J. Emilio Flores for The New York Times
Facing cuts in Medicare payments, Dr. David D. Richardson, an ophthalmologist in Los Angeles County, closed his practice last week to all but emergency patients and those needing surgery.

By Robert Pear, July 7, 2008, The New York Times — Congress returns to work this week with Medicare high on the agenda and Senate Republicans under pressure after a barrage of radio and television advertisements blamed them for a 10.6 percent cut in payments to doctors who care for millions of older Americans.

The advertisements, by the American Medical Association, urge Senate Republicans to reverse themselves and help pass legislation to fend off the cut.

How to pay doctors through the federal health insurance program is an issue that lawmakers are forced to confront every year because of what is widely agreed to be an outdated reimbursement formula. But the dispute, which showcases the continued potency of health care issues, has reached a new level of urgency this year. Some doctors are reassessing their participation in the program and powerful interests on all sides are in a lobbying frenzy.

Just before the Fourth of July recess, the House passed a bill to prevent the Medicare pay cut by a vote of 355 to 59. In the Senate, Republicans blocked efforts to take up the bill, so the cut took effect on July 1, as required by the formula. But the Bush administration has delayed processing of new claims to give Congress time to come up with a compromise.

Senator Harry Reid of Nevada, the majority leader, said he planned to force another vote this week, and Democrats pressed their case over the weekend in their national radio address.

Democrats need just one more vote to pass the bill, and they hope to win over Republicans who were hit by advertisements over the recess. The advertisements assert that Republicans have been protecting “powerful insurance companies at the expense of Medicare patients’ access to doctors.” The commercials were aimed at 10 Republican senators, including seven up for election this fall.

But President Bush has vowed to veto the bill, so the fight — and the uncertainty — could continue for weeks.

Mr. Bush and many Republicans oppose the bill because it would finance an increase in doctors’ fees by reducing federal payments to insurance companies that offer private Medicare Advantage plans as an alternative to the traditional government-run Medicare program.

Insurance companies and the White House argue that the bill would hurt beneficiaries who rely on private Medicare plans. America’s Health Insurance Plans, a trade group, ran television advertisements last week, urging Congress to “stop cuts to Medicare Advantage.”

Medicare is just one issue on which Congress is stalled. The Senate has yet to finish work on a bipartisan bill to help homeowners facing foreclosure. Lawmakers are also struggling with legislation to regulate electronic surveillance and deal with soaring gasoline prices.

But the Medicare issue has been a sticking point for years. The question is how to rein in the rapidly rising cost of the federal health program. Members of both parties say they want to change the formula, which defines a “sustainable growth rate” for spending on doctors. But Congress is nowhere near agreement.

The pending bill offers a short-term fix. It would reverse the 10.6 percent cut and increase Medicare payments to doctors by 1.1 percent in January. Under the current formula, doctors would still face cuts of more than 5 percent a year from 2010 to 2012.

Despite the president’s veto threat, many House Republicans bolted and voted for the bill, putting added pressure on their colleagues in the Senate.

As the maneuvering goes on in Washington, doctors around the country have begun to reassess their participation in Medicare.

Dr. David D. Richardson, 40, an ophthalmologist in Los Angeles County, closed his practice last week to all but emergency patients and those needing surgery.

“I love practicing medicine,” Dr. Richardson said, “but I would lose more money by keeping my office open than by pulling it back to a skeleton crew. Just like a physician in the emergency room, I try to reduce the hemorrhaging.”

In Topeka, Kan., Dr. Kent E. Palmberg, senior vice president and chief medical officer of the Stormont-Vail HealthCare system, said its 70 primary care doctors were “no longer accepting new Medicare patients as of July 1 because of the draconian cut in Medicare reimbursement.”

Dr. Gerald E. Harmon, a family doctor in Pawleys Island, S.C., said he decided last week that he would not take new Medicare patients “until further notice.”

“This is not what we enjoy doing,” says a notice in his waiting room. “It is what we must do to maintain financial viability.”

Dr. Harmon said that Democrats had been more helpful on Medicare legislation, but that the two parties shared responsibility for the impasse.

“Rome is burning, and Nero is fiddling away, trying to get re-elected,” Dr. Harmon said.

Doctors have also entered the political arena. One made a direct appeal to Mr. Bush at a fund-raiser last week in Jackson, Miss. Dr. J. Patrick Barrett, a spine surgeon and president of the Mississippi State Medical Association, said he had told Mr. Bush that the Medicare pay cut would be “extremely detrimental to the health and welfare of the elderly population.”

