PLAB test details for overseas doctors
Professional and Linguistic assessment exam (PLAB)
More Details about PLAB part 1 examination
Skills of PLAB part 1 test.
Four groups of skills will be tested in approximately equal proportions:
a. Diagnosis: Given the important facts about a patient (such as age, sex, nature of presenting symptoms, duration of symptoms) you are asked to select the most likely diagnosis from a range of possibilities.
b. Investigations: This may refer to the selection or the interpretation of diagnostic tests. Given the important facts about a patient, you will be asked to select the investigation which is most likely to provide the key to the diagnosis. Alternatively, you may be given the findings of investigations and asked to relate these to a patient's condition or to choose the most appropriate next course of action.
c. Management : Given the important facts about a patient's condition, you will be asked to choose from a range of possibilities the most suitable course of treatment. In the case of medical treatments you will be asked to choose the correct drug therapy and will be expected to know about side effects.
d. Others: These may include:
i. Explanation of disease process: The natural history of disease will be tested with reference to basic physiology and pathology.
ii. Legal/ethical : You are expected to know the major legal and ethical principles set out in the GMC publication Duties of a Doctor.
iii. Practice of evidence based medicine: Questions on diagnosis, investigations and management may draw upon recent evidence published in peer-reviewed journals. In addition, there may be questions on the principles and practice of evidence-based medicine.
iv. Understanding of epidemiology: You may be tested on the principles of epidemiology, and on the prevalence of important diseases in the UK.
v. Health promotion: The prevention of disease through health promotion and knowledge of risk factors.
vi. Awareness of multicultural society: You may be tested on your appreciation of the impact on the practice of medicine of the health beliefs and cultural values of the major cultural groups represented in the UK population.
vii. Application of scientific understanding to medicine
Content of part 1 of PLAB exam (new format since 2004 September)
The content to be tested is, for the most part, defined in terms of patient presentations. Where appropriate, the presentation may be either acute or chronic. Questions in Part 1 will begin with a title which specifies both the skill and the content, for example, The management of varicose veins.
You will be expected to know about conditions that are common or important in the United Kingdom for all of the systems outlined below. Examples of the cases that may be asked about are given under each heading and may appear under more than one heading.
These examples are for illustration and the list is not exhaustive. Other similar conditions might appear in the examination.
a. Accident and emergency medicine (to include trauma and burns)
Examples: Abdominal injuries, abdominal pain, back pain, bites and stings, breathlessness/wheeze, bruising and purpura, burns, chest pain, collapse, coma, convulsions, diabetes, epilepsy, eye problems, fractures, dislocations, head injury, loss of consciousness, non-accidental injury, sprains and strains, testicular pain.
b. Blood (to include coagulation defects)
Examples: Anemia's, bruising and purpura.
c. Cardiovascular system (to include heart and blood vessels and blood pressure)
Examples: Aortic aneurysm, chest pain, deep vein thrombosis (DVT), diagnosis and management of hypertension, heart failure, ischaemic limbs, myocardial infarction, myocardial ischaemic, stroke, varicose veins.
d. Dermatology, allergy, immunology and infectious diseases
Examples: Allergy, fever and rashes, influenza/pneumonia, meningitis, skin cancers.
e. ENT and eyes
Examples: Earache, hearing problems, hoarseness, difficulty in swallowing, glaucoma, ‘red eyes’, sudden visual loss.
f. Female reproductive system (to include obstetrics, gynecology and breast)
Examples: Abortion/sterilization, breast lump, contraception, infertility, menstrual disorders, menopausal symptoms, normal pregnancy, postnatal problems, pregnancy complications, vaginal disorders.
g. Gastrointestinal tract, liver and biliary system, and nutrition
Examples: Abdominal pain, constipation, diarrhea, difficulty in swallowing, digestive disorders, gastrointestinal bleeding, jaundice, rectal bleeding/pain, vomiting, weight problems.
h. Metabolism, endocrinology and diabetes
Examples: Diabetes mellitus, thyroid disorders, weight problems.
i. Nervous system (both medical and surgical)
Examples: Coma, convulsions, dementia, epilepsy, eye problems, headache, loss of consciousness, vertigo.
j. Orthopedics and rheumatology
Examples: Back pain, fractures, dislocations, joint pain/swelling, sprains and strains.
k. Psychiatry (to include substance abuse)
Examples: Alcohol abuse, anxiety, assessing suicidal risk, dementia, depression, drug abuse, overdoses and self harm, panic attacks, postnatal problems.
l. Renal System (to include urinary tract and genitourinary medicine)
Examples: Haematuria, renal and ureteric calculi, renal failure, sexual health, testicular pain, urinary infections.
m. Respiratory system
Examples: Asthma, breathlessness/wheeze, cough, hemoptysis, hoarseness, influenza/pneumonia.
n. Disorders of childhood (to include non-accidental injury and child sexual abuse; fetal medicine; growth and development)
Examples: Abdominal pain, asthma, child development, childhood illnesses, earache, epilepsy, eye problems, fever and rashes, joint pain/swelling, loss of consciousness, meningitis, non-accidental injury, testicular pain, urinary disorders.
o. Disorders of the elderly (to include palliative care)
Examples: Breathlessness, chest pain, constipation, dementia, depression, diabetes, diarrhoea, digestive disorders, headache, hearing problems influenza/pneumonia, jaundice, joint pain/swelling, loss of consciousness, pain relief, terminal care, trauma, urinary disorders, vaginal disorders, varicose veins, vertigo, vomiting.
p. Peri-operative management
Examples: Pain relief, shock,
How to approach the extended matching question examination (part 1 plab-EMQ)
The examination paper will contain 200 questions in the extended matching and SBA (single best answer ) format., divided into a number of themes.
Each theme has a heading which tells you what the questions are about, in terms both of the clinical problem area (e.g. chronic joint pain) and the skill required (e.g. diagnosis).
Within each theme there are several numbered items, usually between four and six. These are the questions the problems you have to solve. There are examples below.
Begin by reading carefully the instruction which precedes the numbered items. The instruction is very similar throughout the paper and typically reads ‘For each scenario below, choose the SINGLE most discriminating investigation from the above list of options. Each option may be used once, more than once or not at all.’
Consider each of the numbered items and decide what you think the answer is. You should then look for that answer in the list of options (each of which is identified by a letter of the alphabet). If you cannot find the answer you have thought of, you should look for the option which, in your opinion, is the best answer to the problem posed.
For each numbered item, you must choose ONE, and only one, of the options. You may feel that there are several possible answers to an item, but you must choose the one most likely from the option list. If you enter more than one answer on the answer sheet you will gain no mark for the question even though you may have given the right answer along with one or more wrong ones.
In each theme there are more options than items, so not all the options will be used as answers. This is why the instruction says that some options may not be used at all.
A given option may provide the answer to more than one item. For example, there might be two items which contain descriptions of patients, and the most likely diagnosis could be the same in both instances. In this case the option would be used more than once.
You will be awarded one mark for each item answered correctly.
SBA section
From september 2004, SBA s will make 30 % of the paper. An SBA or single best answer or MCQ (multiple choice answer)or BOF (best of five) is one and the same thing. In such questions you have to choose one single most appropriate answer to the given question. AIPPG forums are well known for carrying the latest papers / SBA;s discussions.
These days some questions are picture questions : common ECGs, X Rays and skin problems are commonly asked in such questions.
Marks are not deducted for incorrect answers nor for failure to answer. The total score on the paper is the number of correct answers given. You should, therefore, attempt all items in part one of PLAB examination.
Tuesday, February 9, 2010
Thursday, January 14, 2010
Rh Disease
Rh Disease
Rh disease (also known as Rh (D) disease, Rhesus disease, RhD Hemolytic Disease of the Newborn, Rhesus D Hemolytic Disease of the Newborn or RhD HDN) is one of the causes of hemolytic disease of the newborn (also known as HDN). The disease ranges from mild to severe. When the disease is mild the fetus may have mild anaemia with reticulocytosis. When the disease is moderate or severe the fetus can have a more marked anaemia and erythroblastosis (erythroblastosis fetalis). When the disease is very severe it can cause morbus haemolyticus neonatorum, hydrops fetalis, or stillbirth.
Serology
During any pregnancy a small amount of the baby's blood can enter the mother's circulation. If the mother is Rh negative and the baby is Rh positive, the mother produces antibodies (including IgG) against the Rhesus D antigen on her baby's red blood cells. During this and subsequent pregnancies the IgG is able to pass through the placenta into the fetus and if the level of it is sufficient, it will cause destruction of Rhesus D positive fetal red blood cells leading to development Rh disease. It may thus be regarded as insufficient immune tolerance in pregnancy. Generally Rhesus disease becomes worse with each additional Rhesus incompatible pregnancy.
The main and most frequent sensitizing event is child birth (about 86% of sensitized cases), but fetal blood may pass into the maternal circulation earlier during the pregnancy (about 14% of sensitized cases). Sensitizing events during pregnancy include miscarriage, therapeutic abortion, amniocentesis, ectopic pregnancy, abdominal trauma and external cephalic version.
The incidence of Rh disease in a population depends on the proportion that are rhesus negative. Many non-caucasian peoples have a very low proportion who are Rhesus negative, so the incidence of Rh disease is very low in these populations. In Caucasian populations about 1 in 10 of all pregnancies are of a Rhesus negative woman with a Rhesus positive baby. It is very rare for the first Rhesus positive baby of a Rhesus negative woman to be affected by Rh disease. The first pregnancy with a Rhesus positive baby is significant for a rhesus negative woman because she can be sensitized to the Rh positive antigen. In Caucasian populations about 13% of Rhesus negative mothers are sensitized by their first pregnancy with a rhesus positive baby. If it were not for modern prevention and treatment, about 5% of the second Rhesus positive infants of Rhesus negative woman, would result in still births or extremely sick babies and many babies who managed to survive would be severely ill. Even higher disease rates would occur in the 3rd and subsequent Rhesus positive infants of rhesus negative woman. By using anti-RhD immunoglobulin (Rho(D) Immune Globulin) the incidence is massively reduced .
Rh disease sensitization is about 10 times more likely to occur if the fetus is ABO compatible with the mother than if the mother and fetus are ABO incompatible.
Prevention
Most Rh disease can be prevented by treating the mother during pregnancy or promptly (within 72 hours) after childbirth. The mother has an intramuscular injection of anti-Rh antibodies (Rho(D) Immune Globulin), sold under the brand name RhoGAM. This is done so that the fetal Rhesus D positive erythrocytes are destroyed before her immune system can discover them. This is passive immunity and the effect of the immunity will wear off after about 4 to 6 weeks (or longer depending on injected dose) as the anti-Rh antibodies gradually decline to zero in the maternal blood.
It is part of modern antenatal care to give all Rhesus D negative pregnant women an anti-RhD IgG immunoglobulin injection at about 28 weeks gestation (with or without a booster at 34 weeks gestation). This reduces the effect of the vast majority of sensitizing events which mostly occur after 28 weeks gestation. Anti-RhD immunoglobulin is also given to non-sensitized Rhesus negative women immediately (within 72 hours - the sooner the better) after potentially sensitizing events that occur earlier in pregnancy.
Blood tests
Maternal blood
* The Kleihauer-Betke test or flow cytometry on a postnatal maternal blood sample can confirm that fetal blood has passed into the maternal circulation and can also be used to estimate the amount of fetal blood that has passed into the maternal circulation.
* The indirect Coombs test is used to screen blood from antenatal women for IgG antibodies that may pass through the placenta and cause hemolytic disease of the newborn.
Fetal blood (or umbilical cord blood)
* The direct Coombs test is used to confirm that the fetus or neonate has an immune mediated hemolytic anemia.
* Full blood count - the hemoglobin level and platelet count are important
* Bilirubin (total and indirect)
Management
Antenatal
* Ultrasound - to detect and monitor hydrops fetalis
* Quantitative analysis of maternal anti-RhD antibodies - an increasing level is a sign of fetal Rh disease
* Intrauterine blood transfusion
o Intraperitoneal transfusion - blood transfused into fetal abdomen
o Intravascular transfusion - blood transfused into fetal umbilical vein - This is more modern and more effective than intraperitoneal transfusion. A sample of fetal blood can be taken from the umbilical vein prior to the transfusion.
* Early delivery (usually after about 36 wks gestation)
Postnatal
* Phototherapy for neonatal jaundice in mild disease
* Exchange transfusion if the neonate has moderate or severe disease (the blood for transfusion must be less than a week old, Rh negative, ABO compatible with both the fetus and the mother, and be cross matched against the mothers serum)
History of medical advances in Rh disease
The rhesus blood type was first discovered in 1937 by Karl Landsteiner and Alexander S. Wiener.
In 1939 Philip Levine and Rufus E. Stetson published their findings about a family who had a stillborn baby who died of hemolytic disease of the newborn. The mother was aged 25 and it was her second pregnancy and she suffered blood loss at the delivery. Both parents were blood group O and the husband's blood was used to give the mother a blood transfusion, but the mother suffered a severe transfusion reaction. They investigated this transfusion reaction. Since the mother and the father were both blood group O, they concluded that there must be a previously undiscovered blood group antigen that was present on the husband's RBCs but was not present on the mother's RBCs and that the mother had formed antibodies against the new blood group antigen. This suggested for the first time that a mother could make blood group antibodies because of immune sensitization to her fetus's RBCs. They did not name this blood group antigen, but it was subsequently found to be the Rhesus factor.
The first treatment for Rh disease was an exchange transfusion, which was invented by Dr. Alexander S. Wiener. That procedure was further refined by Dr, Harry Wallerstein, a transfusionist. Although the most effective method of treating the problem at the time, it was only partially ameliorative in cases where damage to the neonate had already been done. Children with severe motor damage and/or retardation could result. However, it is estimated that in the two decades it was used approximately 200,000 lives were saved, and the great majority were not brain damaged.
