Pharmaceutical Charities
A short-term fix for individuals may actually be contributing to the exorbitant cost of some pharmaceutical drugs, according to a Wall Street Journal article. Drug companies have programs that provide expensive medicine, at no cost, to poor, uninsured patients. These programs do not, however, help insured people who must pay expensive premiums and high co-pays for the same drugs. Non-profit organizations, such as Patient Services, Inc. (PSI), are filling their need. These pharmaceutical charities provide financial assistance to insured people who depend upon high-price drugs but cannot afford their insurance costs. The cancer drug Avastin costs about $50,000 for a year's treatment. Factor VIII, the blood-clotting protein required by hemophiliacs, costs about $100,000 year per person. A drug for people with Fabry disease generally costs between $175,000 and $200,000 a year. Insurance premiums for one 25-year-old auto mechanic with this condition run $27,000 a year. Patient Services pays the insurance costs, and the insurer pays for the drug.

Patient Services and sim ilar non-profits get much of their funding from pharmaceutical companies. Dana Kuhn, who co-founded PSI, solicits donations from the companies by emphasizing how much they have to gain. By donating a few thousand dollars to PSI so that a patient can continue to pay for premiums and co-pays, pharmaceutical companies receive several thousand dollars from insurers for the drugs themselves. In addition, drug companies can get a tax deduction for their donations. These donations do not violate federal anti-kickback laws, because the companies do not have any influence on which patient actually gets the money from their donations. The Inspector General's office said PSI "interposes an independent charitable organization between donors and patients in a manner that effectively insulates' patients and doctors from making prescribing decisions based on the donations." However, non-profit organizations set up by pharmaceutical companies to promote the ir own products are not legal. In 2004, PSI raised $22 million to help almost 20,000 patients pay their insurance costs. About 75% of that total ($17 million) came from 13 drug companies.

Mr. Kuhn told the Wall Street Journal that PSI promises to give their recipients financial assistance for two years: "After that, it is hoped that they can be weaned off the program, by finding a different insurance plan or a new job with better benefits." That hope may be misplaced as employers and insurers struggle with rising medical costs. PSI is a stop-gap for some individuals; but long-term, it does not address exorbitant prices and gross profit margins of 90% for some pharmaceuticals. These prices will continue to rise as more expensive bio-engineered products, designed to target chronic diseases, come to market. The burden is shifted to insurers, who then shift it to their customers and employers. One question is not even mentioned in this article: "Just how effective are these products?" Demand could ease quite a bit if patients and doctors had accurate information about a drug's effect instead of relying on hype. ar Anand G. Through charities, drug makers help people – and themselves.

The Wall Street Journal. December 1, 2005: A1, A10.
Patient Services, Inc. Annual Report for 2004.
Available at www.uneedpsi.org. Accessed September 20, 2006.

Flu Vaccine Efficacy
Are the flu vaccines that the Centers for Disease Control and Prevention (CDC) promotes each year as effective as the agency insists? At least two studies indicate that they are not. Part of the reason is the time-consuming method for making the vaccines, whose formulations change every year. Vaccine researchers have to make an educated guess, months in advance, about which strain(s) of influenza A and B will be most prevalent during a specific flu season. An Influenza Vaccine Supply International Task Force report says, "it takes on average 6 months from the time [that] specific reagents are provided by WHO [World Health Organization] to supply 300 million vaccine doses." If researchers guess right, the vaccine can lower the chances of getting some types of influenza for that season. Morbidity and Mortality Weekly Report 2004, produced by the CDC, says that a vaccine that has a good antigenic match to circulating influenza A or B viruses can prevent 70% to 90% of adults under age 65 and 77% to 90% of children over a year old from getting that type of flu. If they guess wrong, the vaccines are far less effective.

