to just stop, and consult my tummy. Was there really room for more? Was I truly still hungry? Each time, the honest answer was no. I wasn’t hungry, I was just feeling tempted, and wanted to greedily push my body over into the “totally stuffed” mode.

This recognizing of the true already-full state of my stomach helped me put on the brakes, and enabled me to wake up guilt-free the following morning, looking fresh and feeling great. Don’t get me wrong, I failed a few times, and the way I looked and felt after reminded me why the rule is such a great one!

The “eat when you’re hungry, stop when you’re full” rule is about consulting your tummy to see if you’re truly hungry, or if there’s truly room for more. Another essential tool to reaching and maintaining a healthy weight is to be in touch with your reasons for wanting to eat. Like so many people, and maybe like you, I used to use food compulsively to make myself feel good. Why not? It did feel absolutely fantastic whenever I was sitting down with a fork, in front of a giant piece of chocolate cake. The problem was what came after, when the cake was gone. Guilt, shame, regret, sluggishness, allergies and other health problems – the list goes on.

There’s a funny thing about addictive, yummy foods, which is very similar to what alcoholics and drug addicts experience. When I crave something, my brain and body trick me by saying “come on, just this once”. Like this: “Why don’t you get into your car and drive to the grocery store and buy yourself a big tub of rocky road ice cream? It will feel so great. Come on, let’s go – we’ll do it JUST THIS ONCE, you really need it, today. You'll feel so much better, and then we get back to our plans for healthy eating.”

That’s the lie: "just this once". Because it doesn’t work that way. When you indulge yourself with foods that you crave, it’s almost guaranteed that your body and mind will crave them again, sooner and more forcefully than ever, often right the next day. Or, later that same day! The more junk food, or comfort food, you give your body, the more your body emotionally and physically wants it and will ask you for it again. This is very different from hunger.

I'm not saying that you don't ever give yourself comfort food, but overall I've found it far more helpful to find non-addictive, healthier foods that I love and make me feel great, than to "treat" myself to the junk foods that I know will get me into trouble, the things that I "can't just have one" of. There's a sweet granola bar that I really enjoy, for example, but I'm done after just one. A package of chocolate chip cookies? I'd eat all of them in under an hour, and probably lick the bag. I know myself. Know yourself, and admit your weak spots: you'll find it helps, so much.

Pay attention to the difference between the feeling of cravings (from boredom, stress, sadness, habit, comfort, etc.) and hunger. There’s a huge difference. Notice how no matter how much you promise yourself “just this once”, the craving soon comes right back.

The only way to make cravings go away is to interrupt them and shut them down by recognizing them as self-sabotaging feelings and impulses that don’t serve you at all. Do something else instead (call a friend, go for a walk, do something on your to-do list), and the craving will pass. Wait until you’re truly hungry to eat something.

You'll notice that the cravings get less and less, and when you do fail and indulge them (we all do), you will see how truly “empty” that promise of feeling good after turns out to be. You’ll also notice that the cravings come back harder, and with a vengeance.

I’ve found that this understanding of what’s going on for me physically and mentally has made all the difference in the world. I can’t let my body trick me anymore, as I know what it’s up to. I no longer feel that I can’t control my impulses and behavior around food. It’s a wonderful freedom, though it’s not always easy. The results, however, are fantastic, particularly when I see how so many other people suffer with their weight and food.

If you'd like to share with me your struggles and experiences with food and weight, put a comment in below and I will happily respond, I'd love to hear from you.

Make this the year you stop “battling” with food and your weight, and discover a joyful relationship instead, one in which you discover that eating healthy, and eating when you’re truly hungry, makes for a life full of energy and joy and a happier, younger-looking you!

Wellsphere’s 1st Annual People’s Health Blogger Awards is a competition where health bloggers are chosen by their readers to be the world’s #1 Health Blogger!! For the first time, we’re letting health blog readers vote for their favorite health bloggers to tell the world who they think are the best health bloggers online. If you write a health blog, this is your chance to be recognized by the people that matter most – your readers!

You can read all the details of the award and how the voting works at http://www.wellsphere.com/healthBloggerAwards.s It's very easy to participate, just enter your blog URL and your email, and we'll send you the code for your personalized "Vote for Me" badge. It's not too late to compete and be named in the 100 Best Health Bloggers!

