We are getting many questions about the new Covered California website. Several of you have received notices that your insurance will be cancelled at the end of 2013 and you are starting to shop for a new policy.
About Stephanie Taylor
Posts by Stephanie Taylor:
Mini-Medical School #4, August 3, 2013
Herbs for Aging by Michele C. Kennedy
(Summary by Dr. Stephanie Taylor)
Michele gave an authoritative tour de force of plant medicine from both the Chinese and Western Medical Traditions. Michele is a highly skilled herbalist with more than twenty years of teaching experience.
Our second Mini-Medical School was a rousing and informative investigation into the world of organic and fermented food. Dr. Taylor gave a short talk on organics and the health benefits of fermented foods. Kathryn Lukas, owner of Farmhouse Culture, shared a history of sauerkraut and offered a demonstration of kraut preparation and a tasting. For those of you who were not able to attend and for those who were there who need references, here is a summary of our event.
Dr. Taylor spoke about the benefits of organic foods and distributed a flyer from CCOF, one of the two organic certifying agencies in California. The other is “USDA Organic”. There are many reasons to eat organic. Pesticide residues are clearly a risk factor for many diseases and disorders, especially for young and growing children. There are a large and increasing number of scientific studies identifying the risks of pesticides and herbicides. On a larger scale, organic gardening is more sustainable for the earth and will probably prove more resistant to climate change than monoculture. If you ever need to buy conventionally farmed foods the best information is from The Environmental Working Group. The EWG has a useful app for your smart phone (also available to download to print). It is called the “Clean Fifteen and Dirty Dozen” food list at www.ewg.org.
Refrigeration is a relatively recent invention. Although our generation has never known anything else, most of mankind’s history with food preservation utilized smoking, salting, drying and fermenting. Fermented foods that are familiar are sourdough bread, sauerkraut, kimchee, yogurt, kefir, kombucha, but also coffee, cocoa and vanilla.
There are four primary benefits of fermented foods: pre-digestion, nutritional enhancement, detoxification and live bacterial cultures. Pre-digestion occurs when relatively indigestible fibers are broken down to smaller parts that are more easily digested by humans. This also makes some minerals more available. Nutritional enhancement refers to the production of several vitamins by the microorganisms directing the fermentation process as well as other compounds such as nattokinase which appears to have specific health benefits. Cabbage ferments produce compounds that appear to reduce cancer risk. Detoxification of phytates occurs in fermentation. Phytates bind minerals and prevent absorption. There is a fermentation enzyme that releases the minerals bound to grains, legumes, seeds and nuts. Finally, the effect of the live bacterial culture is vitally important. You can take supplemental pro-biotics, but research shows that they colonize the gut somewhat briefly. It is better to think of your bacterial companions as a vast and complex rainforest that you cannot replant with just one or two species. Clearly, it is in your best interest to consume a variety of friendly probiotic foods and supplements to establish a healthy ecosystem. The human cells in your body are outnumbered 10 to 1 by the bacteria in your digestive tract, so being on good terms is very important. Recent research demonstrated improved immune function with a healthy gut flora. This is actually no surprise since a large portion of your immune system is in the gut!
Kathryn Lukas then gave us a masterful presentation of the history of sauerkraut, and a demonstration of kraut making. All of her Farmhouse Culture ingredients are locally sourced, including the salt! It was amazing to see the cut cabbage, coming from the field already colonized with right lactic acid bacteria, develop into a kraut just with the application of salt. We followed the demonstration with a tasting of her creative varieties with Kimchee and Ginger Beet being a big favorite. Farmhouse culture products are locally available at Whole Foods in the refrigerated section. More information is available at www.farmhouseculture.com.
References and resources
Sandor Katz, The Art of Fermentation, 2012, Chelsea Green-A great summary of ferments by a master fermenter and also friend of Kathryn!
For kraut making supplies and a good time Kathryn recommends: Mountain Feed and Farm Supply, 9550 Highway 9, Ben Lomond, CA, www.mountainfeed.com
Classes and resources at Happy Girl Kitchen at 173 Central in Pacific Grove, California, www.happygirlkitchen.com
Welcome to 2013, described by some of our best philosophers as “The Great Turning”. This is a time of great change but also great opportunity for creativity. A Womanswellspring is changing as well. We are successful as an independent women’s wellness center. In order to continue to advance and improve, there will be some changes in the financial structure and some new offerings for the coming year.