Another, little-publicized fact is that influenza A and B viruses account for less than 15% of all flu-like illnesses that strike each season. The CDC insists that well-matched vaccines do have some effect on influenza-like illnesses (ILI), but Peter Doshi, in his commentary for Harper's Magazine on CDC's vaccine marketing, writes, "…even the best shots have no effect on at least half the illnesses thought to be flu." In the 2003-2004 flu season, that year's vaccine did not "precisely match the predominant flu strain," according to Center for Infectious Disease Research & Policy at the University of Minnesota. To gauge the vaccine's effectiveness, a survey was conducted at Children's Hospital in Denver, Colorado. Researchers asked each of the hospital's 1,800-plus workers if they had a flu vaccine and if they had the flu between November 1 and December 11. The results suggest that the flu vaccine had "'no or low effectiveness' [depending on how the data was analyzed] against flu-like illnesses" during that period, according to a report in Morbidity and Mortality Weekly Report (January 16, 2004). Because it takes about two weeks for the immune system to respond fully to the vaccine, the researchers excluded workers who had been vaccinated on or after November 1 from the results. The CDC discounted the study because it did not have a random sample: a questionnaire had been sent to all hospital staff. The CDC also argued that the study "did not determine how many [influenza-like illnesses] were actual flu, among other limitations." Influenza-like illnesses have the same symptoms as influenza A or B: headache, fever, muscle aches, cough, and runny nose.

Among people age 65 and older, a Cochrane Review of 15 studies reports that "inactivated influenza vaccines were ineffective against influenza-like illnesses, influenza, or pneumonia…." Yet, the review also found that flu vaccination appeared to reduce hospitalizations for pneumonia by up to 30%. When asked how an ineffective vaccine could reduce hospitalization rates, Tom Jefferson, MD, who led the review team, said, "We are not sure….Our [finding] was based on non-randomized studies, which are well-known for producing overestimates of effectiveness. The real effect is likely to be more modest."

Even in poorly matched years, the CDC aggressively promotes influenza vaccines. In his article "Viral Marketing," Peter Doshi critiques the agency's use of fear and exaggerated claims of flu-associated deaths to make Americans "into a captive market for vaccines of questionable worth." When Americans began to panic during the vaccine shortage in 2004, the CDC encouraged people to wash their hands regularly to cut down on transmission of this "annoying illness." Instead of maintaining its drumbeat that emphasizes flu's life-threatening potential, the CDC reassured the public that most people "recover just fine." When vaccine availability increased, the CDC returned to its fear-generating campaign.

How effective is the influenza vaccine? It depends on the year and who you talk to. Overall, data does not support the CDC's heavy promotion of influenza vaccines. Drawing on over thirty years of data, scientists at the National Institutes of Health concluded in a 2005 report, "We could not correlate increasing vaccination coverage after 1980 with declining mortality rates in any age group." Tom Jefferson, who led the Cochrane Review, told the Center for Medical Consumers, "'Vaccines are a business, like any other. The only difference is that governments are co-sponsors with industry….Overestimation of the threat by the target diseases, suppression of data on possible adverse events, and exaggeration of effectiveness are frequent, as the case of influenza vaccines d emonstrates. In the case of population vaccination programs, both government and industry have conflicts of interest. Beware."

Center for Infectious Disease Research & Policy. Study questions efficacy of flu vaccine. Available at: www.cidrap.umn.edu/cidrap/content/influenza/general/news/jan1504flu.html. Accessed September 19, 2006.
Center for Medical Consumers. Influenza vaccines, influenza drugs – both losing effectiveness. Available at: www.medicalconsumers.org/pages/InfluenzaVaccinesInfluenzaVaccines.html. Accessed September 18, 2006.
Doshi P. Viral marketing. Harper's Magazine. March 2006: 54-55.
Influenza Vaccine Supply International Task Force. Influenza Pandemic Preparedness Position Paper. (Revised in September 2005) Available at: www.ifpma.org/site_docs/Health/PP_IVS_Sep2005.pdf. Accessed September 6, 2006

.

