NBC Nightly News Dec. 27, 2005
Campbell Brown reporting : Warning to Doctors Using blood thinners
Causes dangerous bleeding.

Facts about Coumadin
I just spent 15 extra days in the hospital because of excessive use of
Coumadin during stent application to heart artery. This is the second
time this happened after many warnings to the heart doctors who
performed the stent surgery. I very nearly bleed to death and needed
nimerous blood transfusions. It happens frequently and doctors continue
to use it despite many lawsuits brought against them - usually after
death by family members who discovered the cause of death.
---- Poster

Adverse Reactions of Warfarin (Coumadin):
Potential adverse reactions to warfarin sodium may include:

FATAL or nonfatal hemorrhage from any tissue or organ: This is a
consequence of the anticoagulant effect. The signs, symptoms, and
severity will vary according to the location and degree or extent of
the bleeding. Hemorrhagic complications may present as paralysis;
paresthesia; headache, chest, abdomen, joint, muscule, or other pain;
dizziness, shortness of breath, difficult breathing or swallowing;
unexplained swelling; weakness; hypotension; or unexplained shock.

Therefore, the possibility of hemorrhage should be considered in
evaluating the condition of any anticoagulated patient with complaints
which do not indicate an obvious diagnosis. Bleeding during
anticoagulant therapy does not always correlate with PT/INR .

Bleeding: which occurs when the PT/INR is within the therapeutic range
warrants diagnostic investigation since it may unmask a previously
unsuspected lesion, e.g., tumor, ulcer, etc.

Necrosis of skin and other tissues.

Adverse reactions reported infrequently include: Hypersensitivity
reactions, systemic cholesterol microembolization, purple toes
syndrome, vasculitis, hepatitis, cholestatic hepatic injury, jaundice,
elevated liver enzymes, fever, dermatitis, including bullous eroptions,
urticaria, abdominal pain including cramping, asthenia, nausea,
vomiting, diarrhea, headache, pruritis, alopecia, and paresthesia.

Rare events of tracheal or tracheobronchial calcification have been
reported in association with long-term warfarin sodium therapy. The
clinical significance of this event is unknown.

Priapism has been associated with anticoagulant administration,
however, a causal relationship has not been established.

Overdosage:

Signs and Symptoms: Suspected or overt abnormal bleeding (e.g.,
appearance of blood in stools or urine, hematuria, excessive menstrual
bleeding, melena, petechiae, excessive bruising or persistent oozing
from superficial injuries) are early manifestations of anticoagulation
beyond a safe and
satisfactory level.

Treatment: Excessive anticoagulation, with or without bleeding, may be
controlled by discontinuing warfarin sodium therapy and if necessary,
by administration of oral or parenteral vitamin K1. (Please see
recommendations accompanying vitamin K1preparations prior to use.)

Such use of vitamin K1 reduces response to subsequent warfarin sodium
therapy. Patients may return to a pretreatment thrombotic status
following the rapid reversal of a prolonged PT/INR .

Resumption of warfarin sodium administration reverses the effect of
vitamin K, and a therapeutic PT/INR can again be obtained by careful
dosage adjustment. If rapid anticoagulation is indicated, heparin may
be preferable for initial therapy.

If minor bleeding progresses to major bleeding, give 5 to 25 mg (rarely
up to 50 mg) parenteral vitamin K1. In emergency situations of severe
hemorrhage, clotting factors can be returned to normal by administering
200 to 500 ml of fresh whole blood or fresh frozen plasma, or by giving
commercial Factor IX complex.

A risk of hepatitis and other viral diseases is associated with the use
of these blood products; Factor IX complex is also associated with an
increased risk of thrombosis. Therefore, these preparations should be
used only in exceptional or life-threatening bleeding episodes
secondary to warfarin
sodium overdosage.

Purified Factor IX preparations should not be used because they cannot
increase the levels of prothrombin, Factor VII and Factor X which are
also depressed along with the levels of Factor IX as a result of
warfarin sodium treatment. Packed red blood cells may also be given if
significant blood loss has occurred. Infusions of blood or plasma
should be monitored carefully to avoid precipitating pulmonary edema in
elderly patients or patients with heart disease.

