G-8 discusses system to follow-up on aid pledges (AP)

AP - An aid group founded by U2 frontman Bono calculates that bulk dmae bitartrate Group of Eight top industrialized nations has delivered only $3 billion of the additional $25 billion promised for Africa for everything from AIDS drugs to training peacekeepers.

The new world of consumer-driven healthcare is opening up many opportunities for people to save money on their medical expenses. As more people carry high deductible plans in conjunction with health savings accounts, medical providers are beginning to compete for that business in a variety of innovative ways. One way many people are saving money on doctor visits is through telephone consultations.

Many times an expensive doctor visit could be avoided if you could just talk to the doctor to discuss the situation over the phone. If you could do a quick email exchange and have a prescription waiting for you at the pharmacy, you could save time and money, and let the funds in your Health Savings Account continue to grow for your retirement. There are now online physician consultation services that allow you to do just that.

While an ER visit may indeed treat medical needs, the reality is that most visits end up being more about peace of mind. If your child's skin is turning red in the middle of the night, you might not know if it's harmless flushing, or a serious allergic reaction. So you rush off to the emergency room, fill out some forms, and sit in a room full of contagious people. You wait and wait, finally get to speak to a nurse, then wait some more, and explain your problem again to the resident. Then you may have a battery of tests done, wait some more, and finally leave with a prescription and a bill for $650.

All this for a problem that could have been far less expensive, and handled more simply and expediently by discussing the situation with your doctor. According to the American Medical Association, about 70% of doctor and emergency room visits are actually just informational.

However, asking your doctor a health question is rarely as easy as picking up the phone. Because insurance companies do not normally reimburse doctors for phone care, most traditional practices avoid offering such service. Instead, their objective is to get you into the office so that you can be billed for the service you receive.

Paying for that office and the surrounding bureaucracy is not cheap. A doctor's costs may include the office itself, a receptionists, a triage nurse, someone handling insurance billing, office managers, and expensive medical equipment. All this is very expensive to maintain, so generating as many office visits as possible is critical for most doctors to even stay in business.

So you get stuck in a system that is inconvenient, expensive, and does not value your time.

Telephone Consultation Services As health savings accounts become more popular and more people are paying for their own doctor visits, several companies have begun offering inexpensive telephone and email consultations with board-certified physicians. These companies can offer dramatically lower prices because they have cut out most of the costs that burden traditional medical facilities.

Though telephone consultations are obviously not appropriate for all medical conditions, it is an accepted standard of care for many health-care problems. In fact, telephone medicine has been around as long as the telephone, and is practiced throughout the country by most doctors at nights and on weekends.

Here are a few companies that are now offering telephone consultations with licensed physicians:

• Doctor on Call (www.unadoctoroncall.com). This company currently has over 240 board-certified physicians on call, with 24-hour access. The physicians with this service will not diagnose or prescribe, but they will provide information based on your questions. The price is a bargain - only $5.95/month for the family for an unlimited number of calls.
• TelaDoc Medical Services (www.teladoc.com). This company also provides 24-hour access to members and dependents age 12+. Telephone medical consultations are with primary care doctors who can also diagnose medical problems and prescribe appropriate medications. There is an initial $18 registration fee, and a monthly fee of $4.25 for an individual or $7 for a family. Consultations are a flat $35.
• Doctokr (www.doctokr.com) is a practice run by Virginia physician Alan Dappen. Though this service is only available to people who can come in to his office for an initial visit, it is a model likely to be copied by other providers as consumers become more price conscious when shopping for medical care. 24-hour access is available by telephone and email. Consultations are billed in 5-minute increments ranging in price from $15 to $22.50. A simple consultation to request medication refills costs from $10 to $15 for up to 5 medications. There is a monthly fee of $5.95.

Saving You Time and Money Not only will these services save you money when compared to a typical doctor visit, but they will also save you time. You may be able to quickly resolve routine medical issues in a fraction of the time you would spend accessing care from urgent care facilities, emergency rooms or physician offices. If you use a service that will prescribe medications, you could have your consultation finished and the medicine in hand in less than the time it would otherwise take just to visit the doctor. As telephone technology evolves, these services will add picture taking and even recording vital signs, and the scope of these physician consultations will become broader. With doctor visits approaching $100 each and ER visits in excess of $800, it doesn't take much to justify the small monthly fee for most of these services.

Though there are certainly times when visiting your doctor's office or the emergency room is the most appropriate thing to do, as a smart consumer you owe it to yourself to be aware of all your options. Using a physician telephone consultation service can help you avoid the expense, time, and hassles of urgent care facilities, emergency rooms, and visits to the doctor.