The Business of Academic Research
An article about the conflict between George Robert Pettit, a tenured chemistry professor and respected academic scientist, and the administration of Arizona State University dispels any illusions about colleges being the cornerstone of pure research. Arizona State University, like other research schools, is pushing academic researchers to produce research results that will make money. As in industry, that push for money ends up censoring any research that does not fit the current economic paradigm.

Dr. Pettit has researched naturally occurring substances for anti-cancer properties for over 30 years. He founded Arizona State's Cancer Research Institute in 1975. Royalty income from his 62 US patents, gifts, and grant money financed the institute's research until the university fired 30 of the 40 employees and "dismantled most of the cancer center" in January 2006. The university said that Dr. Pettit had overdrawn his account, and the center was out of funds. A National Institutes of Health (NIH) grant had been providing about one-third of the center's $1.5 million annual budget. Because of increased competition for NIH grants and decreased enthusiasm for Dr. Pettit's research topic, the NIH did not renew its five-year grant to Dr. Pettit. University administrators refused to let Dr. Pettit re-file his proposal. According to The Wall Street Journal, Dr. Pettit had antagonized the administration by publicizing a complaint he had about a collaborating professor, taking the issue to state and other officials instead of following the university chain of command. The university also said that Dr. Pettit had refused to cooperate with Arizona Technology Enterprises (AZTE), "an affiliate set up by [the university's president] to turbocharge the university's patent-licensing program." Dr. Michael Crow, who became Arizona State's president in 2002, "[blames] some of the conflict on a ‘cultural' change at the school. ‘When [Dr. Pettit] came here, it wasn't a research institution, but a very good regional state college. Now he's a smaller fish in a bigger pond.'"

Gary Krahenbuhl, former dean of Arizona State's College of Arts and Sciences, sees the conflict as te the rise of the corporate university." "In the corporate model, anyone who is not a ‘team player' in the eyes of the president, is punished," he says. Krahenbuhl, who used to be Pettit's immediate boss, retired shortly after Michael Crow became the university's president. Donald Stein, a professor of medicine at Emory University and the editor of a 2004 book on the commercialization of research universities, says, "This is driving a lot of people literally to distraction, this coming up with funds to continue your survivability." Many schools are pushing their staff to generate funding as a way to finance new buildings. Yet, federal grants from NIH are harder to come by. Applications have greatly increased, but funding has not.

Wysocki B, Jr. Once collegial, research schools now mean business.
The Wall Street Journal. May 4, 2006; A1, A11.

Natural Remedies from Lilipoh
If you are interested in non-allopathic remedies for children's health challenges, get a copy of Lilipoh Publishing's holistic wellness guide, Special Edition: New Light on Children's Health. The 52-page magazine gives home care recommendations for dealing with over 75 common problems, many of which also affect adults. Anthroposophical medicine underlies the recommendations for each condition. Inspired by Rudolf Steiner's philosophy, anthroposophical medicine combines conventional medicine with a recognition of our spiritual aspect and relationship to all of nature. The guide, which was produced in cooperation with The Wellness Nurses of The Los Angeles Alliance for Childhood, explains how to use compresses, poultices, wraps, soaks, herbal teas, and homeopathics. For each condition, it gives symptoms, basic care guidelines , and recommendations for appropriate fluids, homeopathic and herbal remedies, applications, and diet.

The listing for "flu" includes early-prevention measures, such as keeping the body warm, especially the feet. In those without a fever, a hot bath or time in a sauna or steam room, followed by a good long sleep, may be enough to prevent the flu from taking hold. Hot elder flower tea or elderberry juice (room temperature) are also helpful when taken at the first sign of flu or exhaustion. Avoiding solid food, particularly protein foods and sugar, also helps prevent the flu. Instead, drink tea, hot lemon juice, vegetable broth with garlic and onions, and eat cooked beets to provide easily digested nutrients as the body works to eliminate pathogens and toxins. For those with the flu, yarrow tea can help reduce fever. Homeopathics, such as Ferrum Phosphoricum 6X, are also recommended. Mothers at the Wellness Nurses' workshops reported that gi ving their children Tylenol actually prolonged the illness: "Allowing your child to be sick takes courage, but at the end, this child moves through illnesses much faster, since its immune response is stronger."

