Thursday, September 29, 2011

Register with the early bird rate and save up to $275!

We're excited to announce that early bird registration for the 2012 National Conference on Tobacco or Health is now open! Register before March 1, 2012 and save up to $275!
Is your 2011 fiscal year ending this month? Use your budget wisely by purchasing registration today. Don't miss your chance to be a part of the largest tobacco control event in the nation!
Taking place in SMOKE FREE Kansas City, Missouri, this event provides you with:
  • Access to nearly 3,500 like-minded tobacco control leaders, researchers, advisors, advocates, professionals, educators, representatives and more.
  • The latest evidence on what works in tobacco control and how to apply current research findings and best practices.
  • Practical ways to improve tobacco control programs and activities.
  • Valuable ideas and tips through networking.

Don't wait!  Register now at

Job openings: Actuaries, actuarial analyst, market conduct examiner

  • Actuaries: Due to retirements, we have two openings for actuaries now, helping with financial examinations, analysis and licensing of life insurers or health insurers. Other typical duties include reviewing rates, equity-indexed annuities, etc. For details on these jobs, including salary and benefits, please see this job listing for both acturarial jobs.

  • Actuarial analyst: We're also looking for an actuarial analyst to fill a vacancy created when a staffer shifted over to a federally-funded project that we're working on (part of health care reform). Duties include reviewing actuarial calculations submitted by health insurance carriers to determine if rate requests are justified. For specifics, here's that job listing. The deadline for applying is 4:59 p.m. on Thursday, Oct. 6.

  • Market Conduct Examiner: We also have a vacancy in our Seattle office for a market conduct examiner. This job includes reviewing and analyzing company records and procedures. Here's a detailed job listing, including other duties, salary, etc. The deadline for applying is 5 p.m. on Friday, Oct. 7, 2011.

Home warranty company ordered to stop selling illegal coverage

A Florida company, its principals and subsidiaries have been ordered to stop selling unauthorized home warranties in Washington state.

Insurance Commissioner Mike Kreidler has ordered International Warranty Administration Services, Inc. and related entities to stop selling service contracts in Washington. The company and its subsidiaries are believed to have sold dozens of unauthorized service contracts in the state, but are not licensed to solicit insurance here.

Kreidler's order also includes The Metropolitan Benefit Group, Inc., doing business as HomeChoice Plans, HomeChoice Household Service Plans, Choice Plans LLC, and "ChoicePlans a division of the IWASI Group." Also named were International Warranty Administration Services' principals Kacey L. Crouch, also known as Kasey L. Crouch, and Mark Lowenstein.

See the link above for the full text of the order.

Insurance agents and brokers fined for violations

Insurance Commissioner Mike Kreidler has ordered fines and other disciplinary action for more than a dozen insurance agents and brokers.

Violations include failing to properly disclose fees, using a false Social Security number and wrongly disclosing a customer’s private health information.

“I should point out that these cases are only a tiny fraction of the more than 118,000 agents and brokers licensed to do business here in Washington,” said Kreidler.

Any Washingtonian with a complaint against an insurer, agent or broker can contact Kreidler’s office at 1-800-562-6900 or file a complaint online at

Any fines collected do not go to the agency. They are deposited in the state’s general fund to pay for other state services.

Fines and disciplinary actions from early June through early September include:

■HSBC Securities (USA) Inc., New York, NY: Fined $7,000 for violations including failing to report administrative actions taken against it.

■Conover Insurance Inc., Yakima, Wash.: Fined $6,000 for providing false information on 12 license renewal applications.

■Kimberly A. Kelly, doing business as Peoples Insurance Agency, Inc., Renton, Wash.: Fined $250 for using a fee disclosure form that didn’t comply with state law.

■Kimberly D. Brookey, Kent, Wash.: Fined $250 for using a fee disclosure form that didn’t comply with state law.

■Ryan J. Graczyk, Spokane Valley, Wash.: Fined $500 for incorrectly and incompletely answering questions on a disclosure form to a consumer.

■Warren M. King, doing business as Exact Financial Group, Inc., Renton, Wash.: Fined $500 for violations including submitting a life insurance application with inaccurate information.

■Swiss Valley Agency, Inc., doing business as North Town Insurance, Spokane, Wash.: Fined $250 for using a fee disclosure form that didn’t comply with state law.

■Rick L. Clatfelter, Chandler, Ariz.: License not renewed for making misleading statements on an insurance application.

■Lucky Bail Bonds, Inc. and Eric Arps, Bellingham, Wash.: Fined $5,500 for violations including misrepresenting to the court that he personally completed and signed certain documents.

■Robert J. Mills Jr., Wilton, CT: Fined $5,000 and ordered to stop selling insurance in Washington without a license.

■Colleen S. Schmertz, Bellingham, Wash.: Fined $500 for issuing bail bonds without a proper insurance license.

■Maria E. Bejines, Monroe, Wash.: License revoked for violations including using a false Social Security number on her insurance license application.

■Phyllis N. Golden, Seattle, Wash.: Fined $250 for providing false information about continuing education courses.

■Tiffany Lynn Lewis, Irving, Tx.: License revoked due to a felony conviction for stealing money from a client.

■Northpoint Escrow & Title, LLC, Bellevue, Wash: Fined $500 for improperly sponsoring a promotional event.

■James Timothy Shelnut, Augusta, Ga.: License revoked for failing to report administrative actions in other states, including violations of Georgia’s Ethics in Government Act.

■Ticor Title Co., Renton, Wash.: Fined $1,500 for improperly sponsoring a promotional event and offering to refund class tuition if attendees failed the quiz at the end of the class.

Orders and specific details about each of these cases are posted online at

Note: In some cases, the fines were larger, but a portion was suspended on the condition that the companies follow compliance plans to remedy the problems. The fines listed above are what’s actually being paid.

Wednesday, September 28, 2011

Insurers fined for violations

Insurance Commissioner Mike Kreidler has fined insurance companies nearly $1 million this year for violating Washington insurance laws. Violations included charging unapproved rates, improper advertising, and failing to offer health coverage to children.
The fines collected do not go to the agency. They are deposited in the state’s general fund to pay for other state services.
Any Washingtonian with a complaint against an insurer, agent or broker can contact the office at 1-800-562-6900 or file a complaint online at

Fines and other disciplinary actions against insurers from June to September include:
■UNUM Life Insurance Co., Portland, Me.: Fined $75,000 for selling long term care coverage using unapproved policies.

■Allstate Insurance Co., Northbrook, Ill: Fined $50,000 for issuing policies using unfiled and unapproved rates.

■UnitedHealthCare, Hartford, Conn.: Fined $26,000 for sending people wishing to appeal the insurer’s decisions to the wrong entity.

■Arch Insurance Co., Kansas City, Mo.: Fined $20,000 for violations including failing to keep adequate accounts and records.

■Chicago Title Insurance Co., Omaha, Neb.: Fined $10,000 for improperly advertising with producers of title insurance business.

■Lifewise Health Plan of Washington, Mountlake Terrace, Wash.: Fined $10,000 for failing to offer coverage to children in certain cases.

■Metropolitan Life Insurance, New York, NY: Fined $10,000 for failing to calculate benefit amounts in accordance with Washington law.

■Victoria Fire & Casualty Co., Cleveland, Ohio: Fined $5,000 for failing to adequately respond to inquiries.

