As a society, we have evolved in many fields, before, we had no way of knowing who would have what disease and how we can avoid passing it onto our children. Now through gene testing becoming more common with the population, it’s revealing those hidden factors. They don’t have gene testing for a lot of diseases because there are too many genetic variations such as in chronic diseases (diabetes), that you can’t pinpoint one marker. Some of the gene testing is probabilities that you might or might not get it, meaning that some people have the strain, but it’s not active until some outside factor such as disease or other environmental factors influence it. Physicians use the few genetic tests that we have to target illnesses and prescribe the appropriate medications.
Most scientists question gene testing because there are too many genetic variations which we don’t have the medicine to treat it yet, even if found. Errors in testing can also have an impact on you. Gene testing is not regulated by the Food and Drug Administration. It is costly and it is not covered by insurance. Even if insurances are going to cover it, they’ll ask for the results of your genetic tests to keep on file. We are so big on privacy that we get angry if someone sees your medicine bottle, but you are going to let a bunch of people look at your genetic results, I don’t think so.
In this article, they mention that Medicare doesn’t pay for gene test. The Center for Medicare and Medicaid services believe that there isn’t enough evidence showing that these tests improve patient’s illness. Insurances can’t cover everything especially government provided insurances, so they have to be carefully in what they find applicable to cover. In this article, they wanted to give precise warfarin doses to each individual based on their genetic makeup. Warfarin, a blood thinner is hard to dose and any slight variations in it, will either cause blood clots or hemorrhages. We’re still far away from personalizing medicine with genetic testing such as to tailoring it to individuals and their needs. Maybe when we have more solid evidence and more participation in genetic testing, we can think about it being covered under an insurance plan.
Wednesday, May 6, 2009
Sunday, May 3, 2009
Pandemics and Politics - A Recipe for Pandemonium
The very nature of influenza virus makes prediction difficult. New strains of influenza for which populations are not immune in combination with increased global travel, urbanization, and overcrowding make pandemic conditions inevitable (see WHO Pandemic Preparedness strategy)(1). Also, seasonal epidemics heavily influence the impact of pandemics. Although the World Health Organization (WHO) and the Centers for Disease Control (CDC) have strategies for outbreak response (global outbreak/pandemic response) that includes communicating real and potential risks at the earlier phases;(2) unfortunately communications are filtered through sources with alternate agendas that do not account for the public’s short or long-term health.
The so-called swine flu provided the perfect mix of mystery and intrigue political mud slingers salivate over. From the first news reports the number of deaths was just as inflated as its origins. Turns out, swine flu doesn’t even come from swine – imagine that! Instead, swine flu is a strain of influenza virus - influenza A (H1N1) - isolated and reported to originate from a confined area in Mexico. Suddenly, suggestions of bioterroism and border closings ran through the media like California-wild fires through the canyons. Bioterroism from a flu virus? Border closings? Outbreaks do call for quarantine to complete epidemiologic investigations as well as treatment to avoid spread (when possible); however, no responsible medical authority made this declaration or even insinuated locking out an entire country as the option. So why did “the media” jump so quickly to this type of conclusion?
Politics. Throughout history disease has been used as an agent of power and politics (see Sheldon Watts for an excellent account on epidemics in history-3). Since a minority (about 20% according to a recent Washington Post poll) of disgruntled Americans (you can see a lot of them on Fox News) are beside themselves with anger about the last election and the perceived success of the First 100 Days, nearly any excuse for political posturing seems justified even in situations of extreme health. The paranoia that the news media has spread to elementary school children(4) who, yes, should be aware of ways to thwart human-to-human transmission but should not be afraid that they are going to die because someone sneezes on them. In fact, the precautions for this strain of flu are like precautions for any other strain of flu which should be taught outside of the confines of a pandemic alert.
Furthermore, what is not discussed nearly enough in the media is the link between very poor health and susceptibility to every day occurrences. The reality is, the American diet does not prepare American’s for epidemic catastrophes let alone pandemics. Furthermore, endemic flu continues to immobilize us as a nation because we have yet to confront the medical and social variants that propagate disease (see Holly Tomlin’s BW706 Final Project). This does not mean that pandemics or warnings should be ignored but the information should be communicated responsibly.
To panic people by combining basic fears of “terror” (thanks to the previous administration) with diseases that will become more commonplace with globalization is not only irresponsible but should be considered an act of treason; especially when the act is for political gain and not the public’s health.
Holly Tomlin
Blog 12
References
1. WHO. Pandemic Preparedness 2009. http://www.who.int/csr/disease/influenza/pandemic/en/index.html. Accessed 03 May 2009.
2. WHO. Global influenza programme: WHO pandemic descriptions and main actions. http://www.who.int/csr/disease/influenza/GIPA3AideMemoire.pdf. Accessed 03 May 2009.
3. Watts S. Epidemics and History: Disease, Power, and Imperialism. 1997
4. A personal account – my friend’s 8 year-old daughter called me with questions about the swine flu because of the stories she saw on the news and the information she received at school.