Voting for the People’s Health Blogger Awards continues until January 15. Once you’ve entered, people can vote for you on your Wellsphere profile, and anywhere that you (or your fans!) place your Vote For Me badge. We’ll be announcing the winner, as well as the 100 Best Health Bloggers on January 19.

Doctors in the competition

The Health Blogger Network on Wellsphere includes some truly remarkable doctors, including many physicians, surgeons, and psychologists. Here is what one of the physicians said about the competition:

I am honored to be among those doing so well in the People's Health Blogger awards. This has been an opportunity to really open my eyes to some of the wonderful blogging going on at Wellsphere. There are some dynamite patient blogs out there, and wonderful patient resources I may even end up referring patients to. It has also been a great opportunity to find new readership and expand the reach of my blog. It is always great to welcome new people and perspectives to enrich the discussion of health, the brain, and medicine.
Thanks, Brain Doc

I would like to highlight a few of the doctors who participate in the Health Bloggers Network on Wellsphere, and who are competing for the People's Health Blogger Award. In my opinion, they are all worthy of your vote! You can vote for them from here, by clicking on their "Vote now" buttons.

Kudos to all the health bloggers who make it to the 100 Best Health Blogger list on January 19. And may the best health blogger win!

Cheers, Geoff
-

Dr. Gwenn , MD http://pediatricsnow.blogspot.com/	Brain Doc, MD http://mormonmd.wordpress.com
Angela G., MD, FACEP http://gardnersgate.blogspot.com/	Dr. Tony DiGioia, MD http://www.amd3.org/ROblog/
Dr. Paul Hsieh, MD http://www.WeStandFIRM.org/blog	Dr. Rory S., PsyD http://thetruthbehindadhd.com/
Dr. Shaheen Lakhan, MD http://brainblogger.com/	Dr. Lynn Dorman, PhD, JD http://growolderbetter.com/

Dr. Gemzel Hernandez, MD is a clinical pulmonologist whose bio includes pulmonary specialization at the University hospital in Caracas, Venezuela, and membership in both the American College of Chest Physicians and the American Thoracic Society. Dr. Hernandez shares his knowledge through his blog at pulmonologist.wordpress.com. In a recent posting, he provides background information to help guide people with the diagnosis of chronic obstructive pulmonary disease (COPD) -

COPD:Basic Steps to help
by Dr. Gemzel Hernandez

Just Dyspnea and It’s my fault

The COPD patient complains of breathlessness when cough and (sometimes) phlegm have been present for a longer period of time. Some experts have considered that when breathlessness is already installed there are chances for improvement. There are options and no space for regrets. Although the self blaming changes the perspective of some patients, physicians and other health care givers may reinforce the power of the patient.

Patients need to consider their own will since not all the control is on health system’s hands. So what a patient can do?

Understanding the basic: Chronicity

Patients with COPD must understand the chronicity of the disease. It’s not by coincidence that it occurs or develop. More than a lotto result is one of the potential reactions to continuous exposure to noxious particles and gases. Although this exposure happened a long time ago there is a trend in our organism to keep living and the immunological reactions continue.

The risk factors

Smoking is a key risk factor and of course the most important. However, our current environments are polluted and there is some concentration of population in big cities or industrial areas where it’s easier to inhale low quality air. At the same time, there are some occupations that predispose to continuous inhalation of bad air.

Old “Normal” Symptoms

The COPD patient develops symptoms progressively. The progressive appearance of symptoms allows certain level of adaptation. Most of the patients consider their symptoms as normal and tend to accept them as natural until they become bothersome not only for them but for people around. It’s not the cough what bothers people as much as somebody breathing with difficulty continuously.

Education as basics

Considering the relevance of self education in the management of the disease, an appropriate interaction of the patient with themselves, and with information sources, care givers, health system, may help them to cope better with the disease. Some patients may prefer an academic source, while others tend to go to news or friendly scientific writers, but the important issue is to select a few that answer and help according to the individual needs.

It may be good to create regularity visiting some sources of getting information from certain books. However it is the patient who must choice to get the most of the current evolving knowledge on COPD.

Some considerations on self education

As general recommendations, given the constant flow of information, there are some basic things that COPD patients may do to help in their health support:

1. Understand the basics of the disease
2. Conceive it as chronic and progressive
3. Identify the cause and modify it
4. Precise a few sources of written information based on individual needs
5. Stick to the physician directions in terms of medication and office visits

In a next post let’s define more features that may help in the selection of written sources of COPD information.

