Expression of Plasma Chromogranin A Can Predict Intestinal Carcinoid Tumour Burden: Presented at ENETS

The presence of the plasma protein blood marker chromogranin A (CgA) has a high diagnostic accuracy in monitoring patients with intestinal carcinoid tumours, according to a study presented here at the 7th European Neuroendocrine Tumor Society Conference (ENETS).
Net, this simple blood test should be done and monitored on a going bases for NET tumors!

Article link below:

http://www.docguide.com/news/content.nsf/news/852576140048867C852576E60049BD67

American College Of Physicians Urges Congress To Vote "Yes" On Comprehensives Health Reform Legislation

READ THIS.......IT SHOWS MD ARE FOR HEALTH CARE!

FOR THOSE THAT YELL "SOCIALIZED MEDICINE"!!!1 "OH MY GOD"....

WHAT THE HELL IS MEDICARE AND PLAN A AND PLAN B? THE PEOPLE WE SHOULD KEEP HEALTHILY, ARE THOSE THAT WORK AND PAY INTO THE DAMN SYSTEM SO OUT SENIORS AND FOLKS LIKE ME, CAN ENJOY OPRAH AND OTHER IMPORTANT THINGS AND HAVE MEDICAL CARE!!!!!!



American College Of Physicians Urges Congress To Vote "Yes" On Comprehensives Health Reform Legislation

Second Opinions with Carcinoid Cancer- my opinion & link to what happened to me and why I am telling you this! LEARN FROM MY MISTAKES READERS. (this is a reprint from 2008)

Second Opinion with carcinoid cancer?

My take on the matter.....

I recently read this posting on board site:

"-- My husband was first diagnosed with carcinoid cancer > in 2000 . .......which revealed that > the cancer had metastatic to the liver. We were > told that he has non secreting tumor and that is why > the test result were normal. ... should I get a second opinion  from the Cleveland Clinic."

This is a fundamental question and one which I had problems with at the beginning of my cancer. I tired to respond to the individual on the site which was too large for the site and never posted.....so I am posting it on this site. I hope it helps.....

BTW, I am listening to a webinarie by "An Evening With Bernie: Be Empowered Through The Holidays"...interesting but too be honest, I don;t believe much about "thinking about myself being cured and badda bing, done"! Maybe on Meyers Briggs personality test I am rated as a strong "I S T J" (for those that know about this) and have a hard time with this type of thing...here's a quote from the webenaire "you are what you is you aren;t what you aren;t what you is" or something like that......sorry but it does not work for me.....black raspberries and pazopanib 800mg is "what it is" in delaying with the beast within....not a mantra and good thoughts....sorry sir....there are some good thoughts on the discussion--manage your disease! Some people will love this...I wish them luck and as he says "give it a chance"....

In any event, here is my response to the question on the lady about second opinion when cancer comes into your life:
--------------------------------------------------------------------------------------------------------

I hope this is not too long a message, probably is, but you, and your status and question are where all
of have been sometime in our life......."you have cancer and you have to do X right away!". It’s a
pretty horrible time in one’s life, and something we will never forget! I live in the Midwest. Although Cleveland Clinic does not get a lot of press relative to carcinoid, it is an excellent hospital, especially in the areas of surgery, specifically with kidney surgery (they were one of the first to do nephron sparing surgery). There are doctors that treat carcinoid at the clinic, and surgeons who are very good. That is very important in your fight! The MD surgeon you are considering using, Dr Allan Siperstein, is well known as an excellent liver surgeon. He is a good choice

Relative to a second opinion, you should strongly consider this in your case..... I am a firm  believer, a converted believer, in second, and third  opinions, even if you have a carcinoid  specialist....... TAKE RESPONSIBILITY FOR YOUR DISEASE, TREATMENT AND YOUR TEAM.....its part of good medical practice and management of the disease and this should be supported by your MD’s.

In Ohio, there are a lot of people who see by Dr Manisha Shah, an oncologist who works in James
Arthur Cancer Center in Columbus Ohio. She specializes in carcinoid/NET tumors. She may be someone you could visit prior to the surgery, just to make sure the plan you currently have is consistent, and aligns with her opinion (she may send you to the OSU surgeon for further review).