Ronald Finn, in Liverpool, England applied a microscopic technique for detecting fetal cells in the mother's blood. It led him to propose that the disease might be prevented by injecting the at-risk mother with an antibody against fetal red blood cells. He proposed this for the first time to the public on February 18, 1960. A few months later, he proposed at a meeting of the British Genetical Society that the antibody be anti-RhD.
Nearly simultaneously with him, William Pollack, then of Ortho Pharmaceutical Corporation, and researchers John Gorman and Vincent Freda of New York City's Columbia-Presbyterian Medical Center, having come to the same realization, set out to prove it by injecting a group of male prisoners at Sing Sing Correctional Facility with antibody provided by Ortho, obtained by a fractionation technique developed by Dr Pollack (who also provided Dr. Finn with several vials of antibody during a visit by Dr. Finn to Ortho).
Animal studies had previously been conducted by William Pollack, using a rabbit model of Rh. This model, named the rabbit HgA-F system, was a perfect animal model of human Rh, and enabled Dr. Pollack's team to gain experience in preventing hemolytic disease in rabbits by giving specific HgA antibody, as was later done with Rh-negative mothers. One of the needs was a dosing experiment that could be used to determine the level of circulating Rh-positive cells in an Rh-negative pregnant female derived from her Rh-positive fetus. This was first done in the rabbit system, but subsequent human tests at the University of Manitoba conducted under Dr. Pollack's direction confirmed that this result matched the human dosing perfectly. The dose is 20 µG of antibody for 1mL of Rh-positive red cells.
Sir William Liley performed the first successful intrauterine transfusion in 1963.
Dr. Gorman's sister-in-law was the first at risk woman to receive a prophylactic injection on January 31, 1964. Clinical trials set up by Dr. Pollack in 42 clinical centers in the US, Great Britain, Germany, Sweden, Italy, and Australia confirmed their hypothesis, and the vaccine was finally approved in England and the United States in 1968. The FDA approved the drug under the name RhoGAM, with a fixed dose of 300 µG, to be given within three days postpartum. There being no known harm done by delaying the dosage for a week or more after birth, Ortho asked the FDA to grant permission for it to be given without a postpartum time restriction. In addition, Dr. John M. Bowman, one of the researchers at the University of Manitoba, and Dr Freda pushed to allow antepartum use. All of this was subsequently granted. Within a year or so, the antibody had been injected with great success into more than 500,000 women. Time magazine picked it as one of the top ten medical achievements of the 1960s. By 1973, it was estimated that in the US alone, over 50,000 babies' lives had been saved. The use of Rh immune globulin to prevent the disease in babies of Rh negative mothers has become standard practice, and the disease, which used to claim the lives of 10,000 babies each year in the US alone, has been virtually eradicated in the developed world. In 1980 Drs. Pollack, Gorman, Freda, and Finn shared the Albert Lasker Award for their work on Rh disease.
Two of the Canadian researchers from the University of Manitoba, Dr. Bruce Chown and Dr. John M. Bowman, licensed a version of the vaccine, known as WinRho SD, in 1980. The drug is sold in 35 countries by the Manitoba-based research firm Cangene, listed on the Toronto Stock Exchange with worth of about $175 million. Cangene was purchased by the Winnipeg Rh Institute, a facility founded by Chown and Bowman and dedicated to conducting research into blood related diseases. Dr. Chown is honored by the Canadian Medical Hall of Fame for his lifelong work with erythroblastosis fetalis.
Rh disease (also known as Rh (D) disease, Rhesus disease, RhD Hemolytic Disease of the Newborn, Rhesus D Hemolytic Disease of the Newborn or RhD HDN) is one of the causes of hemolytic disease of the newborn (also known as HDN). The disease ranges from mild to severe. When the disease is mild the fetus may have mild anaemia with reticulocytosis. When the disease is moderate or severe the fetus can have a more marked anaemia and erythroblastosis (erythroblastosis fetalis). When the disease is very severe it can cause morbus haemolyticus neonatorum, hydrops fetalis, or stillbirth.
Serology
During any pregnancy a small amount of the baby's blood can enter the mother's circulation. If the mother is Rh negative and the baby is Rh positive, the mother produces antibodies (including IgG) against the Rhesus D antigen on her baby's red blood cells. During this and subsequent pregnancies the IgG is able to pass through the placenta into the fetus and if the level of it is sufficient, it will cause destruction of Rhesus D positive fetal red blood cells leading to development Rh disease. It may thus be regarded as insufficient immune tolerance in pregnancy. Generally Rhesus disease becomes worse with each additional Rhesus incompatible pregnancy.
The main and most frequent sensitizing event is child birth (about 86% of sensitized cases), but fetal blood may pass into the maternal circulation earlier during the pregnancy (about 14% of sensitized cases). Sensitizing events during pregnancy include miscarriage, therapeutic abortion, amniocentesis, ectopic pregnancy, abdominal trauma and external cephalic version.
The incidence of Rh disease in a population depends on the proportion that are rhesus negative. Many non-caucasian peoples have a very low proportion who are Rhesus negative, so the incidence of Rh disease is very low in these populations. In Caucasian populations about 1 in 10 of all pregnancies are of a Rhesus negative woman with a Rhesus positive baby. It is very rare for the first Rhesus positive baby of a Rhesus negative woman to be affected by Rh disease. The first pregnancy with a Rhesus positive baby is significant for a rhesus negative woman because she can be sensitized to the Rh positive antigen. In Caucasian populations about 13% of Rhesus negative mothers are sensitized by their first pregnancy with a rhesus positive baby. If it were not for modern prevention and treatment, about 5% of the second Rhesus positive infants of Rhesus negative woman, would result in still births or extremely sick babies and many babies who managed to survive would be severely ill. Even higher disease rates would occur in the 3rd and subsequent Rhesus positive infants of rhesus negative woman. By using anti-RhD immunoglobulin (Rho(D) Immune Globulin) the incidence is massively reduced .
Rh disease sensitization is about 10 times more likely to occur if the fetus is ABO compatible with the mother than if the mother and fetus are ABO incompatible.
Prevention
Most Rh disease can be prevented by treating the mother during pregnancy or promptly (within 72 hours) after childbirth. The mother has an intramuscular injection of anti-Rh antibodies (Rho(D) Immune Globulin), sold under the brand name RhoGAM. This is done so that the fetal Rhesus D positive erythrocytes are destroyed before her immune system can discover them. This is passive immunity and the effect of the immunity will wear off after about 4 to 6 weeks (or longer depending on injected dose) as the anti-Rh antibodies gradually decline to zero in the maternal blood.
It is part of modern antenatal care to give all Rhesus D negative pregnant women an anti-RhD IgG immunoglobulin injection at about 28 weeks gestation (with or without a booster at 34 weeks gestation). This reduces the effect of the vast majority of sensitizing events which mostly occur after 28 weeks gestation. Anti-RhD immunoglobulin is also given to non-sensitized Rhesus negative women immediately (within 72 hours - the sooner the better) after potentially sensitizing events that occur earlier in pregnancy.
Blood tests
Maternal blood
* The Kleihauer-Betke test or flow cytometry on a postnatal maternal blood sample can confirm that fetal blood has passed into the maternal circulation and can also be used to estimate the amount of fetal blood that has passed into the maternal circulation.
* The indirect Coombs test is used to screen blood from antenatal women for IgG antibodies that may pass through the placenta and cause hemolytic disease of the newborn.
Fetal blood (or umbilical cord blood)
* The direct Coombs test is used to confirm that the fetus or neonate has an immune mediated hemolytic anemia.
* Full blood count - the hemoglobin level and platelet count are important
* Bilirubin (total and indirect)
Management
Antenatal
* Ultrasound - to detect and monitor hydrops fetalis
* Quantitative analysis of maternal anti-RhD antibodies - an increasing level is a sign of fetal Rh disease
* Intrauterine blood transfusion
o Intraperitoneal transfusion - blood transfused into fetal abdomen
o Intravascular transfusion - blood transfused into fetal umbilical vein - This is more modern and more effective than intraperitoneal transfusion. A sample of fetal blood can be taken from the umbilical vein prior to the transfusion.
* Early delivery (usually after about 36 wks gestation)
Postnatal
* Phototherapy for neonatal jaundice in mild disease
* Exchange transfusion if the neonate has moderate or severe disease (the blood for transfusion must be less than a week old, Rh negative, ABO compatible with both the fetus and the mother, and be cross matched against the mothers serum)
History of medical advances in Rh disease
The rhesus blood type was first discovered in 1937 by Karl Landsteiner and Alexander S. Wiener.
In 1939 Philip Levine and Rufus E. Stetson published their findings about a family who had a stillborn baby who died of hemolytic disease of the newborn. The mother was aged 25 and it was her second pregnancy and she suffered blood loss at the delivery. Both parents were blood group O and the husband's blood was used to give the mother a blood transfusion, but the mother suffered a severe transfusion reaction. They investigated this transfusion reaction. Since the mother and the father were both blood group O, they concluded that there must be a previously undiscovered blood group antigen that was present on the husband's RBCs but was not present on the mother's RBCs and that the mother had formed antibodies against the new blood group antigen. This suggested for the first time that a mother could make blood group antibodies because of immune sensitization to her fetus's RBCs. They did not name this blood group antigen, but it was subsequently found to be the Rhesus factor.
The first treatment for Rh disease was an exchange transfusion, which was invented by Dr. Alexander S. Wiener. That procedure was further refined by Dr, Harry Wallerstein, a transfusionist. Although the most effective method of treating the problem at the time, it was only partially ameliorative in cases where damage to the neonate had already been done. Children with severe motor damage and/or retardation could result. However, it is estimated that in the two decades it was used approximately 200,000 lives were saved, and the great majority were not brain damaged.
Ronald Finn, in Liverpool, England applied a microscopic technique for detecting fetal cells in the mother's blood. It led him to propose that the disease might be prevented by injecting the at-risk mother with an antibody against fetal red blood cells. He proposed this for the first time to the public on February 18, 1960. A few months later, he proposed at a meeting of the British Genetical Society that the antibody be anti-RhD.
Nearly simultaneously with him, William Pollack, then of Ortho Pharmaceutical Corporation, and researchers John Gorman and Vincent Freda of New York City's Columbia-Presbyterian Medical Center, having come to the same realization, set out to prove it by injecting a group of male prisoners at Sing Sing Correctional Facility with antibody provided by Ortho, obtained by a fractionation technique developed by Dr Pollack (who also provided Dr. Finn with several vials of antibody during a visit by Dr. Finn to Ortho).
Animal studies had previously been conducted by William Pollack, using a rabbit model of Rh. This model, named the rabbit HgA-F system, was a perfect animal model of human Rh, and enabled Dr. Pollack's team to gain experience in preventing hemolytic disease in rabbits by giving specific HgA antibody, as was later done with Rh-negative mothers. One of the needs was a dosing experiment that could be used to determine the level of circulating Rh-positive cells in an Rh-negative pregnant female derived from her Rh-positive fetus. This was first done in the rabbit system, but subsequent human tests at the University of Manitoba conducted under Dr. Pollack's direction confirmed that this result matched the human dosing perfectly. The dose is 20 µG of antibody for 1mL of Rh-positive red cells.
Sir William Liley performed the first successful intrauterine transfusion in 1963.
Dr. Gorman's sister-in-law was the first at risk woman to receive a prophylactic injection on January 31, 1964. Clinical trials set up by Dr. Pollack in 42 clinical centers in the US, Great Britain, Germany, Sweden, Italy, and Australia confirmed their hypothesis, and the vaccine was finally approved in England and the United States in 1968. The FDA approved the drug under the name RhoGAM, with a fixed dose of 300 µG, to be given within three days postpartum. There being no known harm done by delaying the dosage for a week or more after birth, Ortho asked the FDA to grant permission for it to be given without a postpartum time restriction. In addition, Dr. John M. Bowman, one of the researchers at the University of Manitoba, and Dr Freda pushed to allow antepartum use. All of this was subsequently granted. Within a year or so, the antibody had been injected with great success into more than 500,000 women. Time magazine picked it as one of the top ten medical achievements of the 1960s. By 1973, it was estimated that in the US alone, over 50,000 babies' lives had been saved. The use of Rh immune globulin to prevent the disease in babies of Rh negative mothers has become standard practice, and the disease, which used to claim the lives of 10,000 babies each year in the US alone, has been virtually eradicated in the developed world. In 1980 Drs. Pollack, Gorman, Freda, and Finn shared the Albert Lasker Award for their work on Rh disease.
Two of the Canadian researchers from the University of Manitoba, Dr. Bruce Chown and Dr. John M. Bowman, licensed a version of the vaccine, known as WinRho SD, in 1980. The drug is sold in 35 countries by the Manitoba-based research firm Cangene, listed on the Toronto Stock Exchange with worth of about $175 million. Cangene was purchased by the Winnipeg Rh Institute, a facility founded by Chown and Bowman and dedicated to conducting research into blood related diseases. Dr. Chown is honored by the Canadian Medical Hall of Fame for his lifelong work with erythroblastosis fetalis.
Friday, November 13, 2009
Health Insurance Portability and Accountability Act (HIPAA)
The Health Insurance Portability and Accountability Act (HIPAA) was enacted by the U.S. Congress in 1996. According to the Centers for Medicare and Medicaid Services (CMS) website, Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Title II of HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. This is intended to help people keep their information private, though in practice it is normal for providers and health insurance plans to require the waiver of HIPAA rights as a condition of service.
The Administration Simplification provisions also address the security and privacy of health data. The standards are meant to improve the efficiency and effectiveness of the nation's health care system by encouraging the widespread use of electronic data interchange in the U.S. health care system.