■Fidelity National Title Insurance Co. (Santa Barbara, Calif.) Chicago Title Insurance Co. and Commonwealth Land Title Insurance Co. (both of Omaha, Neb.): Ordered to stop offering discounts to producers of title insurance business.

Orders and details about each of these cases are posted online at

Note: In some cases, the fines were larger, but a portion was suspended on the condition that the companies follow compliance plans to remedy the problems. The fines listed above are what’s actually being paid.

Tuesday, September 27, 2011

Two more health plans request rate changes

Kaiser Foundation Health Plan of the Northwest is requesting a 9% average rate increase for its individual health plans (health plan you buy yourself) and Regence BlueCross BlueShield of Oregon is asking to lower its small employer plan rates (health plans for employers with 1-50 employees) by an average of 1.6%.

See the all of the information submitted with the rate requests and a brief summary of both on our new health rate page. Both rates, if approved, take effect Jan. 1, 2012.

Bizarre insurance claims

Forbes has posted a list of bizarre insurance claims compiled by Chartis Insurance Co. Don't try these at home. Among them:

A man who set his Porsche on fire trying to dry out the floor mat with a leaf blower.

Someone who slowly melted an Andy Warhol painting by hanging it above a fireplace.

A man who managed to destroy his car engine -- and the car was a Bentley Continental -- by trying to charge it up by setting a brick on the accelerator, and then going to take a shower. The overheated engine seized.

Click on the link above for the rest.

Kreidler: Health insurer rate requests now public

For the first time, consumers can now see health insurers' complete rate requests, Washington State Insurance Commissioner Mike Kreidler recently told Comcast's Newsmakers program.

Kreidler pushed for a change in state law to allow the forms to be disclosed. Soon, consumers will not only be able to view the documents easily online, but comment on the requested rates.

Monday, September 26, 2011

Keeping a Food Journal

If you are looking to loose weight or just make healthier choices for your body, keeping a food journal can be a powerful tool to assist you. Keeping track of what you are eating will help bring awareness to your eating habits and patterns. To keep track of meals, snacks and drinks that you consume, keep a small notepad in your purse, or keep a log on your phone, laptop or ipad.. whatever is most convenient for you to use throughout your day. You can even purchase food journals like the Diet Minder from book stores. The food diary process is designed to be fun and informative. It will help you recognize poor habits or foods that you react to and will help you find connections between what you eat and how you feel.

What to keep track of:
  • The Date
  • Time of day
  • What foods – What foods were eaten, how were they prepared and in what quantity. Be sure to include all ingredients. Be sure to include beverages and include misc items such as gum/candy.
  • Hunger level (on a scale of 0-5) at time of meal/snack
  • Meal situation – The place and activity surrounding meal/snack. Indicate home cooked versus eating out, etc.
  • Sensations – Indicate emotional and physical feelings, mood etc.
  • Indicate any medications or supplements you are taking and when
  • You can also include any physical exercise you do

The most important part of a food journal is noting how you feel physically and emotionally before, during and after each meal, snack or beverage. At first it may feel odd or you may not be sure what you are feeling. That is okay! Just write what you feel. Physical symptoms will be bodily sensations and may be a little bit easier to recognize than emotional ones.

Here are tips to get you started:

• Clues for physical imbalance: headaches, stomach pain, muscle cramps, coughing, fatigue, insomnia, restlessness, shakiness, muscle weakness, poor concentration, pallor.

• Clues for emotional imbalance: anxious, bored, scared, mad, sad, depressed, scattered, restless, irritable, agitated, hyper, guilt.

• Clues for physical balance: bright eyes, hunger, stamina, natural deep breathing, high energy, restful sleep, focus, alertness, strength, good attention span, clear complexion and good color.

• Clues for emotional balance: confident, excited, energized, humorous, happy, interested, focused, calm, relaxed, easygoing, patient.

Many people do not realize how much they eat until they start to write it all down. Try not to let the journal create negative feelings or feelings of guilt. Instead use it to hold yourself accountable for what you put in your mouth. If it helps, partner up with a friend and share your journals with each other at the end of each week. Sometimes knowing that someone else will read everything you’ve eaten is motivation enough to stick to healthy choices!

If you forget to write down a meal, just keep going. It’s all fine. Just keep writing!

Keep it Fresh!

Some words are worth more… by blogger of the month Chris Brown

Some words are worth more in life, like the phrase “I love you.”, or “I promise to…”. Last Thursday night we had the opportunity to make a promise to ourselves and our future patients with words that were worth a bit more. Thursday night we took the physician’s oath, a modern version of the Hippocratic Oath. It was a very meaningful experience and offered a moment to reflect on the seriousness of what it is we are beginning. The oath will help guide us to be physicians that patients both need and deserve. 

Students awaiting the start of the Physician's Oath ceremony

The ceremony
The ceremony was very nice; we had several guest speakers, each of which has played a central role in the development of the school and the program. We were even fortunate enough to have Dr. Lynne Quittell, head of the admissions for the program and pediatric pulmonologist at Columbia University Medical Center in New York, give a speech. The whole event was webcast for families back home. The speeches were very nice and centered on how we are at the beginning of a long journey, but a very important one. During the middle of our Physician’s Oath ceremony there was also a performance by a classical guitarist, which added a bit to the formality of the situation.

Part of the ceremony included a speech from Avi, the last blogger of the month. He introduced our class’ code of ethics, an additional pledge to compliment the Physician’s Oath taken earlier.  Part of Avi’s speech really brought perspective to the night and that how when undertaking the role of a physician it will be a matter of life and death. Ultimately we will become physicians and the information and skills that we are learning right now will eventually be used to improve the quality of life of others and in some cases save lives. To approach our education from this point of view can prove to be a rather stressful and daunting task, but in the end this is why we chose this path. And really who doesn’t need a little stress and a few grey hairs… it’ll make you look distinguished.  The ceremony continued with the reading of our code of ethics by several classmates and then with a nice buffet dinner outside in the courtyard of the Deichmann building.

Class skits
As part of the Physician’s Oath ceremony, each class puts on a skit or video after the dinner. I haven’t laughed that hard in a long time. We have many talented and creative people in this program. The quality of each skit was amazing and really touched on life here in medical school in Be’er Sheva. I’m not really sure whose skit was the funniest; they all had a different feel to them. I was given the opportunity to be an introvert in the first year class’ sketch, which really gave me the chance to let the inner introvert out. Well I guess “Letting the inner introvert out” is kind of a repetitive term used to describe an action that introverts wouldn’t normally partake in, but there are varying levels introverts, and I definitely up there(the fact that I’m having this conversation in my head right now probably says something about me or why I was cast the part. I wonder how this will impact my life here, I guess we’ll see. Well it was definitely good times.  Alright now I’m just getting off topic and why am I still writing this down? I need to stop.  Alright back to the blog…).

Dr. Clarfield and upperclassmen playing music after the
Physician's Oath ceremony.
Live music
After the skits were finished, we all had the opportunity to go outside and listen and dance to live music provided by fellow upperclassmen and one of the directors of our school Dr. Clarfield. It was great to see the head of our program here in Be’er Sheva celebrating with us and displaying a part of him many of us do not get the opportunity to see.

The after party
You would think that after a very long week that we would all be exhausted and call it a night, but no; exhausted, we pushed through and went out to an unusual discotheque The Draft. What’s special about The Draft, well by night it is a popular dance club, but by day it’s a fitness gym. Which makes sense, do things to improve your body and health during the day then balance it out with drinking and dancing in a smoke filled atmosphere at night, well maybe not too much sense, well maybe not at all, but it seems to be working as a business model so what can I say.

