The providers, MDs and hospitals had no incentive to reduce unnecessary or redundant procedures. Additionally, healthcare consumers were not motivated to question the volume of care or its expense, as they did not pay the bill.

Medicine was treated more as an art with an individual perspective, which often led to expensive variations in treatment. As a result of treatment inconsistencies and expanding costs, healthcare in America came to an annual cost of more than $1 trillion.

In the progression of healthcare reimbursement, managed care was developed to attempt to control escalating costs. Managed care is a means of restricting care to usual and customary services by taking the physician out of the care decision. Care is based on predetermined contractual coverage, often dictated by a clerk.

Managed care limits the amount paid to the healthcare provider, often with the goal of maximizing the managed care organization’s profits. In essence, managed care created the environment of managing cost — not care!

While managed care was successful in managing costs, there were numerous consumer complaints regarding quality and limits on care. It is this disenchantment that is creating an opportunity for health clubs.

Shii Ann and Clay got further instructions to go to Chuay Gahn camp while Ken and Helen got a note to go to Sook Jai camp. Shii Ann learned about the monkey, Magilla, and thought their camp was just a wonderful thing.

Helen was quite impressed with Sook Jai’s shelter. “Wow! You guys built this?” And then she noticed the chicken, “You’ve got to be kidding me!” She also really liked how close the water hole was.

Ken stated to the cameras that he “listened. I didn’t tell her much because, let’s face it, this is my enemy.” Helen was also cautious in her responses. She didn’t want to give out any secrets to the “New York City cop.”

Meanwhile, Shii Ann makes a do-or-die strategic decision: she lays it all out on the table for Clay. “Well, you know what? Our tribe hasn’t got along since day one. I’ll tell you what. I’ll tell you the truth here.”

I’m not sure if this was strategy or just Shii Ann needing a release. She said to the camera, “because I’ve been so pent up for 18 days, I just spilled my guts.”

She blabs to Clay, “I’ll tell you right now what they’re saying. We keep our five and start voting out you guys. And if Ken wasn’t around, I wouldn’t be here.

Ken is the person who’s like, ‘You know what, that’s not fair. Why are you booting her out? She works hard.’ And Penny, by the way, is as sweet as she looks. I’ll tell you, she is the most manipulative player on our team.”

Clay shares their obvious strategy, “Well we’ve already said if we could get Jake on the older side and get one more person that he likes…”

The study authors, led by Thomas A. Pearson, M.D., from the University of Rochester School of Medicine, used data obtained from the multicenter Lipid Treatment Assessment Project, or L-TAP, to determine what percentage of patients who were receiving lipid-lowering therapy for elevated “bad” cholesterol (LDL-C) actually achieved treatment goals.

These goals were last outlined in 1997 by the National Cholesterol Education Program, which was established by the federal National Institutes of Health in 1983. The NCEP periodically issues revised cholesterol guidelines.

The almost 5,000 study patients were divided into three groups:
Low risk of heart disease, having less than two known risk factors for coronary artery disease, or CAD, and no history of the disease;
High risk of heart disease, having two or more risk factors, but no apparent CAD; and
Those with known CAD. CAD was diagnosed in those who had a history of heart attack, or had bypass surgery or angioplasty.

CAD risk factors include smoking, high blood pressure, diabetes, age, low “good cholesterol” (HDL-C), and family history of premature CAD. The study evaluated equal numbers of men and women, and the patients’ average age was 60.

The NCEP-recommended treatment goals for group-1 patients was less than 160 milligrams of LDL-C per deciliter; for group 2, it was less than 130 milligrams per deciliter; and for group 3, less than 100 milligrams per deciliter.

Surprisingly, only 18 percent of those with known CAD (group 3) were being treated with enough medication without a prescription to lower their LDL-C to the NCEP-recommended level. In group 2, only 37 percent of these high-risk patients had levels of 130 milligrams per deciliter or less, while in the low-risk group 1, the level of 160 milligrams per deciliter was attained in 68 percent. Overall, the success rate was 38 percent.