Title I: Health Care Access, Portability, and Renewability
Title I of HIPAA regulates the availability and breadth of group health plans and certain individual health insurance policies. It amended the Employee Retirement Income Security Act, the Public Health Service Act, and the Internal Revenue Code.
Title I also limits restrictions that a group health plan can place on benefits for preexisting conditions. Group health plans may refuse to provide benefits relating to preexisting conditions for a period of 12 months after enrollment in the plan or 18 months in the case of late enrollment. However, individuals may reduce this exclusion period if they had group health plan coverage or health insurance prior to enrolling in the plan. Title I allows individuals to reduce the exclusion period by the amount of time that they had "creditable coverage" prior to enrolling in the plan and after any "significant breaks" in coverage. "Creditable coverage" is defined quite broadly and includes nearly all group and individual health plans, Medicare, and Medicaid. A "significant break" in coverage is defined as any 63 day period without any creditable coverage.
Some health care plans are exempted from Title I requirements, such as long-term health plans and limited-scope plans such as dental or vision plans that are offered separately from the general health plan. However, if such benefits are part of the general health plan, then HIPAA still applies to such benefits. For example, if the new plan offers dental benefits, then it must count creditable continuous coverage under the old health plan towards any of its exclusion periods for dental benefits.
However, an alternate method of calculating creditable continuous coverage is available to the health plan under Title I. That is, 5 categories of health coverage can be considered separately, including dental and vision coverage. Anything not under those 5 categories must use the general calculation (e.g., the beneficiary may be counted with 18 months of general coverage, but only 6 months of dental coverage, because the beneficiary did not have a general health plan that covered dental until 6 months prior to the application date). Unfortunately, since limited-coverage plans are exempt from HIPAA requirements, the odd case exists in which the applicant to a general group health plan cannot obtain certificates of creditable continuous coverage for independent limited-scope plans such as dental to apply towards exclusion periods of the new plan that does include those coverages.
Hidden exclusion periods are not valid under Title I (e.g., "The accident, to be covered, must have occurred while the beneficiary was covered under this exact same health insurance contract"). Such clauses must not be acted upon by the health plan and also must be re-written so that they comply with HIPAA.
To illustrate, suppose someone enrolls in a group health plan on January 1, 2006. This person had previously been insured from January 1, 2004 until February 1, 2005 and from August 1, 2005 until December 31, 2005. To determine how much coverage can be credited against the exclusion period in the new plan, start at the enrollment date and count backwards until you reach a significant break in coverage. So, the five months of coverage between August 1, 2005 and December 31, 2005 clearly counts against the exclusion period. But the period without insurance between February 1, 2005 and August 1, 2005 is greater than 63 days. Thus, this is a significant break in coverage, and any coverage prior to it cannot be deducted from the exclusion period. So, this person could deduct five months from his or her exclusion period, reducing the exclusion period to seven months. Hence, Title I requires that any preexisting condition begin to be covered on August 1, 2006.
Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform
Title II of HIPAA defines numerous offenses relating to health care and sets civil and criminal penalties for them. It also creates several programs to control fraud and abuse within the health care system. However, the most significant provisions of Title II are its Administrative Simplification rules. Title II requires the Department of Health and Human Services (HHS) to draft rules aimed at increasing the efficiency of the health care system by creating standards for the use and dissemination of health care information.
These rules apply to "covered entities" as defined by HIPAA and the HHS. Covered entities include health plans, health care clearinghouses, such as billing services and community health information systems, and health care providers that transmit health care data in a way that is regulated by HIPAA.
Per the requirements of Title II, the HHS has promulgated five rules regarding Administrative Simplification: the Privacy Rule, the Transactions and Code Sets Rule, the Security Rule, the Unique Identifiers Rule, and the Enforcement Rule.
Privacy Rule
The Privacy Rule took effect on April 14, 2003, with a one-year extension for certain "small plans". The HIPAA Privacy Rule regulates the use and disclosure of certain information held by "covered entities" (generally, health care clearinghouses, employer sponsored health plans, health insurers, and medical service providers that engage in certain transactions.) It establishes regulations for the use and disclosure of Protected Health Information (PHI). PHI is any information held by a covered entity which concerns health status, provision of health care, or payment for health care that can be linked to an individual. This is interpreted rather broadly and includes any part of an individual's medical record or payment history.
Covered entities must disclose PHI to the individual within 30 days upon request. They also must disclose PHI when required to do so by law, such as reporting suspected child abuse to state child welfare agencies.
A covered entity may disclose PHI to facilitate treatment, payment, or health care operations, or if the covered entity has obtained authorization from the individual. However, when a covered entity discloses any PHI, it must make a reasonable effort to disclose only the minimum necessary information required to achieve its purpose.
The Privacy Rule gives individuals the right to request that a covered entity correct any inaccurate PHI. It also requires covered entities to take reasonable steps to ensure the confidentiality of communications with individuals. For example, an individual can ask to be called at his or her work number, instead of home or cell phone number.
The Privacy Rule requires covered entities to notify individuals of uses of their PHI. Covered entities must also keep track of disclosures of PHI and document privacy policies and procedures. They must appoint a Privacy Official and a contact person responsible for receiving complaints and train all members of their workforce in procedures regarding PHI.
An individual who believes that the Privacy Rule is not being upheld can file a complaint with the Department of Health and Human Services Office for Civil Rights (OCR). However, according to the Wall Street Journal, the OCR has a long backlog and ignores most complaints. "Complaints of privacy violations have been piling up at the Department of Health and Human Services. Between April 2003 and Nov. 30, the agency fielded 23,896 complaints related to medical-privacy rules, but it has not yet taken any enforcement actions against hospitals, doctors, insurers or anyone else for rule violations. A spokesman for the agency says it has closed three-quarters of the complaints, typically because it found no violation or after it provided informal guidance to the parties involved."
Transactions and Code Sets Rule
The HIPAA/EDI provision was scheduled to take effect from October 16, 2003 with a one-year extension for certain "small plans". However, due to widespread confusion and difficulty in implementing the rule, CMS granted a one-year extension to all parties. As of October 16, 2004, full implementation was not achieved and CMS began an open-ended "contingency period". Penalties for non-compliance were not levied. However, all parties are expected to make a "good-faith effort" to come into compliance.
CMS announced that the Medicare contingency period ended July 1, 2005. After July 1, most medical providers that file electronically will have to file their electronic claims using the HIPAA standards in order to be paid. There are exceptions for doctors that meet certain criteria.
Key EDI(X12) transactions used for HIPAA compliance are:
EDI Health Care Claim Transaction set (837) is used to submit health care claim billing information, encounter information, or both, except for retail pharmacy claims (see EDI Retail Pharmacy Claim Transaction). It can be sent from providers of health care services to payers, either directly or via intermediary billers and claims clearinghouses. It can also be used to transmit health care claims and billing payment information between payers with different payment responsibilities where coordination of benefits is required or between payers and regulatory agencies to monitor the rendering, billing, and/or payment of health care services within a specific health care/insurance industry segment.
For example, a state mental health agency may mandate all healthcare claims, Providers and health plans who trade professional (medical) health care claims electronically must use the 837 Health Care Claim: Professional standard to send in claims. As there are many different business applications for the Health Care claim, there can be slight derivations to cover off claims involving unique claims such as for Institutions, Professionals, Chiropractors, and Dentists etc.
EDI Retail Pharmacy Claim Transaction (NCPDP Telecommunications Standard version 5.1) is used to submit retail pharmacy claims to payers by health care professionals who dispense medications, either directly or via intermediary billers and claims clearinghouses. It can also be used to transmit claims for retail pharmacy services and billing payment information between payers with different payment responsibilities where coordination of benefits is required or between payers and regulatory agencies to monitor the rendering, billing, and/or payment of retail pharmacy services within the pharmacy health care/insurance industry segment.
EDI Health Care Claim Payment/Advice Transaction Set (835) can be used to make a payment, send an Explanation of Benefits (EOB) remittance advice, or make a payment and send an EOB remittance advice only from a health insurer to a health care provider either directly or via a financial institution.
EDI Benefit Enrollment and Maintenance Set (834) can be used by employers, unions, government agencies, associations or insurance agencies to enroll members to a payer. The payer is a healthcare organization that pays claims, administers insurance or benefit or product. Examples of payers include an insurance company, health care professional (HMO), preferred provider organization (PPO), government agency (Medicaid, Medicare etc.) or any organization that may be contracted by one of these former groups.
EDI Payroll Deducted and other group Premium Payment for Insurance Products (820) is a transaction set which can be used to make a premium payment for insurance products. It can be used to order a financial institution to make a payment to a payee.
EDI Health Care Eligibility/Benefit Inquiry (270) is used to inquire about the health care benefits and eligibility associated with a subscriber or dependent.
EDI Health Care Eligibility/Benefit Response (271) is used to respond to a request inquire about the health care benefits and eligibility associated with a subscriber or dependent.
EDI Health Care Claim Status Request (276) This transaction set can be used by a provider, recipient of health care products or services or their authorized agent to request the status of a health care claim.
EDI Health Care Claim Status Notification (277) This transaction set can be used by a health care payer or authorized agent to notify a provider, recipient or authorized agent regarding the status of a health care claim or encounter, or to request additional information from the provider regarding a health care claim or encounter. This transaction set is not intended to replace the Health Care Claim Payment/Advice Transaction Set (835) and therefore, is not used for account payment posting. The notification is at a summary or service line detail level. The notification may be solicited or unsolicited.
EDI Health Care Service Review Information (278) This transaction set can be used to transmit health care service information, such as subscriber, patient, demographic, diagnosis or treatment data for the purpose of request for review, certification, notification or reporting the outcome of a health care services review.
EDI Functional Acknowledgement Transaction Set (997) this transaction set can be used to define the control structures for a set of acknowledgments to indicate the results of the syntactical analysis of the electronically encoded documents. Although it is not specifically named in the HIPAA Legislation or Final Rule, it is necessary for X12 transaction set processing . The encoded documents are the transaction sets, which are grouped in functional groups, used in defining transactions for business data interchange. This standard does not cover the semantic meaning of the information encoded in the transaction sets.
Security Rule
The Final Rule on Security Standards was issued on February 20, 2003. It took effect on April 21, 2003 with a compliance date of April 21, 2005 for most covered entities and April 21, 2006 for "small plans". The Security Rule complements the Privacy Rule. While the Privacy Rule pertains to all Protected Health Information (PHI) including paper and electronic, the Security Rule deals specifically with Electronic Protected Health Information (EPHI). It lays out three types of security safeguards required for compliance: administrative, physical, and technical. For each of these types, the Rule identifies various security standards, and for each standard, it names both required and addressable implementation specifications. Required specifications must be adopted and administered as dictated by the Rule. Addressable specifications are more flexible. Individual covered entities can evaluate their own situation and determine the best way to implement addressable specifications. The standards and specifications are as follows:
* Administrative Safeguards – policies and procedures designed to clearly show how the entity will comply with the act
o Covered entities (entities that must comply with HIPAA requirements) must adopt a written set of privacy procedures and designate a privacy officer to be responsible for developing and implementing all required policies and procedures.
o The policies and procedures must reference management oversight and organizational buy-in to compliance with the documented security controls.
o Procedures should clearly identify employees or classes of employees who will have access to electronic protected health information (EPHI). Access to EPHI must be restricted to only those employees who have a need for it to complete their job function.
o The procedures must address access authorization, establishment, modification, and termination.
o Entities must show that an appropriate ongoing training program regarding the handling of PHI is provided to employees performing health plan administrative functions.
o Covered entities that out-source some of their business processes to a third party must ensure that their vendors also have a framework in place to comply with HIPAA requirements. Companies typically gain this assurance through clauses in the contracts stating that the vendor will meet the same data protection requirements that apply to the covered entity. Care must be taken to determine if the vendor further out-sources any data handling functions to other vendors and monitor whether appropriate contracts and controls are in place.
o A contingency plan should be in place for responding to emergencies. Covered entities are responsible for backing up their data and having disaster recovery procedures in place. The plan should document data priority and failure analysis, testing activities, and change control procedures.
o Internal audits play a key role in HIPAA compliance by reviewing operations with the goal of identifying potential security violations. Policies and procedures should specifically document the scope, frequency, and procedures of audits. Audits should be both routine and event-based.
o Procedures should document instructions for addressing and responding to security breaches that are identified either during the audit or the normal course of operations.
* Physical Safeguards – controlling physical access to protect against inappropriate access to protected data
o Controls must govern the introduction and removal of hardware and software from the network. (When equipment is retired it must be disposed of properly to ensure that PHI is not compromised.)
o Access to equipment containing health information should be carefully controlled and monitored.
o Access to hardware and software must be limited to properly authorized individuals.
o Required access controls consist of facility security plans, maintenance records, and visitor sign-in and escorts.
o Policies are required to address proper workstation use. Workstations should be removed from high traffic areas and monitor screens should not be in direct view of the public.
o If the covered entities utilize contractors or agents, they too must be fully trained on their physical access responsibilities.
* Technical Safeguards – controlling access to computer systems and enabling covered entities to protect communications containing PHI transmitted electronically over open networks from being intercepted by anyone other than the intended recipient.
o Information systems housing PHI must be protected from intrusion. When information flows over open networks, some form of encryption must be utilized. If closed systems/networks are utilized, existing access controls are considered sufficient and encryption is optional.
o Each covered entity is responsible for ensuring that the data within its systems has not been changed or erased in an unauthorized manner.
o Data corroboration, including the use of check sum, double-keying, message authentication, and digital signature may be used to ensure data integrity.
o Covered entities must also authenticate entities it communicates with. Authentication consists of corroborating that an entity is who it claims to be. Examples of corroboration include: password systems, two or three-way handshakes, telephone callback, and token systems.
o Covered entities must make documentation of their HIPAA practices available to the government to determine compliance.
o In addition to policies and procedures and access records, information technology documentation should also include a written record of all configuration settings on the components of the network because these components are complex, configurable, and always changing.
o Documented risk analysis and risk management programs are required. Covered entities must carefully consider the risks of their operations as they implement systems to comply with the act. (The requirement of risk analysis and risk management implies that the act’s security requirements are a minimum standard and places responsibility on covered entities to take all reasonable precautions necessary to prevent PHI from being used for non-health purposes.)