In an interview, Dr. Barrett said: “I lose money whenever I operate on a Medicare patient. In the last week, a number of doctors have told me they will quit seeing new Medicare patients or will cut back on the amount of Medicare work they do.”

The A.M.A.’s advertisements focus on Senators John Cornyn of Texas, John E. Sununu of New Hampshire and Roger Wicker of Mississippi, among others.

Republicans defend their position in various ways. Mr. Cornyn said the bill provided only “a patchwork fix.” Senator Charles E. Grassley of Iowa said Democrats were playing “partisan games.”

Senator Jon Kyl of Arizona, the Republican whip, said, “Nobody wants to cut physicians’ pay.” But lawmakers disagree over how to cover the cost of remedial legislation.

More than 10 million of the 44 million Medicare beneficiaries are in private Medicare Advantage plans offered by companies like Humana, UnitedHealth and Coventry Health Care. Many of these plans offer extra benefits like vision and dental care. But independent studies have repeatedly found that the private plans cost the government more per person than traditional Medicare.

Expecting the battle to resume this week, Coventry Health Care, in an e-mail message dated July 3, asked insurance agents across the country to call Congress and oppose the pending Medicare bill, saying that it would be “harmful to beneficiaries.”

On the other side of the issue, military families have joined doctors and AARP, the advocacy group for older Americans, in lobbying for the bill.

Relatives of active-duty military personnel, military retirees and their dependents receive care under a federal program known as Tricare, which uses the Medicare fee schedule to pay doctors.

When Medicare reduces payments to doctors, fees under the military program are also reduced, and it becomes more difficult for military families to find doctors.

Congress is “playing chicken with your health care,” the Military Officers Association of America told its members in a bulletin last week.

Medicare receives 15 million claims a week for services paid under the physician fee schedule, so any change in payment rates has big implications.

Michael O. Leavitt, the secretary of health and human services, said he would try to “minimize the impact” of the cut by instructing Medicare contractors to hold claims for 10 business days.

Kerry N. Weems, the acting administrator of the Centers for Medicare and Medicaid Services, said doctors would not be paid at the lower rates “before July 15 at the earliest.”

However, Medicare officials said, that is simply what the law requires. Under existing law, claims cannot be paid sooner than 14 days after they are received. And if claims are filed on paper, rather than electronically, they cannot be paid sooner than 29 days after they are received.

Want to do your body a world of good? It’s as easy as expanding your grocery list.

By Jonny Bowden PhD, Although some guys aren’t opposed to smoking some weed, most wouldn’t think of eating one. It’s a shame, really, since a succulent weed named purslane is not only delicious but also among the world’s healthiest foods.

Of course, there are many superfoods that never see the inside of a shopping cart. Some you’ve never heard of, and others you’ve simply forgotten about. That’s why we’ve rounded up the best of the bunch. Make a place for them on your table and you’ll instantly upgrade your health — without a prescription.


These grungy-looking roots are naturally sweeter than any other vegetable, which means they pack tons of flavor under-neath their rugged exterior.

Why they’re healthy: Think of beets as red spinach. Just like Popeye’s powerfood, this crimson vegetable is one of the best sources of both folate and betaine. These two nutrients work together to lower your blood levels of homocysteine, an inflammatory compound that can damage your arteries and increase your risk of heart disease. Plus, the natural pigments — called betacyanins — that give beets their color have been proved to be potent cancer fighters in laboratory mice.

How to eat them: Fresh and raw, not from a jar. Heating beets actually decreases their antioxidant power. For a simple single-serving salad, wash and peel one beet, and then grate it on the widest blade of a box grater. Toss with 1 tablespoon of olive oil and the juice of half a lemon.

You can eat the leaves and stems, which are also packed with vitamins, minerals, and antioxidants. Simply cut off the stems just below the point where the leaves start, and wash thoroughly. They’re now ready to be used in a salad. Or, for a side dish, sauté the leaves, along with a minced clove of garlic and a tablespoon of olive oil, in a sauté pan over medium-high heat. Cook until the leaves are wilted and the stems are tender. Season with salt and pepper and a squeeze of lemon juice, and sprinkle with fresh Parmesan cheese.


Absent from most American kitchens, this cruciferous vegetable is a major player in European and Asian diets.

Why it’s healthy: One cup of chopped cabbage has just 22 calories, and it’s loaded with valuable nutrients. At the top of the list is sulforaphane, a chemical that increases your body’s production of enzymes that disarm cell-damaging free radicals and reduce your risk of cancer. In fact, Stanford University scientists determined that sulforaphane boosts your levels of these cancer-fighting enzymes higher than any other plant chemical.

