November 20, 2014

FDA Reminds Consumers that Nonprescription Drugs Can Impair Driving

Although many people believe that any medicine you can buy without a prescription can’t hurt you if you follow the directions, that’s not necessarily true — all drugs have potential side effects, and some over-the-counter (OTC) meds can impair your ability to think and react quickly enough to perform common functions as you normally would.

The FDA recently issued a warning to consumers that many common OTC drugs, including antihistamines, can make you drowsy, and compromise your ability to think and react quickly. People who take these drugs should ensure they’re functioning normally before they drive or use dangerous tools or machinery.

The warning reminded consumers to choose their nonprescription drugs carefully, and use them only as the directions dictate. And medicines specifically for adults should never be used by children — see our blog, “Feds Try Harder to Make Manufacturers Test Drugs for Use by Children.”

As described on, certain drugs are more likely to impair your ability to function. One such class is antihistamines, which are found in many common cold, flu and allergy medications to treat a runny nose, sneezing, itchy throat and watery eyes. Often, antihistamines are added to other active ingredients to reduce pain and fever, but often cause drowsiness.

Diphenhydramine, the active ingredient in Benadryl, can make you drowsy, unfocused and slow to react. Loperamide, the active ingredient in Imodium, which treats diarrhea, can cause drowsiness.

Drugs that treat nausea, vomiting and dizziness are called anti-emetics. They’re also listed in the FDA warning because they can make you sleepy and fatigued.

A drug’s effect can vary — sometimes you’re affected for a short time after you take it, and sometimes the effect can last hours. Some drugs leave you with a “hangover” effect the next day.

If you feel lousy enough to consider taking these meds, do so when you don’t have to drive or perform functions with equipment that has the potential to hurt you if your attention or dexterity isn’t up to par.

As AboutLawsuits noted, every drug has “Drug Facts” information to help consumers make safe choices. There’s also information about how the drug might make them feel, including warnings about drowsiness or driving.

If you take other medications, prescription or otherwise, ask your doctor before you add anything new, especially if you take sedatives or tranquilizers. Combining drugs can intensify or reduce the effect of another drug, or the combination can present a risk of harm neither on its own produces. Also, even OTC meds can interact with alcohol, supplements and some foods.

Pay attention to the active ingredients in all the drugs you take — the FDA warns against taking more than one medication with the same active ingredient, because that can cause additional side effects. Acetaminophen, the active ingredient in Tylenol, is a well-known example of too much of a good thing. Too much of this drug can damage your liver.

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November 19, 2014

Too Few Women Are Screened for Cervical Cancer

Earlier this year, experts concluded that most women don’t need annual pelvic exams, but they also confirmed that regular Pap tests are still necessary to screen for cervical cancer. The Centers for Disease Control and Prevention, however, recently concluded that millions of women are not getting this test.

According to the CDC, 8 million women 21 to 65 years old haven’t been screened for cervical cancer in the last five years. Like all life-threatening cancers, early detection is the best way to prevent or treat cervical cancer.

Every year, more than 12,000 U.S. women are diagnosed with cervical cancer, and for more than 4,000, it’s fatal. According to the CDC, more than half of women diagnosed with cervical cancer have never or seldom been screened.

A Pap test screens for abnormal cells that may develop into cancer. The test is not painful, and consists of a doctor scraping cells from the cervix for analysis by a lab. Generally, vaginal cells also are tested for the presence of the human papillomavirus (HPV), which causes most cervical cancers.

If abnormal cells are found, they can be removed before developing into cancer.

Because of its proven ability to prevent transmission of the virus, the HPV vaccine is recommended for middle-school boys and girls, before they become sexually active. Although boys, of course, can’t get cervical cancer, they can transmit the virus to their sexual partners.

Unfortunately, as we’ve blogged, the vaccine isn’t being given to everyone who should have it. Only 1 in 3 girls and 1 in 7 boys have finished the three-dose series that can protect against not only cervical cancer, but cancers of the penis, anus, mouth and throat.

Regular cervical cancer and HPV screening for women is simple and affordable — the Affordable Care Act (“Obamacare”) requires that health insurers provide all cancer screenings at no charge to the patient.

