Bank of America agreed to buy Merrill Lynch, it created a behemoth. Now comes Citigroup, which with Wachovia's banking assets (it's not buying Wachovia Securities, for example) becomes the leading U.S. retail bank with 9.8 percent U.S. market deposit share (you can't own more than 10 percent of U.S. deposits by law), and total deposits globally of $1.3-trillion.
It also means Citigroup will become the largest banking force in the state of Florida by absorbing Wachovia's extensive branch banking system in the state. Poor Wachovia branch employees were tapping their internal e-mail systems after 9 a.m. this morning, still waiting for an official word to the company's workers even as the Internet and TV news blared reports of the Citigroup takeover.
The biggest shock today will be in Charlotte, N.C., headquarters home to both Bank of America and Wachovia. With Wachovia soon to be back in the hands of a New York City bank, the gnashing of teeth by Charlotte's elite business leaders can be heard all the way to Tampa Bay. Not to excavate the Civil War yet again these days, but Charlotte (especially former Bank of America CEO and Force of Nature Hugh McColl) took great delight when the banking industry's assets concentrated in its town topped that of those Yankees up in New York. No longer.
We'll continue to explore the amazing implications of all these deals throughout this week.

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What does it mean? Retail health clinics—also known as convenient care clinics, mini clinics or in-store clinics—are small health-care facilities located in drug stores, grocery stores or big retailers like Target and Wal-Mart. They provide simple, nonemergency services to walk-in patients, regardless of insurance status. They are much cheaper than a traditional doctor's visit because they're generally staffed by nurse practitioners and/or physicians assistants. Retail health clinics have extended hours including nights, weekends, and sometimes even holidays. They charge a set price for common services, everything from sports physicals to treating ear infections. Currently, there are about 1,000 such clinics in the United States, according to the Convenient Care Association, but that number is expected to increase to as many as 1,500 by the end of this year.
Why the buzz? Back in July, Summer Kartchner was hiking in the mountains near Salt Lake City when a bee stung her on the hand. That night her entire hand began to swell and by Saturday morning she knew she needed to have it looked at. It hurt but she didn't think it was bad enough to justify a trip to the emergency room or a clinic, so she decided to try a retail clinic that had recently opened in her local grocery store. Summer got her hand examined within a few minutes and was prescribed an antibiotic to treat the sting. The whole thing took less than an hour and cost just $35, and even that was quickly reimbursed by her health insurance. It is rare to have such a positive experience with healthcare on both the provider and insurance side, she says.

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this awesome article the other day. Here are the highlights:

"People who want to live a long and healthy life might want to take up running.... A study published on Monday shows middle-aged members of a runner's club were half as likely to die over a 20-year period as people who did not run. Running reduced the risk not only of heart disease, but of cancer and neurological diseases such as Alzheimer's, researchers at Stanford University in California found. "At 19 years, 15 percent of runners had died compared with 34 percent of controls," Dr. Eliza Chakravarty and colleagues wrote in the Archives of Internal Medicine.


The team surveyed 284 members of a nationwide running club and 156 similar, healthy people as controls. They all came from the university's faculty and staff and had similar social and economic backgrounds, and all were 50 or older. Starting in 1984, each volunteer filled out an annual survey on exercise frequency, weight and disability for eight activities -- rising, dressing and grooming, hygiene, eating, walking, reach, hand grip and routine physical activities.

Most of the volunteers did some exercise, but runners exercised as much as 200 minutes a week, compared to 20 minutes for the non-runners.

People who took up exercise when they were older also improved their health, he said. The study also showed that people cannot use the risk of injury as an excuse not to run -- the runners had fewer injuries of all kinds, including to their knees.

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Antoin Rezko.

At the center of the fundraising is the governor himself, whisked into gatherings large and small to shake hands, spin a story and thank those who have paid hundreds or thousands of dollars to support him.

Pressed Tuesday about the fundraising bill that passed May 30, Blagojevich said it wasn't tough enough and signaled he wouldn't sign the legislation into law.

Donors to the governor say their contributions have no bearing on their state business. Still, some would welcome the ban.

It will be good for me, for purely selfish reasons, said Tony Karam, an executive vice president at Albert Benesch Co., a national consulting firm with a Chicago office that has had more than $40 million in Illinois Tollway and Transportation road contracts since 2003. I'd like to see it signed because it will save me money. We won't have to contribute anything. I wouldn't even have to entertain the idea of supporting him . . . or her or anyone.

Karam and his employees donated $24,500 in the last six months.