New Light on Children's Health costs $5 and can be obtained by calling 610-917-0792, emailing publisher@lilipoh.com, or by accessing www.lilipoh.com/holistic_wellness_a.html. Special rates for stores, schools, and groups are available. The publisher also produces a quarterly magazine, Lilipoh, which presents articles on the many expressions of anthroposophy, including health and medicine, Waldorf education, biodynamic gardening, the arts, and community.

Dealing with Pandemics
About three times every 100 years, an influenza pandemic occurs, affecting communities around the world. These pandemics result when a new influenza A virus, to which most people have no immunity, spreads quickly from person to person. Previous experience in 1918, 1957, and 1968 indicates that pandemics tend to "spread in 2-3 waves over a total period of 13 to 23 months." The specter of the 1918 Spanish flu pandemic, during which millions of people died, underlies today's headlines about H5N1 avian flu. No one knows whether H5N1, which affects birds, will mutate enough to spread from person to person. Officials do know that an influenza pandemic will occur at some point. Media reports focus on antivirals, such as Tamiflu, and flu vaccines as the primary protection against a scourge, but producing and transporting effective medicinals takes time. Another – and less-discussed – way to curtai l infectious disease is by isolating the sick and using quarantine measures.

We rarely hear about quarantine in the US now, but at one time, entire households, who had a single member infected with influenza, scarlet fever, or another communicable disease, used to be placed in quarantine. Restricting the movement of those exposed to the illness – even if they were not ill – prevented its spread to others in the community. Germs spread very efficiently in large groups of people. During the 1918 flu pandemic, schools, churches, movie theaters, and businesses were closed to help prevent the illness from spreading from one household to another. A 2006 study by John Brownstein and colleagues at Children's Hospital Boston showed that air travel – another way that large groups of people come in close proximity –– greatly speeds up the spread of influenza. These researchers tracked air travel numbers, flu mortality rates, and the length of flu seasons between 1996 and 2005. They say, "During the 2001-2002 flu season [after the Sept. 11 attacks and the resulting 27% decrease in international air travel], it took 53 days for flu to spread across the United States, 60% longer than the average time of 33 days." Also, the number of flu deaths peaked two weeks later than usual that year. France, which had no flight restrictions, showed no change. Quarantines and restricting air travel will not stop a pandemic, but these measures slow its spread and may buy time to make an effective vaccine and transport useful treatments.

One topic that is too often ignored in the many stories about pandemics and bird flu is how very disruptive a pandemic like the one in 1918 is to everyday life. South Carolina reporter Amanda Ridley writes, "…if a pandemic strikes again, life as it exists today would stop. Quarantines would be ordered by state public health officials and enforced by the local governmen t. There would be no quick trips to the grocery store – because they would all be closed." Officials recommend that people have enough food, water, and medications to last three months. Sounds a little like Y2K again, doesn't it? Still, history indicates that we are due for another influenza pandemic. Most of us in the US have become very dependent on government and business services for our everyday needs. We don't have water wells in the back yard or a root cellar and garden to provide food. As in other emergencies, government and health officials do not have a magic solution that will let people continue to live as usual. Instead, we have to depend on our own resources and that of our communities.

Centers for Disease Control and Prevention. Fact sheet – Isolation and Quarantine. Available at www.cdc.gov/ncidod/dq/sars_facts/isolationquarantine.pdf. Accessed September 18, 2006.
Fox M. Sept. 11 study shows flu spreads by airplane. Reuters (11 September 2006). Available at www.alertnet.org. Accessed September 18, 2006.
Influenza Vaccine Supply International Task Force. Influenza Pandemic Preparedness Position Paper. (Revised in September 2005) Available at: www.ifpma.org/site_docs/Health/PP_IVS_Sep2005.pdf. Accessed September 6, 2006.
McKenna M. Association of Health Care Journalists Avian & Pandemic Influenza Tipsheet. Available at www.healthjournalism.org/news/2006/0626birdflu.htm. Accessed September 6, 2006.
Ridley A. The flu pandemic of 1918. The Spartanburg Herald-Journal April 2, 2006: A1, A4, A5.