As explained by NBC News, CDC experts reviewed national surveys from 2012, and found that more than 11 in 100 women reported that they had not been screened for cervical cancer in the past five years, often because of a lack of health insurance: Nearly 1 in 4 women without health insurance and 1 in 4 without a regular doctor or other health-care provider said they hadn’t had a screening.

Lack of screening doesn’t just reflect lack of money. Dr. David Fishman, an expert on women’s cancers, told NBC that “Women who should be having Pap smears are not getting plugged in, and this is a significant problem in our country. The Pap smear, in my opinion, is the most powerful tool in the history of medicine to detect precancerous change such that no woman should ever die from cervical cancer.”

Annual cervical cancer screening isn’t necessary: The United States Preventive Services Task Force (USPSTF) and the American Cancer Society recommend that women 21 to 65 get either a Pap smear or a test for HPV every three years. Some experts believe that women older than 65 who have had three “clear” screens in a row needn’t be screened again, but others believe that’s too young to stop screening. A study this year suggested that women older than 65 might have a higher risk of cervical cancer.

Bottom line: if you’re female, get a Pap test and/or an HPV screen at least every three years, and more frequently if you’ve had a positive result in the past.

To understand what’s involved in the standard, but outdated pelvic exam, and why it’s different from a Pap test, see our blog.

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November 17, 2014

Robotic Technology Costs More and Has More Complications for Ovary and Cyst Removal

The use of robots in the surgical suite has a checkered history and a fat file of lawsuits by patients who suffered burns, bleeding and other serious harms. Another study has added to the record of woe: robot-assisted surgery to remove ovaries or ovarian cysts had more complications than more traditional and less invasive procedures, such as laparoscopy, and also was more expensive.

For these procedures, laparoscopy involves making a small incision into which surgical tools are inserted; robotic surgery involves the vaginal insertion of instruments controlled by the surgeon using a joystick. Screen-generated images guide both procedures.

As reported by (KHN), research by Dr. Jason Wright, chief of gynecologic oncology at Columbia University, suggests that removing ovaries with the help of a robot cost about $2,500 more than laparoscopic removal, and removing cysts cost $3,300 more.

Even more worrisome for most people than the additional cost, however, is that the women whose surgeries had been performed with the assistance of a robot were slightly more likely to have complications, including bladder injury, bowel obstruction or excessive bleeding.

We’ve called into question the widespread use of robotic surgery many times (here and here). Many people believe that although some disorders are appropriate for robotic technology, it’s overused because surgeons and hospitals make huge investments in the equipment, which encourages their maximum use, even if it isn’t the best option for certain procedures.

The Wright study reviewed the operations of nearly 90,000 women who had ovaries or cysts removed between 2009 and 2012, comparing the cost and safety of robotic surgeries with laparoscopy.

The study “really questions the utility of using robotic-assisted surgery,” Wright told KHN. “More studies need to be done before it’s accepted as the standard of care.”

The data didn’t show why there were complications. But recent reports of software glitches, battery malfunctions and difficulties in seeing through the robotic system’s lens were noted on the FDA’s Manufacturer and User Facility Device Experience database. We’ve blogged about poor surgeon training, as well.

Despite the extra cost and complications, Wright’s team said that the use of robots for these kinds of procedures is on the rise, from about 3.5 in 100 ovary removals in 2009 to 15 in 100 in 2012. Cyst removals showed a similar trend.

For now, according to Wright, “Patients need to understand the risks and benefits of different procedures… The newest, most high-tech thing that’s available isn’t necessarily the best.”

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November 16, 2014

Hospital Settles with Ebola Victim’s Family

Last week Texas Health Presbyterian Hospital settled the malpractice claims brought by the family of Thomas Eric Duncan, the man who died of Ebola because of serial mistakes the Dallas facility made.

Although the terms of the settlement weren’t disclosed, the family’s attorney, according to the Los Angeles Times, said it was comparable to what a jury might have decided in a civil lawsuit. In Texas, of course, that’s not much — it’s one of many states that cap malpractice judgments. In the Lone Star state, the maximum a harmed party may receive for pain and suffering against a physician is $250,000, and damages against a hospital are the same amount.