Unique Identifiers Rule (National Provider Identifier)
HIPAA covered entities such as providers completing electronic transactions, healthcare clearinghouses, and large health plans, must use only the National Provider Identifier (NPI) to identify covered healthcare providers in standard transactions by May 23, 2007. Small health plans must use only the NPI by May 23, 2008.
Effective from May 2006 (May 2007 for small health plans), all covered entities using electronic communications (e.g., physicians, hospitals, health insurance companies, and so forth) must use a single new NPI. The NPI replaces all other identifiers used by health plans, Medicare (i.e., the UPIN), Medicaid, and other government programs. However, the NPI does not replace a provider's DEA number, state license number, or tax identification number. The NPI is 10 digits (may be alphanumeric), with the last digit being a checksum. The NPI cannot contain any embedded intelligence; in other words, the NPI is simply a number that does not itself have any additional meaning. The NPI is unique and national, never re-used, and except for institutions, a provider usually can have only one. An institution may obtain multiple NPIs for different "subparts" such as a free-standing cancer center or rehab facility.
Enforcement Rule
On February 16, 2006, HHS issued the Final Rule regarding HIPAA enforcement. It became effective on March 16, 2006. The Enforcement Rule sets civil money penalties for violating HIPAA rules and establishes procedures for investigations and hearings for HIPAA violations; however, its deterrent effects seem to be negligible with few prosecutions for violations.
HITECH Act security-breach notification requirements
The Health Information Technology for Economic and Clinical Health Act (HITECH Act), enacted as part of the American Recovery and Reinvestment Act of 2009, imposes notification requirements on covered entities, business associates, vendors of personal health records (PHR) and related entities in the event of certain security breaches relating to protected health information (PHI). The U.S. Department of Health and Human Services (HHS) issued guidance on the subject; HHS and the Federal Trade Commission (FTC) are working to harmonize their respective regulations and are seeking public comment with a view to issuing interim final regulations by August 17, 2009, the deadline imposed by the HITECH Act.
Effects on research and clinical care
The enactment of the Privacy and Security Rules has caused major changes in the way physicians and medical centers operate. The complex legalities and potentially stiff penalties associated with HIPAA, as well as the increase in paperwork and the cost of its implementation, were causes for concern among physicians and medical centers. An August 2006 article in the journal Annals of Internal Medicine detailed some such concerns over the implementation and effects of HIPAA.
Effects on research
HIPAA restrictions on researchers have affected their ability to perform retrospective, chart-based research as well as their ability to prospectively evaluate patients by contacting them for follow-up. A study from the University of Michigan demonstrated that implementation of the HIPAA Privacy rule resulted in a drop from 96% to 34% in the proportion of follow-up surveys completed by study patients being followed after a heart attack. Another study, detailing the effects of HIPAA on recruitment for a study on cancer prevention, demonstrated that HIPAA-mandated changes led to a 73% decrease in patient accrual, a tripling of time spent recruiting patients, and a tripling of mean recruitment costs.In addition, informed consent forms for research studies now are required to include extensive detail on how the participant's protected health information will be kept private. While such information is important, the addition of a lengthy, legalistic section on privacy may make these already complex documents even less user-friendly for patients who are asked to read and sign them.
These data suggest that the HIPAA privacy rule, as currently implemented, may be having negative impacts on the cost and quality of medical research. Dr. Kim Eagle, professor of internal medicine at the University of Michigan, was quoted in the Annals article as saying, "Privacy is important, but research is also important for improving care. We hope that we will figure this out and do it right."
Effects on clinical care
The complexity of HIPAA, combined with potentially stiff penalties for violators, can lead physicians and medical centers to withhold information from those who may have a right to it. A review of the implementation of the HIPAA Privacy Rule by the U.S. Government Accountability Office found that health care providers were "uncertain about their [legal] privacy responsibilities and often responded with an overly guarded approach to disclosing information...than necessary to ensure compliance with the Privacy rule". Reports of this uncertainty continue. Costs of implementation
In the period immediately prior to the enactment of the HIPAA Privacy and Security Acts, medical centers and medical practices were charged with getting "into compliance". With an early emphasis on the potentially severe penalties associated with violation, many practices and centers turned to private, for-profit "HIPAA consultants" who were intimately familiar with the details of the legislation and offered their services to ensure that physicians and medical centers were fully "in compliance". In addition to the costs of developing and revamping systems and practices, the increase in paperwork and staff time necessary to meet the legal requirements of HIPAA may impact the finances of medical centers and practices at a time when insurance company and Medicare reimbursement is also declining.
HIPAA and drug and alcohol rehabilitation organizations
Special considerations for confidentiality are needed for health care organizations that offer federally-funded drug or alcohol rehabilitation services.
Predating HIPAA by over a quarter century are the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 and language amended by the Drug Abuse Office and Treatment Act of 1972.
The Administration Simplification provisions also address the security and privacy of health data. The standards are meant to improve the efficiency and effectiveness of the nation's health care system by encouraging the widespread use of electronic data interchange in the U.S. health care system.
Title I: Health Care Access, Portability, and Renewability
Title I of HIPAA regulates the availability and breadth of group health plans and certain individual health insurance policies. It amended the Employee Retirement Income Security Act, the Public Health Service Act, and the Internal Revenue Code.
Title I also limits restrictions that a group health plan can place on benefits for preexisting conditions. Group health plans may refuse to provide benefits relating to preexisting conditions for a period of 12 months after enrollment in the plan or 18 months in the case of late enrollment. However, individuals may reduce this exclusion period if they had group health plan coverage or health insurance prior to enrolling in the plan. Title I allows individuals to reduce the exclusion period by the amount of time that they had "creditable coverage" prior to enrolling in the plan and after any "significant breaks" in coverage. "Creditable coverage" is defined quite broadly and includes nearly all group and individual health plans, Medicare, and Medicaid. A "significant break" in coverage is defined as any 63 day period without any creditable coverage.
Some health care plans are exempted from Title I requirements, such as long-term health plans and limited-scope plans such as dental or vision plans that are offered separately from the general health plan. However, if such benefits are part of the general health plan, then HIPAA still applies to such benefits. For example, if the new plan offers dental benefits, then it must count creditable continuous coverage under the old health plan towards any of its exclusion periods for dental benefits.
However, an alternate method of calculating creditable continuous coverage is available to the health plan under Title I. That is, 5 categories of health coverage can be considered separately, including dental and vision coverage. Anything not under those 5 categories must use the general calculation (e.g., the beneficiary may be counted with 18 months of general coverage, but only 6 months of dental coverage, because the beneficiary did not have a general health plan that covered dental until 6 months prior to the application date). Unfortunately, since limited-coverage plans are exempt from HIPAA requirements, the odd case exists in which the applicant to a general group health plan cannot obtain certificates of creditable continuous coverage for independent limited-scope plans such as dental to apply towards exclusion periods of the new plan that does include those coverages.
Hidden exclusion periods are not valid under Title I (e.g., "The accident, to be covered, must have occurred while the beneficiary was covered under this exact same health insurance contract"). Such clauses must not be acted upon by the health plan and also must be re-written so that they comply with HIPAA.
To illustrate, suppose someone enrolls in a group health plan on January 1, 2006. This person had previously been insured from January 1, 2004 until February 1, 2005 and from August 1, 2005 until December 31, 2005. To determine how much coverage can be credited against the exclusion period in the new plan, start at the enrollment date and count backwards until you reach a significant break in coverage. So, the five months of coverage between August 1, 2005 and December 31, 2005 clearly counts against the exclusion period. But the period without insurance between February 1, 2005 and August 1, 2005 is greater than 63 days. Thus, this is a significant break in coverage, and any coverage prior to it cannot be deducted from the exclusion period. So, this person could deduct five months from his or her exclusion period, reducing the exclusion period to seven months. Hence, Title I requires that any preexisting condition begin to be covered on August 1, 2006.
Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform
Title II of HIPAA defines numerous offenses relating to health care and sets civil and criminal penalties for them. It also creates several programs to control fraud and abuse within the health care system. However, the most significant provisions of Title II are its Administrative Simplification rules. Title II requires the Department of Health and Human Services (HHS) to draft rules aimed at increasing the efficiency of the health care system by creating standards for the use and dissemination of health care information.
These rules apply to "covered entities" as defined by HIPAA and the HHS. Covered entities include health plans, health care clearinghouses, such as billing services and community health information systems, and health care providers that transmit health care data in a way that is regulated by HIPAA.
Per the requirements of Title II, the HHS has promulgated five rules regarding Administrative Simplification: the Privacy Rule, the Transactions and Code Sets Rule, the Security Rule, the Unique Identifiers Rule, and the Enforcement Rule.
Privacy Rule
The Privacy Rule took effect on April 14, 2003, with a one-year extension for certain "small plans". The HIPAA Privacy Rule regulates the use and disclosure of certain information held by "covered entities" (generally, health care clearinghouses, employer sponsored health plans, health insurers, and medical service providers that engage in certain transactions.) It establishes regulations for the use and disclosure of Protected Health Information (PHI). PHI is any information held by a covered entity which concerns health status, provision of health care, or payment for health care that can be linked to an individual. This is interpreted rather broadly and includes any part of an individual's medical record or payment history.
Covered entities must disclose PHI to the individual within 30 days upon request. They also must disclose PHI when required to do so by law, such as reporting suspected child abuse to state child welfare agencies.
A covered entity may disclose PHI to facilitate treatment, payment, or health care operations, or if the covered entity has obtained authorization from the individual. However, when a covered entity discloses any PHI, it must make a reasonable effort to disclose only the minimum necessary information required to achieve its purpose.
The Privacy Rule gives individuals the right to request that a covered entity correct any inaccurate PHI. It also requires covered entities to take reasonable steps to ensure the confidentiality of communications with individuals. For example, an individual can ask to be called at his or her work number, instead of home or cell phone number.
The Privacy Rule requires covered entities to notify individuals of uses of their PHI. Covered entities must also keep track of disclosures of PHI and document privacy policies and procedures. They must appoint a Privacy Official and a contact person responsible for receiving complaints and train all members of their workforce in procedures regarding PHI.
An individual who believes that the Privacy Rule is not being upheld can file a complaint with the Department of Health and Human Services Office for Civil Rights (OCR). However, according to the Wall Street Journal, the OCR has a long backlog and ignores most complaints. "Complaints of privacy violations have been piling up at the Department of Health and Human Services. Between April 2003 and Nov. 30, the agency fielded 23,896 complaints related to medical-privacy rules, but it has not yet taken any enforcement actions against hospitals, doctors, insurers or anyone else for rule violations. A spokesman for the agency says it has closed three-quarters of the complaints, typically because it found no violation or after it provided informal guidance to the parties involved."
Transactions and Code Sets Rule
The HIPAA/EDI provision was scheduled to take effect from October 16, 2003 with a one-year extension for certain "small plans". However, due to widespread confusion and difficulty in implementing the rule, CMS granted a one-year extension to all parties. As of October 16, 2004, full implementation was not achieved and CMS began an open-ended "contingency period". Penalties for non-compliance were not levied. However, all parties are expected to make a "good-faith effort" to come into compliance.
CMS announced that the Medicare contingency period ended July 1, 2005. After July 1, most medical providers that file electronically will have to file their electronic claims using the HIPAA standards in order to be paid. There are exceptions for doctors that meet certain criteria.
Key EDI(X12) transactions used for HIPAA compliance are:
EDI Health Care Claim Transaction set (837) is used to submit health care claim billing information, encounter information, or both, except for retail pharmacy claims (see EDI Retail Pharmacy Claim Transaction). It can be sent from providers of health care services to payers, either directly or via intermediary billers and claims clearinghouses. It can also be used to transmit health care claims and billing payment information between payers with different payment responsibilities where coordination of benefits is required or between payers and regulatory agencies to monitor the rendering, billing, and/or payment of health care services within a specific health care/insurance industry segment.
For example, a state mental health agency may mandate all healthcare claims, Providers and health plans who trade professional (medical) health care claims electronically must use the 837 Health Care Claim: Professional standard to send in claims. As there are many different business applications for the Health Care claim, there can be slight derivations to cover off claims involving unique claims such as for Institutions, Professionals, Chiropractors, and Dentists etc.
EDI Retail Pharmacy Claim Transaction (NCPDP Telecommunications Standard version 5.1) is used to submit retail pharmacy claims to payers by health care professionals who dispense medications, either directly or via intermediary billers and claims clearinghouses. It can also be used to transmit claims for retail pharmacy services and billing payment information between payers with different payment responsibilities where coordination of benefits is required or between payers and regulatory agencies to monitor the rendering, billing, and/or payment of retail pharmacy services within the pharmacy health care/insurance industry segment.
EDI Health Care Claim Payment/Advice Transaction Set (835) can be used to make a payment, send an Explanation of Benefits (EOB) remittance advice, or make a payment and send an EOB remittance advice only from a health insurer to a health care provider either directly or via a financial institution.
EDI Benefit Enrollment and Maintenance Set (834) can be used by employers, unions, government agencies, associations or insurance agencies to enroll members to a payer. The payer is a healthcare organization that pays claims, administers insurance or benefit or product. Examples of payers include an insurance company, health care professional (HMO), preferred provider organization (PPO), government agency (Medicaid, Medicare etc.) or any organization that may be contracted by one of these former groups.