Also, please note, I went to a carcinoid expert from 2002 - 03 and  after 2 years & and 3 surgeries, I decided it was time to start getting second and third opinions, when a third operation was suggested 3 months after the prior one. This disease is very rare, and therefore, approaches and treatments aren't as standardized as in other cancers. Also,when you go off for a second opinion, don't be surprised that you may get a different approach/opinion, even from the carcinoid experts themselves. At times, there are many different ways
to get at the "beast" in your body- surgery, surgical techniques, systemic treatment, approaches, etc, and you will receive different opinions, even  within the carcinoid circles themselves.
As an example, in my specific case, I went to four of the top carcinoid MD's-- in 2004 for opinions. To my surprise, I received, more or less, 4 different options for the treatment/surgical for my very rare renal carcinoid (to be clear, most of the differences were in the area of surgical  techniques-- what to operate, how much, and use, or not to use, onco lab (some believe, some don't), Sando during surgery, use of neo probe during surgery (oh I wish they would have used this!) and lastly, whether to operate or not).

There was nothing wrong with different opinions, as all are experts, and have specialties and techniques which have worked for their particular practice and experience in the past. However, to note, it can become very confusing, and terribly difficult, when you are trying to choose the right option.....

The good part  about all this is, that you get options, which beat NO OPTIONS! But be prepared and bring notes and pre written questions- who what where when why and then ask again.....and maybe a third time....ask cacinoid questions to the surgeons (STUDY) to see how much they know--- for example, I asked the question "if the Octreoscan lights up, and nothing shows up on on CAT or MRI, how do you handle it???--> Dr in LSU was all over this and his response and procedure was very good, the MD someplace else needed to see something on CAT/MRI or they did nothing......(so that tells you "what"? Dr. in Nola knew carcinoid and tools, & the ones I was using not as much....therefor, my 2 surgeries were not as effective as they should have been, and I lost out on options and readings the Octreoscan was giving us.....DO YOU GET IT!?!?!---> STUDY AND DO YOU HOMEWORK, ASK QUESTIONS, ONCE YOUR SATISFIED WITH THE TEAM, THEN SUPPORT THEM AND LET THEM AT YOU!

What is 100% important, and something you have to verify, then revivify, is the quality, knowledge,experience and understanding of the surgeon(s) which  the carcinoid oncologist is sending you to for surgery (if they recommend surgery).  What you should be looking for is:

1) The experience with carcinoid surgery for the surgeon and his team?

2) Knowledge of carincoid surgery, and how they plan leverage the tools and scans during and before surgery (for example, do they know what an Octreoscan is?). Do they understand and work with an Octreoscan-- what if something lights up in the

Octrescan and does not show up in CAT or MRI (as what happened to me?)-- what are they going to do? Have they worked with tools such as neo- probe (sic?) during surgery, etc? Will they give you a Sando injection prior to the surgery?

3) What is the relationship between the carcinoid oncologist and the surgeon(s)? Do they communicate and how well? What you would love to see happen, is to have them all talking your case in front of you, as a team, with the x-rays and pictures in front, and brainstorming back and forth in a collaborative and supportive, team oriented manner

You will want the experienced carcinoid oncologist working in "lock step" with the surgeons and his team in all areas, and they’re somewhat aligned on procedure, scan and test data, and have addressed what they will do. To note, in some  cases, you won’t get all the answers as the surgeons may have to "open you up" and get in there to see exactly what is needed. In the end, it's the surgeon who has the “r” for you, once you go under, but, you would like to see good, effective teamwork between them and the carcinoid oncologist.

4) Finally, after surgery, what are plans to be seen going forward? You need to have a carcinoid oncologist who will be seeing you long term.....I believe this relationship is very important and will probably become a lifelong one (be prepared to buy them a friendship ring or bracelet or something...:). Make sure that once the tumors are addressed via surgery, you then have a very, very good carcinoid  expert working with you going forward--- he will then take over and play point on pathology interpretation, lab tests, set up on-going exams and markers, other scans, additional surgeries and systemic treatments options, etc. You will become
joined at the hip with the MD.