Looking back at the night
The Physician’s Oath ceremony was a moment for which I and, I hope, my classmates will take to heart and serve as something that we can use to reflect on as we develop into physicians. The oath can serve as a moment to mark the formal beginning of a journey in which we will always strive to do our best, remembering that only our best will make the most difference. I feel extremely fortunate to be in this program and with my fellow classmates.

Additional Highlights to the Week…
Transportation (Sort of)
On a less serious note I got a new bike, which is going to be great, though the brakes leave a little bit to be desired, so I haven’t been really able to ride it very often or very quickly for that matter. It will be a useful addition to getting to and from study sessions.

My new bike, or new to me. You may note wire jetting
of the handles (that's supposed to be attached to the
brakes, which are absent at the moment.

Communicating with Friends and Family
Technology is amazing, this past week I was also able to speak with the family I lived with while serving in the Peace Corps and friends via Skype in Senegal. It was amazing to be able to reconnect with them even though it was brief. It was great getting to see their faces, though they said I got fat, which is nice I guess, one of the many cultural differences…

My host Mom and brother with a good friend in my old hut
talking to me via Skype.

Last blog entry: Thanks for letting me share
One thing I learned while living in Africa was hope and being here, surrounded by so many people working towards helping others, I cannot help but be filled with even more hope. We all move forward towards a common goal of making the lives of others better. Thanks for giving me the opportunity to share a bit about my life here for the past month.  - blogger of the month Chris Brown

Here is a picture of a painting I've been working on over the past
couple of weeks in my spare time.

Doctors Without Borders: Reminding Us of a Stark Reality

Dr. Unni Karunakara
Martha Dale, director of China programs, Yale GHLI

As Dr. Unni Karunakara, international president of Médecins Sans Frontières (Doctors Without Borders), spoke recently as part of the Global Health Leadership Institute’s Spotlight Series at Yale about the 40-year history of MSF, I was transported back to the comfort of my living room where such humanitarian relief efforts were terrifying images thousands of miles away projected on TV screens or displayed in the paper.

When at first exposed to the stories of children starving in Biafra (reason enough to clean my plate in the early 1970s); Pol Pot’s slaughter of Cambodians and the resulting refugees crisis (genocide in real time); or the famine in Ethiopia of the 1980s the imagery soon becomes a lasting memory. As we become witness to more of these tragic events, it seems that our conscience inured and our capacity to react dulled. I checked-off from my mental record the list of countries and humanitarian disasters that rolled by during Dr. Karunakara’s slide presentation – each a stunning photographic portrait of victims of famine, genocide, natural disasters, armed conflict - in Somalia, Sudan, Liberia, Chechnya, Afghanistan, Rwanda, Haiti, Central America, Japan and more. Yet, this same timeline of disasters has been matched by unparalleled heroic efforts by MSF volunteers who embrace these events as opportunities for “action in the presence of failure,” providing assistance to people in their greatest time of need.

I realized then, as citizens of the world we have grown far too accustomed to assuming that violence, neglect or catastrophes will forever be present. The world is better for having MSF with its dual goals of providing humanitarian medical assistance as well as bearing witness - by speaking out to bring attention to these crises. Organizations such as Yale GHLI work in succession with MSF and other agencies providing humanitarian relief work and to help rebuild over the longer term infrastructure and systems for sustained health care delivery. And to our best ability we must all be both witnesses of and responders to human suffering.

Calling self-experimentation N=1 is incorrect and misleading

This is not a post about semantics. Using “N=1” to refer to self-experimentation is okay, as long as one understands that self-experimentation is one of the most powerful ways to improve one’s health. Typically the term “N=1” is used in a demeaning way, as in: “It is just my N=1 experience, so it’s not worth much, but …” This is the reason behind this post. Using the “N=1” term to refer to self-experimentation in this way is both incorrect and misleading.

Calling self-experimentation N=1 is incorrect

The table below shows a dataset that is discussed in this YouTube video on HealthCorrelator for Excel (HCE). It refers to one single individual. Nearly all health-related datasets will look somewhat like this, with columns referring to health variables and rows referring to multiple measurements for the health variables. (This actually applies to datasets in general, including datasets about non-health-related phenomena.)

Often each individual measurement, or row, will be associated with a particular point in time, such as a date. This will characterize the measurement approach used as longitudinal, as opposed to cross-sectional. One example of the latter would be a dataset where each row referred to a different individual, with the data on all rows collected at the same point in time. Longitudinal health-related measurement is frequently considered superior to cross-sectional measurement in terms of the insights that it can provide.

As you can see, the dataset has 10 rows, with the top row containing the names of the variables. So this dataset contains nine rows of data, which means that in this dataset “N=9”, even though the data is for one single individual. To call this an “N=1” experiment is incorrect.

As a side note, an empty cell, like that on the top row for HDL cholesterol, essentially means that a measurement for that variable was not taken on that date, or that it was left out because of obvious measurement error (e.g., the value received from the lab was “-10”, which would be a mistake since nobody has a negative HDL cholesterol level). The N of the dataset as a whole would still be technically 9 in a situation like this, with only one missing cell on the row in question. But the software would typically calculate associations for that variable (HDL cholesterol) based on a sample of 8.

Calling self-experimentation N=1 is misleading

Calling self-experimentation “N=1”, meaning that the results of self-experimentation are not a good basis for generalization, is very misleading. But there is a twist. Those results may indeed not be a good basis for generalization to other people, but they provide a particularly good basis for generalization for you. It is often much safer to generalize based on self-experimentation, even with small samples (e.g., N=9).

The reason, as I pointed out in this interview with Jimmy Moore, is that data about oneself only tends to be much more uniform than data about a sample of individuals. When multiple individuals are included in an analysis, the number of sources of error (e.g., confounding variables, measurement problems) is much higher than when the analysis is based on one single individual. Thus analyses based on data from one single individual yield results that are more uniform and stable across the sample.

Moreover, analyses of data about a sample of individuals are typically summarized through averages, and those averages tend to be biased by outliers. There are always outliers in any dataset; you might possibly be one of them if you were part of a dataset, which would render the average results at best misleading, and at worst meaningless, to you. This is a point that has also been made by Richard Nikoley, who has been discussing self-experimentation for quite some time, in this very interesting video.

Another person who has been talking about self-experimentation, and showing how it can be useful in personal health management, is Seth Roberts. He and the idea of self-experimentation were prominently portrayed in this article on the New York Times. Check this video where Dr. Roberts talks about how he found out through self-experimentation that, among other things, consuming butter reduced his arterial plaque deposits. Plaque reduction is something that only rarely happens, at least in folks who follow the traditional American diet.

HCE generates coefficients of association and graphs at the click of a button, making it relatively easy for anybody to understand how his or her health variables are associated with one another, and thus what modifiable health factors (e.g., consumption of certain foods) could be causing health effects (e.g., body fact accumulation). It may also help you identify other, more counter-intuitive, links; such as between certain thought and behavior patterns (e.g., wealth accumulation thoughts, looking at the mirror multiple times a day) and undesirable mental states (e.g., depression, panic attacks).

Just keep in mind that you need to have at least some variation in all the variables involved. Without variation there is no correlation, and thus causation may remain hidden from view.