But the fast resolution tells a story beyond the fact that mistakes were made that demanded redress for the patient’s family. The underlying message is, that for all its initial missteps we blogged about last month (See “Ebola Patient’s ER Discharge Was Classic Malpractice”), ultimately the hospital did the right thing: The chief executive apologized to the family, and again publicly in a letter printed in local newspapers.

And when the settlement was announced, hospital officials repeated the apology in no uncertain terms.

Capping the amount aggrieved parties may receive as a result of medical malpractice is unfair, and undermines justice, especially when the amounts are as low as Duncan’s relatives presumably received. As PopTort, the civil justice blog, noted last week, Texas law essentially immunizes hospitals, which doesn’t exactly incentivize them to reduce errors and promote patient safety.

But at least the dirty laundry was washed with dispatch. We can only hope Presbyterian Hospital continues to do the right thing: Don’t screw up, and when you do, don’t dance around the truth — acknowledge what happened, who got hurt and make a meaningful gesture to make it better.

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November 13, 2014

Judge Smacks Down Nursing Home For Trying to Force Arbitration on Customers

A judge in Pennsylvania did the right thing last week in tossing out a mandatory arbitration clause in a lawsuit concerning neglect at a nursing home.

Readers of this blog know that forcing people into arbitration when there’s a dispute that rightfully belongs in a court of law is never good for the aggrieved party. (See our blog, “Arbitration Agreements: Bad for Consumers, Good for Nursing Homes”.)

Forced arbitration not only deprives you of your right to be heard in a court of law, often it’s demanded of people when they’re in a vulnerable, helpless state. Arbitration, which is always forced onto consumers by businesses, never the other way around, is promoted as an objective, time-efficient and money-saving approach to settling disputes.

But the opposite usually is true: Arbitrators with a reputation for rewarding the plaintiff often find themselves out of work because industries remove them from the list of suitable arbitrators both sides must use to select one. Arbitration doesn’t necessarily save time and legal fees, because even if the consumer wins, he or she still retains counsel in many cases, and must pay a share of the arbitrator fees.

The Pennsylvania case concerned Manor Care, according to It’s one of the largest nursing home management companies in the U.S. Its contract forced the family of a resident of a facility in Reading, Penn., to arbitrate their claim that their loved one was abused, and that the nursing home was negligent.

A woman discovered that her mother was taken to the nursing home by her day nurse. When the daughter arrived there, she was told to sign the arbitration agreement, as AboutLawsuits says, “during the emotional upheaval of discovering that her mother was there.”

Judge Jeffrey Sprecher ruled that the agreement was too heavily weighted in favor of the facility, was misleading and violated the law. He called the arbitration agreement “unconscionable,” and said that the daughter was not authorized to sign the agreement for her mother; that the agreement was designed so that the people signing it wouldn’t understand its effect.

“Most families and residents are unaware that they are signing away their right to file a nursing home lawsuit in the event the facility provides negligent or sub-standard care,” according to AboutLawsuits, “and that they have little choice but to sign the agreement when they are faced with the need to move themselves or a loved one into a skilled nursing facility.”

A similar forced arbitration agreement in a Florida Manor Care nursing home lawsuit also was found to be unenforceable in 2011. In that case, the Florida Supreme Court found that many of the provisions in the agreement, including a $350,000 cap on noneconomic damages and an agreement that the resident could never receive punitive damages, violated Florida law and could not be enforced.

Learn more about the evils of forced arbitration agreements on our blog, “Potential Dangers of Arbitration Agreements.”

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November 12, 2014

Too Many Stress Tests Involve Unnecessary Exposure to Radiation

Cardiac stress testing can be a useful tool to assess heart function, but since it became trendy for companies to subject their executives to treadmill stress tests as part of their annual checkups, the technology has grown too big for its britches.

That’s paraphrasing the results of a study published recently in the Annals of Internal Medicine. The study, as summarized by, showed that “Inappropriate use of cardiac stress testing — particularly testing done with imaging — is costing the U.S. health care system more than half a billion dollars,…”

But in addition to the cost, cardiac stress tests with imaging subject people to radiation, which the study says each year might lead to as many as 500 future cases of cancer. So the overuse of this technology isn’t just a waste of money, it’s a threat to patient safety.