EDI Payroll Deducted and other group Premium Payment for Insurance Products (820) is a transaction set which can be used to make a premium payment for insurance products. It can be used to order a financial institution to make a payment to a payee.
EDI Health Care Eligibility/Benefit Inquiry (270) is used to inquire about the health care benefits and eligibility associated with a subscriber or dependent.
EDI Health Care Eligibility/Benefit Response (271) is used to respond to a request inquire about the health care benefits and eligibility associated with a subscriber or dependent.
EDI Health Care Claim Status Request (276) This transaction set can be used by a provider, recipient of health care products or services or their authorized agent to request the status of a health care claim.
EDI Health Care Claim Status Notification (277) This transaction set can be used by a health care payer or authorized agent to notify a provider, recipient or authorized agent regarding the status of a health care claim or encounter, or to request additional information from the provider regarding a health care claim or encounter. This transaction set is not intended to replace the Health Care Claim Payment/Advice Transaction Set (835) and therefore, is not used for account payment posting. The notification is at a summary or service line detail level. The notification may be solicited or unsolicited.
EDI Health Care Service Review Information (278) This transaction set can be used to transmit health care service information, such as subscriber, patient, demographic, diagnosis or treatment data for the purpose of request for review, certification, notification or reporting the outcome of a health care services review.
EDI Functional Acknowledgement Transaction Set (997) this transaction set can be used to define the control structures for a set of acknowledgments to indicate the results of the syntactical analysis of the electronically encoded documents. Although it is not specifically named in the HIPAA Legislation or Final Rule, it is necessary for X12 transaction set processing . The encoded documents are the transaction sets, which are grouped in functional groups, used in defining transactions for business data interchange. This standard does not cover the semantic meaning of the information encoded in the transaction sets.
Security Rule
The Final Rule on Security Standards was issued on February 20, 2003. It took effect on April 21, 2003 with a compliance date of April 21, 2005 for most covered entities and April 21, 2006 for "small plans". The Security Rule complements the Privacy Rule. While the Privacy Rule pertains to all Protected Health Information (PHI) including paper and electronic, the Security Rule deals specifically with Electronic Protected Health Information (EPHI). It lays out three types of security safeguards required for compliance: administrative, physical, and technical. For each of these types, the Rule identifies various security standards, and for each standard, it names both required and addressable implementation specifications. Required specifications must be adopted and administered as dictated by the Rule. Addressable specifications are more flexible. Individual covered entities can evaluate their own situation and determine the best way to implement addressable specifications. The standards and specifications are as follows:
* Administrative Safeguards – policies and procedures designed to clearly show how the entity will comply with the act
o Covered entities (entities that must comply with HIPAA requirements) must adopt a written set of privacy procedures and designate a privacy officer to be responsible for developing and implementing all required policies and procedures.
o The policies and procedures must reference management oversight and organizational buy-in to compliance with the documented security controls.
o Procedures should clearly identify employees or classes of employees who will have access to electronic protected health information (EPHI). Access to EPHI must be restricted to only those employees who have a need for it to complete their job function.
o The procedures must address access authorization, establishment, modification, and termination.
o Entities must show that an appropriate ongoing training program regarding the handling of PHI is provided to employees performing health plan administrative functions.
o Covered entities that out-source some of their business processes to a third party must ensure that their vendors also have a framework in place to comply with HIPAA requirements. Companies typically gain this assurance through clauses in the contracts stating that the vendor will meet the same data protection requirements that apply to the covered entity. Care must be taken to determine if the vendor further out-sources any data handling functions to other vendors and monitor whether appropriate contracts and controls are in place.
o A contingency plan should be in place for responding to emergencies. Covered entities are responsible for backing up their data and having disaster recovery procedures in place. The plan should document data priority and failure analysis, testing activities, and change control procedures.
o Internal audits play a key role in HIPAA compliance by reviewing operations with the goal of identifying potential security violations. Policies and procedures should specifically document the scope, frequency, and procedures of audits. Audits should be both routine and event-based.
o Procedures should document instructions for addressing and responding to security breaches that are identified either during the audit or the normal course of operations.
* Physical Safeguards – controlling physical access to protect against inappropriate access to protected data
o Controls must govern the introduction and removal of hardware and software from the network. (When equipment is retired it must be disposed of properly to ensure that PHI is not compromised.)
o Access to equipment containing health information should be carefully controlled and monitored.
o Access to hardware and software must be limited to properly authorized individuals.
o Required access controls consist of facility security plans, maintenance records, and visitor sign-in and escorts.
o Policies are required to address proper workstation use. Workstations should be removed from high traffic areas and monitor screens should not be in direct view of the public.
o If the covered entities utilize contractors or agents, they too must be fully trained on their physical access responsibilities.
* Technical Safeguards – controlling access to computer systems and enabling covered entities to protect communications containing PHI transmitted electronically over open networks from being intercepted by anyone other than the intended recipient.
o Information systems housing PHI must be protected from intrusion. When information flows over open networks, some form of encryption must be utilized. If closed systems/networks are utilized, existing access controls are considered sufficient and encryption is optional.
o Each covered entity is responsible for ensuring that the data within its systems has not been changed or erased in an unauthorized manner.
o Data corroboration, including the use of check sum, double-keying, message authentication, and digital signature may be used to ensure data integrity.
o Covered entities must also authenticate entities it communicates with. Authentication consists of corroborating that an entity is who it claims to be. Examples of corroboration include: password systems, two or three-way handshakes, telephone callback, and token systems.
o Covered entities must make documentation of their HIPAA practices available to the government to determine compliance.
o In addition to policies and procedures and access records, information technology documentation should also include a written record of all configuration settings on the components of the network because these components are complex, configurable, and always changing.
o Documented risk analysis and risk management programs are required. Covered entities must carefully consider the risks of their operations as they implement systems to comply with the act. (The requirement of risk analysis and risk management implies that the act’s security requirements are a minimum standard and places responsibility on covered entities to take all reasonable precautions necessary to prevent PHI from being used for non-health purposes.)
Unique Identifiers Rule (National Provider Identifier)
HIPAA covered entities such as providers completing electronic transactions, healthcare clearinghouses, and large health plans, must use only the National Provider Identifier (NPI) to identify covered healthcare providers in standard transactions by May 23, 2007. Small health plans must use only the NPI by May 23, 2008.
Effective from May 2006 (May 2007 for small health plans), all covered entities using electronic communications (e.g., physicians, hospitals, health insurance companies, and so forth) must use a single new NPI. The NPI replaces all other identifiers used by health plans, Medicare (i.e., the UPIN), Medicaid, and other government programs. However, the NPI does not replace a provider's DEA number, state license number, or tax identification number. The NPI is 10 digits (may be alphanumeric), with the last digit being a checksum. The NPI cannot contain any embedded intelligence; in other words, the NPI is simply a number that does not itself have any additional meaning. The NPI is unique and national, never re-used, and except for institutions, a provider usually can have only one. An institution may obtain multiple NPIs for different "subparts" such as a free-standing cancer center or rehab facility.
Enforcement Rule
On February 16, 2006, HHS issued the Final Rule regarding HIPAA enforcement. It became effective on March 16, 2006. The Enforcement Rule sets civil money penalties for violating HIPAA rules and establishes procedures for investigations and hearings for HIPAA violations; however, its deterrent effects seem to be negligible with few prosecutions for violations.
HITECH Act security-breach notification requirements
The Health Information Technology for Economic and Clinical Health Act (HITECH Act), enacted as part of the American Recovery and Reinvestment Act of 2009, imposes notification requirements on covered entities, business associates, vendors of personal health records (PHR) and related entities in the event of certain security breaches relating to protected health information (PHI). The U.S. Department of Health and Human Services (HHS) issued guidance on the subject; HHS and the Federal Trade Commission (FTC) are working to harmonize their respective regulations and are seeking public comment with a view to issuing interim final regulations by August 17, 2009, the deadline imposed by the HITECH Act.
Effects on research and clinical care
The enactment of the Privacy and Security Rules has caused major changes in the way physicians and medical centers operate. The complex legalities and potentially stiff penalties associated with HIPAA, as well as the increase in paperwork and the cost of its implementation, were causes for concern among physicians and medical centers. An August 2006 article in the journal Annals of Internal Medicine detailed some such concerns over the implementation and effects of HIPAA.
Effects on research
HIPAA restrictions on researchers have affected their ability to perform retrospective, chart-based research as well as their ability to prospectively evaluate patients by contacting them for follow-up. A study from the University of Michigan demonstrated that implementation of the HIPAA Privacy rule resulted in a drop from 96% to 34% in the proportion of follow-up surveys completed by study patients being followed after a heart attack. Another study, detailing the effects of HIPAA on recruitment for a study on cancer prevention, demonstrated that HIPAA-mandated changes led to a 73% decrease in patient accrual, a tripling of time spent recruiting patients, and a tripling of mean recruitment costs.In addition, informed consent forms for research studies now are required to include extensive detail on how the participant's protected health information will be kept private. While such information is important, the addition of a lengthy, legalistic section on privacy may make these already complex documents even less user-friendly for patients who are asked to read and sign them.
These data suggest that the HIPAA privacy rule, as currently implemented, may be having negative impacts on the cost and quality of medical research. Dr. Kim Eagle, professor of internal medicine at the University of Michigan, was quoted in the Annals article as saying, "Privacy is important, but research is also important for improving care. We hope that we will figure this out and do it right."
Effects on clinical care
The complexity of HIPAA, combined with potentially stiff penalties for violators, can lead physicians and medical centers to withhold information from those who may have a right to it. A review of the implementation of the HIPAA Privacy Rule by the U.S. Government Accountability Office found that health care providers were "uncertain about their [legal] privacy responsibilities and often responded with an overly guarded approach to disclosing information...than necessary to ensure compliance with the Privacy rule". Reports of this uncertainty continue. Costs of implementation
In the period immediately prior to the enactment of the HIPAA Privacy and Security Acts, medical centers and medical practices were charged with getting "into compliance". With an early emphasis on the potentially severe penalties associated with violation, many practices and centers turned to private, for-profit "HIPAA consultants" who were intimately familiar with the details of the legislation and offered their services to ensure that physicians and medical centers were fully "in compliance". In addition to the costs of developing and revamping systems and practices, the increase in paperwork and staff time necessary to meet the legal requirements of HIPAA may impact the finances of medical centers and practices at a time when insurance company and Medicare reimbursement is also declining.
HIPAA and drug and alcohol rehabilitation organizations
Special considerations for confidentiality are needed for health care organizations that offer federally-funded drug or alcohol rehabilitation services.
Predating HIPAA by over a quarter century are the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 and language amended by the Drug Abuse Office and Treatment Act of 1972.
Medical Transcription and India: The Current Scenario and the Future
Medical transcription is an interesting, challenging and paying career and one of the fastest growing fields in healthcare. Medical records dictated by doctors (or their secretaries/nurses) into a tape or onto a digital voice processing system are accurately and swiftly transcribed i.e. converted into a word document, by the MT or MLS (medical language specialist). These records could be clinic notes, office notes, operative or consultation notes, discharge summaries, etc. The document is proofread to at least 98% accuracy before being “uploaded” back to the doctor’s office or clinic.
In the US, the entire healthcare industry is based on insurance. Therefore, detailed medical records are needed for processing insurance claims. As a result, MTs are in high demand there, and the cost of getting the job done is also very high. India is a very good locale for outsourcing this work due to a number of factors. We have a huge mass of English-speaking and computer-literate people in this country. Moreover, the difference in time zones between the US and India, makes it quite easy to return documents within the usual stipulated time frame of 24 hours.
A transcription service could range from a small home-based business to sophisticated, high-tech corporations, which employ large numbers of transcriptionists, proofers, quality analysts etc. Athough the clientele is mostly in the US, British and even Australian doctors are beginning to consider India as a possible source of getting this work done – done quickly and well, at a fraction of the cost incurred in their own countries!!
India witnessed an “MT boom” a few years ago, with innumerable training institutes mushrooming all over the place. Lack of proper training and understanding of this new concept led to an almost total closure of these institutes. Those that have remained in the field are today flourishing business enterprises, offering this new job opportunity to thousands.
To be a good MT one needs good listening and language skills and knowledge of medical terms (also called Language of Medicine or LOM). Fluency in English with understanding of the American way of speech and accent is a must. A thorough knowledge of the AAMT (American Association for Medical Transcription) rules is also needed. A full-fledged training course would impart all this. Throughout his/her career an MT needs to keep up with changes in medical terminology, medical procedures etc. and have the ability to detect medical inconsistencies in dictation and fix poor grammar and syntax. One also needs patience, as the work tends to get monotonous and repetitive. Regular continuing education programs, which are comprehensive, are therefore essential to be successful in this field.
In the metros and major cities of India, many big business names have ventured into this field and are flourishing. Most of these companies have in-house training programs so that the trainees are assured of a job at the end of their course. As a rule, a fresh MT starts with a salary of Rs. 5000 per month. Incentives are based on the amount of work done (called “line-count”) and the accuracy maintained. A really conscientious and skilled MT would earn a pretty decent salary. As the work can be done at home, it provides a wonderful opportunity for young, educated mothers who would otherwise have to put their careers on hold while their children grow up. Retired persons, the disabled, or those who simply do not wish to venture out of their homes for earning could all thrive in this career.
In short, the future looks bright for those in the field of Medical Transcription.
In the US, the entire healthcare industry is based on insurance. Therefore, detailed medical records are needed for processing insurance claims. As a result, MTs are in high demand there, and the cost of getting the job done is also very high. India is a very good locale for outsourcing this work due to a number of factors. We have a huge mass of English-speaking and computer-literate people in this country. Moreover, the difference in time zones between the US and India, makes it quite easy to return documents within the usual stipulated time frame of 24 hours.