The success rate was higher in those patients who were treated with prescription drugs as opposed to diet alone, but was highest in those treated with both diet and drugs. Those who were treated with “statin” drugs had a greater rate of achieving NCEP goal levels of LDL-C than those who were treated solely with other drugs. The majority of physicians responsible for prescribing treatment for the study patients said they were aware of the NCEP guidelines, and they knew that lowering LDL-C was an important treatment approach to CAD prevention.

Why then is there such a low level of successful treatment for this very treatable condition? The drugs used most commonly and effectively, the statins, are generally quite safe and easily tolerated. It has been clearly established that cholesterol-lowering therapy reduces the occurrence of both initial and recurrent coronary events. Several studies over the past few years have yielded similar results: not enough is being done to lower elevated cholesterol levels.

The study authors have no easy answer, but theorize that one or more of the following factors may explain this situation: too low a dosage of drug, low drug efficacy, wrong choice of drug, and noncompliance with the prescribed regimen.

Youth. Incredibly, organizations that focus on children — including the National 4-H Council and the Children and Youth At-Risk Program of the University of Pennsylvania School of Social Work — were supported by tobacco funds.

What nice people those cigarette manufacturers are!

They manufacture a product that kills over 400,000 Americans each year, and they they give away hundreds of millions of dollars to good causes.

While Dr. Siegel’s new report does not go beyond documenting the extent of philanthropy from cigarette manufacturers, a 1990 report by Larry White, published by the American Council on Science and Health, did look at the dilemma, “The Ethics of Accepting Tobacco Money.” Mr. White acknowledges that the recipients of tobacco money customarily engage in “good works.” And it might be argued that the value of those good works outweighs any ethical considerations about taking tobacco money.

Yet, there is broad agreement that money from certain sources should not be deemed acceptable for funding even good work. For example, few if any charitable institutions would knowingly accept money from the mafia. Why? Because accepting it would make them an accomplice to the immoral actions of the donor. A recipient of such funds also might feel obligated not to offend the donor for fear of losing future funding.

Further, it is evident that in receiving money, an organization or researcher or a performing artist is bestowing something on the giver — in this case, the cigarette company. When Philip Morris sponsors an event at the Metropolitan Museum of Art, some of the museum’s legitimacy rubs off on the cigarette maker. As Mr. White noted, “When Harvard University accepts an R.J. Reynolds grant, RJR acquires a little chunk of Harvard’s credibility.”

There is a particular cruel irony in Big Tobacco’s support of organizations that serve youth, minorities and women — three groups the cigarette manufacturers are targeting for cigarette sales, thus imperiling their health and life.

As Mr. White concluded, “Whatever good tobacco industry philanthropy does is more than offset by the vast toll in human suffering caused by smoking their products. Tobacco industry giving is not politically neutral. It is intended to promote an industry whose product kills hundreds of thousands of Americans each year.”

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In a new and comprehensive report entitled “Tobacco Industry Sponsorship in the United States, l995-l999,” Dr. Michael Siegel of the Boston University School of Public Health documents — in a systematic and comprehensive way — corporate sponsorship by tobacco companies during that five-year period. Specifically, Siegel identified 304 tobacco company sponsorships of events, programs or organizations in the following areas:

AIDS. Tobacco companies provided funding to at least 42 different AIDS service organizations. The centerpiece of tobacco industry support for AIDS patients is Philip Morris with its sponsorship of the Positive Helpings program — support which provides money to aid the nutritional needs of people living with HIV.

Charities/Causes. Tobacco companies have supported a wide variety of general charities including: humanitarian organizations (Christian Relief Services), health and human services (including the American Red Cross of Louisville and Hospice groups) and disaster relief (Hurricane Floyd) — as well as legal services (Association of the Bar of the City of New York Fund).

Domestic Violence. Through the Doors of Hope initiative, Philip Morris provided grants totaling $2 million to 180 organizations across the country to support food and meals, emergency shelter, counseling and other aid to victims of domestic violence.

Education. The industry supported programs at colleges and universities across the country, including the Universities of Central Florida, Louisville, Kentucky, Rochester and Virginia, as well as Duke, MIT and North Carolina State University among others. The largest contribution identified was $3 million to the University of Louisville in 1996 for completion of a football stadium.

Environment. The industry supported organizations that promote the protection and restoration of water and land resources — and supported many environmental conferences, including the Drinking Water/Pollution Prevention Forum and the Keep America Beautiful national conference.

