Creative Semantics

Insurance companies are supposed to pay for health care, although they do everything they can think of to avoid doing so. One company in particular (a small player here though a much bigger gorilla in other markets) does so by playing with words, even when another behemoth lost a lawsuit over the same issue.

The topic involves paying for preventive services while a patient is in the office for care of an acute illness or management of a chronic condition. The way we communicate with insurance companies about what we do in the office is by way of codes; CPT codes, to be precise. There are separate codes to differentiate between preventive services and the so-called Evaluation and Management (E/M) services. The latter are your basic office visit codes covering all the “cognitive” services I offer — as opposed to procedural codes, where I actually do something to you other than talk with and examine you.

In general, you can only have one office visit per day. However if you happen to ask me to take a mole off while you’re in for a diabetes check, or if I find that you’re wheezing when you just came in for a checkup, there is a way to code for more than one appropriate service at a time by using something called the -25 modifier.

The -25 modifier is added to the E/M code to indicate that the evaluation service was completely separate from the procedural one. That is, the diabetes exam had nothing to do with the mole, or the asthma was completely separate from the Boy Scout physical. For a long time, many insurance companies refused to pay for an E/M code in addition to a preventive visit. Here for a pap but came down with a chest cold? Sorry; you have to choose which one you want me to take care of today, because although they really are completely separate services, I can’t get paid for both.

Then this little insurance company, call them “Company A”, lost a class action lawsuit over just this issue, and had to pay out big time. You’d think others might have taken notice; sadly, not. What’s infuriating, though, is how they now play with words to avoid paying.

Here’s how it works: their provider relations people tell me on the phone that preventive services are “well visits”. By this semantic equivalence, evaluation and management services — all other visits for acute illness or chronic disease — are “sick visits”. And of course, how can you be “sick” and “well” at the same time? Mutually exclusive, you see.

False, wrong, and illegal as hell. But what realistic recourse do I have? Other than dropping that plan — and inconveniencing/alienating a chunk of patients — none. Sometimes it sucks to be small.

Jack Forbush

When an FDA panel voted against a risky new diet drug last summer, I warned that we hadn’t heard the last of that one.

I only wish I was wrong… but my prediction has come true already.

The drug is called Qnexa, and don’t be fooled by any “new” research you might have heard about: The study just published in the Lancet is the same old study that got the drug rejected before, just wearing a different suit.

In it, researchers claim patients who took the drug for a year lost an average of 22 pounds, lowered their cholesterol levels and brought their blood pressure down.

But last year, the feds combined this data with the results of a second study — both funded by the company — and concluded that the med didn’t offer much in the belly-shrinking department.

In fact, according to the LA Times, the FDA concluded that the difference between Qnexa and a placebo was “of nominal statistical significance.”

What’s more, the company admits that anyone who does manage to lose weight on the drug may have to keep taking it forever if they hope to keep it off.

You know who benefits from that, right? The drug company, of course — while each day you take the med is another day in which you run the risk of side effects… and the ones attached to Qnexa are a doozy.

In a study I told you about last year, 40 percent of the patients who took the drug dropped out of the study — and when you read the details in the Lancet, it’s not hard to see why.

The drug’s side effects include a “pins and needles” feeling, dry mouth, constipation, insomnia, a distorted sense of taste, depression, anxiety and the dizzies.

But what would you expect from a drug that combines a powerful anticonvulsant with one of the active ingredients of fen-phen?

Do yourself a favor — don’t wait for Qnexa, which probably will win approval eventually.

Just lose weight the old-fashioned way: Eat better.

Instead of battling weird drug side effects, you might actually feel good for a change.

Imagine that.

Jack Forbush

The needle nuts are at it again — and this time, they’re pushing a dangerous vaccine on babies for a disease you shouldn’t worry about in the first place.

The feds have signed off on a plan to give Menactra, a vaccine that’s supposed to prevent invasive meningococcal disease, to babies as young as nine months old.

“The highest rate of meningococcal disease occurs in children under one year of age,” said Dr. Karen Midthun, director of FDA’s Center for Biologics Evaluation and Research.

Sounds scary, right?

But here’s what she didn’t say: The overall odds of dying of meningococcal disease are so low you’re more likely to be hit by lightning TWICE!

The condition strikes just 2,500 Americans a year, killing 300 — putting the risk of death at literally one in a million.