A transcription service could range from a small home-based business to sophisticated, high-tech corporations, which employ large numbers of transcriptionists, proofers, quality analysts etc. Athough the clientele is mostly in the US, British and even Australian doctors are beginning to consider India as a possible source of getting this work done – done quickly and well, at a fraction of the cost incurred in their own countries!!
India witnessed an “MT boom” a few years ago, with innumerable training institutes mushrooming all over the place. Lack of proper training and understanding of this new concept led to an almost total closure of these institutes. Those that have remained in the field are today flourishing business enterprises, offering this new job opportunity to thousands.
To be a good MT one needs good listening and language skills and knowledge of medical terms (also called Language of Medicine or LOM). Fluency in English with understanding of the American way of speech and accent is a must. A thorough knowledge of the AAMT (American Association for Medical Transcription) rules is also needed. A full-fledged training course would impart all this. Throughout his/her career an MT needs to keep up with changes in medical terminology, medical procedures etc. and have the ability to detect medical inconsistencies in dictation and fix poor grammar and syntax. One also needs patience, as the work tends to get monotonous and repetitive. Regular continuing education programs, which are comprehensive, are therefore essential to be successful in this field.
In the metros and major cities of India, many big business names have ventured into this field and are flourishing. Most of these companies have in-house training programs so that the trainees are assured of a job at the end of their course. As a rule, a fresh MT starts with a salary of Rs. 5000 per month. Incentives are based on the amount of work done (called “line-count”) and the accuracy maintained. A really conscientious and skilled MT would earn a pretty decent salary. As the work can be done at home, it provides a wonderful opportunity for young, educated mothers who would otherwise have to put their careers on hold while their children grow up. Retired persons, the disabled, or those who simply do not wish to venture out of their homes for earning could all thrive in this career.
In short, the future looks bright for those in the field of Medical Transcription.
Monday, October 12, 2009
Pros and Cons of the Healthcare Reform Proposal(s)
Pros:
* Everybody can have health insurance if they want it.
o Insurers will not be able to stop paying for people who are sick, even if they lose their jobs.
o People who cannot afford health insurance won’t have to pay as much money.
o People who are already sick will be eligible for healthcare.
* In the long run it will (hopefully) reduce medical costs significantly. Rising medical costs are the main reason the long-term budget projections are so alarming. Something has to be done. Unfortunately, this bill might not do enough. While there will definitely be some savings, it’s not clear that they will be as transformative as hoped.
* Health insurers can no longer cap coverage. In other words, they will no longer say that they have spent enough on you and you’re on your own for the next hundred thousand dollars. This should reduce medical bankruptcy.
* There will be increased competition in the insurance market. It might be from a public option. It might also be from some kind of non-profit, state-specific co-operative. This might push the healthcare companies to lower costs and provide better service.
Cons:
* For the first ten years, it will cost about $100 billion a year. This is about the yearly cost of the Iraq War.
* The bill might increase the cost of health insurance. This depends on whether the gains from increased efficiencies and increased competition is outweighed by the cost of providing additional benefits.
* The Individual Mandate. You will have to either buy health insurance if you don’t have it or have a 2% tax increase. This insurance will be subsidized—but there is no guarantee that the subsidy will suffice for your specific situation.
* There will be a tax increase on very high income people. If you are making more than half a million (or maybe a full million) you will have about a 1% tax increase.
Other stuff that might be good or bad, depending how you see it
* Increased government involvement in healthcare. Government already pays for huge amounts of healthcare—so this won’t be anything new.
* Additional regulation on insurance companies. This might increase costs. It will increase quality.
* Physicians will have increased access to information about what treatments are most effective for their cost. If two treatments work equally well and one is cheaper, doctors can recommend that one. This was almost universally considered a good thing until a few years ago, but some people have started criticizing it lately.
* Large employers may also have to offer health insurance to more of their employees. If they do not, they may have to pay some extra tax.
Things that aren’t true:
* Death Panels
* Nazis
* Inability to choose your doctor
* Healthcare will be “rationed.” My conservative buddies will claim that this will “inevitably lead” to rationing. I disagree. I do think we can agree that there is nothing in the healthcare bill that will reduce the amount of healthcare available. The topic of what counts as “rationing” healthcare (and whether we already do it) is complex and contentious—but the healthcare bill will not directly cause additional rationing.
* Bureaucrats will tell doctors how to do their jobs (in ways that they don’t already do).
* Everybody can have health insurance if they want it.
o Insurers will not be able to stop paying for people who are sick, even if they lose their jobs.
o People who cannot afford health insurance won’t have to pay as much money.
o People who are already sick will be eligible for healthcare.
* In the long run it will (hopefully) reduce medical costs significantly. Rising medical costs are the main reason the long-term budget projections are so alarming. Something has to be done. Unfortunately, this bill might not do enough. While there will definitely be some savings, it’s not clear that they will be as transformative as hoped.
* Health insurers can no longer cap coverage. In other words, they will no longer say that they have spent enough on you and you’re on your own for the next hundred thousand dollars. This should reduce medical bankruptcy.
* There will be increased competition in the insurance market. It might be from a public option. It might also be from some kind of non-profit, state-specific co-operative. This might push the healthcare companies to lower costs and provide better service.
Cons:
* For the first ten years, it will cost about $100 billion a year. This is about the yearly cost of the Iraq War.
* The bill might increase the cost of health insurance. This depends on whether the gains from increased efficiencies and increased competition is outweighed by the cost of providing additional benefits.
* The Individual Mandate. You will have to either buy health insurance if you don’t have it or have a 2% tax increase. This insurance will be subsidized—but there is no guarantee that the subsidy will suffice for your specific situation.
* There will be a tax increase on very high income people. If you are making more than half a million (or maybe a full million) you will have about a 1% tax increase.
Other stuff that might be good or bad, depending how you see it
* Increased government involvement in healthcare. Government already pays for huge amounts of healthcare—so this won’t be anything new.
* Additional regulation on insurance companies. This might increase costs. It will increase quality.
* Physicians will have increased access to information about what treatments are most effective for their cost. If two treatments work equally well and one is cheaper, doctors can recommend that one. This was almost universally considered a good thing until a few years ago, but some people have started criticizing it lately.
* Large employers may also have to offer health insurance to more of their employees. If they do not, they may have to pay some extra tax.
Things that aren’t true:
* Death Panels
* Nazis
* Inability to choose your doctor
* Healthcare will be “rationed.” My conservative buddies will claim that this will “inevitably lead” to rationing. I disagree. I do think we can agree that there is nothing in the healthcare bill that will reduce the amount of healthcare available. The topic of what counts as “rationing” healthcare (and whether we already do it) is complex and contentious—but the healthcare bill will not directly cause additional rationing.
* Bureaucrats will tell doctors how to do their jobs (in ways that they don’t already do).
Saturday, August 15, 2009
How to Avoid the Swine Flu Naturally
#
Step 1
Step 1: Take Elderberry: Compounds in elderberry bind with viruses before they can penetrate the walls of cells. This inhibits their ability to spread. Elderberry is nontoxic when cooked, even for children. It is available syrup, tincture or capsules in any health food store. Look here for more in depth information on Elderberry visit: http://stason.org/articles/wellbeing/health/How-To-Prevent-Colds-Flu-with-Elderberry.html
#
Step 2
Step 2: Take a homeopathic flu remedy: Homeopathy has an excellent record for preventing flu. Since this current swine-avian-human virus that is going around has the same symptoms as other types of flu, you will be able to use the same remedy as you would a normal flu with great success. This is because homeopathy works on the "Law of Similars". This means you look at the set of symptoms someone has to determine what remedy to take. Since this flu has the same symptoms as other flu's, the same remedies will be effective.
Oscillococcinum is one remedy that has been used with great success for prevention and treatment of the flu. The recommended dosage is to take it once a week for prevention. It has also shown to be helpful to take a dose at the first signs of the flu. Simply follow the directions on the container.
Influenzinum is a remedy that homeopathic manufacturers create every year for that years expected virus. Since the symptoms are the same for this swine-avian-human virus as the regular flu, this remedy should also be effective for this. The suggested dosage for this remedy is once a month.
These remedies are available in some pharmacies as well as health food stores.
#
Step 3
Nutrition: Too much sugar (and white flour) in the diet, is the biggest nutritional mistake people make. I include white flour because of its ability to change to glucose (sugar) rapidly. 1 tsp of sugar will depress the natural killer cell activity of the white blood cells by 50% for 2 days. (“Lick the Sugar Habit” by Nancy Appleton). There are also other immune factors that sugar inhibits so this is VERY IMPORTANT!
It is important to read labels on all your food. You MUST read the fine print to look for added sugar. Many foods and drinks have naturally occurring sugar that is included in the Nutrition Facts box on labels. This sugar is not harmful.
If a product has high fructose corn syrup, it is especially bad for your immune system.
Limiting sugar intake can be difficult for some people. The Standard American Diet (SAD) is very high in sugar. This means that having a lot of sugar seems normal to most people. You may not even realize how much sugar you are eating. I would suggest keeping a diary for one day to see what you are really eating.
Many health care professionals feel this is a contributing factor to chronic diseases as well as acute illnesses such as the flu. It is OK to have a little sugar in the diet but if you are ill, or going somewhere you are likely to be in contact with people that are ill, it is best to eat a healthy diet.
A simple healthy diet is one with lots of vegetables, whole fruits, whole grains, a protein with every meal, and only a few boxed, processed foods.
#
Step 4
Soap and water: Friction is the most important part of good hand washing. This makes soap and water a much better choice then antibacterial cleansers or towels. Scrub your hands for at least 20 seconds getting in between the fingers and fingernails with regular soap and water.
Try to keep your hands away from your face during a day of handling money or shaking hands with people. You can pick up a virus from many surfaces but you will only get the virus if it gets into your system by breathing it in or directly through your nose, mouth, or eyes.
If you are in an area where people are wearing a mask for prevention, it must fit tightly over the noise and mouth. You will see some people wearing a mask under the nose. This will offer no protection from airborne viruses.
#
Step 1
Step 1: Take Elderberry: Compounds in elderberry bind with viruses before they can penetrate the walls of cells. This inhibits their ability to spread. Elderberry is nontoxic when cooked, even for children. It is available syrup, tincture or capsules in any health food store. Look here for more in depth information on Elderberry visit: http://stason.org/articles/wellbeing/health/How-To-Prevent-Colds-Flu-with-Elderberry.html
#
Step 2
Step 2: Take a homeopathic flu remedy: Homeopathy has an excellent record for preventing flu. Since this current swine-avian-human virus that is going around has the same symptoms as other types of flu, you will be able to use the same remedy as you would a normal flu with great success. This is because homeopathy works on the "Law of Similars". This means you look at the set of symptoms someone has to determine what remedy to take. Since this flu has the same symptoms as other flu's, the same remedies will be effective.
Oscillococcinum is one remedy that has been used with great success for prevention and treatment of the flu. The recommended dosage is to take it once a week for prevention. It has also shown to be helpful to take a dose at the first signs of the flu. Simply follow the directions on the container.
Influenzinum is a remedy that homeopathic manufacturers create every year for that years expected virus. Since the symptoms are the same for this swine-avian-human virus as the regular flu, this remedy should also be effective for this. The suggested dosage for this remedy is once a month.
These remedies are available in some pharmacies as well as health food stores.
#
Step 3
Nutrition: Too much sugar (and white flour) in the diet, is the biggest nutritional mistake people make. I include white flour because of its ability to change to glucose (sugar) rapidly. 1 tsp of sugar will depress the natural killer cell activity of the white blood cells by 50% for 2 days. (“Lick the Sugar Habit” by Nancy Appleton). There are also other immune factors that sugar inhibits so this is VERY IMPORTANT!
It is important to read labels on all your food. You MUST read the fine print to look for added sugar. Many foods and drinks have naturally occurring sugar that is included in the Nutrition Facts box on labels. This sugar is not harmful.
If a product has high fructose corn syrup, it is especially bad for your immune system.
Limiting sugar intake can be difficult for some people. The Standard American Diet (SAD) is very high in sugar. This means that having a lot of sugar seems normal to most people. You may not even realize how much sugar you are eating. I would suggest keeping a diary for one day to see what you are really eating.
Many health care professionals feel this is a contributing factor to chronic diseases as well as acute illnesses such as the flu. It is OK to have a little sugar in the diet but if you are ill, or going somewhere you are likely to be in contact with people that are ill, it is best to eat a healthy diet.
A simple healthy diet is one with lots of vegetables, whole fruits, whole grains, a protein with every meal, and only a few boxed, processed foods.
#
Step 4
Soap and water: Friction is the most important part of good hand washing. This makes soap and water a much better choice then antibacterial cleansers or towels. Scrub your hands for at least 20 seconds getting in between the fingers and fingernails with regular soap and water.
Try to keep your hands away from your face during a day of handling money or shaking hands with people. You can pick up a virus from many surfaces but you will only get the virus if it gets into your system by breathing it in or directly through your nose, mouth, or eyes.
If you are in an area where people are wearing a mask for prevention, it must fit tightly over the noise and mouth. You will see some people wearing a mask under the nose. This will offer no protection from airborne viruses.
Friday, August 14, 2009
Swine Flu & Homeopathy
Swine Flu / Swine Influenza
What is Swine Flu / H1N1 Influenza?
Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans.
The 2009 flu outbreak in humans is due to a new strain of influenza A virus subtype H1N1 that derives in part from human influenza, avian influenza, and two separate strains of swine influenza. The origins of this new strain are unknown. It passes with apparent ease from human to human, an ability attributed to an as-yet unidentified mutation. The strain in most cases causes only mild symptoms and the infected person makes a full recovery without requiring medical attention and without the use of antiviral medicines.
Why is there so much panic about Swine Flu? After all it's just a flu!