The events are kept quiet and closed to the public. They're usually sponsored by top state lobbyists who, like the governor, work to keep details a secret. The Tribune learned about several of the undisclosed fundraisers and showed up to document the story behind the bi-annual campaign ledgers that Blagojevich is required by law to file.

After a photo opportunity to support Mississippi River flooding victims, a state plane sped Blagojevich back to Chicago and his state SUV dropped him at the door of Carlucci's restaurant in Rosemont to meet with clients of a top fundraiser, lobbyist Milan Petrovic.

On a different June night, another top fundraiser and lobbyist, John Wyma, was waiting inside Chicago's trendy Naha restaurant when the governor balked at the sight of Tribune reporters and photographers outside. With his security detail running interference, the governor dashed through a crowd of amused passers-by and into the restaurant.

Behind the guarded gates of an Oak Brook estate, Blagojevich was the star of a fundraising barbecue thrown by one of the state's most successful engineering contractors.

Each of the three events was attended by state contractors. In June, state contractors accounted for at least $250,000 of the $650,000 in donations collected that month.

Blagojevich took in roughly $1.9 million in donations for the first six months of the year, and a Tribune analysis found at least $399,000 came from more than 125 state contractors or employees of state contractors who have been awarded more than $1.1 billion in state business since Blagojevich was first elected.

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The purpose of this article:
Many collectors now own one or more antique mercury barometers, or may have planned to one day, and I'd like to present another view of the public health issue so that they can make informed decisions. If you disagree with my conclusions, you have my email address.
In my own defense, I have no intention of dealing in something that harms people and I'll comply with the public health laws wherever I encounter them. So, amateur scientist that I may be, I've scoured the learned material on the Internet for the facts that contribute to my side of the controversy, just like everyone else does.
Who uses mercury, and how much of it?
Mercury is used all over the world for many manufacturing processes and in many manufactured items that the average person comes into contact with every day. (So why aren't we dropping over dead by the thousands from mercury poisoning, one might well ask?) According to the US Government's Environmental Protection Agency website, (latest figures are for 2001) the biggest users in order by quantity of the mercury consumed in the US are wiring devices and switches (largely the auto industry and climate control equipment such as your household thermostat) 42%, measuring and control devices 28%, dental amalgams 14%, electric lighting 9%, and the rest for "other". Mercury use in the US has dropped from 2,225 metric tons in 1980 to 245 metric tons in 2001 and is still dropping. Mercury is an element of which there is a finite amount and it is recovered and recycled aggressively, at least in this country. The quantity that is escaping into the environment, then, should also be dropping as time goes on.
I refurbish the antique barometers we sell and recharge their mercury systems with freshly processed instrument grade elemental mercury. The mercury I buy is shipped to me, specially packed and properly labeled as hazardous, by regular UPS service. Old, contaminated mercury that may have been in the barometers is collected and recycled through a mercury processing company. No mercury is lost or discarded from my shop. There is no federal government restriction on buying mercury. I purchase fresh, triple distilled, instrument grade mercury in 16-pound flasks, and one flask can often last me two years. I'm probably one of the more active of about twenty restorers of barometers in this country, so that should give some context for the comparative consumption level of the antique barometer industry. It's miniscule.

How do people come in contact with mercury?
Harm from mercury is highly dependent on how you come into contact with this element, what form it is in, and the length and concentration of the exposure. Quoting the US Geological Survey's web site on the subject of mercury contamination:
Humans generally uptake mercury in two ways: (1) as methylmercury (CH3Hg+) from fish consumption, or (2) by breathing vaporous mercury (Hg0) emitted from various sources such as metallic mercury, dental amalgams, and ambient air. Our bodies are much more adapted for reducing the potential toxicity effects from vaporous mercury, so health effects from this source are relatively rare.
The exposure to mercury from an antique barometer is the vaporous variety, not the biologically altered methyl mercury that exists in the food chain. Exposure through the food we eat comes mainly from the mercury that leeches out of toxic waste sites and landfills, then travels to the oceans and goes up the aquatic food chain. The biggest single source is seafood, and recent Department of Health warnings to pregnant mothers, among others, reflect this.
I could find no data that quantified the two main types of exposure, though the "relatively rare" quote for health effects from mercury vapor applies. Advances in modern times in the reduction of vaporous mercury from manufacturing, at one time the largest offender, have all but eliminated vaporous mercury as a threat.

