ReBootYourLifeToday

Hormone Replacement Therapy and Breast Cancer in Women Over 55

Some women get through menopause saying, “What’s the big deal?” Some women have easily controlled symptoms. Then there’s the rest of us. I had a terrible time of it.  What saved me was the much maligned Hormone Replacement Therapy (HRT).  Today in the New York Times they reported on yet another study saying that women who take HRT are at greater risk of breast cancer.  http://www.nytimes.com/2010/10/20/health/20hormone.html?th&emc=th

But wait a minute.  I had to take biological statistics in grad school.  (The emphasis is on the “had to” part as math and I have never been good friends.)  But I did learn some important things that have served me well over the years.  One of them is before you run really scared about any study do some math yourself. 

 The study in question followed 12,000 older women who were past menopause.  I did the math and looked at the findings:  They found the increased risk for those women who were taking or had taken HRT for more than 5.5 years was .01%!  I also learned in Bio Stat that .01% is statistically insignificant. 

Let’s compare that .01% increased risk to that of drinking more than 2 drinks a day which will give a woman nine times the risk of developing breast cancer!!!!  Why don’t we ever see that in the New York Times or anywhere else in the media?

 In researching out this subject I found some other important studies that haven’t received much press:  Estrogen-alone hormone therapy does not increase the risk of breast cancer in postmenopausal women at all, according to an updated analysis of the breast cancer findings of the Women’s Health Initiative (WHI) Estrogen-Alone Trial. These trials were conducted by the National Institute of Health not some pharmaceutical company trying to sell its’ drugs.  http://www.nytimes.com/2010/10/20/health/20hormone.html?th&emc=thmen's

If you’ve had a hysterectomy the above is good news.  Women with a uterus are given progesterone as well as estrogen.  Those were the women who were studied in the New York Times article and had the .01% increased risk.  However, if you’ve had your uterus removed as so many of us have, you can skip the progesterone and have no increased risk.  So if you’re one of the millions of women having trouble with menopause, we just got a cancer free card.  How good is that?

And there’s more good news:  “New results from a sub-study of the Health Initiative (WHI) Estrogen-Alone Trial show that younger postmenopausal women who take estrogen-alone hormone therapy have significantly less buildup of calcium plaque in their arteries compared to their peers who did not take hormone therapy.  Coronary artery calcium is considered a marker for future risk of coronary artery disease.” 

Results of the WHI Coronary Artery Calcium Study are published in the June 21, 2007, issue of the New England Journal of Medicine. The WHI is sponsored by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.   http://www.nejm.org/medical-index

So if you’re suffering take the HRT in bio-identical form which works well for many women or the tried and true Premarin which has been around for over 50 years.  By the way, I’m sure that if men had to go through menopause, the good news about HRT would be front page news every day!

The New Health Care Law and How It Affects Women Over 55 Part Two

 As promised here’s the insurance side of the health care industry.  Readers of this blog know my last post was about the medical provider side of the health care business.  This time we’re examining the role that insurance companies play.  It’s very complicated too, but I’ll do my best to make it interesting:

Insurance companies are basically middle men.  There are many middle men (brokers) of different stripes in our economy.    But insurance companies have far more power than any other type of middle man.

 Here’s how insurance companies work.  They collect money from employers and individuals in the form of premiums. They collect large sums of money, but pay it out at their own discretion.  The premium payer (your employer or you ) are never in charge of what the insurance company pays out. The insurance company can say, “We won’t pay for your health care because it was not pre-approved.”  They can say, “You have a pre-existing condition so we won’t pay.”   They have many more excuses to leave you with huge bills.

 In other words just like the provider side of health care, the insurance company is the one who decides what care they will pay for, where you get your care, and how much care you can have.  They work under the new Golden Rule: He who has the gold, rules.  The company has all the gold so they make the rules.

 There is no other middle man in our economy that has that kind of power.  

So how did the health insurance business get such overwhelming power?  I’m not a fan of conspiracy theories and I’m not going to tell you that a bunch of fat, bald men sat in a smoke filled room 50 years ago and dreamed up a scheme that would make them billions decades later.  I worked in health care over a long period of time and I watched how they got their power first hand.  In the first place, for most of our history insurance companies were headed by doctors, former hospital administrators or other health care professionals who knew a good deal about providing health care on a large scale. 