Final thoughts on a second opinion (I promise!), there are some oncologists that will do a second opinion remotely-via mail and PC- you send them your  scans, reports, everything, and they will call you with their opinion (and your surgeon). Dr.Warner in New York, does this (did it for me). Many others do it also. Also, make sure the carcinoid MD that you eventually select and use, will work with your regular local oncologist. I live in Ohio and we do not have any carcinoid experts in the city. People around here mainly drive to Columbus and see Dr Shah if they want to be seen locally. I have seen have seen her locally. I know am being treated by a German MD and a local onoclogist working with him.

I was on currently on an experimental treatment, and travel to Houston, Texas MDAnderson CC monthly, and work with Dr , and locally with ither Dr. for a while . This all stopped in Febr 2009 and I needed to find a solution quickly.
NOTE: I NO LONGER AM ON TBHE STUDY, I AM GOING THRU PRRT THERAPY IN GERMANY BAD BERKA CLINIC SINCE MAY 2009.

With this disease, traveling becomes part of your  life, and part of the "cash burning" which comes with it. (btw, I am preparing a "bail out" funding plan which I want to present to congress to see if I (we) can get some type of relief for our disease treatments....the money spent monthly in battling this disease is large……and our government seems to  be handing out cash to folks in need--- so, just imagine, if I (and others) cannot continue treatment and travel due to cash problems- what happens to the airlines, airports, rental carts, hotels, hospitals,scan and lab techs, nurses, MD's, pharmacy companies, etc, etc, the list goes on……mind boggling. So I, and many others, should be due something, I think to ask for relief and help from the US Government!

If you decide on seeing Dr Shah, I understand she will work with your local oncologist on a going basis, so seeing her prior to surgery would be a prudent thing to do. If she and her team are aligned with the surgical option and approach, I think the surgeon at Cleveland Clinic (Siperstein)is an excellent choice, you can ask her..
This decision and procedure you are about to undertake is one of the most important decisions you will ever make (#1 is your choice of a spouse, I believe!, or is it the purchase of a flat screen TV?!?!?:)).

If you have carcinoid, you have time, so use it to get that second opinion from someone on the top of the carcinoid list. Tell Dr Silverstein and your local MD what you are doing ahead of time. The surgeon and MD should be very supportive. He and the oncologist you are working with (or plan to work with) should then communicate during and after your appointment,

as to surgery, procedure and next steps-- especially if something is “funky” – e.g., on the Octrescan, and not seen on MRI and CAT, with the second opinion doc.
Once the surgery is over, you can then use a local carcinoid md or them or another and use LD, , into your primary carcinoid team (albeit long distance, but everything is travel able, unless you are going to Cuba- which one day I want to visit the place of my youth, and also

investigate this scorpion venom treatment...!, or North Korea, which I would also love to visit, but afraid that I may get shot if I walk down the wrong beach, innocently betraying the "Great Leader's" trust in staying on the appointed tourist trail....)

Finally, take care and try to relax (I hope you are not in pain)..... I went through the same thing when it happened to me....we heard we have to operate right away, no time to waste, I needed to operate right now, no time to waste "ahora mismo", I was

told......... It was a very nerve wracking, unsettling and I was lost and confused, and I didn’t even know I had cancer then. I never got a second opinion until it was too late! I should have, I made a big mistake.

Sue, one of the best things you have done is you and your husband have found the ACOR site, in addition there are a number of carincoid foundation web sites  (link on my blog), which you should start getting in to and reading and learning about this thing right away. There are many good sites for support and questions. You can find the links on the right side under BOARDS.
 You will make it.........and you started off right by asking the right questions and have a game plan. I did not have this option when I started.

I am attaching another older link, which is from 2 years ago and when I was still much bitter than I should have been, but if you cut thru the bitterness, if describes what happened to me, and why its important to get opinions and to then ensure a professional, trained and lock step team working in tandem on you case!

http://www.renalcarcinoid.com/2008/09/tumors-starts-to-progress-on-862008.html

Best of luck and sorry for the long write up......finally, DONT LOOK JUST AT US BASED md'S FOR SECOND OPINIONS. BAD BERKA, UPPSALA SWEDEN ALSO OFFER VERY GOOD SECOND OPINIONS.  THEY ALL HAVE CONTACT INFO AND UPPSALA A WEB SITE.

TAKE CHARGE OF YOU DISEASE, WORK WITH YOUR MD HOWEVER, ALWAYS GET SECOND AND THIRD OPINIONS WHEN THINGS BECOME "DICEY" AND YOU FEEL, GET THE GUT FEELING, THAT YOU SHOULD BE SEEING OTHERS.