The overuse of imaging tests, as readers of this blog are aware, often figure into discussion about rising health-care costs, and some of their providers are starting to get religion. As MinnPost noted, professional medical associations have issued new practice guidelines limiting their use, and the Choosing Wisely campaign says flat out that people with a low risk of heart disease probably shouldn’t have these tests, even if they have symptoms. That’s also true for people who have been diagnosed with heart disease but who have no symptoms.

The cardiac stress test involves the patient using a treadmill or stationary bike while being hooked up to devices that measure heart rate and blood pressure. Generally, the speed, elevation and/or resistance of the exercise machine are increased, requiring greater exertion.

When imaging is included, a radioactive substance is injected into the patient’s bloodstream at rest, then again during the exercise. The illuminated substance is tracked to the heart via a special scanner similar to an X-ray machine. It’s known as a nuclear stress test.

The researchers in the new study wanted to find out why the use of cardiac stress testing was on the rise in the U.S.: The number of cardiac stress tests performed every year has more than doubled in the last two decades, from 1.6 million per year in 1993-1995 to 3.8 million per year in 2008-2010.

That means, according to MinnPost, in 1993, 28 in every 10,000 patients visiting their doctor underwent a stress test. In 2010, it was 45 in 10,000.

Some of the inflated numbers, researchers said, reflect an aging population, a demographic at higher risk for heart disease. But that can’t explain why imaging as part of a standard stress test has grown so much. Not only is that component much more expensive, but, said MinnPost, “studies have found [they] don’t add much, if any, extra clinical value. The current study found that the proportion of cardiac stress tests done with imaging — primarily nuclear stress tests — has exploded, from 49 percent in 1993-1995 to 87 percent in 2008-2010.”

At least 1 in 3 of those imaging tests probably was inappropriate, the researchers concluded. They cost $494 million annually and exposed people to radiation that could lead 491 of them to develop cancer later in life.

The same number of stress tests that don’t include imaging would cost about $7.7 million a year.

Like so much else in the medical-industrial complex, the profit motive is a big factor here, the lead researcher suggested. When a facility has fancy, expensive equipment, it wants — and needs — to use it. “Nuclear imaging stress tests command higher reimbursement,” Dr. Joseph Ladapo of New York University’s Langone Medical Center told one reporter. “No one likes to talk about this but there is plenty of evidence that physicians respond to financial incentives.”

And, Ladapo noted, there’s a widespread belief that “more intensive technology equals better care, something that we are increasingly finding to not be true. And the behaviors or practices are passed down to trainees in residency programs, so it’s a hard cycle to break.”

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November 10, 2014

Electronic Medical Records Can Frustrate Doctors and Threaten Patients

When it comes to medical malpractice, doctors are concerned about something the rest of us haven’t thought much about —the use of electronic medical records.

Writing on, Neil Chesanow, senior editor of the site geared toward health care practitioners, explains how a doctor can be sued if his or her medical records compromise patient safety or confidentiality.

As we’ve written, although mistakes happen and some need to be corrected through legal means, the single best way a doctor can avoid being sued is to make the doctor-patient relationship a priority of care.

That means communicating often, and with respect. Studies have shown that health-care providers who admit their mistakes, and apologize, are less likely to be sued. This seems especially so in terms of record-keeping.

Being compensated for having been medically harmed isn’t about vengeance, it’s about rightful redress of grievances. And people who have strong relationships are much less likely to be aggrieved about mistakes of minimal consequence.

A lot of Medscape’s professional readers say that electronic health records (EHRs) are time-consuming and make patient visits longer. Many try to streamline their use, and in the process leave themselves vulnerable to malpractice lawsuits.

“Even if your EHR has a bug or design flaw,” Chesanow writes, “it's up to you to contact the vendor to get it fixed. Otherwise, if a patient is harmed as a result of the glitch, you may bear the blame in court. That's what the vendor contract you signed essentially says: The buck stops with you.”