The so-called swine flu provided the perfect mix of mystery and intrigue political mud slingers salivate over. From the first news reports the number of deaths was just as inflated as its origins. Turns out, swine flu doesn’t even come from swine – imagine that! Instead, swine flu is a strain of influenza virus - influenza A (H1N1) - isolated and reported to originate from a confined area in Mexico. Suddenly, suggestions of bioterroism and border closings ran through the media like California-wild fires through the canyons. Bioterroism from a flu virus? Border closings? Outbreaks do call for quarantine to complete epidemiologic investigations as well as treatment to avoid spread (when possible); however, no responsible medical authority made this declaration or even insinuated locking out an entire country as the option. So why did “the media” jump so quickly to this type of conclusion?
Politics. Throughout history disease has been used as an agent of power and politics (see Sheldon Watts for an excellent account on epidemics in history-3). Since a minority (about 20% according to a recent Washington Post poll) of disgruntled Americans (you can see a lot of them on Fox News) are beside themselves with anger about the last election and the perceived success of the First 100 Days, nearly any excuse for political posturing seems justified even in situations of extreme health. The paranoia that the news media has spread to elementary school children(4) who, yes, should be aware of ways to thwart human-to-human transmission but should not be afraid that they are going to die because someone sneezes on them. In fact, the precautions for this strain of flu are like precautions for any other strain of flu which should be taught outside of the confines of a pandemic alert.
Furthermore, what is not discussed nearly enough in the media is the link between very poor health and susceptibility to every day occurrences. The reality is, the American diet does not prepare American’s for epidemic catastrophes let alone pandemics. Furthermore, endemic flu continues to immobilize us as a nation because we have yet to confront the medical and social variants that propagate disease (see Holly Tomlin’s BW706 Final Project). This does not mean that pandemics or warnings should be ignored but the information should be communicated responsibly.
To panic people by combining basic fears of “terror” (thanks to the previous administration) with diseases that will become more commonplace with globalization is not only irresponsible but should be considered an act of treason; especially when the act is for political gain and not the public’s health.
Holly Tomlin
Blog 12
References
1. WHO. Pandemic Preparedness 2009. http://www.who.int/csr/disease/influenza/pandemic/en/index.html. Accessed 03 May 2009.
2. WHO. Global influenza programme: WHO pandemic descriptions and main actions. http://www.who.int/csr/disease/influenza/GIPA3AideMemoire.pdf. Accessed 03 May 2009.
3. Watts S. Epidemics and History: Disease, Power, and Imperialism. 1997
4. A personal account – my friend’s 8 year-old daughter called me with questions about the swine flu because of the stories she saw on the news and the information she received at school.
Saturday, May 2, 2009
Opulence and Insecurity and the outmoded 40-hour Work Week – A Personal Rant
How insecurity develops is a matter of psychology – quite frankly I don’t care where it comes from. What concerns me is the impact personal insecurities have on innovation, development, and progression. In a time when technology affords us the opportunity to exchange basic and complex information from seconds to minutes from one continent to the next as well as physically travel to those same regions within less than a day, for the life of me, I cannot understand why big businesses do not consider optimizing productivity potential beyond physical presence at a desk, behind a computer monitor, sipping gallons of coffee each day.
Part of the blessings (yes – I mean blessings) of technology is that it should free up people’s time to allow neurons and synapses to fire in different directions, expand brain capacity, and encourage creativity. Technology (laptops, iPhone®, Blackberries®, cars, buses, trains) should instill confidence in our capacities as human beings. Instead, people’s fear of technology has held the rest of us hostage to their insecurities and made us slaves (no disrespect) to an establishment that is afraid to embrace … dare I say it… yes – I will… embrace change. It’s like being an extra in your own reality t.v. show, a riddle wrapped in a Twinky®, Bizzaro to Superman – it doesn’t make sense!
Even more senseless are the salaries corporate fat cats make to keep the illusion going – particularly middle managers. They compound the insanity by celebrating mediocrity with big bonuses while utter stupidity is perversely excused and accepted. Do I really need to be chained to a desk listening to an earning’s call reiterating the same bleak economic forecasts of days before? Wouldn’t my time be better spent engaging in real scientific exchange that requires hours of research and contemplation that produces results? Perhaps such an exchange would add a little sunshine to the next forecasts…? But because I’m surrounded (quite literally) by the hypocrisy of an antiquated philosophy that impedes real work and progress (as well as an uncertain economy) I’m stuck between a rock and a hard place in a glass house built on quick sand.
Yet, I’m not giving up nor will I be fooled by misguided attempts to buy my personal ethic that craves intellectual challenge without being micromanaged.
Holly Tomlin
Blog 11
Part of the blessings (yes – I mean blessings) of technology is that it should free up people’s time to allow neurons and synapses to fire in different directions, expand brain capacity, and encourage creativity. Technology (laptops, iPhone®, Blackberries®, cars, buses, trains) should instill confidence in our capacities as human beings. Instead, people’s fear of technology has held the rest of us hostage to their insecurities and made us slaves (no disrespect) to an establishment that is afraid to embrace … dare I say it… yes – I will… embrace change. It’s like being an extra in your own reality t.v. show, a riddle wrapped in a Twinky®, Bizzaro to Superman – it doesn’t make sense!
Even more senseless are the salaries corporate fat cats make to keep the illusion going – particularly middle managers. They compound the insanity by celebrating mediocrity with big bonuses while utter stupidity is perversely excused and accepted. Do I really need to be chained to a desk listening to an earning’s call reiterating the same bleak economic forecasts of days before? Wouldn’t my time be better spent engaging in real scientific exchange that requires hours of research and contemplation that produces results? Perhaps such an exchange would add a little sunshine to the next forecasts…? But because I’m surrounded (quite literally) by the hypocrisy of an antiquated philosophy that impedes real work and progress (as well as an uncertain economy) I’m stuck between a rock and a hard place in a glass house built on quick sand.