Ascorbic Acid, Glucose, & the Immune System
Back in 1942, Cowan, Diehl, and Baker reported, in the Journal of the American Medical Association, that 200 mg/day of vitamin C (ascorbic acid) reduced the severity and the incidence of head colds among a group of college students. At the time, the nutritional guidelines recommended just 30 mg/day to prevent scurvy, the only condition ascribed to vitamin C deficiency. Since then, researchers have learned much about ascorbic acid's immune, enzymatic, antioxidant, and regulatory functions. One factor has particular significance for clinicians, researchers, and consumers who want to use ascorbic acid to boost the immune system: glucose and ascorbic acid compete with one another. Retired public health scientists Fred and Alice Ottoboni wrote a fascinating paper on ascorbic acid's effect on the immune system and the inhibitory action of glucose, published in The Journal of Orthomolecular Medicine (2005; 20[3]: 179-183).

Nearly all animals convert glucose into ascorbic acid. Humans, other primates, and guinea pigs are among the exceptions. The enzyme needed for the final step of the conversion, L-gulonolactone oxidase, is ineffective in these animals; they must get ascorbic acid in food or supplements. Researchers estimate that "if humans had intact glucose/ascorbic acid pathways, they would produce about two to four grams of ascorbic acid per day under normal conditions and at least 15 grams per day under stress."

Insulin moves both glucose and ascorbic acid, which are structurally similar, into cells throughout the body, including phagocytic immune cells. Phagocytic cells, such as leukocytes, attack and remove microbes, tumor cells, and other debris from the blood. Leukocytes contain large amounts of ascorbic acid, "up to 80 times greater than in the plasma." Since glucose and ascorbic acid compete for insulin transport, too m uch glucose (due to a diet high in sugar and other carbohydrates, for example) can inhibit the amount of ascorbic acid that gets transported into cells.

Glucose and ascorbic acid are competitors in another way. Ascorbic acid stimulates the hexose monophosphate (HMP) shunt, and glucose inhibits it. HMP is "a series of biochemical reactions used to reduce niacin coenzyme NADP to NADPH." Phagocytes need NADPH to make superoxide and other reactive oxygen species used to destroy pathogens. Not only does ascorbic acid have a role in producing reactive oxygen compounds, it also deactivates these oxidative compounds which have escaped from the phagocyte and threaten to harm surrounding tissue. The hexose monophosphate shunt also produces 5-carbon sugars (ribose and deoxyribose), needed to make RNA and DNA – the genetic material for new cells. One of the immune system's first reactions to microbial invasion is rapid production of phagocytic leuk ocytes. If the body has too much glucose and too little ascorbic acid, it will not produce enough genetic material to make new cells.

The authors say that glucose's inhibitory effect on ascorbic acid "explains why some studies have shown little or no benefit from oral administration of ascorbic acid; they did not control for dietary provision of glucose, which would successfully compete with ascorbic acid and prevent its utilization." Consumers who take vitamin C with sugary fruit drinks or pastries are defeating the purpose of boosting the immune system.

Ottoboni F, Ottoboni A. Ascorbic acid and the immune system. The Journal of Orthomolecular Medicine. 2005; 20(3): 179-183.

Neuraminidase Inhibitors to Treat Flu
Neuraminidase inhibitors (NIs), which include oseltamivir (Tamiflu) and zanamivir (Relenza), are antiviral drugs that are designed to lessen flu symptoms. These drugs prevent the influenza virus from spreading to healthy cells by blocking the action of neuraminidase, an enzyme that helps the virus in infected cells replicate. Tamiflu, in particular, has been heavily promoted as a way to lessen the risk of getting the illness after exposure and to reduce flu severity. It has not been approved for use by pregnant women, infants under one year old, or people with chronic heart disease, lung disease, kidney failure, or other high-risk medical conditions. Tamiflu's most common side effects include nausea and vomiting. Relenza, which has been approved for treatment, not prevention, can cause diarrhea.