How does mercury harm a person?
The media has demonized mercury to the point that it has become feared in the way that poisonous arsenic compounds or corrosive acids are feared. Well, not all the bad press is quite accurate (surprise!). You can hold liquid mercury from a barometer in your hand and it will neither burn your flesh nor ruin your lungs with its vapor, causing you to drop over dead.
The hazards to one's health come in various forms, and of course are more pronounced in children with their smaller body mass. Quoting again from the USGS web site, Fact Sheet 146-000 titled Mercury in the Environment:
The toxic effects of mercury depend on its chemical form and the route of exposure. Methylmercury [CH3Hg] is the most toxic form. It affects the immune system, alters genetic and enzyme systems, and damages the nervous system, including coordination and the senses of touch, taste, and sight. Methylmercury is particularly damaging to developing embryos, which are five to ten times more sensitive than adults. Exposure to methylmercury is usually by ingestion, and it is absorbed more readily and excreted more slowly than other forms of mercury.
Elemental mercury, Hg(0), the form released from broken thermometers, causes tremors, gingivitis, and excitability when vapors are inhaled over a long period of time.
"A long period of time" is months and years of high concentrations of the vapor (not the liquid), not minutes or hours in an open atmosphere. Regarding liquid mercury, the same Fact Sheet goes on to say:
If elemental mercury is ingested, it is absorbed relatively slowly and may pass through the digestive system without causing damage.
The California Poison Control System, on its web site, addresses exposure to liquid, elemental mercury (the type in barometers) with this statement:
Of all the forms of mercury, elemental mercury is the most commonly swallowed form of mercury, usually from a broken thermometer. Fortunately, elemental mercury from a thermometer is not absorbed from the stomach and will not cause any poisoning in a healthy person. In a healthy person, the slippery swallowed mercury will roll into the stomach, out in to the bowels and will be quickly eliminated without causing any symptoms. Handling liquid mercury for a very short period of time usually does not result in any problems. An allergic rash is possible, though. Mercury is not well absorbed across the skin so skin contact is not likely to cause mercury poisoning, especially with a brief one-time exposure. Even if a person has cuts in their skin, mercury is too heavy to be contained by a cut. Merely washing the wound well will wash the mercury out of the wound.
Now, I don't mean to let liquid mercury off the hook just because there is a more harmful form out there, but I do want to put the relative threats into context. The level of danger from handling liquid mercury, or being exposed to its vapor, is actually quite low, and EPA and OSHA controls over manufacturing and disposal have dramatically reduced the risk from "prolonged exposure" to mercury vapor in our time to the point that it is, and I quote again, "relatively rare." Antique barometers contain liquid, elemental mercury and are in the vapor emitting class of sources. Read on, if I haven't lost you by now.
How much mercury vapor does an antique barometer emit?
First of all, some of them emit none at all.

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The premise is incorrect. Our medical schools and residency training programs do not produce very many "autonomous, self-directed doctors." Our training programs produce doctors who are highly dependent upon hospital-based resources and entwined networks of physicians (interns, residents, chief residents, attending physician, consulting physicians, radiologists, and pathologists) and other health care experts (clinical pharmacologists, physical and rehabilitational therapists, dieticians, and clinical psychologists). Most newly trained physicians who try to be autonomous and self-directed fail. They end up joining group practices, becoming hospital-based physicians, or changing specialties (a number of pathologists and radiologists previously practiced internal medicine or surgery).
I agree that most physicians can not treat complex patients, especially during hospitalizations. Fixing this problem in hospitals is simple: use hospitalists and intensivists (for ICU care). In the outpatient realm, the problem is more difficult unless one is practicing in a good multi-specialty group. Here is where good medical informatics could play a big role. If the primary physician and the specialists could interact electronically and have unrestricted access to the patient's medical records from each physician, then nothing would be missed, tests wouldn't be duplicated, and there would be less risk of prescribing drugs that don't play nice together. We have the technology to do this securely, but few electronic medical records programs support this type of data sharing.
My background: Clinical pathologist who has taught medical students, doctor of pharmacy students, and pathology residents for 25 years. Currently at University of Tennessee Health Science Center.

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There is no shame in mental illness, House Speaker Nancy Pelosi (D-Cal.) said following passage of the House bill in March. The great shame would be if Congress had not taken action.

But much work remains. Significant disparities between the Senate and House bills have forced sponsors into informal but delicate negotiations. The saga has aligned senators of both parties, the White House, business groups and the insurance industry -- all of whom support more business-friendly reforms -- against House lawmakers pushing for broader patient benefits.

The negotiations could prove a dilemma for House Democrats, who have increasingly shown an eagerness to stand firm on non-compulsory legislation in lieu of caving to the demands of industry and the administration. Led by Pelosi, Democrats in Congress's lower chamber have confronted the White House head-on over wiretapping legislation and a free trade deal with Columbia, for example -- in each case supporting the populist agenda that swept the party into power two years ago. The resulting stalemates seem to indicate that Democrats would be willing to kick these issues to next year, when the party is expected to command larger congressional majorities and, perhaps, control the White House.