Yet, I’m not giving up nor will I be fooled by misguided attempts to buy my personal ethic that craves intellectual challenge without being micromanaged.
Holly Tomlin
Blog 11
Beans (A Poem for Organ Donation)
Beans
Because they fail to work properly on their own
A catheter was inserted into her abdomen
For easy access to the machine she uses daily
To help her kidneys balance the minerals that flow
In and out of her blood stream
The process is intricately connected to her fluid and food-intake
As well as the money she makes
The support she has from friends and fam
That worries about the fragility visible in her face
As she recants tales of fighting her landlord
Who doesn’t care about her handicap placard
Or the government that sits on the hill counting kidney transplants,
Comparing them to dollars and cents
As if they were beans in a jar
For years she’s struggled with doctors
Trying to make sense of the disease they cannot fully explain
- It causes swelling, bone loss, brain damage, and severe joint pain
She was taken off the transplant list, put back on… then taken off again
No one understands the agony she’s in
Not even I – her sister-friend
Although weak from frustration, mineral imbalance, and poverty
She writes letters to congress, speaks at rallies, and talks to anyone willing to listen
To God she prays for a kidney that works
As hard as she does to make life meaningful and whole
Like two kidney beans in concert
It is for KH that I write
In hopes that others will get to know the miracle of organ donation
And know that life…your life amounts to more than a hill of beans…
Holly Tomlin
Blog 10
Friday, May 1, 2009
End of Life Health Care is Our Biggest Health Care Problem, both Financially and Morally
These are horrible questions, but these questions must be asked. I do not claim to know the answers, but I do know that what we are doing now does not make sense.
The truth is that an extremely disproportionate percentage of health care costs are incurred in the last year of a person’s life. Over ¼ of Medicare expenditures (27%) are made on patients in their last year. ( http://www.usatoday.com/money/industries/health/2006-10-18-end-of-life-costs_x.htm ) Roughly, $2000.00 to $3000.00 dollars are spent in a patient's last week of life.( http://archinte.ama-assn.org/cgi/content/short/169/5/480 ) As the baby boomers age, unpleasant choices are going to have to be made.
However, no one (understandably) wants to say, “Sorry, now that your best years are behind you and your utility to us has ended, you are more of a burden than you are worth, so if you wouldn’t mind too terribly, would you please die now?” “Broke your arm? Here is some morphine. These casts are getting expensive.”
Of course, the above is absurd, but it begs the question: Where do we draw the line? To what degree do we care for the health of the elderly before we decide it is not worth it? Is it moral to ask that question at all? Is it a sliding scale? Starting at the age of 70, is a person entitled to less care with each passing year? Do we draw the line according to condition, as in a broken finger is treated but a stroke is not? Do we draw the line according to prognosis, as in once the doctor decides that a person will not last a year, the morphine drip is wheeled in? If you thought insurance companies were tough on claims before, what happens when this Pandora’s Box is opened? Once it is considered reasonable for insurance companies to deny claims for terminal patients, what happens when the patients do not die as quickly as predicted? What if the doctor was wrong and the patient has 10 years left?
Our success with medical technology is ironically a part of the problem. It sounds horrible to ask, but in some twisted way, are we a little too good at keeping people alive?
This issue makes me upset, because my parents are in their mid-to-late 60’s.
We can not fix this problem by rationing care and deciding who gets what. This is not an issue that politicians can fix or bureaucrats can manage. The only way this problem will be alleviated is if our opinions about death and our opinions about our life cycle change.
In the meantime, I guess it all needs to come back to what is best for the patient.
The truth is that an extremely disproportionate percentage of health care costs are incurred in the last year of a person’s life. Over ¼ of Medicare expenditures (27%) are made on patients in their last year. ( http://www.usatoday.com/money/industries/health/2006-10-18-end-of-life-costs_x.htm ) Roughly, $2000.00 to $3000.00 dollars are spent in a patient's last week of life.( http://archinte.ama-assn.org/cgi/content/short/169/5/480 ) As the baby boomers age, unpleasant choices are going to have to be made.
However, no one (understandably) wants to say, “Sorry, now that your best years are behind you and your utility to us has ended, you are more of a burden than you are worth, so if you wouldn’t mind too terribly, would you please die now?” “Broke your arm? Here is some morphine. These casts are getting expensive.”
Of course, the above is absurd, but it begs the question: Where do we draw the line? To what degree do we care for the health of the elderly before we decide it is not worth it? Is it moral to ask that question at all? Is it a sliding scale? Starting at the age of 70, is a person entitled to less care with each passing year? Do we draw the line according to condition, as in a broken finger is treated but a stroke is not? Do we draw the line according to prognosis, as in once the doctor decides that a person will not last a year, the morphine drip is wheeled in? If you thought insurance companies were tough on claims before, what happens when this Pandora’s Box is opened? Once it is considered reasonable for insurance companies to deny claims for terminal patients, what happens when the patients do not die as quickly as predicted? What if the doctor was wrong and the patient has 10 years left?