Now, I’m not heartless — any death at all is tragic. If there was a safe and effective way to save 300 lives out of 300 million people, I’d sign up for it in an instant.

But this ain’t it.

Take a look at this warning right on the front page of the vaccine’s Web site, just past all the usual promises of pain, redness, swelling, headache and fatigue: “There is a potential for an increased chance of getting Guillain-Barré syndrome following vaccination. Vaccination with Menactra vaccine may not protect all individuals.”

Talk about a double whammy — an increased risk of a crippling and potentially deadly nervous system disorder AND the vaccine may not even work!

Health officials claim the Guillain-Barré risk is small… but get this: The World Health Organization says the odds of getting the syndrome following a Menactra vaccination are 1.25 in a million.

In other words, the risk of getting Guillain-Barré syndrome from the vaccine is actually slightly greater than the overall risk of dying of the disease the shot is supposed to (but might not) prevent.

You just can’t make this stuff up!

Jack Forbush

SSRIs ‘miss’ up to 13 symptoms of depression

What do you call an antidepressant that leaves you sad? If you’re in the drug industry, you call that “effective.”

After all, you didn’t kill yourself (not yet, anyway) — and that’s what passes for success these days.

A new analysis of data from the STAR*D trial finds that people who take SSRI antidepressants cope with at least three, often five, and up to 13 lingering symptoms of depression — even while the drug is supposedly working.

The most common symptoms included insomnia (79 percent of patients), sadness (71 percent), concentration problems (70 percent), low energy (63 percent), and an even more severe form of insomnia (60 percent).

But the researchers behind this one are glass-half-full kinda guys — they say the good news here is that the drugs worked “overall,” and that suicidal thoughts were rare.

Hooray!

“Some people fear that antidepressant medication increases thoughts of suicide,” study author Dr. Shawn McClintock said in a news release. “This provided counterevidence of that.”

Call me Oscar the Grouch if you will, but I can’t help but focus on the rest of the data in the Journal of Clinical Psychopharmacology — like the 75 percent of volunteers who had FIVE or more lingering symptoms of depression even after taking these meds… or the two-thirds of patients who took SSRIs and didn’t go into remission.

That level of “success” is right in line with placebos, which often get a 30 percent response rate or more in depression trials.

Heck, at least half of all depressed people respond to nothing more than a little time — it’s a condition that usually goes away on its own, no drugs, therapy, or herbal remedies necessary.

If you do want to pop a pill, stick to something that really is proven to work and won’t leave you sad and tired — like St. John’s wort. In a 2005 study, this ancient herbal remedy had a 50 percent remission rate in just six weeks, while paroxetine (aka Paxil) had the usual drug/placebo response: just 35 percent.

If time and St. John’s wort won’t do the trick, don’t head for the pharmacy — head for the butcher.

Many people — especially vegans — suffer depression and other mood-related issues when they’re not getting enough of the vitamin B12 found in meats.

I don’t know about you, but just the smell of steak on the grill is enough to lift my mood.

Jack Forbush

Time for a little science experiment: Go into your kitchen and get out the sugar, a teaspoon and a clear drinking glass.

Now, put 22 teaspoons of sugar into the glass.

Builds up fast, doesn’t it?

You’d have to be clinically insane to put that glass to your lips and knock back all that sugar… but that’s exactly what you’re doing, every single day, if you’re an “average American.”

Put it all together, and you get 355 calories in added sugar a day — or almost an entire meal made of white stuff. And over the course of a week, it adds up to a pound and half of sugar.

One food industry analyst in the news, Phil Lempert, says that’s about double what you should be eating… but I’ve got news for Phil: You’re only half right, pal.

You shouldn’t be eating ANY added sugar, period.

But instead, we’re going in the opposite direction. Want to know what you’re grandkids are eating? Add another five teaspoons to that glass.

And these are just averages. If you’d like to see what millions of Americans at the high end are eating, you’d have to add almost 20 more teaspoons — 46 in all!

That’s enough to cause an 8-ounce glass to runneth over with sugar — and that’s why America is fatter and sicker than ever before.

We could slash disease rates in this country overnight if we’d simply stop adding sugar to everything from bread to salad dressing.

But that’s not going to happen.

So look out for yourself: Read food labels carefully… and if you see added sugar in any of its guises, treat it like a hand grenade and get rid of it as fast as you can.

Jack Forbush