ALSO, BE CAREFUL WITH OUT OF NETWORK FEES AND WHAT IS BEING PAID AND WHAT IS NOTE! i AM UNDER COLLECTION FOR A $580 1 HOUR APPOINTMENT. MY INSURANCE PAID $455, HOWEVER, I OWE $125. i BELIEVE $525 FOR A 1 HOUR DISCUSSION IS EXCESSIVE, I DID NOT DO MY HOMEWORK AND THEREFOR HAVE EL PASO COLLECTIONS CALLING ME NOW!

LIFE WITH CANCER SUCKS! 

Daylight-saving time returns tomorrow at 2 a.m MARCH 14, 2010. - NYPOST.com & Link to revised post of the Cost of Therapies: PRRT vs US available therapies; my treatment summary!

Daylight-saving time returns tomorrow at 2 a.m. - NYPOST.com



A revised post on Cost of Therapies: (ignore the link title)
-this post outlines my therapies, and cost of PRRT vs other therapies in the USA. Read this!

http://www.renalcarcinoid.com/2010/02/bad-berka-trip-checklist-and-marriott.html

HEALTH CARE - COMPARE OUR SYSTEM TO THE REST OF THE WORLD AND VIDEO! THIS POST WILL TEACH YOU EXACTLY WHERE THE US IS AT COMPARED TO KEY COUNTRIES, AND HOW HEALTH CARE COSTS EFFECTS US BUSINESS--reprint

HEALTH CARE - COMPARE OUR SYSTEM TO THE REST OF THE WORLD AND VIDEO!

This is a REPRINT of an article I blogged about in Nov 2009! Since the FINAL VOTE is coming up on this important legislation, I think we should take a look at it again, and not be swayed by the special interest funded commercials we are hearing on radio, and seeing on TV and the Computer Web Sites...

Read, and MAKE UP YOUR OWN MIND ON WHETHER THIS SYSTEM WE HAVE TODAY, IN THE US, WHICH GIVES POEPLE OVER 65 HEALTH CARE FOR BASICALLY FREE, WHILE THE REST ARE OUT TO FEND FOR THEMSELVES, IS THIS THE BEST WAY TO TO THINGS!

IT SHOULD HELP YOU TO UNDERSTAND WHAT OTHER COUNTRIES DO AND HOW THEY MANAGE HEALTH CARE FOR EVERYBODY, NOT JUST THE ELDERLY OR THE RICH!
MAKE A DIFFERENCE, CALL YOU CONGRESS AND SENATE AND EXPRESS YOUR VIEWS TODAY!

HEALTH CARE - COMPARE OUR SYSTEM TO THE REST OF THE WORLD AND VIDEO!

I ran into this program this evening and found it on the Internet On PBS!.

It is incredible and outlines the heath care systems of the worlds most advanced countries, compares them to the United States system.

Could one actually learn by studying some of the these systems??

.......its incredible that in the conversation on health care reform, NOT ONE SENATE SUB-COMMITTEE OR TEAM OR CONGRESSPEOPLE HAVE NOT VISITED ANY COUNTRY,& SEE HOW OTHER SYSTEMS WORK, OR DON'T WORK....HELL THEY VISIT COUNTRIES ALL THE TIME FOR OTHER THINGS (i.e., boondoggles).

FOR THIS, THE MOST IMPORTANT REFORM TO DATE IN OUR GOVERNMENT, WE DO IT BY SAYING "NAHHHHH, AIN'T GOING TO LEARN ANYTHING FROM ANYBODY"!

ITS AMAZING, AT THE LACK OF UNDERSTANDING AND ARROGANCE WE CARRY IN THE USA......IT IS ALSO INTERESTING THAT NOT ONE "BIG PHARMA" ARE OFFERING TRIPS TO OTHER COUNTRIES TO LEARN FROM OTHERS AS THEY DO FOR "CONFERENCES".

TAIWAN DID IT AND NOW HAS A 1ST RATE HEALTH CARE SYSTEM.