Our success with medical technology is ironically a part of the problem. It sounds horrible to ask, but in some twisted way, are we a little too good at keeping people alive?
This issue makes me upset, because my parents are in their mid-to-late 60’s.
We can not fix this problem by rationing care and deciding who gets what. This is not an issue that politicians can fix or bureaucrats can manage. The only way this problem will be alleviated is if our opinions about death and our opinions about our life cycle change.
In the meantime, I guess it all needs to come back to what is best for the patient.
The Terms "Right to Die" and "Assisted Suicide" Won't Do
As I write this posting about end of life issues, I am well aware that I am not an expert on this topic. Thus, I am writing more in the spirit of asking questions rather than making statements. Even the statements that I make here will be along the lines of “thinking out loud.”
I consider life precious. It is a gift. We have been admitted into the club of human existence. Regardless of the quality or circumstances of one’s life, just being born makes one fortunate. I am not naive. Some lives turn out badly. However, to be given a shot at life makes a person one of the elite entities in the history of (as far as we know) the universe. While the following sayings are not valid when taken to extremes, there is an element of truth when people say “I never had a bad day in my life” and “I’m great just as long as I’m on the right side of the grass.”
I think that suicide by an otherwise healthy person is an unnatural act brought about by mental illness. However, if a person is physically (not mentally) suffering and that person’s best days are definitely chronologically behind him or her, then it is understandable why one may want to end their lives.
The term “assisted suicide” is one of those “b.s.” semantic terms used to place a spin on a philosophy, like “pro-life,” “pro-choice,” and the agenda-laden “anti-choice.” Besides, “assisted suicide” does not account for the terminal nature of the lives of those who choose to end things. I know I just criticized re-naming things for “spin” reasons, but I think in the context of end-of-life issues, it might be warranted. Euthanasia, while a legitimate term, has become such a loaded word that it seems no longer appropriate. Besides, we euthanize cats, dogs, and horses, and those animals do not choose to end their lives. Humans need their own term, one that reflects the choice one has made to end their own suffering on their own terms. I am not sure what term to suggest. I have some mind, but I will refrain from writing them here.
Though I never was passionate about the issue, I had always considered ‘assisted suicide” wrong. Dr Kevorkian seemed a little creepy to me, like he was a little too into it. He was turning what otherwise should have been the ultimate moment of dignity for a person into a circus.
My mind changed on the subject when I had surgery a few years ago to try to correct my sleep apnea. The surgery involved trying to open up my nasal passages. I then understood why suffering, terminally ill patients would want to end it all. My suffering was so great that if I did not know that I would get better, I would have wanted to die.
What is a better way? Have the person sign a do not resuscitate (DNR), no breathing assistance and no feeding tube letter then fill them with morphine to ease their last days?
Somehow, I think that might be the way to go. Unless I am mistaken, that is what we are doing now. Maybe we need to let more people know they have that option.
I do not know the answers here. I am just asking questions.
Another aspect of this issue is the cost of end-of life care. I will cover that in my next posting.
I consider life precious. It is a gift. We have been admitted into the club of human existence. Regardless of the quality or circumstances of one’s life, just being born makes one fortunate. I am not naive. Some lives turn out badly. However, to be given a shot at life makes a person one of the elite entities in the history of (as far as we know) the universe. While the following sayings are not valid when taken to extremes, there is an element of truth when people say “I never had a bad day in my life” and “I’m great just as long as I’m on the right side of the grass.”
I think that suicide by an otherwise healthy person is an unnatural act brought about by mental illness. However, if a person is physically (not mentally) suffering and that person’s best days are definitely chronologically behind him or her, then it is understandable why one may want to end their lives.
The term “assisted suicide” is one of those “b.s.” semantic terms used to place a spin on a philosophy, like “pro-life,” “pro-choice,” and the agenda-laden “anti-choice.” Besides, “assisted suicide” does not account for the terminal nature of the lives of those who choose to end things. I know I just criticized re-naming things for “spin” reasons, but I think in the context of end-of-life issues, it might be warranted. Euthanasia, while a legitimate term, has become such a loaded word that it seems no longer appropriate. Besides, we euthanize cats, dogs, and horses, and those animals do not choose to end their lives. Humans need their own term, one that reflects the choice one has made to end their own suffering on their own terms. I am not sure what term to suggest. I have some mind, but I will refrain from writing them here.
Though I never was passionate about the issue, I had always considered ‘assisted suicide” wrong. Dr Kevorkian seemed a little creepy to me, like he was a little too into it. He was turning what otherwise should have been the ultimate moment of dignity for a person into a circus.
My mind changed on the subject when I had surgery a few years ago to try to correct my sleep apnea. The surgery involved trying to open up my nasal passages. I then understood why suffering, terminally ill patients would want to end it all. My suffering was so great that if I did not know that I would get better, I would have wanted to die.
What is a better way? Have the person sign a do not resuscitate (DNR), no breathing assistance and no feeding tube letter then fill them with morphine to ease their last days?
Somehow, I think that might be the way to go. Unless I am mistaken, that is what we are doing now. Maybe we need to let more people know they have that option.
I do not know the answers here. I am just asking questions.
Another aspect of this issue is the cost of end-of life care. I will cover that in my next posting.