Today's featured expert is Dr. Rory Stern, PsyD, a clinical psychologist who specializes in child and parental coaching. His passion is to help kids and their parents through information and coaching, and by avoiding any damaging "negative labels." He thinks the label "ADHD" is overused, and that many kids who might be labeled ADHD can be better helped if parents and therapists focus on the underlying problems that contribute to behaviors.

In a recent posting, Dr. Stern addresses the controversy over the use of ADHD medications as a means of improving cognitive performance, and the potential dangers of recreational or other non prescription use of these drugs by students.

By the way, when you visit Dr. Stern's blog, click on his "Vote Now!" button to give him your vote for a People's Health Blogger Award. You can also vote for him on his Wellsphere profile.

ADHD Medications Boost Brain Power?
by Rory Stern, PsyD

For a long time now, there has been a great debate about whether or not stimulant medications (e.g., Ritalin, Adderall) offer those taking it an advantage. After all, the medication’s purpose is to help improve focus, attention, and concentration.

Who wouldn’t benefit from that?

Back in college, I remember students talking about using these medications like this (even those not prescribed) during exams or finals. **This is something I DO NOT encourage or advise!

I’ve really stayed away from this discussion because quite honestly, it ranks up there about whether or not ADHD is even a real condition. You all know how I feel about that…

Anyway, last night, my wife called my attention to a renewed debate about whether or not stimulant medications like Ritalin and Adderall offer students an unfair advantage? The information I found suggests no evidence to support this benefit, but what frightens me the most is that we are having this discussion. It’s NOT a good idea to suggest we supplement our childrens “diets’” with mind enhancing medication.

I found the following blog post on the US News and World Report website - if you’d like to read more.

For me — there are plenty of other natural ways to improve focus, concentration, working memory, and more…

Today's featured medical expert is Dr. Edward (Ted) Leyton, MD, FCFP, CGPP, a physician who specializes in integrative medicine. His background includes a medical degree from University of Western Ontario, fellowship in the College of Family Physicians of Canada, and certifications in General Practice Psychotherapy and Neuro-Linguistic programming and coaching. His practice is in Kingston, Ontario, where he says "I help to move people towards positive aspects of wellness and away from the negative aspects of illness."

Dr. Leyton's blog "Empower Yourself" is published on Wellsphere in the Complementary & Alternative Medicine community. He also publishes a free monthly "Healthy Tips" newsletter, which you can sign up for at Dr.Leyton's Healthy Tips Newsletter

Here is a recent post on the use of Human Chorionic Gonadotropin treatments for the prevention of migraine headaches. I should mention that this treatment is an off label use of a licensed pharmaceutical product, which is not currently a standard or well accepted practice. I do note that in addition to Dr. Leytons' experiences, and the books that his father authored on this topic, there have been a small number of more recent publications documenting anecdotal benefits (see Rev Neurol. 1996 Aug;24(132):977-9.). It seems there may be enough reason to conduct a clinical trial of HCG in treatment of migraine. I know the many sufferers of migraine that is not well managed by current treatment options would welcome such a trial.

THE TREATMENT OF MIGRAINE HEADACHES USING HUMAN CHORIONIC GONADOTROPIN

by

Edward Leyton MD FCFP CCFP

Introduction: Hormonal migraine headaches are defined as a typical migraine headache that occurs in a periodic fashion around the time of the menstrual cycle. The preventive treatment outlined here was first described by Nevil Leyton MB LRCP in London England in the 1940's. Dr. Leyton noticed that migraines could be induced in some individuals who were given estrogen by injection. Subsequently he developed the idea that an 'anti-estrogenic' hormone such as that found in the chorion of the placenta might prevent attacks. This was supported by the fact that for many migraine patients the headaches disappear or markedly improve during pregnancy, when Human Chorionic Gonadotropin (HCG) is secreted by the placenta in high levels. He subsequently went on to treat migraines using both this approach and that of histamine or prostigmine desensitization at his Harley St. Clinic and the London Clinic. Over thirty years Dr. Leyton treated over 10,000 patients from all over the world. This approach was never accepted by the mainstream medical profession, even though he published three books on the subject (now all out of print). The treatment was first described in the Lancet in 1942(1), and subsequently in the Medical Press and Circular in 1944 and 1952(2,3). Dr. Leyton also authored three books on the subject: two medical texts entitled "Migraine and Periodic Headache - A Modern Approach to Successful Treatment"(4); "Headaches - The Reason and Relief"(5); and a lay text "Migraine"(6). The treatment was so successful that another book written by E. Harvey-Sutherland entitled "Migraine Clinic - An Eight Year Survey of Preventive Treatment" described the advent and growth of the Putney Migraine Clinic and was published first in 1957 with a second addition in 1958.(7)