ONE THING YOU WILL LEARN FROM THE VIDEO LINK,THAT IN ALL COUNTRIES THE SAME QUESTION WAS ASKED:

"DOES ANYONE FILE FOR BANKRUPTCY DUE TO HEALTH CARE EXPENSES OR ISSUES DUE TO ILLNESS OF A PATIENT"?

THE ANSWER IN ALL COUNTRIES IS NO! NO! NO! NEVER!

SECONDLY, DUE TO OUR LACK OF SYSTEM AND UNFAIRNESS, WE ARE RANKED #37 IN MEDICAL CARE, COMPARED TO OTHER COUNTRIES ACROSS THE WORLD!

PLEASE LOOK AT THIS VIDEO AND READ THE ARTICLE AND INFORMATIVE GRAPHS.

SEND THEM TO YOUR "TEA PARTY FRIENDS" SO THEY CAN LEARN SOMETHING ON THIS TOPIC, OR HAVE THEM CONTACT ME, AND I WILL SHOW THEM LETTERS, AND SCANS AND INFORMATION ON MY DENIALS... DUE TO "THE HELL OF A CHRONIC, RARE DISEASE". ITS A DAMN SHAME, AND SOMETHING I NEVER, EVER, NEVER WOULD HAVE BELIEVED COULD HAPPEN TO ME IN THIS COUNTRY.

I KNOW A LOT OF PEOPLE FROM OUT OF COUNTRY, ESPECIALLY FROM LATIN AMERICA, AND THEY ALL HAVE A MISTAKEN BELIEF THAT USA#1 IN MEDICAL WORLD!

WHEN I TELL THEM I AM GOING TO GERMANY FOR MEDICAL CARE, AND BEFORE THAT, I WAS PURCHASING CHEMO DRUGS, NOW APPROVED IN THE US, FROM A SMALL CENTRAL AMERICAN COUNTRY FROM 2006/7, THESE PEOPLE CAN NOT BELIEVE IT!

ITS WHEN I GO THROUGH THE "JOURNEY THROUGH HELL" IN DETAIL, DOES ONE START TO UNDERSTAND THE UNFAIRNESS (at times), COST AND COMPLEXITY OF THE SYSTEM --

NOTE--IF YOU ARE NOT COVERED BY GOVERNMENT INSURANCE SYSTEM-MEDICARE!---- ONCE YOU GET ON THIS YOU ARE IN MUCH BETTER SHAPE TO SOME DEGREE.

PLEASE TAKE A FEW MINUTES, SEE THIS VIDEO, READ WHAT I HAVE POSTED OR/AND THE LINK.

IT IS VERY INTERESTING AND "EYE OPENING" WITH RESPECT TO COST, METHODS AND MEDICAL CARE BETWEEN COUNTRIES.

GREAT WAY TO OPEN YOUR EYES AND LEARN!....ITS NEVER TOO LATE TO HELP PASS WHATEVER INFLUENCE, WHATEVER THE HELL THEY HAVE DEVELOPED, AS THE "USA HEALTH CARE REFORM"-- DEVELOPED IN A VACUUM. BUT ITS SOMETHING NEVERTHELESS...SOMETHING, ANYTHING, OTHER THAN THE "DENIAL INCS" AND THE COST PROHIBITIVE SYSTEM CURRENTLY RUNNING OUR HEALTH CARE SYSTEM, AND EVENTUALLY YOUR LIFE (OR DEATH)!

OUR SYSTEM WILL NOT BE ABLE TO CONTINUE THIS PROCESS FOR LONG, AS OUR AGING POPULATION, AND OUR GOVERNMENT,YES "TEA PARTY MEMBER", OUR GOVERNMENT, ARE MANAGING AND PAYING FOR THE PATIENTS HEALTH CARE, AT WHATEVER COST, AGE AND SITUATION OF THE PATIENT.

Here is the link!

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/

>>COURTESY OF FRONT LINE , THE LINK ABOVE, AND ON DETAILS OF THIS BLOG.

THE PROGRAM IS IN THE WEB SITE...WATCH IT....ITS AMAZING!!!!

LEARN, AND THEN IF YOU AGREE, HELP TO MAKE A DIFFERENCE AND A CHANGE IN THIS COUNTRY NOW! (MY CONCERN IS WHAT THE REFORM IS ALL ABOUT AND HOW "WATERED DOWN" IT WILL BE....?)