I am Beginning Consider "Comitting a Gaffe" Laudable
I applaud the Vice President’s candor recently with regard to the swine flu. He said that right now he would advise his family to avoid planes and trains and any tight spaces. I am sure the airline and rail industries were not happy, but they are not the Vice President’s first obligation. His first obligation is to protect the health and safety of Americans. Lest one think that we have completely entered a new era of openness and responsibility in Washington, the attempted corrective spin on the part of president Obama’s press secretary was beneath comical. Robert Gibbs’ attempt to make things “right” (i.e. politically correct) was so pathetic that it elicited laughter from the otherwise Obama-phile press corps. They were not laughing with him. They were laughing AT him. You can see the video here: http://www.realclearpolitics.com/video/2009/04/30/gibbs_on_what_biden_meant_to_say.html
This reinforces the issue I raised in an earlier post. Just how responsible should our government be when it comes to protecting the lives of our citizens? We cannot just shut down the society, especially at this point. Restricting trade and travel right now is not warranted. However, the population should know the risks and decide for itself. The key is the authorities providing accurate and complete information. Accurate and complete information should not be held back just to avoid a “panic” or to avoid dampening the economy. Staying out of airplanes or trains is not a panic. That is a conscious, measured decision that one makes based on what is best for that person and his or her family. Our government owes the common person honesty. We can decide for ourselves what risks we want to take with our own personal lives.
Hospitals are seeing up to a 50% increase in emergency room visits by people who are afraid they have swine flu. Is that not a good thing? Does increased overall vigilance make it more likely that we will be able to contain the problem and avoid a pandemic?
This reinforces the issue I raised in an earlier post. Just how responsible should our government be when it comes to protecting the lives of our citizens? We cannot just shut down the society, especially at this point. Restricting trade and travel right now is not warranted. However, the population should know the risks and decide for itself. The key is the authorities providing accurate and complete information. Accurate and complete information should not be held back just to avoid a “panic” or to avoid dampening the economy. Staying out of airplanes or trains is not a panic. That is a conscious, measured decision that one makes based on what is best for that person and his or her family. Our government owes the common person honesty. We can decide for ourselves what risks we want to take with our own personal lives.
Hospitals are seeing up to a 50% increase in emergency room visits by people who are afraid they have swine flu. Is that not a good thing? Does increased overall vigilance make it more likely that we will be able to contain the problem and avoid a pandemic?
To smoke or not?
I don’t get it. They get so happy to tackle a smoking problem in this article. I wonder who they surveyed. They should come and survey the kids in the cities. Half of the kids quit because they want to and I don’t think it’s inaccessibility to smoking paraphernalia that is the cause of the decline. If you want to smoke, you’ll find away to get around it. I worked in a store and older kids just buy it for the younger kids. In the Pennsylvania smoking law, no where does it say that minors are restricted from smoking, just says that they can’t purchase it. You can get arrested for selling cigarettes to minors but police can’t arrest the minors who are smoking, if they catch them smoking. That’s a twisted way of putting things into perspective. It’s like saying something but doing something else which defeats the whole purpose.
I live by a busy road, with a high school on its side and police cars driving by left and right. All the stores are near there, and the high school, middle school, and elementary schools are near to each other. So when the school lets out all the “should be” role models for the younger kids are smoking and they give it to them as they pass by. You see smoking groups by each store. Then you see the police, just ignoring them. I think if you use reverse psychology, you have more of a chance to make kids stop smoking, by allowing them to purchase it legally. They’ll get tired of it once it becomes readily available. I mean, the whole thrill other than the addiction of smoking is because you are doing something against what society deems you can’t. So kids are at the age where they like breaking the rules. If there is no rule, they have nothing to break and it’s not fun anymore. Smoking will not be cool anymore. In certain areas, sometimes having no rules is more effective than having rules to follow. I mean who follows rules anyway, if we fully abide by them, we’ll all be at the bottom of the social ladder. It comes down to that whether to smoke or not, it’s their choice.
I live by a busy road, with a high school on its side and police cars driving by left and right. All the stores are near there, and the high school, middle school, and elementary schools are near to each other. So when the school lets out all the “should be” role models for the younger kids are smoking and they give it to them as they pass by. You see smoking groups by each store. Then you see the police, just ignoring them. I think if you use reverse psychology, you have more of a chance to make kids stop smoking, by allowing them to purchase it legally. They’ll get tired of it once it becomes readily available. I mean, the whole thrill other than the addiction of smoking is because you are doing something against what society deems you can’t. So kids are at the age where they like breaking the rules. If there is no rule, they have nothing to break and it’s not fun anymore. Smoking will not be cool anymore. In certain areas, sometimes having no rules is more effective than having rules to follow. I mean who follows rules anyway, if we fully abide by them, we’ll all be at the bottom of the social ladder. It comes down to that whether to smoke or not, it’s their choice.
Restrict late term abortion: A law?
My opinions are neutral in the abortion area. I think no one should suffer whether it is the baby, the mother, the healthcare personnel, or the families. However, abortion is needed if carrying the baby to term will jeopardize the physical and mental health of the patient. If the family has no means to provide for the baby and putting the baby up for adoption, in most cases, not a good idea. The kid would suffer through the system as sad as that sounds. This doesn’t mean I condone reckless behavior beforehand of the caused problem. Sometimes, a person’s irresponsibility shouldn’t be the cause of death of a life. I mean having a baby should be a joyous occasion; a lot of abortions are proving that feeling wrong. All these anti-abortion people, it’s funny that the most statements I read are from the men, I mean what do they know and don’t tell me it’s that someone who was close to them had an abortion and that changed their life. If you had an abortion, I would think that would change anyone's life. I think they stay by the idea without knowing anything else. I get why they are against it, not killing a life, personal morals, and for religious reasons. However, are they willing to endanger one’s life to save another?