All that changed in the age of greed we’ve been living through for the past 15 to 20 years.  All of sudden the health care professionals were replaced by MBA’s whose specialty was upping the stock price and making huge bonuses for themselves just like their Wall St cousins.  Now the name of the game was to make lots of money by cutting corners and paying out the minimum, obviously leaving loads of money for their bonuses.

How did they do that?  They loved the concept of pre-existing conditions.  That liberated large profits. The daughter of a friend went to get some medicine for  acid reflux. She was denied coverage for the doctor’s visit and medication because she had recently been pregnant!  You say she wasn’t going to the doctor for anything that was pregnancy related, so how can that be?  Well it be because they told her that pregnancy by itself was a pre-existing condition and she was not eligible for any coverage at all. 

What a great money maker since about 90% of women have been pregnant at one time so that would exclude over half of the population.  What a brilliant idea!  (My friend’s daughter appealed and won.)  However, you get the idea:  The more ways they can dream up to declare an illness as a pre-existing conditions the more money they can put in their bonuses.

Insurances companies were furious about the part in the new health care law that banned pre-existing conditions.  But that’s not what’s got their hair on fire.  What they will spend any amount of money to abolish is the condition that all Americans must have coverage.

You say, that means they’ll get millions more customers, doesn’t that make them happy?  No, it makes them weak in the knees.  Why? Because that means they can no longer cherry pick, as they call it.  They want to find the groups of people who are least likely to be sick.  Under the new law they have to take everyone.  And it’s this provision of the new law that is being challenged in court.  Why would anyone not want to have health insurance?  Because they have to pay a certain amount of the premium themselves and some people don’t what to do that.  Well the insurance industry saw an opening and ran with it.  They could protect their profits by making the “big, bad government” the villain.  Now they say the big, bad government is going to make you pay for something that you don’t want – how unconstitutional! 

 OK, let’s look at this.  A young person says, “I’m healthy so why do I have to pay for health insurance?  Here’s the reason:  This guy may be healthy but what happens if he gets run over by a truck and has to spend months in the hospital?   He doesn’t have insurance, who pays his bills?  Or, you’re a young woman who  accidentally gets pregnant and goes ahead with the pregnancy.  The baby is born prematurely and weighs 3 pounds at birth.  Those premie babies literally cost over $1 million each.  This young woman doesn’t have the $1 million dollars so who pays?   The big, bad government pays in both these cases because the bills bankrupt the patients and they are eligible for Medicaid (MediCal in California) and it’s those huge uninsured bills that are helping to bankrupt the country.

 So now everyone must have insurance which is how all other developed countries run their health care programs.  And now the insurance companies will have to pay for the guy who got run over and the girl with the premie baby.  That’s what – and they desperately don’t want that because there won’t be enough money for their bonuses or their huge salaries.  Got it?  Well, they got it right away and got the fierce battle over health care reform going in the Senate just like they have for over 50 years. They brought out the big guns and used every politician they supported over the years to make a cynical and nonsensical fuss.  They made life miserable for all those politicians who actually wanted to do some good for the people that sent them to Washington.  Now it’s up to the Supreme Court to judge whether we need reform or whether insurance executives get to keep their yachts. 

Let’s Talk About the New Health Care Law and How it Affects Women over 55

The health care business, and it is a business, is extraordinarily complex.  At least it’s the most complex thing I ever worked in. I worked in health care administration for 18 years after I got my master’s degree in Health Care Administration.  So I know for a fact, that the health care law can’t be boiled down to handy sound bites like death panels or socialist take over.   (Think about it.  All the western European countries have nationalized health care systems and they live longer than we do.  So if they were killing grandmas with death panels how could their life expectancy be higher than ours?)

Five presidents over the last 60 years have tried to get health care reformed.  So how could there have been such a media blitz of outcry?  The average guy could not possibly understand what was going on, so the protests were well organized and generously funded by those who stand to lose big bucks under the new law.  (The president of Wellpoint took home a bonus of $11 million in 2009 that’s in addition to his regular salary.) This is not new, we’ve seen all kinds of fat cats organize and fund so called “public outcry” before.