VISIT THE BLOG ENTRY I WROTE FROM AN ARTICLE ON "WHETHER OUR SYSTEM OF GOVERNMENT IS ABLE TO DEAL WITH COMPLEX ISSUES EFFECTIVELY?" THE ANSWER IS NO!

THIS IS THE MOST IMPORTANT LEGISLATION AND CHANGE THAT IS NEEDED FOR THE SURVIVAL OF OUR FORM OF GOVERNMENT, AND ECONOMIC SYSTEM, AS WE HAVE A "BOMB" HEADED OUR WAY--- AGING POPULATION, MASSSIVE IMMIGRATION, OUT OF CONTROL,  PEOPLE NOT INSURED DUE TO THE SYSTEM. 

TO NOTE, EVEN IF INSURED, IT DOES NOT MATTER IN THIS SYSTEM, ESPECIALLY WITH A CHRONIC DEADLY DISEASE. THE SYSTEM TAKES OVER, AND CLERKS LIKE "HEATHER" AT THE INSURANCE COMPANY, BEGIN TO MANAGE LIFE AND DEATH DECISIONS VIA ACCEPTANCE OF CLAIMS AND DENIALS.

Front line Report

==================================================================================

Each country has a health care system that delivers health care for everyone -- but with remarkable differences.

-Graphs: U.S. Health Stats Compared to Other Countries

-Health Care Systems -- The Four Basic Models

Summary of differences between countries below:

United Kingdom

An interview with an expert on the UK's system +Percentage of Gross Domestic Product (GDP) spent on health care: 8.3
Average family premium: None; funded by taxation.

Co-payments: None for most services; some co-pays for dental care, eyeglasses and 5 percent of prescriptions. Young people and the elderly are exempt from all drug co-pays.
What is it? The British system is "socialized medicine" because the government both provides and pays for health care. Britons pay taxes for health care, and the government-run National Health Service (NHS) distributes those funds to health care providers. Hospital doctors are paid salaries. General practitioners (GPs), who run private practices, are paid based on the number of patients they see. A small number of specialists work outside the NHS and see private-pay patients. (this was not allowed in Canada, it may have changed now)

How does it work? Because the system is funded through taxes, administrative costs are low; there are no bills to collect or claims to review. Patients have a "medical home" in their GP, who also serves as a gatekeeper to the rest of the system; patients must see their GP before going to a specialist. GPs, who are paid extra for keeping their patients healthy, are instrumental in preventive care, an area in which Britain is a world leader.

What are the concerns? The stereotype of socialized medicine -- long waits and limited choice -- still has some truth. In response, the British government has instituted reforms to help make care more competitive and give patients more choice. Hospitals now compete for NHS funds distributed by local Primary Care Trusts, and starting in April 2008 patients are able to choose where they want to be treated for many procedures.

Japan

An interview with an expert on Japan's system +Percentage of GDP spent on health care: 8

Average family premium: $280 per month, with employers paying more than half.

Co-payments: 30 percent of the cost of a procedure, but the total amount paid in a month is capped according to income.
What is it? Japan uses a "social insurance" system in which all citizens are required to have health insurance, either through their work or purchased from a nonprofit, community-based plan. Those who can't afford the premiums receive public assistance. Most health insurance is private; doctors and almost all hospitals are in the private sector.

How does it work? Japan boasts some of the best health statistics in the world, no doubt due in part to the Japanese diet and lifestyle. Unlike the U.K., there are no gatekeepers; the Japanese can go to any specialist when and as often as they like. Every two years the Ministry of Health negotiates with physicians to set the price for every procedure. This helps keeps costs down.

What are the concerns? In fact, Japan has been so successful at keeping costs down that Japan now spends too little on health care; half of the hospitals in Japan are operating in the red. Having no gatekeepers means there's no check on how often the Japanese use health care, and patients may lack a medical home.

Germany

An interview with an expert on Germany's system +Percentage of GDP spent on health care: 10.7

Average family premium: $750 per month; premiums are pegged to patients' income.
Co-payments: 10 euros ($15) every three months; some patients, like pregnant women, are exempt.

What is it? Germany, like Japan, uses a social insurance model. In fact, Germany is the birthplace of social insurance, which dates back to Chancellor Otto von Bismarck. But unlike the Japanese, who get insurance from work or are assigned to a community fund, Germans are free to buy their insurance from one of more than 200 private, nonprofit "sickness funds." As in Japan, the poor receive public assistance to pay their premiums.