The most significant flu pandemic occurred in 1918/1919. The global mortality rate from the 1918/1919 pandemic is not known, but is estimated at 2.5 to 5% of those who were infected died. With 20% or more of the world population suffering from the disease to some extent, a case-fatality ratio this high would mean that about 0.5-1% or 50 million to 100 million people worldwide were killed. In 1957, an Asian flu pandemic infected some 45 million Americans and killed 70,000. Eleven years later, lasting from 1968 to 1969, the Hong Kong flu pandemic afflicted 50 million Americans and caused 33,000 deaths, costing approximately $3.9 billion. In 1976, about 500 soldiers became infected with swine flu over a period of a few weeks.
The scare and panic about the bird flu and swine flu have occurred because people now know what a simple flu can lead to and are afraid of the consequences - not just to the human capital but also to the global financial health.
Swine Flu / H1N1 Influenza Symptoms
The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea. Symptoms of Swine flu may include all or some of the following:
* Fever
* Muscle aches
* Lethargy
* Coughing
* Headache
* Sore throat
* Runny nose
* Nausea
* Vomiting
* Diarrhea
* Lack of appetite
Complications Of Swine Influenza
Those at higher risk of catching influenza in general include those with the following:
* Age of 65 years or older
* Chronic health problems (such as asthma, diabetes, heart disease)
* Pregnant women
* Young children
But the past epidemics and pandemics of flu have shown that during pandemics most people who succumb are healthy young adults.
Complications of Swine Flu can include:
* Pneumonia
* Bronchitis
* Sinus infections
* Ear infections
* Death
Transmission of Swine Flu (How does Swine Flu spread?)
As with other flu like illnesses, Swine influenza is spread as follows:
* Coughing
* Sneezing
* Kissing
* Touching infected objects
* Touching nose, mouth and/or eyes with infected hands
* Swine flu does not spread by eating pork.
Treatment of Swine Flu / H1N1 Influenza
Swine Flu Vaccination / Swine Flu Shot
The protective ability of influenza vaccines depends primarily on the closeness of the match between the vaccine virus and the epidemic virus, so the presence of non reactive H3N2 SIV variants suggests that current commercial vaccines might not effectively protect pigs from infection with a majority of H3N2 viruses. The current vaccine against the seasonal influenza strain H1N1 is thought unlikely to provide protection. The director of CDC's National Center for Immunization and Respiratory Diseases said that the United States' cases were found to be made up of genetic elements from four different flu viruses—North American swine influenza, North American avian influenza, human influenza A virus subtype H1N1, and swine influenza virus typically found in Asia and Europe.
What You Can Do to Prevent H1N1 Influenza / Swine Flu?
There are everyday actions people can take to stay healthy.
* Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
* Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
* Avoid touching your eyes, nose or mouth. Germs spread that way.
* Try to avoid close contact with sick people.
* Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.
* If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.
Above all. Don't get stressed by the fear of getting the swine flu. Stress can undermine your immune system. The flu doesn't kill everyone and in most cases may prove benign. Mild exercise, meditation or yoga and healthy nutritious diet can help keep your immune system in good condition and able to ward of any infections. Not every 'infection' becomes a full blown 'disease'. Most infections are taken care of by your body even before you know that you were infected. Most infections affect gravely those people who are vitally deranged. So instead of panicking about the flu, stay calm and focus on becoming a healthy 'you'.
Natural Remedy
Homeopathy Remedies for Swine Flu / H1N1 Influenza
Why Homeopathy?
Homeopathy was very successful in dealing with the 1918-19 flu pandemic. Here is a quote from the famous historian Julian Winston:
Perhaps the most recent use of homeopathy in a major epidemic was during the Influenza Pandemic of 1918. The Journal of the American Institute for Homeopathy, May, 1921, had a long article about the use of homeopathy in the flu epidemic. Dr. T A McCann, from Dayton, Ohio, reported that 24,000 cases of flu treated allopathically had a mortality rate of 28.2% while 26,000 cases of flu treated homeopathically had a mortality rate of 1.05%. This last figure was supported by Dean W.A. Pearson of Philadelphia (Hahnemann College) who collected 26,795 cases of flu treated with homeopathy with the above result.
The most common remedy used was Gelsemium, with occasional cases needing Bryonia and Eupatorium reported. Dr. Herbert A. Roberts from Derby, CT, said that 30 physicians in Connecticut responded to his request for data. They reported 6,602 cases with 55 deaths, which is less than 1%. Dr. Roberts was working as a physician on a troop ship during WWI. He had 81 cases of flu on the way over to Europe. He reported, "All recovered and were landed. Every man received homeopathic treatment. One ship lost 31 on the way."
http://www.hpathy.com/papersnew/winston-homeopathy-epidemics.asp
Homeopathic Remedies
Considering that the Swine Flu virus produces symptoms similar to the human influenza virus, the following homeopathy medicines may prove useful in cases of swine influenza:
#Gelsemium. [Gels]
This remedy corresponds to the commencement of the trouble, when the patient is weak, tired and aches throughout the body. It removes speedily the intense aching and muscular soreness. There is constant chilliness and the patient hugs the fire; the fever is less acute than that of Aconite, and the cough is hard and painful. There are paroxysms of sneezing with excoriating discharge, and great torpor and apathy. Extensive experience with this remedy in the great Epidemic of 1918 proved its usefulness. Simple cases were speedily cured. Aconite will sometimes prove the better remedy for children, but the drug will never be a prominent one in influenza. Still it may be prescribed when indicated; it will, perhaps, soothe and moderate the subsequent attack, but its action is not quick here as in simple fevers, as we have to deal with a blood affection.
#Baptisia.
Influenza with marked gastro-intestinal symptoms may need this remedy, especially when there are putrid diarrhoea stools. Clarke considers this remedy the nearest specific for the disease; he prefers the 30th potency. Hughes also praises it, but uses it in the 1x and 2x dilutions, which seem to have more extensive testimony as to their efficacy.
#Eupatorium perfoliatum.
This remedy has much soreness and aching of the entire body; hoarseness and cough, with great soreness of the larynx and upper respiratory tract. Coryza with thirst. Drinking causes vomiting. The cough is a very shattering one, hurts the head and chest, and as in Drosera, the patient holds the chest with the hands. The breakbone pains are characteristic of the remedy. Add to these symptoms acute bilious derangements, and it is all the more indicated. Many physicians rely on this remedy in influenza / flu almost exclusively in the early stages.
#Sabadilla. [Sabad]
Sneezing is the great keynote of this remedy. Sneezing and lachrymation on going into the open air. The throat is swollen and the pain is worse on empty swallowing; the sneezing is excessive, shaking the whole body. Shudderings, with gooseflesh chills creeping upwards, are also prominent symptoms. Frontal headache, dryness of mouth, without thirst and cough, worse on lying down, are additional symptoms. It suits well many cases of the catarrhal form of flu; other remedies having sneezing are Cyclamen and Euphorbia.
#Arsenicum. [Ars]
This remedy covers more phases of flu than perhaps any other remedy. Hughes believes that it will cut short an attack, especially when there is a copious flow, prostration and paroxysmal coryza. Its periodicity makes it suitable to epidemics, and it suits the early symptoms when the affection is in the upper portion of the respiratory tract. The burning dryness and copious watery excoriating secretion and the involvement of the conjunctiva are unmistakable indications. Langour and prostration are prominent symptoms.
#Arsenicum iodide.
Chills, flushes of heat and severe fluent coryza, discharge irritating and corrosive, sneezing and prostration. It corresponds to true influenza and is highly recommended by Hale. Sanguinaria nitrate is especially valuable when the trachea and larynx are affected. Phytolacca is specific when the throat is inflamed and spotty, with great hardness and tenderness of the glands.
#Dulcamara. [Dulc]
This is one of our best remedies in the acute form; the eyes are suffused, the throat is sore and the cough hurts because of the muscular soreness. If brought on by damp, cold changes in the weather, so much the surer is Dulcamara indicated.
#Bryonia.
The trouble here is largely bronchial and going downward. When a person is very grumpy and feels miserable with the flu, wanting only to lie still and be left alone, this remedy is likely to be useful. Headache, muscle aches, and cough or stomach pain may be the major symptoms. Everything feels worse from even the slightest motion. The person’s mouth usually is dry, with a thirst for large cold drinks.
#Phosphorus may be indicated, especially when the trouble moves towards the chest. It is a very useful remedy for the debility following la grippe, as it is usually of the pure nervous type. It is the great post-influenza "tonic."
#Rhus toxicodendron. [Rhus-t]
Influenza, with severe aching in all the bones, sneezing and coughing. The cough is worse evenings and is caused by a tickling behind the upper part of the sternum. Especially is it useful in cases brought on by exposure to dampness. There is much prostration and depression, and the patient may have some symptoms which are suspicious as pointing towards typhoid fever, such as burning tongue, stupor and delirium. Aching pains and nightly restlessness are keynotes symptoms. Causticum, like both Rhus and Eupatorium, has a tired, sore, bruised sensation all over the body and soreness in the chest when coughing, but it has in addition involuntary urination when coughing.
#Allium cepa. [All-c]
Profuse catarrhal coryza; the nose runs freely, there is sneezing, irritability cough, the face is swollen and looks inflamed. Camphora. This remedy is often sufficient at the outset to cut short an attack, or at least modify the severity.
#Sticta. [Stict]
Nasal catarrh; headache, thirst, nightly expectoration, great watering of eyes, running at nose, hoarseness of voice, frontal headache and depression of whole system. Tuberculous subjects attacked by influenza. "There is no better remedy," says Dr. Fornias,"for the incessant wearing, racking cough of this class of patients." Tuberculinum is an excellent prevention of recurring attacks of influenza / flu in those who have annual attacks.
#Ipecac
Adapted to cases where the gastric symptoms predominate; tongue clean or slightly coated. Nausea: with profuse saliva; vomiting of white, glairy mucus in large quantities, without relief; sleepy afterwards; worse from stooping. Low thirst. Cough: dry spasmodic, constricted, asthmatic. Difficult breathing from least exercise; violent dyspnoea, with wheezing and anxiety about the stomach. Cough, with rattling of mucus in bronchi when inspiring; threatened suffocation from mucus. Pains as if bones were all torn to pieces.
#Veratrum album
Adapted to diseases with rapid sinking of the vital forces; complete prostration; collapse. Cold perspiration on the forehead (over entire body, Tab. ) with nearly all complaints. Thirst: intense, unquenchable, for large quantities of very cold water and acid drinks; wants everything cold. Diarrhoea: frequent, greenish, watery, gushing: mixed with flakes: cutting colic, with cramps commencing in hands and feet and spreading all over; prostrating, after fright; < least movement; with vomiting, cold sweat on forehead during and prostration after. Vomiting: excessive with nausea and great prostration: < by drinking ( Ars. ); by least motion ( Tab. ); great weakness after.
The Current Swine Flu Epidemic or Possible Influenza Pandemic
It has been reported that in the current Swine influenza epidemic, the gastrointestinal symptoms (Nausea, Vomiting) are pronounced. Considering this remedies like Baptisia, Arsenic-album or Ipecac may work as Genus epidemicus or as prophylactic treatment for the current Swine influenza epidemic.
How to differentiate in these flu medicines?
If the patient has mild flu like symptoms (runny nose and watery eyes etc) but no other peculiar symptom but is anxious if it might be swine flu - think about Aconite.
If the flu patient is listless, prostrated, indifferent, has offensive diarrhoea and the parts rested upon feel sore and bruised - think about Baptisia.
If the flu patient is restless, anxious or fearful, thirsty but drinks small quantities and often, prostrated, diarrhoea after eating or drinking and nausea on seeing/smelling food, burning pains - think about Arsenicum-album.
If the nausea is more pronounced, the patient is thirstless and has pain felt in bones - think about Ipecac. Also Ipecac should be thought of if a flu patient is developing or has developed broncho-pneumonia.
If the gastrointestinal symptoms are not marked but the patient has deep pains as if bones are aching - think about Eupatorium perf.
If the flu patient is feeling dull, dizzy, drowsy, has low thirst, feels chilly, esp in back - think about Gelsemium.
Lessons from the 1918/1919 Flu Pandemic
Many people believe that the current virus strain closely matches the 1918/1919 flu pandemic, although it is not exactly like it.
In the 1918/1919 flu pandemic, people without symptoms could be stricken suddenly and within hours be too weak to walk; many died the next day. Symptoms included a blue tint to the face and coughing up blood caused by severe obstruction of the lungs. In some cases, the virus caused an uncontrollable hemorrhaging that filled the lungs, and patients drowned in their body fluids (pneumonia). In others, the flu caused frequent loss of bowel control and the victim would die from losing critical intestinal lining and from blood loss.
If such symptoms present themselves in the current pandemic, the remedies that may prove useful would be Arsenic-album, Cantharis, Phosphorus, Cuprum-met, Camphora, Veratrum-album, Ipecac or Carbo-veg.
Ars-alb, Phosphorus, Ipecac and Carbo-veg seem to have a more pronounced action on lungs/respiratory symptoms in the above mentioned symptom group. Cantharis, Phosphorus, and Carbo-veg seem to cover the bloody stools better. Camphor and Verat-alb cover the acute collapse with bluish discoloration better.
Note
Homeopathic remedies need strict individualization and are given as specifically prepared, non-toxic, micro-dose homeopathic potencies. Please consult a qualified homeopath before taking any homeopathic remedy for Swine flu / influenza
Reference for Swine Flu Information
1. Center for Disease Control (CDC), USA
What is Swine Flu / H1N1 Influenza?
Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans.