How to eat it: Put cabbage on your burgers to add a satisfying crunch. Or, for an even better sandwich topping or side salad, try an Asian-style slaw. Here’s what you’ll need.

4 Tbsp peanut or canola oil

Juice of two limes

1 Tbsp sriracha, an Asian chili sauce you can find in the international section of your grocery store

1 head napa cabbage, finely chopped or shredded

1/4 cup toasted peanuts

1/2 cup shredded carrots

1/4 cup chopped cilantro

Whisk together the oil, lime juice, and sriracha. Combine the remaining ingredients in a large mixing bowl and toss with the dressing to coat. Refrigerate for 20 minutes before serving. The slaw will keep in your fridge for 2 days.


Guava is an obscure tropical fruit that’s subtly acidic, with sweetness that intensifies as you eat your way to the center.

Why it’s healthy: Guava has a higher concentration of lycopene — an antioxidant that fights prostate cancer — than any other plant food, including tomatoes and watermelon. In addition, 1 cup of the stuff provides 688 milligrams (mg) of potassium, which is 63 percent more than you’ll find in a medium banana. And guava may be the ultimate high-fiber food: There’s almost 9 grams (g) of fiber in every cup.

How to eat it: Down the entire fruit, from the rind to the seeds. It’s all edible — and nutritious. The rind alone has more vitamin C than you’d find in the flesh of an orange. You can score guava in the produce section of higher-end supermarkets or in Latin grocery stores.

Swiss chard

Hidden in the leafy-greens cooler of your market, you’ll find this slightly bitter, salty vegetable, which is actually native to the Mediterranean.

Why it’s healthy: A half cup of cooked Swiss chard provides a huge amount of both lutein and zeaxanthin, supplying 10 mg each. These plant chemicals, known as carotenoids, protect your retinas from the damage of aging, according to Harvard researchers. That’s because both nutrients, which are actually pigments, appear to accumulate in your retinas, where they absorb the type of shortwave light rays that can damage your eyes. So the more lutein and zeaxanthin you eat, the better your internal eye protection will be.

How to eat it: Chard goes great with grilled steaks and chicken, and it also works well as a bed for pan-seared fish. Wash and dry a bunch of Swiss chard, and then chop the leaves and stems into 1-inch pieces. Heat a tablespoon of olive oil in a large sauté pan or wok, and add two garlic cloves that you’ve peeled and lightly crushed. When the oil smokes lightly, add the chard. Sauté for 5 to 7 minutes, until the leaves wilt and the stems are tender. Remove the garlic cloves and season the chard with salt and pepper.


This old-world spice usually reaches most men’s stomachs only when it’s mixed with sugar and stuck to a roll.

Why it’s healthy: Cinnamon helps control your blood sugar, which influences your risk of heart disease. In fact, USDA researchers found that people with type-2 diabetes who consumed 1 g of cinnamon a day for 6 weeks (about 1/4 teaspoon each day) significantly reduced not only their blood sugar but also their triglycerides and LDL (bad) cholesterol. Credit the spice’s active ingredients, methylhydroxychalcone polymers, which increase your cells’ ability to metabolize sugar by up to 20 times.

How to eat it: You don’t need the fancy oils and extracts sold at vitamin stores; just sprinkle the stuff that’s in your spice rack (or in the shaker at Starbucks) into your coffee or on your oatmeal.


Although the FDA classifies purslane as a broad-leaved weed, it’s a popular vegetable and herb in many other countries, including China, Mexico, and Greece.

Why it’s healthy: Purslane has the highest amount of heart-healthy omega-3 fats of any edible plant, according to researchers at the University of Texas at San Antonio. The scientists also report that this herb has 10 to 20 times more melatonin — an antioxidant that may inhibit cancer growth — than any other fruit or vegetable tested.

How to eat it: In a salad. Think of purslane as a great alternative or addition to lettuce: The leaves and stems are crisp, chewy, and succulent, and they have a mild lemony taste. Look for it at your local farmer’s market, or Chinese or Mexican market. It’s also available at some Whole Foods stores, as an individual leafy green or in premade salad mixes.

Pomegranate juice

A popular drink for decades in the Middle East, pomegranate juice has become widely available only recently in the United States.

Why it’s healthy: Israeli scientists discovered that men who downed just 2 ounces of pomegranate juice daily for a year decreased their systolic (top number) blood pressure by 21 percent and significantly improved bloodflow to their hearts. What’s more, 4 ounces provides 50 percent of your daily vitamin C needs.