How does it work? Sickness funds are nonprofit and cannot deny coverage based on preexisting conditions; they compete with each other for members, and fund managers are paid based on the size of their enrollments. Like Japan, Germany is a single-payment system, but instead of the government negotiating the prices, the sickness funds bargain with doctors as a group. Germans can go straight to a specialist without first seeing a gatekeeper doctor, but they may pay a higher co-pay if they do.

What are the concerns? The single-payment system leaves some German doctors feeling underpaid. A family doctor in Germany makes about two-thirds as much as he or she would in America. (Then again, German doctors pay much less for malpractice insurance, and many attend medical school for free.) Germany also lets the richest 10 percent opt out of the sickness funds in favor of U.S.-style for-profit insurance. These patients are generally seen more quickly by doctors, because the for-profit insurers pay doctors more than the sickness funds.

Taiwan

An interview with an expert on Taiwan's system +Percentage GDP spent on health care: 6.3!

Average family premium: $650 per year for a family for four.

Co-payments: 20 percent of the cost of drugs, up to $6.50; up to $7 for outpatient care; $1.80 for dental and traditional Chinese medicine. There are exemptions for major diseases, childbirth, preventive services, and for the poor, veterans, and children.

What is it? Taiwan adopted a "National Health Insurance" model in 1995 after studying other countries' systems. Like Japan and Germany, all citizens must have insurance, but there is only one, government-run insurer. Working people pay premiums split with their employers; others pay flat rates with government help; and some groups, like the poor and veterans, are fully subsidized. The resulting system is similar to Canada's -- and the U.S. Medicare program.

How does it work? Taiwan's new health system extended insurance to the 40 percent of the population that lacked it while actually decreasing the growth of health care spending. The Taiwanese can see any doctor without a referral. Every citizen has a smart card, which is used to store his or her medical history and bill the national insurer. The system also helps public health officials monitor standards and effect policy changes nationwide. Thanks to this use of technology and the country's single insurer, Taiwan's health care system has the lowest administrative costs in the world.

What are the concerns? Like Japan, Taiwan's system is not taking in enough money to cover the medical care it provides. The problem is compounded by politics, because it is up to Taiwan's parliament to approve an increase in insurance premiums, which it has only done once since the program was enacted.

Switzerland

An interview with an expert on Switzerland's system +Percentage of GDP spent on health care: 11.6

Average monthly family premium: $750, paid entirely by consumers; there are government subsidies for low-income citizens.

Co-payments: 10 percent of the cost of services, up to $420 per year!
What is it? The Swiss system is social insurance like in Japan and Germany, voted in by a national referendum in 1994 (why don't we do the same, vote on this via referendum?? IT WOULD BE A MINI STIMULUS PLAN WITH THE SPENDING ON ADS AND SUCH).
Switzerland didn't have far to go to achieve universal coverage; 95 percent of the population already had voluntary insurance when the law was passed. All citizens are required to have coverage; those not covered were automatically assigned to a company. The government provides assistance to those who can't afford the premiums.

How does it work? The Swiss example shows that universal coverage is possible, even in a highly capitalist nation with powerful insurance and pharmaceutical industries (*this is the HQ of company Novartis Pharma, which is one of the biggest pharma companies in the world, and is the major pharma company in NET tumors)
Insurance companies are not allowed to make a profit on basic care and are prohibited from cherry-picking only young and healthy applicants. They can make money on supplemental insurance, however. As in Germany, the insurers negotiate with providers to set standard prices for services, but drug prices are set by the government.
What are the concerns? The Swiss system is the second most expensive in the world -- but it's still far cheaper than U.S. health care.

Drug prices are still slightly higher than in other European nations, and even then the discounts may be subsidized by the more expensive U.S. market, where some Swiss drug companies make one-third of their profits (please note this, an example of this is the carcinoid drug sandostatin. The cost in the USA, $7-$15K per injection of LAR30 monthly, the cost anywhere else in the world $3K.)

This is very important PIECE OF DATA, as WE- YOU AND ME, OUR COMPANIES, and/or our Government, subsidizes cheaper drugs for the rest of the world....!). How about if we did this for appliances, cars, etc...would be feel the same and not do something about it? I don't think so!