Saturday, September 24, 2011

Humans on a Cafeteria Diet

In the 1970s, as the modern obesity epidemic was just getting started, investigators were searching for new animal models of diet-induced obesity.  They tried all sorts of things, from sugar to various types of fats, but none of them caused obesity as rapidly and reproducibly as desired*.  1976, Anthony Sclafani tried something new, and disarmingly simple, which he called the "supermarket diet": he gave his rats access to a variety of palatable human foods, in addition to standard rodent chow.  They immediately ignored the chow, instead gorging on the palatable food and rapidly becoming obese (1).  Later renamed the "cafeteria diet", it remains the most rapid and effective way of producing dietary obesity and metabolic syndrome in rodents using solid food (2).

Read more »

Thursday, September 22, 2011

Breaking The Habit

Habit. A settled or regular tendency or practice, especially one that is hard to give up. We all have habits, some good, some bad. I have a habit of cleaning and scrubbing all my produce before cooking it. Good habit, right? But I also have a habit of buying too much produce at once and throwing half of it away because it goes bad. Not so good habit.

We all have bad habits that we probably wish we could break. Some, like the above, aren't necessarily detrimental to our health, but others can definitely effect our well-being. For Instance, I also have a habit of buying a healthy snack, such as my favorite Mary's Sticks and Twigs, and eating the whole bag in one sitting. Yikes.

Making changes in our lives in order to improve our health and well being usually requires breaking some of our bad habits. Easier said than done, but let's face it, we could all use some improvement. So how do we give up our bad habits and trade them in for good ones, or at least better ones?

The first step is identifying the habits that you wish to change. Find habits that continuously hinder your health, happiness or well being. Any change we wish to make in our lives starts with and requires motivation. The general desire or willingness to do something. Only you have the power change yourself, but without the desire to precipitate change, success will be difficult.

Once you are ready to take action, follow these simple tips and you will be sure to succeed!

1) Lasting change takes time. Don't try to change all your bad habits at once, you will be sure to get overwhelmed and likely fail. Start with one and focus on making that one stick.

2) Be realistic. Chose to change things that are within your control, otherwise you can set yourself for disappointment and get discouraged.

3) Take baby steps. You may have more success by upgrading your bad habit to a less evil one first and then breaking it all together, rather than going cold turkey from the start.

4) Set goals. Make a list of the necessary steps to achieve your goal, and check them off as you reach them.

5) Stay motivated. Write yourself daily reminders and stick them on your mirror, refrigerator or some place you will constantly see them, especially in places where the bad habit is bound to occur.

6) Keep track of your progress. Keeping a journal each day can help you identify when and why you are having difficulty versus success. Take a few minutes each morning to write down your intentions for the day, and few minutes each evening to reflect on how you did.

7) Ask for help. We can't always do everything on our own. Don't be afraid to use your resources and ask for help!

8) Be grateful. Be aware of the others that have helped you reach your goals and express your gratitude.

9) Start today! Why put off til tomorrow, what you can do today. Procrastination will hinder your motivation and allows the opportunity for distraction.

So what are you waiting for? What bad habit will you start breaking today?

Keep it Fresh!

Wednesday, September 21, 2011

Primal Docs

Chris Armstrong, creator of the website Celiac Handbook, has designed a new non-commercial website called Primal Docs to help people connect with ancestral health-oriented physicians.  It's currently fairly small, but as more physicians join, it will become more useful.  If you are a patient looking for such a physician in your area, or an ancestral health-oriented physician looking for more exposure, it's worth having a look at his site:

Primal Docs

Update 9/22: apparently there is already another website that serves a similar purpose and has many more physicians enrolled: Paleo Physicians Network.

How to appeal when your insurer says no

We've updated our online guide showing how you can file an appeal when your health insurer denies a claim or turns down a medical procedure. We've added sample letters, tips, and updated it to reflect new regulations.

See "How to Appeal a Health Care Insurance Decision: A Guide for Consumers in Washington State."

Tuesday, September 20, 2011

Back To School!

We all probably think, in some way or another, that we could be making healthier choices as far as our diet is concerned. And as much as we want ourselves to be healthy, we want even more to feed our children as healthy as possible. Our child's health is so important, because their young developing bodies are more vulnerable and therefore susceptible to illness. Feeding our kids a healthy, wholesome diet will not only help prevent sick days, but it will also be the most important thing we can do for their report cards. A healthy child will be focused, alert and attentive, allowing them to be at their utmost capacity to learn and perform their best! However, when our kids head off to school we relinquish the power to control everything they eat for a good part of the day. Therefore it is important to get them excited about making healthy choices and then send them off with healthy options so that we can feel confident that they will choose to eat the way we want them to.

Most of our schools unfortunately do not have healthy cafeteria options. Instead the cafeteria is an oasis of fried non-foods, baked goods, sugary sodas and juices. Get kids excited about bringing their lunch from home by providing them with fun ways to pack their lunch. Maybe it's a lunchbox with their favorite colors or characters. A great budget-friendly idea is to let them decorate brown paper bags anyway they want. This can also be a fun family arts and crafts hour each night before bedtime. Make it more eco-friendly by using recycled materials such as your paper grocery bags, or purchasing plain stainless steel canisters and containers that can be reused and decorating them instead. Sweeten the deal by surprising them with hand written notes, stickers or fun little games inside their lunch box.

Finding the time to prepare healthy meals and snacks for our children can be tough, especially for parents that work full time. However we don't want to sacrifice their health by being rushed to find something to send them off to school with. Make it easier on yourself by planning ahead. Set aside a half hour each Sunday evening, or whenever is best, to layout the kids' meals and snacks for the week. Also use this time to make anything that you can in advance. For example, make a batch of a healthy trail mix and separate it out into individual snack-size baggies. Involving the kids will get them more interested in what they are eating, and make them more apt to enjoy it!

Finding the right foods to feed our children can be even more difficult! Every child is going to be different, as far as what they like and are willing to eat. It is important to do your best while staying within realistic boundaries. All the effort in the world to prepare the healthiest meal possible is going to go to waste if your child is going to get to school and not eat it. Start with small, reasonable changes and work your way up. You will be surprised at how much your child will crave less junk foods and more healthy foods as they build healthier habits. In general, stick to healthy, natural, whole foods such as fruits, vegetables, lean proteins, healthy fats and whole grains. Avoid (as much as possible) hydrogenated oils, trans-fats and processed and refined packaged foods, especially those that contain lots of sugars, artificial colors and artificial flavorings!

Most importantly, nothing will feed our childrens' needs and nurture them as much as love! A home cooked or prepared meal will contain all the love and caring that you put into making it!

Keep It Fresh!
- Jill

Monday, September 19, 2011

Making the most out of a day, by blogger of the month Chris Brown

Which one of these items does not belong?