I am beginning an annual fee of $250 in addition to the usual charges for the office visit. The annual fee is deliberately kept low in order to allow as many of you as possible to participate. The annual fee will give us enough financial stability to expand the Wellspring educational offerings. You can also elect to pay in quarterly installment of $62.50.
The best way to think about this new financial format is as a co-operative. By supporting your local community based physician, you will receive benefits. Rather than a financial dividend at the end of the year, you will receive useful and interesting educational experiences, as well as a 25% discount on classes and supplements. Plans for 2013 include an expanded Mini-Medical School lecture series. There will be six lectures a year given at 12:30 PM the first Saturday of even numbered months. All lectures take place at Chautauqua Hall, in Pacific Grove. Topics will decided by consensus and will be interactive. There are additional health improvement projects planned for later in the year. Research consistently shows that when we work together consistantly toward improvement of your health, we get much better outcomes, and that is the direction we will take in 2013.
This is not a boutique or concierge model. Concierge practices are designed to deliver primary care to a smaller number of patients with more personal attention at a fairly substantial price. Womanswellspring is a consulting service, working with your primary care provider. We offer longer office visits, and in depth and interdisciplinary coverage of health issues not possible in a conventional medical practice. If you decide to decline our invitation, I will continue to care for you on an emergency basis until January 31, 2013, and will make every effort to help you find another physician.
I hope as many of you as possible can join in this great adventure of life!
Blessings on your New Year.
The recent publication of a study suggesting that mammography is over detecting breast cancer is very confusing to women. The conclusion from the study is that small, localized breast cancers probably never spread, and should not be treated. Unfortunately, we do not have the tools to reliably determine which breast cancers are well behaved and which will become aggressive. It would be inappropriate to generalize from this study and to recommend less frequent mammography. Again, we do not have the knowledge to make a clear recommendation. The Preventive Services Task Force issued a controversial recommendation that mammography should start at 50 and be every two years. That model saves money and procedures, but accepts that some women will be diagnosed later and possibly have a less favorable outcome. That works on paper, but it doesn’t work if you happen to be that one women who was missed in the two year screening cycle. Overall, we just do not have the information we need to make the best choice. This is a decision that is, again, best made between a woman and her doctor.
There is some good news! The KEEPS trial results were announced at the North American Menopause Meeting in October. This study clears much of the confusion surrounding hormone replacement in the menopause. This was a double-blind, placebo controlled study of 700 women ages 41-59, who were healthy and within three years of menopause They were given low dose Premarin orally, or a moderate dose estradiol patch, or a placebo. Women with a uterus were given additional natural progesterone. This trial differs from previous trials in using lower doses and natural, rather than synthetic, progesterone. The hormone therapy group had a reduction in hot flashes and night sweats and an increase in bone density. The group on the patch also had an increase in sexual interest and desire. Measures of cardiovascular risk showed either no change or a modest reduction in risk. There was no increase in breast or endometrial cancer, heart attack, stroke, or deep venous thrombosis. The cognitive studies showed a decrease in depression, anxiety and anger in women on Premarin. This group also has an improvement in recall. The estradiol patch did not have a significant effect on memory.
In summary, this well designed study supports the evolving understanding that hormone replacement works best of given within 3-5 years of menopause. It also adds weight to the preference for natural progesterone rather than a synthetic. Benefit on cardiovascular risk and cognitive parameters are demonstrated with no measurable classic risks, such as breast cancer, after 4 years of observation This study should reassure women who opt for HRT during the menopausal transition.
When faced with conflicting research studies, women should do as much homework as possible and then discuss their thoughts with their doctor. Since not every doctor can follow all the research, you may need to consider consultation with a specialist. This may be money well spent if it leads to a better health outcome. We live in a complex and rapidly evolving world. It is an exciting time to be alive, but for now, we will need to accept a certain degree of uncertainty.