THIS HURTS US BUSINESSES TRYING TO COMPETE!

In general, the Swiss do not have gatekeeper doctors, although some insurance plans require them or give a discount to consumers who use them.

LINK FOR GRAPHS HEALTH CARE STATS COMPARED TO OTHER COUNTRIES (URL BELOW, click below)
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/etc/graphs.html

FOUR BASIC MODELS (URL BELOW)

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/models.html

One of the four basic systems, "the out of pocket system" is generally where the USA is at.
Some summary data from the link above (go to it and read it!)

"These four models should be fairly easy for Americans to understand because we have elements of all of them in our fragmented national health care apparatus. When it comes to treating veterans, we're Britain or Cuba. For Americans over the age of 65 on Medicare, we're Canada. For working Americans who get insurance on the job, we're Germany."

"For the 15 percent of the population who have no health insurance, the United States is Cambodia or Burkina Faso or rural India, with access to a doctor available if you can pay the bill out-of-pocket at the time of treatment or if you're sick enough to be admitted to the emergency ward at the public hospital."


"The United States is unlike every other country because it maintains so many separate systems for separate classes of people. All the other countries have settled on one model for everybody. This is much simpler than the U.S. system; it's fairer and cheaper, too".

NETs Patient Misdiagnosis- NEED YOUR HELP- This is a poll from CNETS Singapore leader Bill Claxton. Please help in completing!

 Bill recently wrote me regarding a poll he is undertaking to help in understanding NETs Patient Misdiagnosis and is looking for participants. The poll takes minutes to complete and will deliver useful information for MD and patients in the future.

The information and link is below. The web site and foundation which Bill leads. The link is  http://www.cnets.org/

It is an excellent site and has tons of information and conferences vidoes set up to servce the Asia Pacific region.

I recommend you to visit (and save) this site.

Objective of the Poll

The objective of the snap poll (link below) is to get information on the misdiagnosis of carcinoid/neuroendocrine disease. It will outline if a pattern exists, and what is the data relative to the misdiagnosis, This could help patients and MD's in the future, as they are diagnosed with issue X, all the while the patient continues to encounter problems. It could get one to the right diagnosis quicker! 

But, they need your help in completing this poll. 

REQUEST FOR DATA

If you have carcinoid/NET tumor and were misdiagnosed, please complete the the poll from the link below. It takes minutes and the results will be shared and useful to many! 

If you have any questions on this, you can contact Bill via the address on the CNETS web site above.

POLL

GEP NETs (http://tinyurl.com/gepnets) accounts for the majority of cases and is perhaps the type of neuroendocrine disease which is most easily screened. However we know relatively little about which types of patients would benefit from screening with, for example, Chromagranin A testing.

Carcinoid Neuroendocrine Tumor Society (a support group in Singapore) created a snap poll on NET's Patient Misdiagnosis. The poll does not require personal information, asks only a single question and all the data which is gathered in the poll belongs to the community. You or anyone else can download the data in Excel format, to share it with your own support group, physicians or researchers.

The question asked in this poll is simple: 'FROM SYMPTOM ONSET UNTIL NET's DIAGNOSIS, WERE YOU MISDIAGNOSED AS HAVING IBS, CROHN's OR ANOTHER GASTRIC DISORDER?' -
Please note, a number of patients are SYMPTOMLESS and EXHIBIT NO TUMOR EFFECTS (CARCINOID SYNDROME). THE DISEASE IS USUALLY FOUND INCIDENTLY. THE POLL IS STILL VALID, AS IT WOULD BE FROM THE FIRST DAY SOMETHING WAS NOTED AS WRONG (ULTRA SOUND, SURGERY,  AND THE DIAGNOSES or CORRECT PATHOLOGY REPORT.


Answering this question takes less than a minute, and each respondent can add their own comments - perhaps to share their personal story of NET's misdiagnosis. It is open to NET's patients or their caregivers. Lungnoids or others can answer 'no' and then add a comment to describe their own misdiagnosis story.   I think you'll see that we can all learn something from this poll.

http://www.doodle.com/ine7qapt2fgp9i2n

Please participate in the poll and (if you are so inclined) invite other folks to participate. Thanks.