Nowadays people are jumping to sue everyone left and right, and passing this bill would have added more to that list. No wonder some of the best doctors avoid practicing certain areas, because they are inhibited in the care that they can give, by the same people that they cared for. I think if they passed the bill, it wouldn’t change things, everything runs its course. Restricting certain laws in late term abortions just so you could sue, I mean doesn’t that defeat the whole purpose about saving a life. Most of the time, it ends up that obtaining money is the true face of abortion. People are still going to do abortions. The person who has the money will do it silently and the person who doesn’t have the money will find other means. Restricting abortion will result in more people dying. I think being more open about sex, will help decline the rate of abortion. If you want to prevent abortion, put your energy in educating people on prevention, be more open about sex education and hopefully make them realize the value of life. Sometimes, the causes for abortion are ridiculous such as for career reasons.
Nowadays people are jumping to sue everyone left and right, and passing this bill would have added more to that list. No wonder some of the best doctors avoid practicing certain areas, because they are inhibited in the care that they can give, by the same people that they cared for. I think if they passed the bill, it wouldn’t change things, everything runs its course. Restricting certain laws in late term abortions just so you could sue, I mean doesn’t that defeat the whole purpose about saving a life. Most of the time, it ends up that obtaining money is the true face of abortion. People are still going to do abortions. The person who has the money will do it silently and the person who doesn’t have the money will find other means. Restricting abortion will result in more people dying. I think being more open about sex, will help decline the rate of abortion. If you want to prevent abortion, put your energy in educating people on prevention, be more open about sex education and hopefully make them realize the value of life. Sometimes, the causes for abortion are ridiculous such as for career reasons.
Artificial insemination:Natural process or not?
Some women get pregnant and they abort due to various reasons. The women who want to have a child can’t but now through artificial insemination women can get pregnant. However, the negative side of this is that with artificial insemination, you never know how many babies you will conceive. This results in having too many babies that won’t survive or sometimes the women get reduction done, meaning they kill off the number of babies conceived. Reduction most of the time is done for health reasons, because with more babies, the women and the fetus have a higher chance of being in danger. Even if 9 fetuses are carried to term, the woman needs a caesarian to get the babies out which will lead to complications. The babies who are born are weak and need extra care, some of them might not survive. In both cases having artificial insemination causes you to choose to have abortion. There is also the factor that with artificial insemination you are choosing the characteristics of your baby, it’s not naturally conceived.
Religious groups and anti-abortionists have a field day with this. Just from one procedure, there are too many deaths, not to mention the unnatural process to pick what characterisitcs you want in your child. What if someone wants to create a superior race as many as they want?Hopefully in the future they find a way to select how many you can conceive at a time. People don’t like surprises when they have to take care of nine kids all at once. For the people who are against abortion, they’ll risk it and carry the babies to term, which might put a strain on them. As with the case of the octuplet’s mom, Suleman, the healthcare professionals also have a duty to care for the health of the patient. In this case, the doctors were at fault because they let her follow through with a dangerous pregnancy. They shouldn’t even have let her have IVF if she already had six other children. I thought they underwent psychological evaluation before choosing these fertility options. Personally, I wouldn’t resort to artificial insemination on the basis that it is not natural, no matter how modern the world gets, there are some things you shouldn’t do. There are plenty of kids, who are not wanted out there, help them before you help yourselves. However, as much as artificial insemination is against my beliefs, other people may have that much desire to create a child by any means. It’s their choice in the end, and whatever is comfortable for them.
Religious groups and anti-abortionists have a field day with this. Just from one procedure, there are too many deaths, not to mention the unnatural process to pick what characterisitcs you want in your child. What if someone wants to create a superior race as many as they want?Hopefully in the future they find a way to select how many you can conceive at a time. People don’t like surprises when they have to take care of nine kids all at once. For the people who are against abortion, they’ll risk it and carry the babies to term, which might put a strain on them. As with the case of the octuplet’s mom, Suleman, the healthcare professionals also have a duty to care for the health of the patient. In this case, the doctors were at fault because they let her follow through with a dangerous pregnancy. They shouldn’t even have let her have IVF if she already had six other children. I thought they underwent psychological evaluation before choosing these fertility options. Personally, I wouldn’t resort to artificial insemination on the basis that it is not natural, no matter how modern the world gets, there are some things you shouldn’t do. There are plenty of kids, who are not wanted out there, help them before you help yourselves. However, as much as artificial insemination is against my beliefs, other people may have that much desire to create a child by any means. It’s their choice in the end, and whatever is comfortable for them.
Congress, the Food and Drug Administration (FDA), and Dietary Supplements
The dietary supplement industry is huge in the United States. A 2002 FDA survey concluded that 75% of Americans used dietary supplements (vitamin or herbal) within the previous year. That survey also concluded that 14.5 of Americans (a different survey said 20%) used herbal (non-vitamin/non-mineral, NVNM) supplements within the previous year. About 6% of Americans used NVNM supplements every day. The most used NVNM supplements were Echinacea, ginkgo balboa, garlic pills, ginseng and saw palmetto.