Here are some ways physicians might try to make EHRs more efficient but that could put you at risk:

  • copying and pasting large pieces of text from one record to another

  • sharing a single password with several staffers in the practice

  • ignoring pop-up support prompts

Asking your doctor about these habits can be difficult; it can make him or her defensive. Practitioners are frustrated by the demands of insurance paperwork and medical facility administration; many feel like they’re forced to use a certain system, then held liable when it doesn’t work. Like everybody else, they get irritated by the idiotic demands by faceless corporations and technology that doesn’t work as it’s supposed to.

Here’s how one doctors expressed his frustration. "The software engineers employed by my office's EHR vendor are arrogant, unresponsive to my requests, and write a simple sentence so poorly that their emails are unintelligible. I am dismissed as a nuisance by the vendor because I don't have any financial authority over the EHR. From a malpractice standpoint, I feel my only options are to quit or keep a record of my complaints and how they have been ignored by the vendor."

So when you ask about how your records are kept, be sympathetic to their plight — a doctor who sees you as a partner instead of a difficult busybody is more likely to tell you what you need to know, and to protect your interests.

"The best doctors were the country doctors," one provider told Medscape. "Doctor to patient — not doctor to computer gizmos, and somewhere in this hole of technology is the patient. Could you throw me a rope, please?"

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November 9, 2014

Doctor Demonstrates How Malpractice ‘Reform’ Won’t Cut Health-Care Costs

Like abortion, gun control and Obamacare, medical malpractice is a hot-button issue that makes people claim crazy things to make a point. People who want the truth about the effect of malpractice “reform” on the cost of health care should listen to Dr. Aaron E. Carroll.

Writing last week in the New York Times, Carroll, a professor of pediatrics at Indiana University School of Medicine, reviewed statistics and studies to reach the conclusion captured in the title of his op-ed: “Malpractice Reform Won’t Do Much to Reduce Health Spending.”

We regularly weigh in on the pressures felt by harmed patients and their advocates when so many interests try to deprive them of their rights by capping the amount a jury can decide they are due. In his commentary, Carroll focuses on one claim these forces make that is demonstrably wrong: that if you “reform” the legal system, the cost of health care will drop.

“The rationale for malpractice reform as cost control is somewhat complex,” Carroll writes. “It assumes the existence of ‘defensive medicine,’ meaning that doctors order additional tests, or perform extra procedures or recommend more visits, all because they think those actions will protect them from being sued. Doctors fear an ‘epidemic’ of lawsuits so much that they practice wasteful medicine to shield themselves from nuisance cases, this theory goes.”

Fear, Carroll shows, should take a back seat in favor of fact.

As he notes, through examining the National Practitioner Data Bank’s statistics about malpractice payments made on behalf of doctors, there’s no “malpractice crisis”; the number of those payments has declined steadily for 10 years.

That doesn’t mean malpractice and protecting against it isn’t costly, but its relative expense pales in comparison to other health-care costs.

Carroll’s review of one study in 2010 showed that the estimated cost of malpractice to be more than $55 billion a year, including about $5.7 billion paid to plaintiffs for damages caused by medical error, and $4.1 billion for expenses such as legal fees and the administration of justice. The rest, about $45.6 billion, was for defensive medicine.

That’s a lot of money, but consider: That study concluded that the cost of the malpractice system was 2.4% of all health-care spending.

Even if you believe that health-care is more expensive because doctors are afraid of being sued, Carroll says, theoretically reform could reduce fear, and waste. It doesn’t.

“In 2003,” Carroll reminds us, “Texas passed a law that capped noneconomic damages at $250,000 per year. The idea was to decrease the number of suits, lowering overall indemnity payments, which would lead insurance companies to decrease premiums for malpractice insurance. This, coupled with reduced claims, would make doctors feel safer, and therefore reduce their practice of defensive medicine.

“Health care spending didn’t go down in Texas, though. In fact, Medicare spending per beneficiary went up more quickly in Texas after the change than it did in the rest of the country.”