How to drink it: Try 100 percent pomegranate juice from Pom Wonderful. It contains no added sugars, and because it’s so powerful, a small glassful is all you need. (For a list of retailers, go to www.pomwonderful.com.)

Goji berries

These raisin-size fruits are chewy and taste like a cross between a cranberry and a cherry. More important, these potent berries have been used as a medicinal food in Tibet for over 1,700 years.

Why they’re healthy: Goji berries have one of the highest ORAC ratings — a method of gauging antioxidant power — of any fruit, according to Tufts University researchers. And although modern scientists began to study this ancient berry only recently, they’ve found that the sugars that make goji berries sweet reduce insulin resistance — a risk factor of diabetes — in rats.

How to eat them: Mix dried or fresh goji berries with a cup of plain yogurt, sprinkle them on your oatmeal or cold cereal, or enjoy a handful by themselves. You can find them at specialty supermarkets or at gojiberries.us.

Dried plums

You may know these better by the moniker “prunes,” which are indelibly linked with nursing homes and bathroom habits. And that explains why, in an effort to revive this delicious fruit’s image, producers now market them under another name.

Why they’re healthy: Prunes contain high amounts of neochlorogenic and chlorogenic acids, antioxidants that are particularly effective at combating the “superoxide anion radical.” This nasty free radical causes structural damage to your cells, and such damage is thought to be one of the primary causes of cancer.

How to eat them: As an appetizer. Wrap a paper-thin slice of prosciutto around each dried plum and secure with a toothpick. Bake in a 400°F oven for 10 to 15 minutes, until the plums are soft and the prosciutto is crispy. Most of the fat will cook off, and you’ll be left with a decadent-tasting treat that’s sweet, savory, and healthy.

Pumpkin seeds

These jack-o’-lantern waste products are the most nutritious part of the pumpkin.

Why they’re healthy: Downing pumpkin seeds is the easiest way to consume more magnesium. That’s important because French researchers recently determined that men with the highest levels of magnesium in their blood have a 40 percent lower risk of early death than those with the lowest levels. And on average, men consume 353 mg of the mineral daily, well under the 420 mg minimum recommended by the USDA.

How to eat them: Whole, shells and all. (The shells provide extra fiber.) Roasted pumpkin seeds contain 150 mg of magnesium per ounce; add them to your regular diet and you’ll easily hit your daily target of 420 mg. Look for them in the snack or health-food section of your grocery store, next to the peanuts, almonds, and sunflower seeds.

Antioxidants, Explained

The science is clear: Plant foods are good for you. And the credit often goes to chemicals they produce called antioxidants. Just as the name suggests, antioxidants help protect your cells against oxidation. Think of oxidation as rust. This rust is caused by free radicals, which are unstable oxygen atoms that attack your cells, inducing DNA damage that leads to cancer. Thankfully, antioxidants help stabilize free radicals, which keeps the rogue atoms from harming your cells.

So by eating more antioxidant-rich foods, you’ll boost the amount of the disease-fighting chemicals floating in your bloodstream. The result: Every bite fortifies your body with all-natural preventive medicine.

Eight More Superfoods You Should Eat

Want to build more muscle, prevent disease, and live longer? It’s as easy as changing your diet: Take out the packaged, processed foods, and add fresh ingredients to your meals.

Try one of the recipes below tonight. They’re easy to prepare, and, unlike the “healthy” meals your mom used to make, they taste good.

SALMON – Baked Salmon with Oregano

BEANS – Barbecued Beans with Turkey Sausage

BLUEBERRIES – Blueberry Belgian Waffles

QUINOA – Southwestern Quinoa and Chickpea Salad

WALNUTS/ALMONDS – Apple Walnut Muffins Almond Macaroons

SPINACH – Baked Potato Gnocchi with Spinach and Ricotta

ARTICHOKES – Artichoke Salad

TOMATOES – Fresh Tomato Garden Soup

Jonny Bowden, PhD, CNS is a board certified nutritionist with graduate degrees in nutrition and psychology. Visit his Web site Jonny Bowden Solutions.

Some interesting information on goji berries (Tibetan and Himalayan) for your general consumption.


It is said that the goji vine has flourished in the Himalayan valleys since the beginning of time. The goji from the Himalayas is the true original.