Festivals. The industry supported a multitude of festivals including the Kentucky Derby Festival and the Wisconsin Sesquicentennial.

Hunger. Tobacco companies made contributions to the efforts to fight hunger in the United States with donations to more than l00 local organizations, including the Helping the Helpers program, which provides donations under emergency circumstances to food pantry programs, soup kitchens and the elderly.

Minorities. The industry is a major giver to minority groups, particularly African-American groups, including the National Convention of the National Black Chamber of Commerce and art exhibits featuring African-American artists.

Performing Arts. Tobacco donations went to the John F. Kennedy Center for Performing Arts and the New York City Opera among many others.

Politics and Government. Dr. Siegel identified 12 events or organizations in this category, including sponsorship of trips to conferences and seminars paid for by tobacco companies. The tobacco companies also sponsored the Presidential and Vice-Presidential debates in 1996 and the annual meetings of the U.S. Conference of Mayors in l998 and 1999.

Sports. Tobacco companies sponsored a variety of sports events, including the Senior PGA Tour Vantage Championship.

Visual Arts. Among the most notable sponsorships here were the Brooklyn Museum of Art and the Cincinnati Art Museum.

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Many of these women will be treated with angioplasty, one of the most common non-surgical approaches to heart disease treatment available today.

Nearly 1 million angioplasties are performed each year and are becoming more common, according to the American Heart Association. They’re performed by interventional cardiologists and involve inserting a small catheter into an artery in the groin or arm and guiding it to the blocked artery. A little balloon on the catheter is then inflated, flattening obstructive, built-up plaque against the artery wall. It also is common for the physician to insert a stent, a tiny mesh coil that stays in the artery and props it open to prevent reclosure.

Prior to angioplasty, the only treatment for blocked arteries was bypass surgery — a major surgical procedure. Angioplasty is performed under light sedation, and the patient typically goes home the same day.

The risks of angioplasty are small, but real nevertheless. There is less than a 5 percent chance of heart attack or emergency bypass surgery, and the risk of fatal complications is less than 2 percent.

Other, less common ways of treating arterial blockages without surgery include directional atherectomy and rotational atherectomy, in which small instruments cut out, or pulverize, blockages. Lasers can also be used to destroy plaque buildup.

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Taking the wiggle out of a sperm’s tail may be key to creating a new contraceptive that doesn’t involve hormones and can be taken by either a man or a woman, say scientists in Boston.

A protein that makes it possible for the sperm to swim to the egg can be switched off — at least in mice, which makes them infertile, say the Harvard Medical School researchers.

Along with the allure of a unisex contraceptive, another plus is that the method uses no hormones, which have been linked to side effects in oral contraceptive pills, implants and injections for women.

But it’s a tossup as to whether men would embrace such a contraceptive, says one reproductive biology expert.

In the Oct. 11 issue of Nature, researchers describe a protein that controls the whip-like movement of sperm tails, which normally allows the male reproductive cell to travel into the female reproductive tract in search of a fertile egg.

When that protein is switched off, the sperm tails lose their lash, meaning they can’t get to the ovum for fertilization to take place.

The discovery was made by a team of neurobiologists and cardiovascular scientists from Harvard Medical School studying ion channels, which are involved in the electrical activities of cells. While searching for ion channels that allow calcium into cells, they found an unusual channel, which they named CatSper.

“The most surprising part was that it was only in the sperm tails,” says David Clapham, a professor of cardiovascular medicine and neurobiology who led the research. When they deleted the gene for the CatSper protein channel in a group of mice, the mice were infertile. “The [sperm] can’t swim as well, and they can’t penetrate the coating of the egg,” he says.

In every other way that the scientists could detect, the mice were normal, although Clapham notes that the team could not test the animals’ psychiatric health. “But since the protein is only in the sperm, then you wouldn’t predict that you’d have any other effects.”

David Garbers, the director of the Cecil H. and Ida Green Center for Reproductive Biology Sciences at the University of Texas Southwestern Medical Center in Dallas, says that because the protein is located only on sperm tails, it’s an ideal target for drug therapies.