A 2006 Cochrane systematic review, led by Tom Jefferson, MD, looked at the neuram inidase inhibitors Tamiflu and Relenza. The researchers found, "Oseltamivir for [post-exposure prophylaxis] has an efficacy of 58.5% for households and of 68% to 89% in contacts of index cases. Zanamivir has similar performance." Neither showed any preventive effect, compared to placebo, against influenza-like illnesses that have the same symptoms but are not caused by influenza A or B viruses. The drugs also have no significant effect on influenza before symptoms occur. Using data from 13 trials, the researchers determined that oral Tamiflu was 61% effective in reducing flu severity at an oral dose of 75 mg daily and 73% effective at 150 mg daily. Relenza, which is inhaled, is 62% effective at 10 mg per day. Because this review is based on published trials (which tend to be biased toward a positive result), the results may be high. The Cochrane researchers conclude: "Because of their low effectiveness, NIs should not be used in routine seasonal influenza control. In a serious epidemic or pandemic, NIs should be used with other public health measures [barrier (masks, gloves), personal hygiene and quarantine measures]. We are unsure of the generalisability [sic] of our conclusions from seasonal to pandemic or avian influenza."

Recent clinical reports indicate that Tamiflu-resistant influenza virus has emerged. A 2004 Japanese study found that 18% (nine of 50) of children with influenza A (H3N2), who were treated with Tamiflu, had a virus with a drug-resistance mutation in the neuraminidase gene. Tamiflu-resistant avian flu virus has also been isolated from people who took the drug. Anna Moscona, MD, says that insufficient doses and treatment that ends too early may be contributing to the development of resistant mutations.

Using Tamiflu prophylactically, an increasingly common practice in some Asian countries, is making the detection of avian flu infection difficult. Tamiflu does not destroy the influenza virus; it only keeps it from replicating. Virologist Menno de Jong, who is at an Oxford University clinical research unit in Vietnam, told Bloomberg News, "If a patient is on oseltamivir for three days before the first swab is taken for diagnostic testing, it's possible the result will be negative, but the patient could be infected." He suggests that a swab sample be taken from the patient before or shortly after taking Tamiflu. The masking effect of Tamiflu makes it very difficult to track the incidence of avian flu accurately.

Center for Infectious Disease Research & Policy. Experts worry that antivirals may mask avian influenza. Available at: www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/aug2406tamiflu.html. Accessed September 7, 2006. (12/22/06: Link no longer works.)
Cochrane Collaboration. Neuraminidase inhibitors for preventing and treating influenza in healthy adults (abstract and plain language summary). Available at: www.cochrane.org/reviews/en/ab001265.html. Accessed September 19, 2006.
De Jong MD, et al. Oseltamivir Resistance during treatment of influenza A (H5N1) infection. New England Journal of Medicine (December 22, 2005) 353;25: 2667-2672
Moscona A. Oseltamivir resistance – disabling our influenza defenses. Available at: www.nejm.org. Accessed September 19, 2006.
Stöppler, MC. Tamiflu for bird flu? Available at: www.medicinenet.com. Accessed September 18, 2006.

Coughs, Cough Medicines, & Upper Respiratory Infections
Francis Brinker, ND, has an informative article, posted at HealthWorld Online, about the use of herbs to treat coughing due to upper respiratory infections. Normally, small hairs on the inner lining of the respiratory tract move mucus-trapped waste and inhaled particles up from the lungs. Viral infections (i.e., colds, flu), however, can interfere with the motion of these small hairs. Also, respiratory fluid becomes thicker and increases as the body tries to remove wastes and protect the lining. Coughing is another way for the body to clear the respiratory tract. Infections are the most common cause of acute coughs. Inhaled irritants, blood clots, tumors, and lung congestion from heart insufficiency are other causes. Chronic coughs, lasting more than three weeks and without other signs of infection, may be due to postnasal drip caused by allergies; some medicines (e.g., ACE inhibitors for high blood pressure & beta blockers for high blood pressure, migraines, o r glaucoma); asthma; and gastroesophageal reflux (heartburn).