SEE:
http://en.wikipedia.org/wiki/Warfarin

I remember when they almost killed President Nixon with blood thinners.
I take an 81mg aspirin daily which is a blood thinner. But, I stopped
it before dental surgery because I knew the danger of bleeding. I have
wondered if they aren't overdoing blood thinners after a heart attack
or stroke.

This is what I call a Hobson's choice...

"Raymond" <Bluerhymer@aol.com> wrote in message
news:1135755374.070074.143180@f14g2000cwb.googlegr oups.com...

Hobson's choice \HOB-sunz-chois\, noun:
A choice without an alternative; the thing offered or nothing.

If you have problems taking aspirin, as many people do, causing stomach
upset, try taking the 81 mg ENTERIC aspirin.

Like all medications, there are risks when taking aspirin—including
stomach bleeding and kidney, heart, and liver problems—when taken daily
for weeks, months, or years. This Web site will help answer some basic
questions about aspirin use for CVD.( coronary vascular disease). Talk
to your health professional before taking aspirin for CVD prevention.
Follow all directions on the label before you take any over-the-counter
medicine. If you are not sure, or have any questions about any
medication, ask your medicin man, pharmacist, or other health voodo
professional.

Q. Can I just take the same aspirin that is in my medicine chest at
home?

A. You should consult with your health professional before beginning an
aspirin-therapy regimen. There are many different varieties of aspirin
products to meet your needs. For example, if you have gastrointestinal
(GI) problems or are already on medication for GI problems, you may
want to take an “enteric coated” (Ecotrin‘, Ascriptin‘) or “buffered”
(Bufferin‘) aspirin to reduce your chances of stomach upset.
Enteric-coated aspirin is specially designed to dissolve more slowly to
avoid stomach upset. Buffered aspirin contains antacids to neutralize
the acid in your stomach that causes upset. Read the label to make sure
you are taking the appropriate product.

Aspirin and Coronary Vascular Disease
Enteric-coated aspirin is specially designed to dissolve more slowly to
avoid stomach upset. Buffered aspirin contains antacids to neutralize
the acid in ...
http://www.nclnet.org/health/aspirin.html

Take one 81 mg aspirin and call me in the morning. That will be $88.00.
Give my nurse you insurance information on the way out. If you are on
Medicare, that will be $166.00
--- Dr."Bandit Bob" Doomer. M.D.

DEFINING FRAUD, WASTE, AND ABUSE
"HELLO SUCKERS"
http://www.jazzbabies.com/nonflash/
http://en.wikipedia.org/wiki/Texas_Guinan

The terms waste, fraud, and abuse are often raised in discussions of
federal health spending without being clearly defined or distinguished
from the spending for health services that Medicare is intended to
cover. One way to think of those issues is to place all of the
activities for which Medicare reimburses providers on a spectrum. At
one end of the spectrum are activities that are unmistakably illegal.
For example, a health care provider-- (like my Dr."Bandit Bob" Doomer)
or, more accurately, nonprovider--who deliberately bills Medicare for
services that have not been rendered to a covered beneficiary is
clearly engaging in a fraudulent activity. At the other end of the
spectrum are the medically necessary, competently performed, and fairly
priced health care services for which Medicare is intended to pay.

Although those poles are relatively easy to identify, there is ample
room between them. Moreover, no clear line separates abusive activities
from fraud. One definition that has been put forth distinguishes
abusive activities as those that are not illegal but that violate the
intent of the program. That definition, however, offers little guidance
in practice. Consider, for example, whether the following examples
should be described as abuse:

A technician mistakenly takes an X-ray of a patient's left leg, then
takes a second X-ray when he discovers his error. The hospital bills
Medicare for both X-rays.

A physician admits a patient to a hospital to ensure that drugs are
paid for that would not otherwise be covered under Medicare.

Some doctors now write prescriptions and fill the same prescription
from their own office and pad the prescription into the office visit
charge for their favorite patients. It should be against the law for
doctors to dispense drugs other than samples. If not illegal, it
certainly is immoral.