Clapham says that the goal will be to develop a drug that can block the protein channel temporarily. Alternatively, he says, it may be possible to increase the activity of the protein channel to increase sperm motility, which Garbers says could potentially help some men with fertility problems related to sperm mobility.

Moreover, a therapy that blocks the channel could be taken by either a man or a woman, says Clapham. “Sperm are deposited in the vagina, and any drug that was circulating in a female could also get to the sperm through the tissues.”

Garbers says that a female version could work as a local therapy, such as an intrauterine device that releases a compound that blocks the channel.

Or ideally, Clapham adds, it could be something taken as a pill. “If you had a pill that worked, then you’d have an easy contraceptive that didn’t have all the side effects that current hormonal contraceptives have,” says Clapham. “Hormonal therapy — progestin and estrogen — affect all tissues and have to be taken long term, every day. This could be taken just around the time of sex, and then it would not have to be taken for very long.”

But whether men would enthusiastically use this theoretical contraceptive is another issue, Garbers adds. “Up until a year or a few years ago, I think it’s safe to say that no woman in her right mind would trust a male who said he was on the pill,” he notes.

But he points out that studies have suggested that roughly 60 percent of men would like a male contraceptive, and that recent paternity cases involving DNA analysis are making some men more aware of their contraceptive options.

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The amount of responsibility you have is going to make this very difficult for you and everyone concerned. Make sure you have all of your bases covered thoroughly. The amount of guilt laid down on me at that time was incredible. By the time I was getting ready to depart I felt I was doing the workload of two people. What about Kathleen? Have a breakdown on your own time. I was about to do just that.

Leaving that morning was hard. The kids were crying and my man was not helping the situation. He was the biggest child of them all in his indirect way. Looking at it now, I think he was afraid that I might not come back. Strange how we all see things in different ways. He could see how far gone I was, even if I couldn’t. I was excited and scared to death in the same breath! The plane was in the air and I felt, for the first time in a long while, able to breathe. It took me the entire day to reach Santa Barbara and the White Lotus Retreat Center.

Placed at the top of the mountain pass overlooking Santa Barbara and the Pacific Ocean, the White Lotus Retreat Center is a oasis of beauty and calm. Immediately I felt at home. I have easily approached people my entire adult life, and this was a very approachable group. I was the wild woman on the mountain, my wonder woman cape and lasso must have been sticking out of my carry on. Confident, ready, fully bent on the mission at hand, I knew what I wanted and was ready to attain it. If I could just sit down and shut up it would be so much easier. Kathleen, you can do this, relax.

With the first sunrise on the mountain came an enormous headache I could not shake. This is what happens to a woman who drinks an average of one to two pots of coffee a day, and then suddenly has none. The problem was, I didn’t know I had the addiction until about the 3rd day when I was finally dying for a cup of joe and I put the two together. Day four, pain is finally gone. Life is good without caffeine.

After the withdrawal from caffeine the rest of the hurdles at the training didn’t seem so high. That was until I met Kathleen. The Kathleen that I had forgotten was around. What an amazing person she was. She and I needed to get to know each other. I spent the next 14 days getting to know as much about myself as I was learning about yoga. There were episodes of great joy and some with endless wells of tears. On more then one occasion I didn’t like what I saw in myself. Things needed to shift to a state of balance. It was time to start to walk the talk. Here marks the beginning of my new life’s journey.

My time at the White Lotus was too short. Re-entry into my real world was like a culture shock. Airports are not safe places for relaxed minds, unless you know how to deal with them. I didn’t have a clue at the time. I was almost in tears with delayed flights, blank faces, rude counter people and the like.

It took me all of about 4 hours to have my full suit of armor back on and completely polished. By the time I got to Green Bay I was exhausted. Being home with my family was wonderful. Sleeping in my own bed felt like heaven. The thought of monday morning and returning to work filled me with fear!

Upon my return to the office, I was greeted by a ransacked desk, a list of grievances the length of my arm, and a very whiny staff. It seems that no one was very happy with me being gone or being back for that matter. All the fires that are put out daily by one and all were left to burn in my absence. It is amazing how you can do your job for five years without a problem, leave for two weeks and all hell breaks loose. I obviously was incompetent. Right? Maybe…maybe not. By the end of the day I felt like I had been flogged to the bone. Of course it took me all of about two days to set the world straight, but the scar was deep. Those first few days back in my world let me know that this place and career was not where I belonged anymore. I started to question everything I did. Was this in line with what I believed to be right livelihood? All of the answers were coming up NO. For the next 9 months I planned my departure.