Before Congress got involved in 1994, the FDA regulated dietary supplements under The Federal Pure Food and Drugs Act (1906) and The Federal Food, Drug, and Cosmetic Act (FD&C Act) (1938). Under these laws, supplements were treated as food, and the FDA emphasized truth in labeling and safety.
In 1958, the FD&C Act New Food Additive Amendments added supplements to the items under FDA control. With these laws, all new food additives needed prior approval.
Everything changed in 1994, when Congress passed the Dietary Supplement Health and Education Act (DSHEA). The new law removed dietary supplements from food category and created a new, separate, and essentially unregulated “dietary supplement” category. The DSHEA defined dietary supplements as “a concentrate, metabolite, constituent, extract, or combination of vitamins, minerals, herbs (or other botanicals), or amino acids used to supplement the diet by increasing the total dietary intake.”
“Dietary Supplement” implies nutritional content though many have none.
The Dietary Supplement Health and Education Act of 1994 created a facade of regulation but essentially stripped the FDA of all authority in regulating the claims these products. The FDA lost its ability to insure that these products actually are what they say they are. An example of this “regulation facade” is the requirement that the supplement industry “evaluate” pill composition. However, the industry is not required to report that evaluation to the FDA. The FDA also cannot require submission of efficacy and safety information prior to the pill going on the market. New supplements do not require FDA approval. The FDA can act only after a dietary supplement has been on the market and there is a problem. The law mandated only voluntary adverse event reporting. Prescription drug companies are required to tell the FDA about any problems possibly related to their drugs, but the supplement companies were not required to do so. The law also stipulated that the supplements could not claim to “diagnose, cure, mitigate, treat, or prevent illness.” However, the supplements do just that, along with a disclaimer that says, “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.” Supplement labels make claims on the front of the label while showing the disclaimer less prominently on the rear of the label. Even worse, the Federal Trade Commission (which regulates all drug advertising outside of the control of the FDA) does not require the disclaimer in dietary supplement advertising.
Do you remember Ephedra? Between 1993 and 1997, over 800 Ephedra adverse event reports were made by doctors. As a result, in 1997, the FDA proposed a ban on ephedra but could not get supporting evidence. The FDA was not allowed to demand adverse event information or product samples. In 2000, the FDA finally bowed to Congressional pressure and dropped the ban proposal. In 2002, the government ordered a safety study. In 2003, some states banned Ephedra. After a 2003 high-profile pro-athlete death (a pitcher for the Baltimore Orioles), Congress finally was forced to allow the FDA to ban Ephedra in 2004.
In 2006, there was growing pressure from the public to regulate the dietary supplement industry. Therefore, Congress passed another law that was designed to give the appearance of protecting the American people but in reality was designed to help the dietary supplement industry. It was “the Dietary Supplement and Nonprescription
Drug Consumer Protection Act.” In this law, the supplement industry gave an inch and took a mile. The new law said companies must report serious adverse events (a government term loosely defined here as a health problem resulting in death or hospitalization) along with a copy of the product label. The supplement companies were also required to keep records of (but not report) all non-serious adverse events for six years. The new law also required product labels to include contact information.
All of this sounds good on the surface, but the supplement industries got a lot more than they gave up. Companies were still not required to provide any information to the FDA before selling a supplement. The adverse event reporting rules result in only about 1% of all adverse events being reported to the FDA. If there is a serious adverse event, the supplement company does not have to send a sample of the product along with the report. The law also (and this is the biggie) prohibited states from regulating supplements in any way whatsoever. The companies still did not have to prove that their products were good, but the FDA still (if it wanted to act) had to prove the supplements were bad AFTER something happened. In the first year of serious adverse event reporting, 608 serious adverse events were reported (368 required reports from supplement companies and 236 from private citizens and healthcare workers). Previously, before the reporting requirement, the supplement industry said they never received any adverse event complaints against any of their products.
Still, the FDA is doing what it can. In 2007, the FDA issued “Dietary Supplement Current Good Manufacturing Practices.” While prohibited from going any further by law, the guidance covered design and construction of physical plants, manufacturing operations, quality control procedures, testing materials, consumer complaints handling, and records maintenance. However, the FDA cannot enforce these practices, and nothing still need be submitted prior to a supplement going on the market.
Because the FDA is not allowed to require it, there is little clinical evidence that these supplements are effective or safe. Some clinical trials have been done on dietary supplements, but lack of standardization leaves results inconclusive at best and meaningless at worst. A given herb has varying potency depending on where and how it was grown (weather, altitude, soil quality, sunlight exposure, etc.) and prepared. The National Institutes of Health said, “Most of the studies we examined do not provide strong evidence for beneficial health-related effects of supplements taken singly, in pairs, or in combinations of three or more....However, several other studies also provide disturbing evidence of risk, such as increased lung cancer risk with β-carotene use among smokers.”
The problem of the FDA’s lack of authority over the supplement industry is made worse by the public’s perception that the supplement industry is subject to FDA authority. The vast majority of Americans believe that supplements are approved by the FDA and are thus effective and safe. Further, the conflicting claims and disclaimers on product labels result in people believing what they want to believe. Studies that show a lack of effectiveness do not cause a nationwide decrease in supplement use. Only well publicized incidents relating to safety result in decreased use.