A typical day…
The alarm on my phone goes off its 5:30 in the morning. I roll over to smack the phone, fumbling for the off button to avoid waking my roommates. I roll back over, pulling the cover over my head in disbelief that it is already time to get up. I finally manage to pull myself out of bed at 5:45 to go make some coffee and breakfast. Around 6 o’clock I study for about 50 minutes, and then get in some exercise and yoga for about half an hour. Then it’s time to make some more coffee, an essential step before actually going to class, take a shower and get ready for school. By 8:00 I’m out the door and on my way to the first class of the day. The subject of the first class of the day varies but lasts until 10:00 and then we get the opportunity for a short coffee break. At 10:15 we’re back to class until 12:00 when we get an hour and fifteen minutes for lunch, which usually entails cafeteria food or a sack lunch. At 1:15 it’s back to two more classes till 5:00 pm. On the way back home I pass by the store to pick up some food for dinner and lunch tomorrow, not forgetting to pass by one of the many fruit and vegetable stands to pick up some fresh fruit. After arriving home I place my things in my room and go to the kitchen to start dinner. While making dinner I check and respond to email. Shortly after dinner, at around 7 o’clock, I make some more coffee, I start studying again till about 9:30 or so, or until I need a break and either go running or read the newspaper to attempt to keep up on current affairs. At about 10:30 it’s back to some more studying and or reading health related articles. I finally crash around 12:00-12:30, dreaming about the next busy day. A cycle that I will repeat many times in the coming year, surely only to contribute to my coffee addiction.

Wine tasting in Be'er Sheva
Some highlights of the past week:
Wine Tasting in Beer Sheva (aka Wine Sheva)
                Walking into the event with fancy cars at the entrance, a jazz band playing in the background and wine glasses clinking, I was walking into an atmosphere of Be’er Sheva I had not yet experienced or expected to find here. The event was similar to something you would likely find in Napa Valley. Students from each of the first three years of medical school were there, which provided a good opportunity to get to know each other, exchanging information and advice about school and life in Be’er Sheva. There were close to 30 different wineries all offering samples, along with cheeses and hot dogs. Things here are always so close to life back in the US, then there is something a little different to remind you that you’re not home, in this case hot dogs at a wine festival.

Histology Lab
                We finally got to do an activity where I really felt like I was in medical school. The combination of the microscopes, the white coats and the histological jargon, it really hit me, I’m in medical school now.  It was a fun lab; we got to look at different cell types in different tissues of the body. It really made the information we had been going over in lecture more concrete and applicable. It was also great that we had two TAs and the professor there to answer questions about the slides and help identify cell types, it was a great learning environment.

Finding the student store at the university
    Don’t judge me, but you wouldn’t believe the size of white board I bought. It’s going to be great for going over biochemical pathways… Although I had seen the store from afar I had never actually set foot into it till last week, only to find pens, pencils and highlighters galore! It’s a one stop shop for all your studying needs and then some, for instance home decorations, underwear, socks and scented candles. Why would they need to sell underwear at the student store? Not really sure, but I know when I’m buying pens and pencils, and I’m trying to remember what else I need to buy, oh yeah underwear, and it’s right there, how convenient…

Favorite conversation of the week
“Hey, what are you doing?”
“I’m looking at the anus”
“Ooh, can I see it next?”
An ordinary day in medical school in the histology lab.

-blogger of the month, Chris Brown

Being glucose intolerant may make you live only to be 96, if you would otherwise live to be 100

This comes also from the widely cited Brunner and colleagues study, published in Diabetes Care in 2006. They defined a person as glucose intolerant if he or she had a blood glucose level of 5.3-11 mmol/l after a 2-h post–50-g oral glucose tolerance test. For those using the other measurement system, like us here in the USA, that is a blood glucose level of approximately 95-198 mg/dl.

Quite a range, eh!? This covers the high end of normoglycemia, as well as pre- to full-blown type 2 diabetes.

In this investigation, called the Whitehall Study, 18,403 nonindustrial London-based male civil servants aged 40 to 64 years were examined between September 1967 and January 1970. These folks were then followed for over 30 years, based on the National Health Service Central Registry; essentially to find out whether they had died, and of what. During this period, there were 11,426 deaths from all causes; with 5,497 due to cardiovascular disease (48.1%) and 3,240 due to cancer (28.4%).

The graph below shows the age-adjusted survival rates against time after diagnosis. Presumably the N values refer to the individuals in the glucose intolerant (GI) and type 2 diabetic (T2DM) groups that were alive at the end of the monitoring period. This does not apply to the normoglycemic N value; this value seems to refer to the number of normoglycemic folks alive after the divergence point (5-10 years from diagnosis).

Note by the authors: “Survival by baseline glucose tolerance status diverged after 5-10 years of follow-up. Median survival differed by 4 years between the normoglycemic and glucose intolerant groups and was 10 years less in the diabetic compared with the glucose intolerant group.”

That is, it took between 5 and 10 years of high blood glucose levels for any effect on mortality to be noticed. One would expect at least some of the diagnosed folks to have done something about their blood glucose levels; a confounder that was not properly controlled for in this study, as far as I can tell. The glucose intolerant folks ended up living 4 years less than the normoglycemics, and 10 years more than the diabetics.

One implication of this article is that perhaps you should not worry too much if you experience a temporary increase in blood glucose levels due to compensatory adaptation to healthy changes in diet and lifestyle, such as elevated growth hormone levels. It seems unlikely that such temporary increase in blood glucose levels, even if lasting as much as 1 year, will lead to permanent damage to cells involved in glucose metabolism like the beta cells in the pancreas.

Another implication is that being diagnosed as pre-diabetic or diabetic is not a death sentence, as some people seem to take such diagnoses at first. Many of the folks in this study who decided to do something about their health following an adverse diagnosis probably followed the traditional advice for the treatment of pre-diabetes and diabetes, which likely made their health worse. (See Jeff O’Connell’s book Sugar Nation for a detailed discussion of what that advice entails.) And still, not everyone progressed from pre-diabetes to full-blow diabetes. Probably fewer refined foods available helped, but this does not fully explain the lack of progression to full-blow diabetes.

It is important to note that this study was conducted in the late 1960s. Biosynthetic insulin was developed in the 1970s using recombinant DNA techniques, and was thus largely unavailable to the participants of this study. Other treatment options were also largely unavailable. Arguably the most influential book on low carbohydrate dieting, by Dr. Atkins, was published in the early 1970s. The targeted use of low carbohydrate dieting for blood glucose control in diabetics was not widely promoted until the 1980s, and even today it is not adopted by mainstream diabetes doctors. To this I should add that, at least anecdotally and from living in an area where diabetes is an epidemic (South Texas), those people who carefully control their blood sugars after type 2 diabetes diagnoses, in many cases with the help of drugs, seem to see marked and sustained health improvements.

Finally, an interesting implication of this study is that glucose intolerance, as defined in the article, would probably not do much to change an outside observer’s perception of a long-living population. That is, if you take a population whose individuals are predisposed to live long lives, with many naturally becoming centenarians, they will likely still be living long lives even if glucose intolerance is rampant. Without carefully conducted glucose tolerance tests, an outside observer may conclude that a damaging diet is actually healthy by still finding many long-living individuals in a population consuming that diet.

Sunday, September 18, 2011

Final Weeks in Rwanda

Eleanor Hayes-Larson,
GHLI Student Fellow
September 2011

My experience in Rwanda was incredibly rich on a variety of levels, both at play and and work. One of my goals for the summer was to leave feeling like I really knew the country. I traveled almost every weekend and saw nearly every corner of the small country. I met and spoke with many people who varied in age, profession and background and feel like I now possess a good understanding of the country. I was very welcomed by my colleagues in the Ministry of Health and leave with new friends. (The picture above was taken with my colleagues as they took me out to dinner on my last night in Rwanda.)

I left Rwanda having completed several rounds of revisions and editing on documents that had not officially been approved for adoption by the time I left but were getting close. When validated, these documents will represent the introduction of the first national policy on health research for Rwanda – very exciting!