 So what’s going on here?  We have the best health care in the world.  Our physicians are the best trained and have the most advanced equipment to work with.  So what’s wrong?  It’s a long story but here goes:

Providing health care grew up in this country as a for profit sector of the economy.  That’s not the case in any other developed country in the world.  We work under a capitalistic system. One of the things that makes our system work so well is the rule of supply and demand.  Our economic system is the envy of the world, but it’s not working for health care as the costs are bankrupting the country.  The reason the supply/demand paradigm doesn’t work in health care is that the supplier of the product is also the provider of the product. 

What am I talking about?  OK, if you want to buy a car, you can do internet research, chose a car with the features you want at the price you’re willing to pay. Then you go to the dealer and test drive the car.  If you still want the car you start negotiating the price and financing.  All the way you are in control.   

 That’s not how it works if you’re sick.  Let’s take a simple little example to illustrate.  You have a rash on your tummy, it’s getting worse and it itches all night.  So you go to the doctor.  He looks at the rash and says he needs to order a panel of tests.  You’re thinking he would give you some ointment and send you off.  But he’s the doctor so you go along with the tests, after all maybe he knows a rash like this is the first sign of something really bad.  When the tests come back they’re all negative except one which was a little off, so he orders more tests.  All the while you’re itching and worried that something is really wrong.  At the end of this experience you find that the rash is caused by the strawberries which you were allergic to as a kid. 

You had grown out of the allergy, but years later it’s back.  And since you’ve been eating those beautiful organic strawberries you bought at the farmer’s market, you’ve got a rash.  However, you’ve also got $2,500 worth of tests.  But, oh well, the insurance company will pay some of it and after all, you’re not dying so that’s the good news.

 As you can see, buying health care is not like buying a car.  You, the consumer, are NEVER in control.  You make the decisions when you buy a car, the doctor makes the decisions when you’re sick.  And to belabor the point, the doctor is the one who determines what care you get and he’s the one who supplies the care as well.  Thus the supply/demand dynamic does not work.

 The doctor in our story ordered up a ton of tests that were not needed and built up a big bill.  Is the doctor a crock?  No, he’s practicing caution medicine.  But there’s still a lot wrong here. We can talk about two things:  lawsuits and training.  This is a litigious society with people who live to sue, so doctors are very cautious and don’t want to expose themselves to malpractice law suits.  The second thing wrong is that physicians are trained to use the “rule out” rule.  In other words when you present a condition they think up every possible disease you could have and they start ruling them out one by one which mean lots of unnecessary tests.   

 With all that said there’s no way to rule out greed as a factor.  Doctors know what an insurance company will pay for.  They know the codes to use to build up the bill.  They know how much that CAT Scanner cost and they know they need to pay for it. They also know how much their Mercedes payment is.  All this and much more tends to build up the bill but not increase the quality of care at all.

 With the above I’ve just touched the tip of a huge iceberg called the health care industry today.  I could literally write a book on hundreds of other issues.  For now let’s look at:

 The bottom line is: the new law is the best thing to happen to Americans  in 50 years – period.  There’s no argument.  We are being bombarded with nonsensical arguments against the new law by those extremely rich folks who run insurance companies and all the other fat cats that make their billions from sick people.  Not a pretty sight for anyone who knows the inner workings of the industry.

 Stay tuned for the next post where I’ll cover the role of insurance companies in this labyrinth of almost 20% of our economy.

Exploding Myths About Aging

Aging is a funny thing.  We don’t think so much about it until climbing stairs our knee hurts or a friend gets diagnosed with a deadly disease.  Then the “I’m getting old” thing comes to the front of our mind to scare us.  And why wouldn’t it be scary, conventional wisdom paints such a dismal picture for the “older woman” that anyone would get heart palpitations. 

So let’s take a look at some conventional wisdom that’s neither wise nor true.

