Contributing Physicians - Dr. Joseph Kahn & Dr. Richard Allen
CJF Board Members
|Dr. Richard Allen
||Dr. Joseph Kahn
GET COVERED IN THE
HEALTH INSURANCE MARKETPLACE
here to view information about the ACA and assistance with signing
up. This is updated information that musicians and others can use. I
have also written an Update on Obamacare that I am sending you to post
on the CJF website. In order for a person to get insurance coverage by
March 1, 2014, the new date for signing up is Feb. 15, 2014, so we
should post this information fast.
Richard Allen Williams, MD, FACC, FAHA
THE WEST NILE FEVER
West Nile Fever is due to a virus infection in people,
birds, and mosquitoes. The disease is spread by mosquitoes who acquire
the virus from infected birds and then bite humans. The number of
cases in people have increased to more than 4000 in the U.S. and there
have been close to 170 deaths this year. For the past 4-5 years there
has been an increasing number of cases every year.
70% of the cases this year have been reported in
California, Illinois, South Dakota, Texas, Oklahoma, Mississippi,
Michigan, and Louisiana. This estimate is probably very low since many
of the cases have mild symptoms and are never reported to a physician.
There is no treatment for the disease and no vaccine to protect
against it The best way to avoid getting West Nile infection is to
wear insect repellent when outdoors, wear long sleeved shirts, and
support local programs to eradicate mosquitoes.
80% of the people infected with the virus develop no,
or few symptoms, while 20% develop mild to severe symptoms such as
headache, joint pain, fever, skin rash, and swollen lymph glands. Most
people with mild infection recover in 6-8 days, however those who
develop severe symptoms frequently have inflammation of the brain or
spinal cord (meningitis) and may die; therefore anyone with symptoms
should be seen by a physician. People with immune deficiencies, or
those over 50 years of age with medical conditions such as cancer,
diabetes, hyprtension, kidney disease, or organ transplants, are at
greater risk for serious illness.
In addition to wearing long sleeves, log pants, and
insect repellant, do not have standing water outside in open
containers, install or repair windows and door screens, and use air
conditioning when possible.
IMPACT OF THE NEW
HEALTH REFORM LAW ON YOU
Richard Allen Williams, M.D.,
Professor of Medicine
UCLA School of Medicine
The Minority Health Institute, Inc.
Los Angeles, California
On March 23, 2010, President
Barack Obama signed H.R. 3590, the healthcare reform bill, into law
and created the Patient Protection and Affordable Care Act (PPACA).
The purpose of this article is to help the public understand various
provisions of the new law regarding its benefits and its limitations.
This comprehensive overview is a public service provided by the
Minority Health Institute and is not intended to cover every single
detail. More specific details may be obtained from the sources cited
below. Here are the main provisions:
It is now mandatory for you to have health insurance.
If you are not covered, you will be penalized. Penalties will not
begin for a few more years. This is the Individual Mandate, and it
applies to every man, woman and child who is a citizen of the United
States regardless of race, ethnicity, gender, or disability status.
You can choose your own private insurance company and
plan. This includes keeping what you already have, if you choose to.
There is no “Public Option”.
Subsidies will be available for those who cannot
afford to pay for coverage on their own. A high-risk pool is being
organized by the Department of Health and Human Services (DHHS) for
such individuals and is promised to be up and running within 90
Your Medicare coverage will not be decreased. In
fact, certain benefits will be increased, such as closure (by 2020)
of the “doughnut hole” which requires increased payment for
prescription drugs after a certain deductible is reached. For
example, right now seniors pay 25% of drug costs up to $2,830. After
that level has been reached, seniors pay 100% of the costs (this is
the “doughnut hole”), until they reach $4,550 (the catastrophic
cap), when the payments of drug costs are decreased to 5%. The new
law will completely eliminate this costly gap. Prescription drug
coverage and preventive benefits will be increased. The financial
burden on Medicare beneficiaries will be decreased by slowing the
rate of Medicare spending. Waste and fraud in the system are
targeted for elimination, which is expected to save billions. A
rebate plan is being set up for Medicare beneficiaries who pay too
much for their drugs.
Preventive care procedures will be free with no
cost-sharing involved. This includes vaccinations for flu and other
disorders, screenings for high blood pressure, etc. So far,
mammograms and screenings for cervical cancer are not included in
these free services.
Low-income persons may enroll into Medicaid, and
eligibility will now be determined based on income rather than
demographic status. An individual who makes less than $14,404 or a
family of four with income less than $29,327 (upper limits of the
Federal Poverty Level or FPL) would qualify for Medicaid by 2014.
You cannot be refused insurance coverage by any
company due to pre-existing conditions.
The lifetime cap on insurance payments is eliminated,
so you will no longer be threatened with the possibility of
bankruptcy due to high medical bills.
You cannot be dropped retroactively by any insurance
company due to frequent need for care or high costs (rescission).
Medical underwriting for out-of-program care will be limited.
Insurance companies will be strongly regulated and will not be able
to raise your premiums arbitrarily. (Recall the recent situation
with Wellpoint, the nation’s largest insurer with 33 million lives,
which threatened a 39% increase in rates to its clients in
If you are an employer and your company has fifty or
more employees, you must offer them an insurance benefits plan.
Coverage will be on a cost-sharing basis. Employers will receive tax
credits for enrolling employees in their plans. If you are an
employee and your company does not pay at least 60% of the cost or
if the cost exceeds 9.5% of your income, you are eligible to apply
for a government subsidy.
Health insurance exchanges will be established BY
2014 which will allow small businesses and individuals without
employer coverage to afford better coverage. This is especially
important for individuals who exceed the Federal Poverty Level.