The other exciting thing about my work in Rwanda this summer is the way it has laid the groundwork for further improvements to the country’s health research. The policy creates a space for the development of strategic plans, other operational documents and research agendas that will truly guide the way forward for research in Rwanda.

As I sit in my room in New Haven, I am very glad to have had the opportunity to work with the Rwandan delegation and to work on the research policy and guidelines. I will continue to work on the documents until they are approved, and I particularly look forward to seeing the ripple effects of more documents and plans being created, which will ultimately result in more and improved research for health in Rwanda.

Leaving South Africa

Ryan Park,
GHLI Student Fellow
September 2011

Coming home to be met by Hurricane Irene and the frantic pace of senior year only solidified my feelings of missing South Africa. Though I left South Africa at a time when my work was just starting picking up speed, I’m very proud of what I was able to help the delegation accomplish. We’re working with two private organizations, BroadReach Health Care and Foundation for Professional Development, to provide training, mentorship, and resources to facility-level health care managers and leaders. Programs will start in the next month in two districts in KwaZulu-Natal and several areas of Gauteng. Since these programs address an area of critical need for South Africa, everyone involved is extremely hopeful that they will have a large impact on maternal and child deaths and on the strength and efficiency of the health system overall.

I’m incredibly grateful to the countless South Africans who made my time in their country the most productive and intellectually stimulating experience of my life. At every meeting, whether it was at district, provincial, or national health offices, with private health care organizations, or at the University of Pretoria, people were welcoming and friendly, yet extremely professional and dedicated. Many people with whom I worked (including the six delegates) had enormous work-loads and severe staff shortages – particularly by U.S. standards – yet they jumped at an opportunity to contribute to the GHLI delegation’s project, seeing in it a way to improve their country’s health system. It was such a privilege for me to work with so many dedicated people throughout the health sector, and I feel very fortunate that GHLI made the opportunity available to me. Even before the plane took off from Johannesburg, I was already brainstorming ways to go back.

Leaving Ghana

Rebecca Distler,
GHLI Student Fellow
September 2011

When I went in for my last day of work in Ghana on August 12th, it didn’t feel like my last day. I was still trying to finish the in-service training manual I had been working on all summer and was still setting up meetings -- even though I wouldn’t be there for them. I was thinking about the progress I had made on the national service policy. But I definitely wasn’t thinking about saying goodbye. So I was horribly shocked to find that when I arrived on Friday, most of the people in my office were all away for a conference. That’s when it started to sink in – that I might never see these people again.

If there is one thing I learned in Ghana, it is the importance of showing up. On Monday morning, a mere 10 hours before I was to fly out of the country, I had a friend drive me to a hotel about an hour outside of the city, where I waited outside the conference meeting room to track down my office mates on their lunch break. When I saw Dr. Nyonator, one of the delegates, he proudly and jokingly introduced me as his “daughter”. I got to give necklaces to the secretaries, shake the men’s hands and exchange e-mail addresses. But most importantly, I got to say goodbye.

I loved my work in Ghana, but what truly made the experience was the people. I could not have asked for a better summer, could not ask for better friends or colleagues. And what I’ve learned is that it is not enough to love what you do – that’s important, yes. But it is also important to be inspired by and challenged by the people you work with. And it is important to always show up, to demonstrate not only your respect but also your true friendship. It is the Ghanaian way, and I think it will also become my way too.

Friday, September 16, 2011

Premera's rate increase disapproved

We've disapproved a request from Premera Blue Cross to increase its individual health plans by 3.1 percent. The company used a medical trend of 7.24 percent to calculate its increase. Medical trend is the change in claims costs over a specific period of time (usually one year) and is often based on both the company's past claims costs and what they expect to spend on claims in the future.

After a careful review of the company's supporting documentation, we don't believe it made its case - specifically, we believe the annual medical trend is likely to be 5.17 percent or less.

The rate was scheduled to take effect on Jan. 1, 2012 and would've impacted 4,039 people.

See if your health plan has filed rate change.

Parents: If you need individual coverage for your children, open enrollment is NOW

Open enrollment for individual health plans started Sept. 15 and runs through Oct. 31. (Individual health plans are those bought by individuals, as opposed to health plans offered by employers or groups.)

We can't say this enough: If you need health insurance for your child, make sure you enroll early. If you miss this open enrollment period, you'll have to wait until March 15, 2012, unless you meet certain qualifications. And if you wait until even the beginning of October, your coverage may not kick in until Nov. 1.

Federal health reform prevents health insurers from denying coverage to children because of a pre-existing health condition. However, just like employer-sponsored health plans, insurers can create open enrollment periods. During these open-enrollment times, children under age 19 do not have to complete a health questionnaire and cannot be denied health insurance.

We should note that there are some exceptions. You can apply for coverage for your child anytime, for example, after the birth or adoption of a child, or when the parent:

  • Is no longer eligible for a state program such as Medicaid.

  • Loses coverage due to a divorce.

  • Loses employer-sponsored coverage (including COBRA coverage).

  • Moves and their plan is not available where they live.

Wednesday, September 14, 2011

Alien abduction insurance? Really? Really.

Bloomberg Businessweek's Joel Stonington has put together an interesting slide show of "the oddest insured things", from Bruce Springsteen's voice ($5.7 million) to the hard-working tongue of a British coffee taster ($16 million).

Arguably the most interesting detail, though, is the fact that one insurer apparently offers insurance in case you are abducted by aliens. Stonington notes that the insurer "is currently paying out on a pair of claims deemed legitimate."

See the link above for the slideshow.

Group Health seeks rate hike

Group Health Options has requested a 11.6% rate increase for its small employer plans. The rate is currently under review and if approved, would take effect Jan. 1, 2012. Group Health Cooperative filed a 0% rate change for its small employer plans.

Summaries of all individual and small employer plan rate requests and memos detailing our decisions can be found on our new Web page

We're able to post these requests and the entire rate filings thanks to a bill passed last session (HB 1220). For years, we've heard from consumers upset with the rising costs of their health insurance - and rightly so. Health care costs are rising well above the rate of general inflation. Unfortunately, before this new law, all rate requests were considered proprietary.

If someone contacted us for information, we could only say "trust us, we carefully reviewed the rate change, and it's justified." Not a lot of comfort if you've experienced double-double digit increases year after year.

Now - thanks to this new law - you can see what we see: How your company spent your premium. and how much of it went to pay medical claims, cover administrative costs (including salaries) and how much was profit.

Our authority over these rates is still limited. If the company can justify the change and prove that the rate is reasonable in relation to the benefit the plan provides, then we must accept it. But at least now if you're paying more for your health plan, you know why.

Other insurers with pending rate requests for small or individual health plans include: Asuris Northwest Health, Kaiser Foundation Health Plan of the Northwest, Lifewise Health Plan of Washington, Premera Blue Cross, Providence Health Plan, and Regence BlueShield.

Tuesday, September 13, 2011

Fat Tissue Insulin Sensitivity and Obesity

In this post, I'll discuss a few more facts pertaining to the idea that elevated insulin promotes the accumulation of fat mass.  

Insulin Action on Fat Cells Over the Course of Fat Gain

The idea that insulin acts on fat cells to promote obesity requires that insulin suppress fat release in people with more fat (or people who are gaining fat) to a greater extent than in lean people.  As I have written before, this is not the case, and in fact the reverse is true.  The fat tissue of obese people fails to normally suppress fatty acid release in response to an increase in insulin caused by a meal or an insulin injection, indicating that insulin's ability to suppress fat release is impaired in obesity (1, 2, 3).  The reason for that is simple: the fat tissue of obese people is insulin resistant.