Or was it? There was a time, years earlier, that I would have run that meeting, with one foot on the same ladder, now all I wanted was OUT! Out to where, this is what I did, this was my career. Just shoot me, please, just shoot me!

After that meeting I was barely able to drive home. Something had snapped in me; I think I went slightly mad for a few moments. Red was the color of everything around me. There was such hostility in me I didn’t even recognize myself. My head spun. There was no consideration for a person’s life here! (Late for the baby sitter, sorry, sorry, sorry, I know I’m late, I couldn’t call, important meeting, went over. I know you have plans, sorry!) I managed to get home after running through a red light, with an angel on my shoulder, in rush hour traffic.

At last I was safe, home in my little nest. Home to those who love me, need me, care about me. Safe. I spent the next hour doing as much yoga as a woman who can’t turn her head can do. Yoga will help me, save me, bring me back to life. Move, breathe, stop thinking, stop sorting and mulling things over, move, breathe. Be still. Be quiet. Yes, I felt much better. Now I can function again. Until tomorrow? No, no I can’t keep doing this…

That day was a turning point in my life. It was a day pretty much a repeat of many before it. Tension, deadlines, conflicts, all right on cue. I used to thrive on it. I could do it all with one hand tied behind my back. Watch! Do a new layout? No problem! Need it by the end of the day? No problem! Change everything back to the original format? No problem! I had a marriage, kids, a career. I had worked my way through school and never stopped as soon as my foot went out that University door. Wonder Woman on parade, that’s who I was.

Everyone was so proud of me. The only child of 8 to get a college degree, yeah! So what changed me? There was such a contrast between the calm and quiet person I was and liked while I practiced yoga, and the wild woman in the nonstop push of corporate life. Or maybe burning the candle at both ends was burning me out as well. A few changes had to be made. What?

That next morning I made a phone call that changed my life. I enrolled in a yoga teacher training program for that coming summer. What was I doing? I didn’t know, but it felt so very right to me. For the past seven years I had been practicing yoga to help keep myself calm and in shape. Yoga had kept me from losing my mind on many occasions, and had helped me keep my head from being screwed on too tightly. I felt I was becoming pretty proficient at the practice and wanted to share it with other people. Yoga had done so much for me. Besides, I really needed to get away by myself. I had never done that before. It was time for me to grow wings.

Experiencing high levels of stress over a long period of time can cause people to lose sleep, eat when they are not hungry, constantly feel fatigued, have difficulty concentrating, and respond irritably to those around them. Long-term stress may cause headaches, skin irritation, ulcers, and diarrhea. When stress causes a person to overeat, weight gain is the consequence that, in turn, can damage self-esteem and make matters worse.

A Natural Response

Stress is a natural response that prepares our mind and body to deal with threats and challenges. Anything perceived as a threat or challenge can trigger the body and mind to respond. The fear of weight-control failure or self-criticism can cause increased stress. An example will help put these ideas into perspective.

The challenge of being placed in a high-risk situation can be stressful for people who struggle with their weight. Suppose you are invited to a company party where there will be a lot of high-calorie foods and alcoholic drinks. Furthermore, you have recently put on a few pounds, and your mother-in-law, who works for the same company, will be there. She always criticizes your eating habits and weight. You fear that your coworkers will pressure you to eat, drink, and have a good time, while your mother-in-law pressures you not to. Needless to say, you’re definitely not looking forward to the party. As the day of the office party gets closer, your body and mind begin to react to the fear of losing control at the party or of coping badly with the expected criticism. Your stress begins to spiral out of control. In this example, the threat is not the office party or even your mother-in-law. Rather, it is the hard work required to resist the pressure of your coworkers to eat at the party or of coping with your mother-in-law’s criticism and not eating to spite her. This results in your feeling that your coworkers, your boss, and others will look down on you for not having control and that your relations with your mother-in-law will get much worse, which affects your marriage. It’s the overwhelming challenge of this situation that produces stress, but you have the ability within you to reduce this stress.

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