We are not certain how goji got its name, but it has been suggested that it takes its name from Gojal, the part of the Himalayas that borders the Hunza valley.
Regardless of the origin of the name, what is certain is that the ancient Himalayan herbal practitioners shared their secrets with the Chinese, Tibetans, Indians, and others. Those who came to learn took goji home with them and planted it in their own valleys.

Another sign that the goji from the Himalayas is the original is that it contains every desirable trait in perfect balance. Its polysaccharide content is outstanding, its spectral signature is ideal, and it is a perfect receptacle for storing and transferring the energy of the sun.

The goji berry has undergone much research. What researchers discovered as they continued to research goji was that they had not just uncovered some ordinary plant or herb. They began to realize that the goji berry that originated in the Himalayas might be the most powerful and important natural health discovery ever made.

The one and only authentic Freelife Himalayan Goji Juice.

According to newly released data, in the July 2008 journal Perspectives on Psychological Science, people in most countries around the world are happier these days. It’s a surprising finding because it’s widely believed that it’s almost impossible to raise an entire country’s happiness 1) ___. The 2007 survey also provides a ranking of 97 nations containing 90% of the world’s population. The results indicate that 2) ___ is the happiest nation in the world and Zimbabwe the unhappiest. The US ranks 16th on the list, immediately after New Zealand. During the past 26 years, the World Values Surveys have asked more than 350,000 people how happy they are, using the same two questions. a) Taking all things together, would you say you are very happy, rather happy, not very happy, not at all happy? b) All things considered, how satisfied are you with your life as a whole these days? Combining responses to these two questions, the 3) ___ of subjective well-being was constructed that reflects both happiness and general life satisfaction. In the 52 countries for which a substantial time series is available (covering 17 years on average), this index rose in 40 countries and fell in only 12. The average percentage of people who said they were “very happy” increased by almost 7 points. Most earlier research has suggested that happiness levels are 4) ___. Important events like winning the lottery or learning you have cancer can lead to short-term changes, but in the long run most previous 5) ___ suggests that people and nations are stuck on a ‘hedonic treadmill.’ The belief has been that no matter what happens or what we do, basic happiness levels are stable and don’t really change. Fully as important as the fact that happiness rose, is the reason why. In recent decades, low-income countries such as India and China have experienced unprecedented rates of economic 6) ___, dozens of medium-income countries have democratized and there has been a sharp rise of gender equality and tolerance of ethnic minorities. Economic growth, democratization and rising social tolerance have all contributed to rising happiness, with democratization and rising 7) ___ having even more impact than economic growth. All of these changes have contributed to providing people with a wider range of choice in how to live their lives—which is a key factor in happiness. The people of rich countries tend to be happier than those of poor countries, but even controlling for economic factors, certain types of societies are much happier than others. The results clearly show that the happiest societies are those that allow people the freedom to choose how to live their lives. As an example, the researchers point to the tolerant social norms and democratic political systems in Denmark, Iceland, Switzerland, the Netherlands and Canada all of which rank among the 10 happiest countries in the world. The events of the past 25 years have brought a growing sense of 8) ___ that seems to be even more important than economic development in contributing to rising happiness. Moreover, the most effective way to maximize happiness seems to change with rising levels of economic development. In subsistence-level societies, happiness is closely linked with in-group solidarity, religiosity and national pride. At higher levels of economic security, free 9) ___ has the largest impact on happiness. Also noted is that the largest recent increases on the subjective well-being index, measuring both happiness and life-satisfaction, occurred in the Ukraine, followed by Moldova, Slovenia, Nigeria, Turkey and Russia.

ANSWERS: 1) level; 2) Denmark; 3) index; 4) stable; 5) research; 6) growth; 7) tolerance; 8) freedom; 9) choice

Target Health Inc. is pleased to announce the acceptance of a new manuscript to be published in the August edition of Monitor, publication of the American Society of Clinical Research Professionals. The paper, entitled: “The Impact of Electronic Data Capture (EDC) on Clinical Data Management – Perspectives From the Present Into the Future,” is co-authored with colleagues from Ferring (Silvana Cappi), Regeneron (Vadim Tantsyura and Doug Nadler), Averion International (Phil Lavin). Parexel International (Imogene Grimes), EDC Consulting (Kirk Mousley) and Target Health (Yong Joong Kim, Joonhyuk Choi, Jules Mitchel). Two book chapters are coming out soon on the topic of Phase 1/Phase 2 studies and Data Management.

For more information about Target Health or any of our software tools for clinical research, please contact Dr. Jules T. Mitchel or Ms. Joyce Hays. Our software tools are designed to partner with both CROs and Sponsors