I sometimes hear this question when someone is frustrated by the financial barriers to health care. I believe that applying a business model to healthcare is unwise and dangerous. Essential human services do not perform well as for profit businesses. If profit is the goal, people get crushed in the rush to improve the bottom line and satisfy investors.
Doctors work hard, make a pretty good living and do not have to be worried about being unemployed. Physicians practice medicine because they love to care for people. But, they are usually very poor businessmen and businesswomen. That weakness in finance has been exploited by the payor system, and most physicians are working as employees to satisfy the payor’s demands for a labor force. Physicians, including organized medicine, have not been active enough in defending our patients against the abuses of the for profit economic system. This is a new challenge.
It might be refreshing to review the “Oath” to gain a new perspective. Here is the contemporary version written in 1964 by Dr. Louis Lasagna of Tufts University. I will let it stand on it’s own, but it is clear that there is a mandate to protect the patient and the family’s economic stability. Physicians do not take a vow of poverty. What is called for in the oath is for physicians to confront financial abuses as they occur and protect patients from unnecessary expense.
I swear to fulfill, to the best of my ability, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. I will apply, for the benefit of the sick, all measures that are required, avoiding those twin traps of over treatment and therapeutic nihilism. I will remember that there is an art to medicine as well as science, and that warmth, sympathy and understanding may outweigh the surgeon’s knife or the chemist’s drug. I will not be ashamed to say “I know not”, nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery. I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play God. I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure. I will remember that I remain a member of society with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. If I do not violate this oath, may I enjoy life and art, be respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.
The Supreme Court decision this week on the Affordable Care Act makes it even more important to control health insurance rates. Health insurance in California is the only insurance type that is free of rate regulation by the Insurance Commissioner. The ballot petition to give the California Insurance Commissioner the power to approve or disapprove health insurance rate increases collected about 800,000 signatures but was 1% short of qualifying for the November 2012 ballot. They will probably qualify for the November 2014 ballot and hopefully, the insurance commissioner’s decisions will be retroactive to 2012 with some rate refunds coming your way. With health insurance mandatory, rate control is even more important! Check the web page occasionally to keep track of this essential ballot initiative.
Our Tenth Tai Chi for Health Workshop took place June 11-17, 2012 in Memphis, Tennessee. We had 172 participants taking week long trainings in many Tai Chi forms including the Sun 73 , Yang 24 and 40 Form, Combined 42 Form, Chen Styles, fan and sword forms as well as push hands. It was an outstanding success and the participants made great strides in their personal Tai Chi Chuan. With the Tuesday night Talent Show and Social dinner, great fun was had by all. The week long workshop is a special opportunity to close out the world and its distractions and concentrate on developing your Tai Chi. Our final demonstration was a record for us, with 159 persons performing the Sun 73 Competition form outside in the natural world.
If you missed this opportunity, the next week long workshop will be in Connecticut in June 2013. But you do not have to wait until then. Our special Master Trainer, Sifu Dan Jones, will be coming to Pacific Grove, California, January 2013 for a weekend workshop in Silk Reeling. Silk Reeling is a foundational practice for Tai Chi that is usually only taught to advanced students. Dan has a gift for teaching this difficult material, and this workshop is appropriate for beginners as well as advanced practitioners. Numbers will be limited to insure quality, so let Dr. Taylor know as soon as you are able. You can leave a message at 831-622-1994 or email Dr. Taylor using the website link. We look forward to seeing you in January for learning and fun. Come on out and play Tai Chi!
What is the annual medical exam? It is much more than ordering a pap and a mammogram.
This is what happens at your annual examination for a low risk person (depends on age):
Interview:Recent personal medical history, surgeries, new family history; dietary and nutritional assessment; physical activity; use of complementary medicines and practices; tobacco, alcohol and drug use; domestic issues.
Physical Examination: Height/weight/BMI/BP. Physical exam and pelvic examination (usually at >21 years of age).
Laboratory Testing: Pap smear, STD screening, HIV Screening, Blood tests for diabetes and heart disease, mammography, colorectal cancer screening.