I have used his HCG treatment for the past 20 years in my practice with good success, but have not used the histamine or prostigmine part of the protocol. I prefer to use food avoidance and stress reduction as adjuncts. This is a preventive treatment - it is not to be used in acute attacks.

History:The following clinical history points are helpful in deciding whether you will respond to HCG treatment:
- migraines began at or shortly after menarche
-migraines are made worse by oral contraceptive, or other estrogenic hormones
-migraines are absent or markedly reduced during pregnancy
- migraines are limited to the peri-menstrual period. This is not an absolute condition for a trial of HCG
- migraines are reduced or absent after menopause, but resume with hormone replacement therapy
- the migraines are 'classical' vs. cluster type headaches

Side Effects: One side effect is a risk of ovarian cysts - I have not observed this in 20 years - it is only a theoretical risk. The menses may be affected - they may be delayed at higher doses of HCG, but this delay can be avoided by giving the injection at least 1 week before the expected date of the onset of menses.

The Protocol: In Canada HCG is available on prescription sold as Profasi HP® in 10,000 IU vials as a dry powder with a diluent of 10 ml. The treatment is administered according to the following schedule, after obtaining your informed consent:

Week 1: 0.1 ml. (100 IU) intramuscularly into the deltoid twice. (eg Mon. & Thurs.)

Week 2:0.2 ml (200 IU) intramuscularly into the deltoid twice.

Week 3:0.3 ml. (300 IU) intramuscularly into the deltoid twice.

Week 4:0.4 ml. (400 IU) intramuscularly into the deltoid twice.

Week 5:0.5 ml. (500 IU) intramuscularly into the deltoid twice.

Week 6-11:0.5 ml. (500 IU) intramuscularly into the deltoid weekly for six weeks

Week 12-23:1.0 ml. (1000 IU) intramuscularly into the deltoid every two week

Month 6-12:1.5 ml. (1500 IU) monthly until the patient has had a year of injections

As you reach the 500 IU level try to avoid having the injections less than one week pre-menstrually, although this is not critical. You will usually notice an effect by the time 12 weeks are up. This effect is usually a decrease in frequency, severity or duration, or all of these. You may be completely free by then. Any improvement should be a sign to continue, hoping for further improvement. At the end of one year you can be given the option of stopping the treatment, but I usually do not advise this, as the migraines often return in a few months. The treatment can safely be given indefinitely. You might want to stop at menopause. If you stop and the headaches return, you should begin at the low dose again. In Dr. Nevil Leyton's experience, the second attempt at treatment after discontinuation may not be as successful, possibly due to anti-HCG formation.

The use of this treatment for male patients is entirely empirical. Obviously they do not have a menstrual cycle so the choice of whther to give this treatment to a male migraineur cannot be based on the above. If a male patient has not responded to diet and stress changes then HCG could be tried. There is no harm to be done at the dosages used, and males have similar pituitary hormones to females.

The Results: The success rate is usually about 70-80% if patients are chosen by the above criteria. Since migraine is a multi-factorial disease, it is important to address other triggers such as tyramine containing foods, dairy allergy, stress, and difficulty expressing anger in conjunction with the above treatment. Migraines do not usually return if the treatments continued.

References

1. Leyton, Nevil. Lancet (1942); 1:488
2. Leyton, Nevil. A New Approach to the Treatment of Migraine. Med. Press and Circ. (1944); 11:302
3. Leyton, Nevil. Med. Press and Circ. (1951) 226:46
4. " Migraine and Periodic Headache - A Modern Approach to Successful Treatment" by Nevil Leyton MA, MRCS, LRCP. William Heinemann Medical Books Ltd.(1954 - 2nd edition)
5. " Headaches - The Reason and Relief" by Nevil Leyton (Heineman 1958)
6." Migraine" by Nevil Leyton MA, MRCS, LRCP. W & G Foyle Ltd. (1962)
7." Migraine Clinic - An Eight Year Survey of Preventive Treatment" by E. Harvey-Sutherland Saint Catherine Press Ltd. London (1958 - 2nd edition).