Children may remain on their parents’ coverage up to
the age of 26 years. This is not limited to children in college.
It is estimated that the Patient Protection and
Affordable Care Act signed into law by President Barack Obama on
March 23, 2010 will save thousands of lives by broadening access to
The health reform program is expected to cost $940
billion over the next decade and to decrease the Federal deficit
during the next twenty years by more than $1trillion, according to
estimates from the non-partisan Congressional Budget Office (CBO).
It is also estimated that it will save about $100 billion in the
next 10 years. This is a bargain of major proportions.
The major provisions of the law will not go into
effect until 2014, when the mandates, penalties, subsidies, etc.
will be fully exercised. However, more than 150 new policies have
already gone into effect with the signing of the Act into law. This
includes most of the regulations on insurance companies mentioned
information on healthcare reform can be obtained online at
Williams can also be contacted through the Minority Health Institute
Fibromyalgia is a disorder that is being
diagnosed much more frequently in the past 10 yrs. than it had been
before. It is more prevalent in females than it is in males. The cause
is unknown but it may be genetic as it tends to run in families. It is
believed that people with fibromyalgia have a lower threshold for pain
because of increased sensitivity in the brain to pain signals, which
is due to an increase in the level of certain neurotransmitters in the
brain that signal pain.
It is characterized by widespread pain on
both side s of the body involving the neck, shoulders, back, buttocks,
elbows, and knees. In addition morning stiffness, fatigue, headache,
depression, insomnia, and memory impairment may be present. There are
no laboratory tests to diagnose fibromyalgia, but on examination there
are at least 11 trigger points on the body. Trigger points
are areas that are sensitive to pressure and elicit more pain than
would be expected from the amount of pressure applied. There is no
known cure for fibromyalgia, but symptoms can be improved with gradual
exercise, rest, and medication for pain such as Advil, Aleeve, and
Ultram. Cymbalta, Lyrica, Neurontin, and Savella are additional
medications that may help to alleviate the symptoms. Some patients
have had relief with accupuncture, massage, or Yoga.
Other ailments that frequently accompany fibromyalgia are migraine,
irritable bowel syndrome, temporomandibular joint syndrome, and
bipolar disorder. Fibromyalgia is not life threatening but can cause
much discomfort and impair an individual’s ability to work. It may
last for many years.
BLACK MEN NEED TO KNOW
ABOUT HEART DISEASE
Black men are an endangered species. As long ago as
the eighteenth century, when the demographer Hoffman surveyed the
health of the slave population of the United States and predicted that
blacks would be extinct by the year 2000 because of their poor
physical status, there has been grave concern about whether African
American men were going to survive. This concern was so great that
slave owners and others dealing in the traffic of slavery felt it
necessary to insure the lives of their most precious commodity. It is
to the perpetual discredit of some of our most prominent insurance
companies and banking institutions that they funded these slaveholders
and insured their human property against loss; this meant that slave
holders did not have to worry about keeping their charges in good
health, because if they died, their masters would be compensated.
FACTS ABOUT GOUT
Gout is becoming much more prevalent than it used to
be because we are living longer (it occurs more frequently as we age
),we are more obese, and our diet puts us at risk for Gout.
Kidney disease is the most common cause of Gout, but genetics may also
Overproduction or decreased excretion of uric acid leads to an
accumulation in the blood and results in uric acid crystals
precipitating and getting deposited in the joints, skin, and kidneys
causing arthritis, tophi (nodules under the skin),kidney stones, and
kidney disease. Gouty arthritis is characterized by sudden acute
attacks of pain in one or more joints interspersed with pain free
intervals, often the joint at the base of the great toe is involved
,and it becomes swollen, hot, red, and exquisitely tender. Kidney
stones are made up of uric acid crystals.
Treatment is with allopurinol or febuxostol, which inhibit the
formation of uric acid, or probenecid to increase the excretion of
uric acid. The flares(acute attacks)are treated with ibuprofen,
Indocin, colchicine, or cortisone to relieve the pain, after which
allopurinol is started to lower the blood level of uric acid and which
should be maintained at 6 mg or less. If the uric acid level is
elevated, but there are no symptoms present, there is no need for
treatment. Flares can occur due to the use of thiazide diuretics,
alcohol,, red meat, organ meat( liver, sweetbreads, hearts,or brain),
small fish(sardines,herring, anchovies), shellfish (shrimp, lobster,
crab), mushrooms, asparagus, cauliflower, spinach, sweets, or fatty
There is no cure but the complications of Gout can be controlled by
the above measures.
Newer medications for the
treatment of Diabetes
Byetta, Januvia, & Victoza
Byetta & Victoza are given by daily injections that stimulate the
secretion of insulin in response to food ( this lowers the blood
sugar). They also Inhibit the secretion of glucagon (which normally
raises the blood sugar), they act on the stomach delaying the passage
of food and they decrease the appetite which encourages weight loss.
All of these actions tend to lower cholesterol, lower blood
pressure, and lower blood sugar. These effects are similar to those
produced by a substance called GLP-1 that is produced by the
Januvia prolongs the activity of GLP-1 in the body making the GLP-1
more effective. Januvia comes in tablet form so that the diabetic
patient does not have to give himself an injection as he/she would
with Byetta or Victoza.
These medications rarely have side effects, and do not cause
hypoglycemia.They are usually used with other antidiabetic medications
and can result in much better control of diabetes. Importantly they
decrease the risk of atherosclerosis (hardening of the arteries)
,which is the number one cause of death in diabetics.
content should not be considered a substitute for medical advice
from your physician. You should talk to your medical
professionals for diagnosis and treatment. None of the
information represents or warrants that any particular drug or
treatment is safe, appropriate, or effective for you.