Myth #1:  There’s no way around losing your marbles, your hearing, your sex drive, your ability to take care of yourself. According to the New England Centenarian Study, "Think aging is all about losing your memory and becoming hard of hearing? Think again. Many people sail through the aging process without walkers or pacemakers. In fact, researchers now believe it's those diseases—diabetes, heart disease, cancer, stroke, osteoporosis — that leave us frail or disabled, rather than the normal aging of our bodies.” www.bumc.bu.edu/centenarian

What this study and many, many others are saying is that just because we’re getting older, that doesn’t mean we’re automatically going straight to what I call the 3 Big D’s – Decline, Disease and Death. In fact, the New England Centenarian Study found that, “The vast majority of those who live to be 100 are able to live independently on their own well into their 90's.”

Myth #2:  After menopause women lose their interest in sex.

The New England Journal of Medicine August, 2007 reported that a survey of women between 57 and 80 years of age found that the majority (54%) were leading active sex lives, reporting engaging in sexual activity with at least one partner in the 12 months preceding the study.  http://www.nejm.org/

They also found that, “Two thirds of those aged 65 to 74 and 54 per cent of those aged 75 to 85 reported having sex at least two or three times a month. Almost a quarter of sexually active septuagenarians and octogenarians claimed that they had sex once a month or more. “

Richard Suzman, Director of the Social and Behavioral Research Program at National Institute on Aging,  National Institutes of Health (NIH). , said that the study, “Suggests a previously uncharacterized vitality and interest in sexuality that carries well into advanced age, which perhaps has not been appreciated as an important part of late life”.

So much for women don’t like sex especially after menopause. 

Myth #3 – Going partially or completely deaf is a natural part of aging.

Well, even the makers of hearing aids agree that only 35 percent of 80-year-olds need a hearing aid, and many folks in their 90s still have perfect hearing.

These are only three of the many myths that we all have come to believe.  What do you believe about aging?  Here’s a test you can use when you get a bad feeling about aging:

 Remember a relative or family friend you knew growing up or know today that was or is physically and emotionally healthy and vibrant.  For example, my mother was  mowing her own grass at age 78.  My mother-in-law had a perfect memory at age 85.  She remembered the birthdates of all her 12 grandkids and 10 great grandkids!

 Think back and find some people like that and tell yourself you are going to be like those people rather than someone sitting in the corner staring into space with no purpose or reason to get out of bed in the morning.

Wow - Women Over 55 Are In Demand - Why?

We’re in demand because we buy lots of stuff and advertisers and economists are just now figuring it out.

 We are not in the coveted demographic of people between age 18 and 34. Most TV, internet and magazine advertising is aimed at this age group.  Why? Because they’re just starting out and they buy everything - clothes, cars, homes, furnishings, baby stuff.   We’ve been written off because, well we’re old ladies, right? 

 I say think again and so have the manufacturers, advertisers and economists.  We're now a coveted group too.  What are we buying?  Anything that says “anti-aging” in the label.  According to a report from market research company Global Industry Analysts the market for anti-aging products is predicted to reach $115.5 billion by 2010.  That’s just for moisturizers and anti-aging creams.  It doesn’t include many other products such as the $7.2 billion spent on hair coloring (not all hair coloring products are bought to cover gray hair, but it is the largest part of the hair color business.)  The anti-aging market also includes tooth whitening products, fancy eye glasses, and on and on.

And there’s the increase in women over 55 using dating services.  The Executive Director of Match.com, one of the largest Internet Dating sites, stated that “Match.com is focusing its target marketing on the Baby Boomer generation as they are our fastest growing age group.” There are even many dating services that are dedicated to people over 55 and they are doing very well.

Is there more?  Of course we haven’t touched the cosmetic surgery market.  Botox injections alone accounted for about $480,000 million in sales in 2009.  Botox is just a fraction of what your dermatologist or plastic surgeon can do for you and it all costs big bucks.  Even in these hard economic times, or maybe because of them, women are still spending tens of thousands of dollars to look younger.   (Looking old is bad news in the job market.)

 Well how do we pay for all of the above?  The US Census says that 40 million women over 55 are in the workforce.  There are more mature women in the workforce today than ever before in history.  That means we have bucks to spend on ourselves and we do it happily!

 So what does all this mean for us?  It means we are getting respect and attention.  And isn’t it just about time?