As we reported last month, the New England Journal of Medicine published a study about the changes in emergency-room care in Texas, Georgia and South Carolina, which also capped damages in 2005. Compared with neighboring states without similar laws, those states had no significant changes in factors like how often imaging was used to rule out problems and and how many patients were admitted to the hospital.

In other words, “reform” didn’t change anything.

The evidence of how misguided it is to effect positive change through taking away harmed people’s right just mounts. Carroll looked at another study of more than 15 million medical insurance claims in 30 states with varying levels of risk of malpractice suits to compare how the same conditions were treated in states with high malpractice-suit risk and in states with low risk.

The difference wasn’t much. “[E]ven if malpractice premiums fell by as much as 30% (which would be huge),” Carroll summarizes, “overall spending on defensive medicine would drop only 0.4%.”

So, he suggests, even with capped damages and reduced indemnity payments, the cost savings aren’t always passed on to physicians in the form of lower malpractice insurance premiums, and so they don’t change their defensive behavior.

“Sometimes those savings are pocketed by insurance companies, as they appear to have been in Florida since malpractice reform passed there in 2003,” Carroll says. “If that happens, there’s no reason to believe doctors will practice much differently.”

But if fear of being sued does contribute to the practice of defensive medicine, it’s not the only thing that does. As Carroll notes, doctors order tests, procedures and consultations for lots of reasons. “The most glaring one is that usually physicians are paid for doing so. Other times, physicians want to play it safe not only because they might be sued, but also because they think it’s in the best interests of their patients to double- or triple-check some detail.”

He refers to a recent study in JAMA Internal Medicine that analyzed how many orders were defensive in nature, and how much of the decision for that procedure was defensive. The doctor subjects rated their own orders using a “defensiveness score” from 0 (not at all defensive) to 4 (completely defensive).

Defensive orders were not uncommon, but being defensive as the sole reason for ordering a test was, accounting for less than 3% percent of overall treatment cost.

“If we’re being honest,” Carroll says, “this is the waste we might trim by malpractice reform — and while 3 percent of medical spending is nothing to turn up our noses at, a one-time reduction of that amount, even if achievable, won’t do much for the long-term problem.

Meanwhile, other orders may also be “defensive,” but if they’re also being issued for reasons unaffected by legal reform, they would continue to made in the future.”

“… There are many legitimate reasons to reform the malpractice system,” Carroll concludes. “It just doesn’t appear that reducing health care spending is one of them.”

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November 8, 2014

An Epidemic of Overtreatment

We all know about epidemics of infectious disease -- that's how the science of epidemiology got its name in the 19th century when the cause of cholera was first traced by statistics to a contaminated water well in London. But here's what a modern epidemic looks like -- this one not an epidemic of disease but an epidemic of overtreatment.

The graph is from a new study about what happened when South Korea started free ultrasound testing for thyroid cancer in 1999. You can see how the incidence rate (detection) of the cancer skyrocketed.

A good thing, right? Wrong.

Because look at the dots crawling along the bottom of the graph: That's the death rate from thyroid cancer in Korea -- it's the same before and after the explosion of detection and treatment. Which means all that extra medical care hasn't done much, except to deliver more medical care.

The graph comes from a new study in the New England Journal of Medicine by a group of Dartmouth researchers who have been hawkeyes on wasteful medical practices.

Thyroid cancer is one of those cancers, like prostate, that many people die WITH but few die FROM. So the more you look for it, the more you find. And when you find a small cancer, most sensible patients don't want to take a chance of waiting around to see if it gets big and ugly. They want it out -- now! Problem is the surgery can paralyze the vocal cords, result in injury or death from anesthesia mishaps, and cause other complications.

The leader of the Dartmouth team, Gilbert Welch, MD, has an op-ed in the New York Times. He says given all the pros and cons, we need to be wary of free screening programs that can tell us more information than is healthy to know.

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November 6, 2014

What to Ask Before Renewing Your Health Insurance Coverage

As the Affordable Care Act’s insurance program gears up for its second enrollment period this month, many observers believe the process to be much improved. But that doesn’t excuse people who sign up on a public insurance exchange from doing their homework.

Open enrollment starts Nov. 15. According to the New York Times, Obama administration officials say that it will be easier this time for consumers to purchase health insurance in the public marketplace, and they promised that would not crash, as it did last year.