The 2009 flu outbreak in humans is due to a new strain of influenza A virus subtype H1N1 that derives in part from human influenza, avian influenza, and two separate strains of swine influenza. The origins of this new strain are unknown. It passes with apparent ease from human to human, an ability attributed to an as-yet unidentified mutation. The strain in most cases causes only mild symptoms and the infected person makes a full recovery without requiring medical attention and without the use of antiviral medicines.
Why is there so much panic about Swine Flu? After all it's just a flu!
The most significant flu pandemic occurred in 1918/1919. The global mortality rate from the 1918/1919 pandemic is not known, but is estimated at 2.5 to 5% of those who were infected died. With 20% or more of the world population suffering from the disease to some extent, a case-fatality ratio this high would mean that about 0.5-1% or 50 million to 100 million people worldwide were killed. In 1957, an Asian flu pandemic infected some 45 million Americans and killed 70,000. Eleven years later, lasting from 1968 to 1969, the Hong Kong flu pandemic afflicted 50 million Americans and caused 33,000 deaths, costing approximately $3.9 billion. In 1976, about 500 soldiers became infected with swine flu over a period of a few weeks.
The scare and panic about the bird flu and swine flu have occurred because people now know what a simple flu can lead to and are afraid of the consequences - not just to the human capital but also to the global financial health.
Swine Flu / H1N1 Influenza Symptoms
The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea. Symptoms of Swine flu may include all or some of the following:
* Fever
* Muscle aches
* Lethargy
* Coughing
* Headache
* Sore throat
* Runny nose
* Nausea
* Vomiting
* Diarrhea
* Lack of appetite
Complications Of Swine Influenza
Those at higher risk of catching influenza in general include those with the following:
* Age of 65 years or older
* Chronic health problems (such as asthma, diabetes, heart disease)
* Pregnant women
* Young children
But the past epidemics and pandemics of flu have shown that during pandemics most people who succumb are healthy young adults.
Complications of Swine Flu can include:
* Pneumonia
* Bronchitis
* Sinus infections
* Ear infections
* Death
Transmission of Swine Flu (How does Swine Flu spread?)
As with other flu like illnesses, Swine influenza is spread as follows:
* Coughing
* Sneezing
* Kissing
* Touching infected objects
* Touching nose, mouth and/or eyes with infected hands
* Swine flu does not spread by eating pork.
Treatment of Swine Flu / H1N1 Influenza
Swine Flu Vaccination / Swine Flu Shot
The protective ability of influenza vaccines depends primarily on the closeness of the match between the vaccine virus and the epidemic virus, so the presence of non reactive H3N2 SIV variants suggests that current commercial vaccines might not effectively protect pigs from infection with a majority of H3N2 viruses. The current vaccine against the seasonal influenza strain H1N1 is thought unlikely to provide protection. The director of CDC's National Center for Immunization and Respiratory Diseases said that the United States' cases were found to be made up of genetic elements from four different flu viruses—North American swine influenza, North American avian influenza, human influenza A virus subtype H1N1, and swine influenza virus typically found in Asia and Europe.
What You Can Do to Prevent H1N1 Influenza / Swine Flu?
There are everyday actions people can take to stay healthy.
* Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
* Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
* Avoid touching your eyes, nose or mouth. Germs spread that way.
* Try to avoid close contact with sick people.
* Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.
* If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.
Above all. Don't get stressed by the fear of getting the swine flu. Stress can undermine your immune system. The flu doesn't kill everyone and in most cases may prove benign. Mild exercise, meditation or yoga and healthy nutritious diet can help keep your immune system in good condition and able to ward of any infections. Not every 'infection' becomes a full blown 'disease'. Most infections are taken care of by your body even before you know that you were infected. Most infections affect gravely those people who are vitally deranged. So instead of panicking about the flu, stay calm and focus on becoming a healthy 'you'.
Natural Remedy
Homeopathy Remedies for Swine Flu / H1N1 Influenza
Why Homeopathy?
Homeopathy was very successful in dealing with the 1918-19 flu pandemic. Here is a quote from the famous historian Julian Winston:
Perhaps the most recent use of homeopathy in a major epidemic was during the Influenza Pandemic of 1918. The Journal of the American Institute for Homeopathy, May, 1921, had a long article about the use of homeopathy in the flu epidemic. Dr. T A McCann, from Dayton, Ohio, reported that 24,000 cases of flu treated allopathically had a mortality rate of 28.2% while 26,000 cases of flu treated homeopathically had a mortality rate of 1.05%. This last figure was supported by Dean W.A. Pearson of Philadelphia (Hahnemann College) who collected 26,795 cases of flu treated with homeopathy with the above result.
The most common remedy used was Gelsemium, with occasional cases needing Bryonia and Eupatorium reported. Dr. Herbert A. Roberts from Derby, CT, said that 30 physicians in Connecticut responded to his request for data. They reported 6,602 cases with 55 deaths, which is less than 1%. Dr. Roberts was working as a physician on a troop ship during WWI. He had 81 cases of flu on the way over to Europe. He reported, "All recovered and were landed. Every man received homeopathic treatment. One ship lost 31 on the way."
http://www.hpathy.com/papersnew/winston-homeopathy-epidemics.asp
Homeopathic Remedies
Considering that the Swine Flu virus produces symptoms similar to the human influenza virus, the following homeopathy medicines may prove useful in cases of swine influenza:
#Gelsemium. [Gels]
This remedy corresponds to the commencement of the trouble, when the patient is weak, tired and aches throughout the body. It removes speedily the intense aching and muscular soreness. There is constant chilliness and the patient hugs the fire; the fever is less acute than that of Aconite, and the cough is hard and painful. There are paroxysms of sneezing with excoriating discharge, and great torpor and apathy. Extensive experience with this remedy in the great Epidemic of 1918 proved its usefulness. Simple cases were speedily cured. Aconite will sometimes prove the better remedy for children, but the drug will never be a prominent one in influenza. Still it may be prescribed when indicated; it will, perhaps, soothe and moderate the subsequent attack, but its action is not quick here as in simple fevers, as we have to deal with a blood affection.
#Baptisia.
Influenza with marked gastro-intestinal symptoms may need this remedy, especially when there are putrid diarrhoea stools. Clarke considers this remedy the nearest specific for the disease; he prefers the 30th potency. Hughes also praises it, but uses it in the 1x and 2x dilutions, which seem to have more extensive testimony as to their efficacy.
#Eupatorium perfoliatum.
This remedy has much soreness and aching of the entire body; hoarseness and cough, with great soreness of the larynx and upper respiratory tract. Coryza with thirst. Drinking causes vomiting. The cough is a very shattering one, hurts the head and chest, and as in Drosera, the patient holds the chest with the hands. The breakbone pains are characteristic of the remedy. Add to these symptoms acute bilious derangements, and it is all the more indicated. Many physicians rely on this remedy in influenza / flu almost exclusively in the early stages.
#Sabadilla. [Sabad]
Sneezing is the great keynote of this remedy. Sneezing and lachrymation on going into the open air. The throat is swollen and the pain is worse on empty swallowing; the sneezing is excessive, shaking the whole body. Shudderings, with gooseflesh chills creeping upwards, are also prominent symptoms. Frontal headache, dryness of mouth, without thirst and cough, worse on lying down, are additional symptoms. It suits well many cases of the catarrhal form of flu; other remedies having sneezing are Cyclamen and Euphorbia.
#Arsenicum. [Ars]
This remedy covers more phases of flu than perhaps any other remedy. Hughes believes that it will cut short an attack, especially when there is a copious flow, prostration and paroxysmal coryza. Its periodicity makes it suitable to epidemics, and it suits the early symptoms when the affection is in the upper portion of the respiratory tract. The burning dryness and copious watery excoriating secretion and the involvement of the conjunctiva are unmistakable indications. Langour and prostration are prominent symptoms.
#Arsenicum iodide.
Chills, flushes of heat and severe fluent coryza, discharge irritating and corrosive, sneezing and prostration. It corresponds to true influenza and is highly recommended by Hale. Sanguinaria nitrate is especially valuable when the trachea and larynx are affected. Phytolacca is specific when the throat is inflamed and spotty, with great hardness and tenderness of the glands.
#Dulcamara. [Dulc]
This is one of our best remedies in the acute form; the eyes are suffused, the throat is sore and the cough hurts because of the muscular soreness. If brought on by damp, cold changes in the weather, so much the surer is Dulcamara indicated.
#Bryonia.
The trouble here is largely bronchial and going downward. When a person is very grumpy and feels miserable with the flu, wanting only to lie still and be left alone, this remedy is likely to be useful. Headache, muscle aches, and cough or stomach pain may be the major symptoms. Everything feels worse from even the slightest motion. The person’s mouth usually is dry, with a thirst for large cold drinks.
#Phosphorus may be indicated, especially when the trouble moves towards the chest. It is a very useful remedy for the debility following la grippe, as it is usually of the pure nervous type. It is the great post-influenza "tonic."
#Rhus toxicodendron. [Rhus-t]
Influenza, with severe aching in all the bones, sneezing and coughing. The cough is worse evenings and is caused by a tickling behind the upper part of the sternum. Especially is it useful in cases brought on by exposure to dampness. There is much prostration and depression, and the patient may have some symptoms which are suspicious as pointing towards typhoid fever, such as burning tongue, stupor and delirium. Aching pains and nightly restlessness are keynotes symptoms. Causticum, like both Rhus and Eupatorium, has a tired, sore, bruised sensation all over the body and soreness in the chest when coughing, but it has in addition involuntary urination when coughing.
#Allium cepa. [All-c]
Profuse catarrhal coryza; the nose runs freely, there is sneezing, irritability cough, the face is swollen and looks inflamed. Camphora. This remedy is often sufficient at the outset to cut short an attack, or at least modify the severity.
#Sticta. [Stict]
Nasal catarrh; headache, thirst, nightly expectoration, great watering of eyes, running at nose, hoarseness of voice, frontal headache and depression of whole system. Tuberculous subjects attacked by influenza. "There is no better remedy," says Dr. Fornias,"for the incessant wearing, racking cough of this class of patients." Tuberculinum is an excellent prevention of recurring attacks of influenza / flu in those who have annual attacks.
#Ipecac
Adapted to cases where the gastric symptoms predominate; tongue clean or slightly coated. Nausea: with profuse saliva; vomiting of white, glairy mucus in large quantities, without relief; sleepy afterwards; worse from stooping. Low thirst. Cough: dry spasmodic, constricted, asthmatic. Difficult breathing from least exercise; violent dyspnoea, with wheezing and anxiety about the stomach. Cough, with rattling of mucus in bronchi when inspiring; threatened suffocation from mucus. Pains as if bones were all torn to pieces.
#Veratrum album
Adapted to diseases with rapid sinking of the vital forces; complete prostration; collapse. Cold perspiration on the forehead (over entire body, Tab. ) with nearly all complaints. Thirst: intense, unquenchable, for large quantities of very cold water and acid drinks; wants everything cold. Diarrhoea: frequent, greenish, watery, gushing: mixed with flakes: cutting colic, with cramps commencing in hands and feet and spreading all over; prostrating, after fright; < least movement; with vomiting, cold sweat on forehead during and prostration after. Vomiting: excessive with nausea and great prostration: < by drinking ( Ars. ); by least motion ( Tab. ); great weakness after.
The Current Swine Flu Epidemic or Possible Influenza Pandemic
It has been reported that in the current Swine influenza epidemic, the gastrointestinal symptoms (Nausea, Vomiting) are pronounced. Considering this remedies like Baptisia, Arsenic-album or Ipecac may work as Genus epidemicus or as prophylactic treatment for the current Swine influenza epidemic.
How to differentiate in these flu medicines?
If the patient has mild flu like symptoms (runny nose and watery eyes etc) but no other peculiar symptom but is anxious if it might be swine flu - think about Aconite.
If the flu patient is listless, prostrated, indifferent, has offensive diarrhoea and the parts rested upon feel sore and bruised - think about Baptisia.
If the flu patient is restless, anxious or fearful, thirsty but drinks small quantities and often, prostrated, diarrhoea after eating or drinking and nausea on seeing/smelling food, burning pains - think about Arsenicum-album.
If the nausea is more pronounced, the patient is thirstless and has pain felt in bones - think about Ipecac. Also Ipecac should be thought of if a flu patient is developing or has developed broncho-pneumonia.
If the gastrointestinal symptoms are not marked but the patient has deep pains as if bones are aching - think about Eupatorium perf.
If the flu patient is feeling dull, dizzy, drowsy, has low thirst, feels chilly, esp in back - think about Gelsemium.
Lessons from the 1918/1919 Flu Pandemic
Many people believe that the current virus strain closely matches the 1918/1919 flu pandemic, although it is not exactly like it.
In the 1918/1919 flu pandemic, people without symptoms could be stricken suddenly and within hours be too weak to walk; many died the next day. Symptoms included a blue tint to the face and coughing up blood caused by severe obstruction of the lungs. In some cases, the virus caused an uncontrollable hemorrhaging that filled the lungs, and patients drowned in their body fluids (pneumonia). In others, the flu caused frequent loss of bowel control and the victim would die from losing critical intestinal lining and from blood loss.
If such symptoms present themselves in the current pandemic, the remedies that may prove useful would be Arsenic-album, Cantharis, Phosphorus, Cuprum-met, Camphora, Veratrum-album, Ipecac or Carbo-veg.
Ars-alb, Phosphorus, Ipecac and Carbo-veg seem to have a more pronounced action on lungs/respiratory symptoms in the above mentioned symptom group. Cantharis, Phosphorus, and Carbo-veg seem to cover the bloody stools better. Camphor and Verat-alb cover the acute collapse with bluish discoloration better.
Note
Homeopathic remedies need strict individualization and are given as specifically prepared, non-toxic, micro-dose homeopathic potencies. Please consult a qualified homeopath before taking any homeopathic remedy for Swine flu / influenza
Reference for Swine Flu Information
1. Center for Disease Control (CDC), USA
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