Acknowledgements

I would like to acknowledge with pride my father's untiring and creative energy in the prevention of suffering by migraine patients. Please forward any treatment results to holodoc@sympatico.ca, as I hope to publish something on this sometime. Thank you.

Today I would like to highlight another of the recipients of the Health Impact award. The American Liver Foundation provides a voice for those who suffer from liver disease, providing valuable resources for patients, families, and friends of those who are coping with liver problems. Wellsphere honors the incredible work they do to raise awareness and support both clinical care and research, by giving them the Health Impact Award.

The American Liver Foundation website is a great guide to the many activities of the foundation. Here are just a few of the activities that demonstrate the impact that the foundation has on the 30 million people who suffer from liver-related diseases.

Liver Life Walk
"Wak for fun, walk for life" is the motto of these fun-filled day-long events held throughout the country. These walks are organized by the many local chapters of the liver foundation throughout the country. You can find the walk closest to you by checking out the Liver Life Walk website.
 
 
 

Liver Life Challenge
These challenge events encourage people to undertake formal endurance training so they can meet the challenge of the cause. Runners and marathonists from Boston to San Francisco join in to act as an ambassador for the cause of the foundation.

The foundation runs an annual Liver Life Challenge Climb of Mount Shasta -- for 2009, you should apply to participate by January 30.

To learn more about the Health Impact Award or find out how your organization may be considered, visit the Health Impact Award information page.

Today's featured medical expert is Brian Klepper, PhD, an analyst, commentator, and expert blogger on the healthcare system. Brian's publications and commentaries have appeared in a wide variety of traditional media such as the Wall Street Journal, the New York Times, and the Washington Post. He is a frequent contributor to publications such as The New England Journal of Medicine, Modern Healthcare, Business Insurance, HealthLeaders and newspapers around the country.

Brian shares his expertise through his postings in the Healthcare industry and policy community on Wellsphere. Here is a recent post describing Brian's insights into some of the issues facing the new administration as it turns its attention to healthcare reform.

The Changes We Need
by Brian Klepper, PhD

A renewed energy and enthusiasm for health care reform notwithstanding, it will be difficult to achieve unless America can achieve a paradigm shift in the way we create policy.

These are, as the Chinese curse reputedly called them, interesting times.

If the burst of new Democratic health care reform proposals is any indication, the fresh breeze of the Obama campaign's "Yes We Can" optimism is blowing across the nation. Mr. Obama’s team is expected to make health care one of its priorities. First out, though, was Senate Finance Committee Chair Baucus (D-MT), who introduced an aggressive health care reform package that builds on Mr. Obama’s campaign platform of cost controls and extended coverage. Senator Kennedy (D-MA) and Representatives Dingell (D-MI) and Stark (D-CA) are expected to offer proposals soon, and undoubtedly there will be others.

The rub is that Congress’ old-guard lobbying system remains in place. Congress is awash in special interest contributions - $2.8 billion from 15,500 lobbyists in 2007 - that exchange money for influence over policy. When the Democrats retook Congress two years ago, they did not substantively change the lobbying rules.

So it is reasonable to ask whether a new day of governance in the common interest is possible. Can we make progress on health care or on any significant problem - climate change, education, energy policy, finance, the social safety net - without addressing the underlying problem of Congress’ receptiveness to special interest influence?

As the new health care proposals unfold, it is worth remembering that, early in the Clintons’ health care reform effort, things looked promising. There was general approval in the business and health care sectors. True, when industry practitioner input wasn’t welcomed, the process began to go south. But the real trouble came when the draft product appeared and some segments believed it threatened their interests. Health care and small business interests acted decisively against the plan, while the large business sector was indifferent. The public relations machine of the opposition demonized and killed the plan.

There is little reason to think that today’s organizations will be less action-oriented if they believe their interests are threatened. So what strategies are available to minimize resistance to changes America needs?

In an ideal world, the new Congress would emphasize that it is a new day by forcefully rejecting the practice of lobbying contributions (in favor of public campaign financing). That would effectively dispatch the problem of achieving health care reform and many other solutions as well. But that seems a stretch.