If you want coverage in a new plan by Jan. 1, 2015, you must enroll by Dec. 15. All coverage purchased on a government exchange for 2014 ends Dec. 31 regardless of when you bought it. Open enrollment closes Feb. 15, but if you wait until then to buy a plan, the coverage won’t start until March 1.

No one can predict the future, but the Associated Press (AP) offers a few tips about how to join this club, or renew your membership in it. For people who currently have a state or federal exchange plan, you’re advised to resist the temptation merely to renew coverage automatically without examining your options. Although it’s easy to do online, you might be missing the opportunity to make a better choice, and to avoid unpleasant surprises.

Here’s what you need to find out before clicking the “buy” button.

The plan you have now might not offer the same coverage next year. So automatic renewal doesn’t guarantee that your coverage or premium will be the same. It just ensures that you have insurance for next year.

You’ll get a letter from your insurer outlining your 2015 coverage and detailing the policy’s terms. Look for changes to coverage, and cost. The deductible, the copay and/or the monthly premium might be different.

If you receive a federal government subsidy or tax credit to help cover the premium cost, the subsidy amount will be included in the letter. Plans that are renewed automatically might show this year’s subsidy amount. So if your premium increases, you’ll pay more next year than this year.

Some plans in force this year will be discontinued. If so, sometimes, insurers automatically enroll you in another plan that’s similar to your 2014 coverage.

Network providers might change — the doctor in your network today might not be included next year. Verify with both the doctor and the insurer to find out.

Even if you like what you see when reviewing your current plan, consider your options — there might be new insurers and more choices than you had this year.

Whether or not your subsidy or tax credit changes depends on your income and your insurance market. According to AP, more than 8 in 10 people who are covered by government plans receive subsidies.

If your income changes or you think it will change, you must update your enrollment file during open enrollment. Will you or anyone in your household get a raise next year? Take a second job? Changes in income will affect your subsidy, which is calculated by the modified adjusted gross income you declared on last year’s tax return.

Did you get married, divorced or have a baby? Lose your job? Life-changing events also can change your subsidy level.

Be honest: Government oversight will determine if your subsidy is too much in 2015, and if so, the excess could be deducted from your tax refund or added to what you owe when you file in 2016.

Subsidies are determined by a benchmark plan in your market. A new plan might become the 2015 benchmark, or that plan might have a new price, which changes your subsidy. If you can’t afford a lower subsidy, you’ll have to shop for another plan.

For help making exchange plan decisions, visit the federal government site, You’ll find answers to common questions, information about the application process and links to individual state marketplaces (not all states have their own exchange; if yours doesn’t and you want coverage through the public marketplace, you must find it on

For information about tax credits, visit the health coverage tax credit page at

There’s also a calculator for subsidy information.

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November 5, 2014

Ask Before You Mix Meds and Supplements

A lot of people believe that dietary supplements they buy over the counter are merely nutritional insurance, but many of these can have unexpected side effects when taken with other medicine. Guidelines recently issued by the FDA warn consumers about the risks of mixing popular dietary supplements with medications.

As explained on, people risk injury if they combine prescription or over-the-counter medication and supplements. Many of these dietary products alter how meds are absorbed or excreted, as well as a drug’s potency and effectiveness.

That puts people at risk of getting too much or not enough of the medication they need, which, in some cases, can be life-threatening. One example is taking vitamin E with warfarin, a common blood thinner. That combination can double the blood-thinning effect, leading to uncontrolled bleeding.

As we’ve blogged, often the contents of herbal and other supplements are unknown, and include not only “fillers,” but contaminants. And, as we’ve noted, more than half of U.S. adults consume some type of supplement, especially multivitamins or minerals, and we spend $28 billion on them every year, despite a lack of evidence that they benefit otherwise healthy adults who eat well.

Per FDA guidelines, bring a list of dietary supplements and medications you consume to every doctor visit and make sure your health-care provider reviews it. If you regularly take prescription or over-the-counter medication and are considering a particular supplement, call and ask your doctor if it’s safe. Make sure to tell your doctor if your health status has changed since your last visit.