In his article, Brinker suggests several types of herbs for treating coughs caused by upper respiratory infections: cough suppressants (antitussives), demulcents, expectorants, and bronchial relaxants. The type of herb to use depends upon the type of cough. Coughs due to viral infection generally are dry at first, eventually producing some thick, white sputum. Cough suppressants (antitussives) are useful for dry coughs, but Brinker recommends that suppressants not be used to calm productive coughs unless the coughing is "exhausting the patient or preventing sleep." Suppressants inhibit the removal of fluid and infectious waste from the respiratory tract, which is the purpose of productive coughs. Wild cherry bark (Prunus) and licorice (Glycyrrhiza) are two herbal cough suppressants. Wild cherry bark, taken in small quantities, reduces irritation of the mucus lining at or below the voice box and can be helpful for nervous coughs as well as dry coughs. In addition to its antitussive effect, licorice has antiviral and immune-stimulating properties. It is also a demulcent, an herb that soothes irritated mucosa linings by providing mucilage. Other demulcents that can alleviate coughs are marshmallow root (Althea) and slippery elm bark (Ulmus). Mullein (Verbascum) works as an expectorant that increases respiratory fluids; this produces a demulcent effect that relieves bronchial membrane irritation. Pleurisy root (Asclepias) and lungwort (Sticta), sedative expectorants that also work as bronchial relaxants, are helpful for people who have dry, persistent coughs and painful breathing or wheezing.

As a cold progresses (particularly if a secondary bronchial infection takes hold), coughs become productive as the patient coughs up thick sputum, clearing the lungs. Cough suppressants should be avoided at this time, unless the cough is exhausting the patient. Some of the expectorants used to treat dry coughs are also useful for productive coughs; but productive coughs, unlike dry coughs, need stimulant expectorants whose "tonic and antiseptic actions help to stimulate repair and diminish fluid secretions due to inflammation." These expectorants include garlic, thyme, and eucalyptus oil, which is often used in throat lozenges. In addition to these expectorants, demulcents, taken as teas, extracts, and lozenges, help so othe respiratory tract irritation.

Brinker criticizes the cough formulas sold in US stores for containing too many different ingredients – expectorant, decongestant, antihistamine, anesthetic, analgesics, bronchial relaxants, and fever-reducers – in a single product. Sometimes, these ingredients counteract each other. For example, antihistamines dry the respiratory mucous membranes, while expectorants increase fluid secretion. This article shows that coughs due to upper respiratory infections have different qualities from patient to patient and can change during the course of the illness. For that reason, Dr. Brinker recommends using symptom-appropriate cough remedies instead of relying upon one pre-formulated combination.

American Academy of Family Physicians. Chronic cough: Causes and cures. Available at http://familydoctor.org. Accessed on September 18, 2006.
Brinker F. Treatment of coughs with herbal remedies. Available at www.healthy.net/scr/Article.asp?Id=774&action=print. Accessed on September 7, 2006.

Hospital Charges, Health Insurance, & Anabaptists
Anabaptists (Amish and Mennonites) forgo health insurance, including Medicare, as part of their religious practice. Because US hospitals typically charge people without insurance more than they charge insured patients for the same treatment, Anabaptists often travel to Mexican hospitals, which charge far less for their care. When Heart of Lancaster Regional Medical Center opened in Lancaster County, Pennsylvania, in 2004, Anabaptists in the area banded together to negotiate for lower rates. Experience with lower costs in Mexico plus their willingness to pay 50% of their fees, in cash, upon admission gave them an advantage in the bargaining. The group also promised not to engage in malpractice suits. In exchange, the hospital gave them up to 40% off its uninsured rates, resulting in costs that are slightly higher than those for Medicare patients. The hospital refused to lower their costs further for fear that it would be accused of fraud for charging Medicare patients more than the Anabaptists. At the Lancaster medical center, Anabaptists can get a hip replacement for a flat charge of $16,577, about half of the national average cost in 2004. The charge includes anesthesia, surgery, medication, testing, the hospital stay, and outside specialists, if necessary. Anabaptists in Lancaster County spend about $5 million in cash each year on health care.