Evaluation and Counseling: Sexuality, fitness and nutrition action plan, family, work, lifestyle and sleep, cardiovascular risk factors, injury prevention, sun exposure.
Immunizations: Diphtheria/Pertussis/Tetanus (every 10 years) , Herpes zoster(shingles) (one dose at 60), Pneumococcal Vaccine at 65, Influenza annually beginning at 50, HPV Vaccine (<26 years). There are many additional tests and screenings for individuals with risk factors, a problem or an illness! You can only decide what is right for you by having an in depth discussion with your personal physician. This summary provides you with a basis for your discussion.
Who sets the standard of care and what are they?
US Preventive Services Task Force http://www.uspreventiveservicestaskforce.org
The American College of Obstetrics and Gynecology http://www.acog.com
Am. Society for Colposcopy and Cervical Pathology http://www.asccp.org
The Pap Smear: Summary: When to start Screening: After age 21. Screening intervals: Every 2-3 years. May screen every 3 years with a history of 3 negative tests. With HPV co-testing (after age 30) every 3-5 years. When to stop screening: Women over 65. With a history of dysplasia screen for 20 years after diagnosis. Screen women over 65 if they are sexually active with multiple partners.
Mammography- Start at age 40 depending on situation. ACOG states every 1-2 years in 40-50 age group and annually thereafter. USPSTF states screening every 2 years. Insufficient evidence of benefit after age 75. Check radiation dose and track exposures at http://www.xrayrisk.com.
Bone Density Screening- Start at age 65, except for high risk groups. High risk is by the FRAX tool ( http://www.shef.ac.uk/FRAX/tool.jsp?country=9 ) defined as smoking, alcohol intake, low body mass, parental fracture history. There are other risk factors, such as amenorrhea, premature menopause, exposure to high risk medications such as steroids.
Other issues- Advanced risk assessment tools (Coronary calcium score, LDL particle count). These may not be covered benefits on your insurance because they are considered “experimental”. This means the insurance company, not the physicians, have decided it is not ready to be used as a screening test.
The professional organizations set the standards based on published and peer reviewed research results. This is considered to be “evidence based medicine”. The decision to pay for testing is usually in the hands of the payor. In the United States, most Americans below the age of 65 are covered by private insurance. Each insurance company has their own approval system and standards for payments. Most private insurance companies are for-profit corporations who are responsible to stock holders. This places the physician between the standard of care and the payor. I believe most patients think their doctor is a representative of their insurance company because they have a contract, whereas the reality is that the physician labor force is simply contract labor.
I choose to step away from that inherent conflict of interest when I cancelled my provider contracts with all the health insurance companies. I do not accept insurance for office visits. Patients pay at the time of service and I courtesy bill their insurance for any out-of-network benefits. It is not easy to be independent, but I can tell you it certainly is honest.
Womanswellspring exited the insurance world January 1, 2010. We set fair rates for our services and patients pay at the time of service. We charge $210.00 for a new 30 minute visit and $190.00 for a return 30 minute visit. Medicare patients get a discount. Short follow ups and procedures are based on time at about $4.00 a minute plus supply costs. It is only fair for you to know your financial obligation openly and before you accept the service. Such is not the case with most insurance companies. Not only is it not clear what your financial obligation will be before you accept the service, it is even more unclear what rate you will be charged for the privilege of having health insurance.
Well, there is good news and you can take action. Dave Jones, the Insurance Commissioner for the entire state of California was in town April 12th, 2012. He made it clear that he has the power to regulate the rate increases of most insurance types, such as homeowners, but not health insurance. This was deliberately left out of the bill establishing the Insurance Commissioner’s powers in the 1980’s. Health insurance rates in California increased 153% over the last ten years which is five times the rate of inflation. There is an initiative to make health insurance companies justify their rates. They will need 500,000 signatures by May 1st to place this on the November Ballot. Please consider helping by adding your signature to the petition at www.justifyrates.org or contact TeamDaveJones@gmail.com or 916-251-6538. Follow the instructions on the second page and sign as yourself and the circulator since it is a single page. Mail to Consumer Watchdog Campaign, PO Box 5547, Santa Monica, CA 90409-5547.