"Greed Is Good." -- per Gordon Gekko

To offset lower fees paid by Medicare, a physician begins recommending
follow-up office visits for certain conditions that previously did not
warrant such visits.

Your doctor may be "shipping you around" to other doctors to simply
spread the insurance wealth

A managed care plan markets itself in a way that attracts relatively
healthy beneficiaries, thus increasing its profits by reducing the
costs of care below those envisioned in the risk-contract reimbursement
formula.

Depending on one's perspective, those activities might or might not be
characterized as abusive. A definitive characterization, however, would
require an understanding of both Congressional intent--that is, knowing
the objective of the legislation that permitted (or prohibited) a
particular activity--as well as the intent of providers or
beneficiaries and the circumstances surrounding their actions.
Certainly, some Medicare spending reflects abusive activities; how much
is considerably less clear.

Distinguishing between spending that is wasteful and spending that is
appropriate is even harder. Among the factors making that determination
problematic are the uncertainties of medical science and the lack of
financial incentives to limit spending.

Medicare pays for services whose ultimate success is often unknown at
the individual level. For example, even the most appropriate use and
careful application of diagnostic tests will often rule out a
particular illness rather than confirm its presence. In addition,
treating a particular illness often allows several approaches, whose
costs may vary substantially. Differences in approach may reflect lack
of scientific consensus or simply differences in patterns of practice
among providers. Studies show that the incidence of many medical
procedures varies far more among regions of the country than can be
explained by differences in the characteristics of the population of
patients.

Advances in medical science may reduce, but will probably never
eliminate, uncertainties in diagnosis and treatment. Although negative
test results or failed treatments may seem wasteful after the fact,
that vantage point is not necessarily the appropriate one from which to
assess the value of the services. Similarly, one may expect medical
approaches to particular illnesses to become more similar over time as
the most successful methods become apparent. Efforts to reduce spending
by forcing that convergence to happen more quickly may stifle
innovation.

Perhaps more important than the potential waste from the technical
aspects of medical care is the institutional environment in which
Medicare beneficiaries and health care providers meet. In markets where
consumers are well-informed and pay the full costs of purchasing goods
and services themselves, economists would generally not view waste as a
relevant issue because people can be presumed to purchase only goods
and services that are of value to them. That presumption, however, is
much less valid for Medicare. Beneficiaries have had little incentive
to concern themselves with costs because they may pay little or nothing
at the margin for additional services. Moreover, consumers of health
care are often ill-equipped to assess the risks and benefits of
alternative therapeutic approaches. The financial incentives faced by
health care providers in the fee-for-service sector also encourage the
provision of more rather than fewer services.

Medicare spending can be reduced by changing the financial incentives
given to beneficiaries and providers. For example, increasing the
exposure of beneficiaries to the costs of health care at the margin
could make them more cost-conscious and potentially reduce spending. As
long as most Medicare beneficiaries have first-dollar coverage through
the Medicaid program or through private medigap insurance, however,
reducing health spending by this route is difficult. Certain types of
managed care could also reduce the use of health care services--in this
case by altering the incentives of providers. How much of the reduction
would occur through cutting unnecessary services is less clear.

Whose fault?
Your congressman and congresswoman, who is in debt to the AMA and the
Pharmacutical drummers.
Billions are lost to provider fraud.
And no one cares as long as it does not come out of the patients'
pocket.
However, it really does in other taxes paid by the same patients.

Our Nation's Fiscal Outlook: The Federal Government's Long-Term Budget
Imbalance
Over the next few decades, the nation’s fiscal outlook will be shaped
largely by demographics and health care costs. As the baby boom
generation retires, federal spending on retirement and health
programs—Social Security, Medicare, and Medicaid—will grow
dramatically. A range of other federal fiscal commitments, some
explicit and some representing implicit public expectations, also bind
the nation’s fiscal future. Absent policy change, a growing imbalance
between expected federal spending and tax revenues will mean escalating
and ultimately unsustainable federal deficits and debt.

http://www.cbo.gov/showdoc.cfm?index=5497&sequence=0

Let us prey
Raymond