I don't know if the Lancaster Anabaptists can provide a model for lowering hospital costs. The cohesiveness of the Anabaptist community, their belief system, and their thrift permitted them to approach the hospital in a way that mainstream Americans, who tend to expect the government and other institutions to care for them, cannot. However, their ability to negotiate a considerably lower price shows that hospitals may be able to lower their prices when they can be assured of payment, up front and in cash, and don't have to worry about malpractice lawsuits. I'm sure that the hospital also realized that the Anabaptist community was willing to continue taking a good chunk of that $5 million or more down to Mexico if the hospital didn't make some concessions.

Often, the US discussion about affordable health care revolves around having insurance to take care of bills; but insurance disguises the true costs of health care. The financial burden of excessive health care and pharmaceutical costs simply shifts into higher insurance premiums and co-pays, rising taxes to support Medicare/Medicaid, and higher costs in goods and services so that employers can pay for their employees' health care. In 2003, US health expenditures (that is, the amount of money spent on health care by state and federal governments, businesses, non-business entities, and individuals) was $1.7 trillion dollars, according to the National Health Statistics Group ( part of the federal Centers for Medicare and Medicaid Services). Hospital costs account for about 31% of that total. Physician services and other clinical services take up about 22%, and retail pharmaceutical drugs make up 11%. Total expenditures have increased over $100 billion every year since 2000. "You get what you pay for," we're told; but, in this case, high costs do not mean high-quality care. The Commonwealth Fund, a non-profit health care research foundation, says that "Americans spend 16% of gross domestic product on health care – double the median for all industrialized countries." Yet, the US has a higher infant mortality rate and higher number of deaths, preventable by timely medical care, than nearly all of the other developed nations in the foundation's report.

Even people with health insurance can find health care costs overwhelming. In an interview with Newsweek, Elizabeth Warren, a Harvard law professor and co-author of The Two-Income Trap: Why Middle-Class Mothers and Fathers Are Going Broke, said that "…more than half of the families who file for bankruptcy do so in the aftermath of a serious medical problem. And three-quarters of these people have health insurance at the onset of the illness or accident that ultimately landed them in bankruptcy. Sometimes it's hospital bills, but more often, it's about co-pay, deductibles, uncovered treatments, drugs, rehab, supplies, all the things that aren't covered by insurance…the financial impact of a serious medical problem goes beyond hospital bills. Lost jobs, drugs, physicians, rehab, health supplies. It's expensive to get sick in American today – too expensive for the average family."

Alliance for Health Reform. "Health Care Costs" Sourcebook for Journalists, 2004. Available at: www.allhealth.org/publications/pub_15.pdf. Accessed September 19, 2006. 2006.
Fox M. US spends more but gets mediocre health care. Reuters (September 20, 2006). Available at: http://news.yahoo.com/s/nm/20060920/hl_nm/usa_dc. Accessed September 21, 2006.
Institute for Health Freedom. Amish drive down medical costs. (Reprinted with permission of National Center for Policy Analysis: Available at: www.ncpa.org/newdpd/dpdarticle.php?article_id=2957.) Health Freedom Watch. First Quarter 2006: 7.
National Center for Health Statistics. Health expenditures. Available at: www.cdc.gov/nchs/fastats/hexpense.htm. Accessed September 21, 2006.
Springen K. Going for broke. Newsweek (web exclusive) August 31, 2006. Available at www.msnbc.msn.com/id/14604090/site/newsweek/page/3/. Accessed September 19, 2006.