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November 3, 2014

Lawmakers Prefer to Protect Off-Road Vehicle Industry Instead of Consumers

Off-road vehicles are fun, and dangerous, but certain members of Congress are more interested, it seems, in supporting vehicle manufacturers than in beefing up safety measures to protect consumers who ride them.

As reported on the investigative news site, a dozen U.S. senators have written to the Consumer Product Safety Commission (CPSC) seeking to bar regulations the federal agency is considering to prevent rollover accidents.

CPSC figures cite 335 deaths involving ROVs from 2003 until April 2013. The agency estimates that ROV accidents cause 11,100 medically treated injuries every year. “In a typical severe accident scenario,” according to FairWarning, “the ROV flips while in a turn, the occupants are fully or partly ejected, and then suffer crushing or paralyzing injuries when the vehicle, often weighing 1,100 pounds, lands on top of them.”

The CPSC has spent five years developing a proposal to reduce the number of accidents. It has tested ROV models to devise minimum standards for vehicle handling, rollover resistance and seat belt use. Manufacturers would be required to display a stability rating on the hangtag for each ROV.

The senators’ letter, written a couple of weeks ago, urges the CPSC to delay a vote on imposing safety standards for recreational off-highway vehicles (ROVs). The senators want the commission to continue discussing the matter with industry reps: “We recommend that the CPSC staff and the industry reach an agreement on voluntary standards that adequately address the risk of injury concerning ROVs.’’

Talk is cheap, but off-road crashes can be fatal, especially to younger users. See our blog, “All-Terrain Vehicles Are Not Toys,” which reported research showing that 3 in 4 teenagers in one state have driven an ATV, and that kids 15 and younger represent 1 in 5 ATV-related deaths.

Is anyone surprised that 8 of the 12 senators who signed the letter have received campaign donations from ROV manufacturers? Is anyone surprised that several of those senators hail from states where ROV makers have corporate headquarters or factories?

As FairWarning noted, some signatories are considered strong consumer advocates, including Al Franken (D-Minn.), Mark Pryor (D-Ark.) and, in an example of either irony or hypocrisy, Claire McCaskill (D-Mo.), who chairs the Senate consumer protection subcommittee, which called out officials from General Motors because their cars had faulty ignition switches that killed people.

The other senators who believe protecting this industry is more important than protecting its customers are Amy Klobuchar (D-Minn.), Dean Heller (R-Nev.), Roy Blunt (R-Mo.), Ron Johnson (R-Wis.), Debra Fischer (R-Neb.), Joe Manchin III (D-W Va.), Ted Cruz (R-Tex.), Marco Rubio (R-Fla.) and Kelly Ayotte (R-N.H.).

Robert Weissman, president of the consumer advocacy group Public Citizen, called the lawmakers’ support for the industry the “normal course of business in Washington, D.C., where members of Congress … wrongfully, but reflexively, think they should defend the interests of the hometown manufacturer against the broader public interest.’’

He also said that evidence for stronger safety standards “overwhelmingly favors regulation.’’

It’s not as if these safety measures would put anybody out of business. The CPSC estimates that manufacturers would spend $61 to $94 per vehicle to meet the requirements, but that societal benefits would be nearly $2,200 per vehicle because of fewer deaths, lower medical bills and less time lost from work. The average ROV sells for about $13,000.

The Recreational Off-Highway Vehicle Assn. (ROHVA) is a trade group for manufacturers. Its members follow voluntary standards, but CPSC officials say those don’t address key safety issues adequately, including vehicle handling and rollover.

Industry officials blame injuries on drivers who try risky stunts or fail to heed warnings to wear helmets, use seat belts and avoid alcohol.

Last week, a CPSC memo said that commission staff “ sees no need for the commission to delay evaluating the [proposed rules]” for ROVs.

The next day, the commission stood up to the pressure and voted to move forward with the proposed rules for rollover crashes, FairWarning reported. “[I]n a 3-2 vote, commissioners rejected the call to stall a rulemaking process that has already taken five years,” the site said. “The majority argued that the prospect of a federal mandate would motivate the industry to strengthen its voluntary standard.”

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