By Wiley Long - President, HSA for America - The nation's leading independent health insurance firm specializing in HSA-qualified Plans that work with a Health Savings Account.

Family sues co. for muscular dystrophy drug (AP)

AP - A Minnesota family is trying to force purchase bulk edta disodium New Jersey drug company to give their son an experimental drug for a fatal form of muscular dystrophy, saying he'll die without it.

Also known as OKG, this compound is formed from two molecules of the amino acid ornithine and one a-KG. OKG has been shown in a variety of studies to have an anabolic effect. OKG has been used successfully via enteral or parenteral administration in conditions such as burn, postsurgery, malnutrition, and wound healing. The mechanism by which OKG exerts these effects is not known; however, the secretion of hormones such as insulin and growth hormone and the conversion to other metabolites (e.g., glutamine, arginine, etc) might play a role.

Animal Studies

Vaubourdolle et al. used an animal burn model to study the effects of OKG administration during a hypercatabolic state. Rats were studied after having their dorsum in water at 90C for 10 seconds (inducing a burn injury) and then starved for 24 hours. The supplementation of OKG (5 g/kg/day) for 2 days decreased the level of muscle mass loss and increased intramuscular glutamine concentration. An isonitrogenous amount of glycine had no effect.

Similar work by Le Boucher found that OKG inhibits myofibrillar degradation in burn-injured rats while glycine had no such effect. In an interesting study using malnourished animals, male rats were starved for 3 days, then refed for 7 days with an oral diet (192 kcal kg/day; 2.25 g/kg/day of nitrogen) supplemented with either OKG, glutamine, or casein Starvation caused a drop in most tissue-amino acids except skeletal muscle leucine (+43%) and liver glutamate (+ 11 %). The primary effect of OKG was to normalize the amino acid concentrations in the liver and small bowel while glutamine normalized glutamine and leucine concentrations in skeletal muscle. In this case, it is apparent that OKG and glutamine act on different tissues . In rats implanted with a tumor, the administration of OKG (3.4-4.0 g/kg/day) for 5 days reduced muscle proteolysis by 33% while an isonitrogeno us amount of glycine had no effect.

In another animal model of trauma (bilateral femur fracture in the rat), there was no difference in body weight gain per gram of nitrogen intake after the administration of ornithine, OKG, or alpha-KG On the other hand, a study that compared OKG with arginine-a-ketoglutarate (AKG) suggested that the effects of OKG are not due to its a-KG content nor to its nitrogen content. That is, OKG produced a greater increase than AKG in muscle glutamine concentrations in burn injured rats. A decrease in intramuscular glutamine concentration is associated with skeletal muscle catabolism, thus, the action of OKG is neither solely related to its nitrogen content, nor to the presence of a-KG.

Human Studies

OKG has similarly been shown to have positive effects in humans on protein metabolism during hypercatabolic states. Vanbourdolle et al. 65 showed that the enteral (via the intestine) administration of OKG to burn patients improved glucose tolerance. In a study that compared varying doses of OKG (10, 20, and 30 g) delivered as one large bolus or via continuous infusion, investigators found that nitrogen balance improved and urinary 3-methylhistidine was reduced (an indicator of muscle protein degradation). In fact, the administration of 30 g as a bolus seemed to have the greatest benefit.

TPN supplemented with 0.35 g/kg of OKG to patients after elective abdominal surgery prevented the drop in protein synthesis seen in the unsupplemented controls. OKG supplementation might exert its anticatabolic effect via the maintenance of intramuscular glutamine levels. However, the mere provision of extra nitrogen does not confer similar effects. In a study that compared TPN supplemented with either OKG or branched-chain amino acids , there was less of a decrease in intramuscular glutamine levels in the OKG group Thus, one could argue that OKG administration is more effective than the BCAAs in reducing muscle glutamine loss and therefore ameliorating skeletal muscle proteolysis.

It is unclear if OKG exerts further anabolic/anticatabolic effects via alterations in the hormonal milieu. For instance, OKG administered to burn patients had no effect on plasma insulin or growth hormone concentration 65 On the other hand, OKG (15 g) given to growth-retarded prepubertal children produced an increase in plasma insulin-like growth factor-1 level.

Safety and Toxicity

High-dose OKG administration (up to 30 g/day) in humans has not been shown to have harmful side effects. It is not known if chronic ingestion (>6-12 months) has any deleterious effects.

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