There has been some question around the blogosphere about when insulin resistance in fat tissue occurs.  Is it only observed in obese people, or does it occur to a lesser extent in people who carry less excess fat mass and are perhaps on a trajectory of fat gain?  To answer this question, let's turn the clocks back to 1968, a year before Neil Armstrong first set foot on the moon. 

Read more »

Monday, September 12, 2011

Tacoma insurance agent charged with theft

An insurance agent in Tacoma has been charged with theft for misppropriating checks from dozens of policyholders.

Michel Anthony James, an independent contractor working as an agent for State Farm, is believed to have deposited checks from more than 40 policyholders into his own business bank account. State Farm discovered the problems when it audited James' accounts.

Based on a subsequent iinvestigation by Insurance Commissioner Mike Kreidler's Special Investigations Unit, James:
  •  failed to apply premiums to policies,
  • wrongly withdrew cash from his premium fund account (which is where those policyholder checks were supposed to go),
  • failed to refund overpayments to policyholders,
  • and violated contractual agreements with State Farm.
He has been charged in Pierce County Superior Court with one count of first-degree theft.

Fasting blood glucose of 83 mg/dl and heart disease: Fact and fiction

If you are interested in the connection between blood glucose control and heart disease, you have probably done your homework. This is a scary connection, and sometimes the information on the Internetz make people even more scared. You have probably seen something to this effect mentioned:
Heart disease risk increases in a linear fashion as fasting blood glucose rises beyond 83 mg/dl.
In fact, I have seen this many times, including on some very respectable blogs. I suspect it started with one blogger, and then got repeated over and over again by others; sometimes things become “true” through repetition. Frequently the reference cited is a study by Brunner and colleagues, published in Diabetes Care in 2006. I doubt very much the bloggers in question actually read this article. Sometimes a study by Coutinho and colleagues is also cited, but this latter study is actually a meta-analysis.

So I decided to take a look at the Brunner and colleagues study. It covers, among other things, the relationship between cardiovascular disease (they use the acronym CHD for this), and 2-hour blood glucose levels after a 50-g oral glucose tolerance test (OGTT). They tested thousands of men at one point in time, and then followed them for over 30 years, which is really impressive. The graph below shows the relationship between CHD and blood glucose in mmol/l. Here is a calculator to convert the values to mg/dl.

The authors note in the limitations section that: “Fasting glucose was not measured.” So these results have nothing to do with fasting glucose, as we are led to believe when we see this study cited on the web. Also, on the abstract, the authors say that there is “no evidence of nonlinearity”, but in the results section they say that the data provides “evidence of a nonlinear relationship”. The relationship sure looks nonlinear to me. I tried to approximate it manually below.

Note that CHD mortality really goes up more clearly after a glucose level of 5.5 mmol/l (100 mg/dl). But it also varies significantly more widely after that level; the magnitudes of the error bars reflect that. Also, you can see that at around 6.7 mmol/l (121 mg/dl), CHD mortality is on average about the same as at 5.5 mmol/l (100 mg/dl) and 3.5 mmol/l (63 mg/dl). This last level suggests an abnormally high insulin response, bringing blood glucose levels down too much at the 2-hour mark – i.e., reactive hypoglycemia, which the study completely ignores.

These findings are consistent with the somewhat chaotic nature of blood glucose variations in normoglycemic individuals, and also with evidence suggesting that average blood glucose levels go up with age in a J-curve fashion even in long-lived individuals.

We also know that traits vary along a bell curve for any population of individuals. Research results are often reported as averages, but the average individual does not exist. The average individual is an abstraction, and you are not it. Glucose metabolism is a complex trait, which is influenced by many factors. This is why there is so much variation in mortality for different glucose levels, as indicated by the magnitudes of the error bars.

In any event, these findings are clearly inconsistent with the statement that "heart disease risk increases in a linear fashion as fasting blood glucose rises beyond 83 mg/dl". The authors even state early in the article that another study based on the same dataset, to which theirs was a follow-up, suggested that:
…. [CHD was associated with levels above] a postload glucose of 5.3 mmol/l [95 mg/dl], but below this level the degree of glycemia was not associated with coronary risk.
Now, exaggerating the facts, to the point of creating fictitious results, may have a positive effect. It may scare people enough that they will actually check their blood glucose levels. Perhaps people will remove certain foods like doughnuts and jelly beans from their diets, or at least reduce their consumption dramatically. However, many people may find themselves with higher fasting blood glucose levels, even after removing those foods from their diets, as their bodies try to adapt to lower circulating insulin levels. Some may see higher levels for doing other things that are likely to improve their health in the long term. Others may see higher levels as they get older.

Many of the complications from diabetes, including heart disease, stem from poor glucose control. But it seems increasingly clear that blood glucose control does not have to be perfect to keep those complications at bay. For most people, blood glucose levels can be maintained within a certain range with the proper diet and lifestyle. You may be looking at a long life if you catch the problem early, even if your blood glucose is not always at 83 mg/dl (4.6 mmol/l). More on this on my next post.

Friday, September 9, 2011

Random highlights from the past week, by blogger of the month Chris Brown

Sunset in Be-er Sheva

Bartering in the Old City
                Earlier in the week I got the opportunity to go to the old city to do both a little bit of exploring and to look for a bike to make getting around a little easier. The beginning of the day started out slowly with coffee and a nice conversation with one of my roommates, after which we decided to go look for bikes in the old city. Upon navigating the public transit system we ended up a little ways from our destination and fortunately stumbled upon the shook, the large open air market. Seeing all the booths filled with fresh fruit, vegetables, honey, meat, fish, and almost anything else you could think of was amazing. The sweet smell of mangos and apples combined with the earthy smell of nuts provided a pleasant background to the busy hubbub of people carrying out their daily errands and customers haggling with vendors trying to get a better price.
                After going through the shook, we ventured out into the old city in search of the bike shop, only to be sidetracked into having a rather large and delicious lunch of kebabs and vegetables with an assortment of enjoyable sauces and of course, the always wonderful hummus. After all the moving of the previous week, a large meal was definitely appreciated.
                Pushing through the inescapable food coma, we set out in search of the bike shop, only to find it had closed early. We ended up going through a market street where I got to practice my bartering skills in order to buy some sheets for my bed.  It turned out to be not so bad, from my prior experience of bartering in Senegal, though I started out too high with my counter offer and we all too quickly agreed on a price. I walked away a bit dissatisfied but I learned that you should never counter with something you’re not willing to pay and if it’s worth that much to you, you’ve made a good purchase. Soon after passing through the street market we started our way back home. Unfortunately we hadn’t achieved our goal to which we had set out but it was a meaningful and memorable trip nonetheless.

Chicken rings and Biochemistry.

Chicken Rings and Biochemistry
                Biochemistry can be fun but with chicken rings, it’s euphoric… The amount of information that we are going over is impressive. Study groups have proved to be an important tool in deepening our understanding of material and have given us an opportunity to apply the material used in class with sample questions. Usually during study groups, a break is taken and this involves some sort of food, and sometimes that food is chicken rings. You might ask “What exactly is a chicken ring?”, “How do they get the chicken in the shape of a ring?”, “Why would you want chicken in the shape of a ring?”, “Who started this?”, or “Can that really be healthy?” Rather than asking such questions, I choose to focus on the fact that they are oddly delicious. So, while we are learning about affinity and kinetics of enzymes in relation to competitive and noncompetitive inhibition, we can stuff our faces with pureed chicken formed into the shapes of rings. What could be better?