Alternatively, the leaders of America’s non-health care firms - who represent six-sevenths of the US economy - could overwhelm the health care industry's resistance by galvanizing, mobilizing and championing reforms.

This is also a stretch, but it is not impossible. The relationships between health care costs, productivity and competitiveness weigh on every American business executive. There are Fortune CEOs - Lee Scott of Wal-Mart, Craig Barrett of Intel, Jim Sinegal of Costco, Howard Schultz of Starbucks, Steve Burd of Safeway - who have campaigned tirelessly on the issues central to serious reforms. Keynoting last week's National Business Coalition on Health annual conference, Barrett told those assembled that "The only way health care is going to change is if people who pay the bill tell the industry to change."

It is impossible to overstate the profound importance of business leaders acting together in the common interest. This group currently exerts more influence over policy than any other. That said, businesses typically are mostly focused on their own niche issues. Information technology companies focus their lobbying on IT. Hospitality companies, insurance companies, energy companies all focus on what matters most to them.

But they could unite on the common interest. Especially as they gain increasing awareness that re-enforcing America's social and market fabric strengthens the stability that has made it possible to successfully pursue the special interest in this country over the last 60 years.

At a time when America so sorely needs real change, when many signs point to the rapid erosion of the health system's stability and sustainability, will America’s Congressional and business leaders stand together for changes that can strengthen the nation's foundation? Will they stand against those who, in continuing pursuit of their own interests, undermine our institutions and our ability to advance?

If they will, then real change is upon us. If they will not, then we are destined to remain where we are now

Today's featured medical expert is Dr. John Halamka, MD, MS, an Emergency Physician, a Dean for Information Technology at Harvard Medical School, and the Chief Information Officer at Beth Israel-Deaconess Medical Center. His other impressive contributions include being Chairman of the New England Health Electronic Data Interchange Network (NEHEN), CEO of MA-SHARE (the Regional Health Information Organization), and Chair of the US Healthcare Information Technology Standards Panel (HITSP).

To recognize his accomplishments, and his commitment to improving the processes of healthcare, Wellsphere gave Dr. Halamka the Health Impact Award.

In addition to his many professional responsibilities, Dr. Halamka finds time to maintain an active and lively blog at Life as a Healthcare CIO, in which he blogs on topics that range from Cool technology, to industry reports on healthcare IT, to his personal adventures in exploring (and caring for) the planet.

Dr. Halamka's blog is found in the Healthcare Industry and Policy community on Wellsphere. Here is a recent post on the benefits of vegan chocolate (which I believe may explain how he has managed to retain his characteristic boyish charm).

Chocolate
by Dr. John Halamka, MD, MS

Many people ask me if my vegan diet leads to continuous cravings for a Big Mac or a nice chunk of cheddar. I can honestly say that my diet of legumes, fresh fruits/vegetables, tofu, rice and green tea keeps me completely satisfied.

There is one other aspect of my diet that I've not discussed before - a little vegan chocolate every day.

Most chocolate contains milk products but a few producers make pure, dark chocolate that is 85% pure cocoa and does not contain any animal products such as milk or cream. My favorite vegan chocolates are

Lindt 85% Dark

Lake Champlain Dark Chocolate

Valrhona Dark Bitter Chocolate

Endangered Species Dark Chocolate

I have also found pure, unsweetened vegan drinking chocolate from single regions such as Peru, Kenya etc. packaged by Allegro

What are the benefits of Dark chocolate? It's rich in antioxidants, it lowers blood pressure, and it enhanced mood per WebMD and Dr. Weil's resources.

What is the downside to chocolate? It contains a bit of theobromine, a methylxanthine like caffeine. I try to avoid all stimulants. Chocolate is not for the locavore. I really try to limit all my foods to 100 miles of where I live.

Admittedly, eating .5 ounce of chocolate a day is vegan but not local, is healthy, but is still a stimulant. My only excuse is that I live in the cold, dark, and snowy Northeast. That little bit of chocolate every day is my cure for Seasonal Affective Disorder. It can also be socially responsible.

A few days ago while traveling, I ordered a microbrewed beer and was asked for my ID. Since I'm nearly 50 and was asked for my ID, I can only assume that those antioxidants in the chocolate must be really keeping me young.