Mental health advocates are optimistic the parity reforms will move this year -- and they have several things working in their favor. First, the Senate bill has broad bipartisan support, with Sen. Edward M. Kennedy (D-Mass.) a leading force behind it. Also, two long-time champions of parity -- Sen. Pete Domenici (R-N.M.) and Rep. Jim Ramstad (R-Minn.) -- are retiring at the end of the year, putting pressure on lawmakers in both chambers to honor their work by enacting reforms before they depart. Both lawmakers have personal investments in the the parity push: Domenici's daughter has schizophrenia, and Ramstad is a recovering alcoholic.

In the eyes of Washington's power-brokers, their cause hardly constitutes must-pass legislation, but with some momentum behind it, the parity legislation could be a rare instance of an election-year success.

Neither the House nor Senate bill forces insurers to cover mental treatments. But under both proposals, group health plans that opt to cover such care could no longer make the mental benefits more restrictive or costly than those for comparable medical and surgical treatments.

A 1996 law took a step in this direction, preventing insurers from applying different limits on annual or lifetime payments. But plans may still discriminate in other ways, like charging mental patients higher co-pays and restricting the number of days they can spend in the hospital.

Elizabeth Prewitt, government relations director for the National Assn. of State Mental Health Program Directors, which supports the House bill, said that roughly 67 percent of adults and 80 percent of children requiring mental health services go without -- a trend exacerbated by discriminatory insurance practices.

If the patient has financial limitations, Prewitt said, they often don't seek treatment at all.

Both the House and Senate bills apply only to group health plans covering 50 people or more.

In a controversial break from the Senate proposal, the House bill mandates that group plans include benefits for any condition contained in the American Psychiatric Assn.'s most recent reference guide for diagnosing mental ailments, called the Diagnostic and Statistical Manual of Mental Disorders, or DSM. The manual lists serious conditions -- like schizophrenia, bipolar disorder and severe depression -- but also includes jet lag, caffeine addiction and sibling rivalry. Employers and insurance groups are quick to criticize the House bill for that provision, saying it will drive up costs and force employers to drop mental health coverage altogether.

Nowhere else do you employ a professional manual to specify the conditions that have to be covered, said E. Neil Trautwein, a vice president at the National Retail Federation and leader of an ad hoc industry coalition lobbying the bill. The practical effect is to require each and every thing in the DSM to be potentially subject to coverage.

The Senate proposal, in contrast, caters more to businesses, allowing the plans -- not the DSM -- to define their scope of coverage. Under both bills, however, insurers would pay only for those conditions they deem medically necessary. Supporters of the House bill contend that the medical necessity limitation makes much of the DSM criticism unjustified. Neither bill mandates mental health coverage. Yet business groups worry that the House language would drive coverage decisions into the courts.

The issue is, how is the language in the House bill interpreted? said Mohit Ghose, spokesman for America's Health Insurance Plans, a trade group. What is the definition of medical necessity?

As is often the case with congressional proposals, the debate hinges more on how the bill is perceived than on what it would do. Peter Newbould, director of congressional and political affairs at the American Psychological Assn., said the DSM provision doesn't deserve the scrutiny it's received.

It's something that conservative senators latch on to -- perhaps supported by business and insurers -- and say, 'No, that's too much,' Newbould said. The problem is not the reality, it's the perception.

Newbould added, Whether or not the DSM language is problematic misses the point that it's DOA in the Senate.

The White House has bolstered this Republican opposition. The administration issued a statement in March charging that the House bill would effectively mandate coverage of a broad range of diseases and conditions and would have a negative effect on the accessibility and affordability of employer-provided health benefits.

Recognizing the political realities, Senate negotiators -- including Democrats -- have accepted the industry's compromise for the sake of passing reforms this year. Kennedy and Domenici have sent a newer version of their bill to House leaders. That bill moves closer to the House proposal but does not contain the DSM language. The question remains whether House leaders will accept the changes or hold out for a more patient-friendly bill.

All sides agree that time is short. With a new administration taking the helm next year, health care reform is expected to be among the top priorities of the new White House. Mental health advocates fear that the parity issue might lose priority in the shuffle.

Time is of the essence, Newbould said. If nothing gets done [this year], we'll get lost in the health care tornado that's soon coming in.

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How to Get Universal Health Care

Joel S. Hirschhorn

Hillary Clinton and Barack Obama say they believe in giving Americans universal health care. I don't believe them. Anyone who takes the time to understand universal health care should conclude that only a simple single payer system will reform the current outrageous system that benefits the insurance and pharmaceutical industries.