Ol' Trusty

Whole class coming to help a friend
                Earlier in the week, a person in our class unfortunately became part of an elite club; few people have the opportunity to join, “People who have been hit by a car”. The important thing is that she is okay and surrounded by a caring group of people that are there to help her through this process and make sure that she is not going through this alone. As if she didn’t have enough to worry about going through medical school and being away from friends and family, she now has to deal with health issues and possibly legal issues as well. She has a long road ahead of her but it will be accompanied by friends there to support her.  Looking at the bright side of this situation, it allowed her to gain a very useful insight that few people, especially doctors, have the opportunity to experience; being able to be a patient and undergo the stress and fear of being sick or hurt. Her ability to relate and empathize to future patients in such circumstances will far outweigh that of most health care workers. Additionally on the lighter side of being hurt, we were able to wheel her around in what must have been the oldest wheelchair in all of Be’er Sheva, something that looked straight out of a WWI hospital ward on Thursday when she came back to classes (see picture). She kept a good outlook and sense humor about the situation. Having so many people in the class come to her aid makes me proud to be part of this class and really demonstrates the quality of the people in this program.

Meeting up with other RPCVs
                During the past week I got the opportunity to meet up with a few Returned Peace Corps Volunteers (RPCVs) for a dinner to share stories and experiences from our service and our current lives in Be’er Sheva. It was really nice getting the opportunity to see how similar a lot of our experiences were, even though we all had served in many different areas of the world, plus we got to eat delicious enchiladas. It is nice to be part of a community so quickly after moving here, though we didn’t get to talk about gastrointestinal issues, a common topic amongst Peace Corps Volunteers, but hopefully next time.
                After another successful week here, with the many surreal aspects that have transpired, I look forward to the coming week and  many more surreal moments that make up life here in Be’er Sheva. Alright, well, off to some more studying and hopefully taking a break to finish fixing the washer. - blogger of the month Chris Brown

Thursday, September 8, 2011

Small-business health insurance tax credits: key deadlines and tips

If you're a small business that provides health coverage for employees -- or wants to -- a couple of key deadlines for taking advantage of tax credits are coming up soon.

From the U.S. Department of Health and Human Services:
If you have up to 25 employees, pay average annual wages below $50,000, and provide health insurance, you may qualify for a small business tax credit of up to 35% (up to 25% for non-profits) to offset the cost of your insurance. This will bring down the cost of providing insurance.

In order to take advantage of these tax credits, you must file by a certain date. Here are two important tax filing deadlines in coming weeks that you should be aware of:
  • September 15. Corporations that file on a calendar year basis and requested an extension to file to September 15 can calculate the small employer health care credit on Form 8941 and claim it as part of the general business credit on Form 3800, which they would include with their corporate income tax return.
  • October 17. Sole proprietors who file Form 1040 and partners and S-corporation shareholders who report their income on Form 1040 have until October 17 to complete their returns. They would also use Form 8941 to calculate the small employer health care credit and claim it as a general business credit on Form 3800, reflected on line 53 of Form 1040.
Important tips:
  • Even if you've already filed your 2010 taxes, you can still claim the credit. Just file an amended 2010 return.
  • Even if you don't have tax liability this year, you can still benefit, since eligible small businesses can carry back the tax credit five years. (It used to be that you could carry back general business credits like this just one year.)
  • Businesses that couldn't use the credit in 2010 can claim it in future years. 
See the link above for more details and specifics.

Wednesday, September 7, 2011

Kreidler orders Regence to fix health insurance problems

We just issued a press release about The Regence Group and its subsidiaries here, which have been having ongoing problems with billing and claims, including a computer system error that resulted in more than 6,000 incorrect transactions.

The same error apparently caused Regence to accidentally withdraw money from the bank accounts of people are not even Regence members. (Some of the withdrawals totaled thousands of dollars.) In the process, some Regence members' names and identification numbers were accidentally disclosed to strangers.

Last week, we and insurance regulators from three other states -- Oregon, Idaho and Utah -- met with Regence Group CEO Mark Ganz and other company officials in Salem, Ore. We provided the company with a list of the problems we've noted or that consumers have complained to us about.

For more details, please see the news release link above.

Finally settling in, by September blogger of the month Chris Brown

One of the many trips of carrying belongings from one apartment
to another in 97 degree heat, I am so very,
very tired of moving. I really hope this apartment works out.

So after a successful first week of real classes it’s on to moving day. A day where hopefully I’ll be able to settle in a bit and really feel at home, an event that has been a long time coming after having spent  a little over two years living in a hut in rural West Africa.

My name is Chris Brown, no not the singer Chris Brown, and I get the opportunity to share a little bit about life here in Be’er Sheva and experiences in the MSIH program. A little about myself; I grew up near Seattle Washington, and graduated from the University of Washington, then after a brief break, about three years, working as a phlebotomist, doing construction, and  teaching French on a volunteer basis, I went back to school to get my Masters in Teaching at Seattle Pacific University. I worked as a high school science teacher (mostly chemistry, with a little physics and biology thrown in to keep things interesting) for about 3 ½ years before deciding, though albeit an extremely honorable and important profession,  I found it to not be an ideal fit for me. It was a great opportunity and experience, one that I will always treasure for the rest of my life. Hopefully helping people learn about health and prevention will allow me to exercise the skills that I learned while teaching on a daily basis and I hope to also one day integrate teaching into my medical career at some point in a more formal fashion. After leaving teaching I left to serve in the Peace Corps as a health volunteer in Senegal, West Africa. I finished Peace Corps about 3 months ago and now I am on to my next adventure, medical school in Israel. As a side note I am also the oldest student in our class at 33 years old despite Avi’s generous 21st birthday wish in the August blog entry or the bar mitzvah card from the whole class for my birthday last month, stating that I’ve finally became a man, at least now I have it in writing.   

One of many beautiful flowering trees
around Be’er Sheva.
Despite the rather “rockety” start to being here in Be’er Sheva, things are going rather smoothly. The school did their best to give us the most up to date information and even changed our classes to a more secure location, including having class in a bomb shelter for a short time, always up for new experiences... Granted some things have not gone as well as they might have gone in the US, the staff is doing well, despite what must be for them and their families a very nervous and stressful time, they still were able to deal with concerns that many of us were feeling.

The raging river in Be’er Sheva,
has a bit of silt in it at this time of year.
It’s the gray thing in the middle…
As conversations within the first year class transition from talking about what we’ve done before medical school, to getting cell phones, to furnishing apartments, to now talking more about classes and the impending deluge of information that is beginning to swarm around us. It feels good to be here, working towards something great. Professors and upperclassmen have been extremely welcoming and one week into the education, granted I was a teacher and am critical how the subject matter is taught, has been going well and I am looking forward to the next week. Well that’s it for now.  I need to go study for Immunology, Biochemistry, Microbiology, Molecular and Cell Biology, Histology, Hebrew, Global Health, and Biostatistics, that’s a lot of classes…

Interesting fact about life in Be’er Sheva: If you don’t like/want or need a piece of furniture you can simply take it outside and place it on a corner or the side of the street (preferably near a garbage or recycling bin) and it’s gone within 30 minutes to a couple of hours, off to be part of another person’s life. - blogger of the month, Chris Brown