The contorted plans from Clinton and Obama are not sufficient reforms. And what John McCain has proposed is sheer nonsense and by itself should cause any conscious American to avoid voting for him.

Fights for health care system reform are centered in Congress, as if legislators will do what they have never done before: achieve true, major and systemic reforms that only serve the public interest, not lobbyists and campaign contributors from business sectors.

Both Clinton and Obama believe that Americans have a moral right to universal health care. If this is correct and if this is what you believe, then achieving universal health care that covers absolutely everyone by making health care affordable to absolutely everyone, as it is in many other nations, requires a different kind of government action. What exactly?

We must expand the Bill of Rights as embodied in the US Constitution to include the right to affordable universal health care. The time has come for the public to conclude that the right to universal health care is as important and necessary as the right to free speech and all the other beloved constitutional rights. Common sense says that health care is a right, not a privilege.

After all, what good are our current constitutional rights if you are ill or dying prematurely because of a lack of good health insurance? Certainly the pursuit of happiness cannot be successful when individuals are suffering from poor health because of inadequate health care.

Why would sensible, caring Americans be against a constitutional right to universal health care? Are there people who would stand up and publicly condemn the right of all Americans to have first rate health care? The only ones I can imagine doing this are those now benefitting financially from the current unjust system, those blocking necessary congressional actions.

What Obama and Clinton should explicitly and loudly advocate is a constitutional amendment that makes universal health care a nonnegotiable right of all Americans.

Why has no member of Congress submitted legislation to get Congress to propose such an amendment for ratification by the states? Clearly, the only rational answer are the many business interests that have corrupted Congress and that benefit from the current system. The Constitution provides an alternative.

Article V provides an option never used in the entire history of the US, because Congress has refused to obey the Constitution and respect state requests. The Article V convention option was put in the Constitution because the Founders and Framers believed that one day Americans would lose trust and confidence in the federal government. With 81 percent of Americans believing the nation is on the wrong track and with so many millions of Americans lacking good health insurance and care, that day has surely arrived. And with abysmally low levels of confidence in Congress and the president, an Article V convention - a temporary fourth branch of the federal government - is clearly the right path to obtaining a universal health care amendment. A convention of state delegates could debate such an amendment and if they agreed to propose it, then the standard ratification by three-quarters of the states would still be necessary.

Yes, this would probably take a few years. But it would be worth it. The prospect of Congress, even with Clinton or Obama as president, achieving universal health care without business-friendly loopholes faster than the amendment approach is not good. The process of pursuing such an amendment, moreover, would help keep pressure on Congress to do the right thing.

If this sounds reasonable and necessary, then learn the truth about the Article V option at www.foavc.org and start talking up a universal health care amendment that Hillary and Obama should support.

[Contact Joel S. Hirschhorn through www.delusionaldemocracy.com; he is a co-founder of Friends of the Article V Convention.

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By Ben Leach
Medical Production Assistant
While studying to become a medical reporter, one of the ways I learned about health care was by working as a pharmacy technician. Under the watchful eyes of the pharmacists, I filled prescriptions and learned about hundreds of prescription drugs and the conditions they treat.  I wasnt expecting to learn so much about prescription insurance plans. 
I recently worked on a series about the cost of health care and I couldnt help but remember how much people spent on their prescription drugs. People needed these drugs to stay healthy, but even with prescription coverage, they were still shelling out a lot of money. In the back of my mind, though, I knew that they didnt have to spend all that cash to get their prescriptions.
Take H2 blockers, a class of drugs used to treat acid reflux. Brand-name H2 blockers such as Nexium and Prevacid can be very expensive. These drugs are slightly different chemically, but they work the same way and treat the same conditions. The problem is that prescription drug plans would usually cover one but not the other. For example, on one plan, Prevacid might have a $25 co-pay, but Nexium might cost  $50 on the same plan.
One cool thing I noticed was that doctors managed to find ways around this problem. One doctor wrote a prescription with six different H2 blockers on it, and for the patients sake, we had to fill only whichever one was cheapest under the patients plan. I saw another solution at my doctors office. The office made a chart with all the H2 blockers and the most widely used prescription plans in the area, and it clearly marked which of these drugs were covered by which plans. If every patient taking an H2 blocker had this chart in his or her pocket, it would have helped save money at the pharmacy counter.
If youre shelling out a ton of money at the pharmacy for medications, you should be sure to investigate ways to save money with your doctor and your insurance plan.  If you know of a successful money saving strategy, please share it here.
Editors Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

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