For the future, the U.S. General Accounting Office recommends that supplement companies be required to 1) Register as dietary supplement companies, 2) provide all supplement names with labels and 3) report all adverse events related to dietary supplements. The General Accounting Office also recommends that the FDA “educate consumers that it does not analyze and approve dietary supplements and seek more authority over supplements sold in U.S.”
I do not expect it to happen anytime soon. Money talks.
References
Sadovsky R, Collins N, Tighe A, Brunton S, Safeer R. Patient use of dietary supplements: a clinician’s perspective. Current Medical Research and Opinion. Vol. 24, No. 4, 2008, 1209–1216
Dietary Supplement Health and Education Act of 1994, Public Law 103-417, 103rd Congress. Available at: http://www.fda.gov/opacom/laws/dshea.html [accessed March 3, 2006]
U.S. Food and Drug Administration. Dietary Supplements Overview. http://www.cfsan.fda.gov/~DMS/supplmnt.html Accessed 4/21/09
Dietary Supplements: FDA Should Take Further Actions to Improve Oversight and Consumer Understanding. The U.S. Government Accountability Office http://www.gao.gov/products/GAO-09-250 Accessed 4/21/09
Public Law 109–462—Dec. 22, 2006 http://www.fda.gov/cder/regulatory/public_law_109462.pdf Accessed 4/21/06
AJ Perez. (2008, September 23). Dietary supplements cause 600 'adverse events' :First data since reporting law. USA TODAY,p. D.7. Retrieved April 22, 2009, from National Newspaper Abstracts (3) database. (Document ID: 1560768251).
Katherine Wong. (2007). New Mandatory Reporting Requirements for Dietary Supplements and Nonprescription Drugs Solve Very Little. The Journal of Law, Medicine & Ethics, 35(2), 336-339. Retrieved April 22, 2009, from Research Library database. (Document ID: 1334834441).
Sarah Lueck and Anna Wilde Mathews. (2003, December 30). FDA Is Expected to Ban Ephedra, Citing Supplement's Health Risks. Wall Street Journal (Eastern Edition), p. A.1. Retrieved April 22, 2009, from ABI/INFORM Complete database. (Document ID: 517744241).
Metabolife Praises FDA Withdraw of Proposed Ephedra Restrictions. (3 April). PR Newswire,1. Retrieved April 22, 2009, from ABI/INFORM Complete database. (Document ID: 52164278).
References
Timbo BB, Ross MP, McCarthy PV, Lin CT. Dietary supplements in a national survey: prevalence of use and reports of adverse events. J Am Diet Assoc 2006;106:1966-74
Dietary Supplement Current Good Manufacturing Practices (CGMPs) and Interim Final Rule (IFR) Facts. U.S. Food and Drug Administration. http://www.foodsafety.gov/~dms/dscgmps6.html Accessed 4/22/09
Report: FDA lacks authority over supplements – Without necessary resources, 'it's like the Wild West' USA TODAY (Arlington, VA) - Wednesday, March 4, 2009 Author: Elizabeth Weise: (c) USA TODAY
Bent S. Herbal Medicine in the United States: Review of Efficacy, Safety,
and Regulation J Gen Intern Med 23(6):854–9. 2008
Foote, J. Protecting Consumers in the Wake of the U.S. Dietary Supplement Health and Education Act. Journal of Allied Health , Spring 2007
Bent S, Ko R. Commonly Used Herbal Medicines in the United States: A Review
Am J Med. 2004 ;116:478–485.
NIH State-of-the-Science Conference Statement on Multivitamin/Mineral Supplements
and Chronic Disease Prevention. The National Institutes of Health. NIH Consensus and State-of-the-Science Statements Volume 23, Number 2. 2006
Tilburt J, Emanuel E. Does the Evidence Make a Difference in Consumer Behavior? Sales of Supplements Before and After Publication of Negative Research Results. J Gen Intern Med 23(9):1495–8 2008.
Plan A or B?
All this controversy surrounding two pills called Plan B, I wonder what happens to the rest of the population who have sex and don’t have access to Plan B. So now they made it readily available to women and men 17 years of age and over, so what, it is only going to be effective if you take it. It’s like other contraceptive methods; everything is there for you in plain sight, to protect yourself from an unwanted pregnancy but what’s the point if you are not going to utilize it. Teenagers severely lack the sexual education and most of them are not mature enough to make a decision or maybe they just don’t plain care. Parents are part of this too, encouraging kids too much by showing their lack of care in their kids’ activities and not restricting them in some cases. So far, kid’s decision making skills are poor.
We all went through that phase that we know everything and because the parents are providing for you, life is a breeze. It’s when the wind propelling that breeze cuts off, and you finally feel the weight known as reality. There has to be a better way to prevent teen pregnancies, and abortions. We just need to be more open about it and have to get through the barrier that the kids somehow can’t see through. The more you restrict the more challenging or wild it’s for teenagers. Kids think that having sex is the next step to adulthood, and when you’re hormones are running wild, it might be too addictive for some to control it. Also, why would you want to burden yourself with an extra person to care for when you can’t even take care of yourself?
Got milk?
I’ve been drinking milk all my life but never delved into what really goes into the process of store bought milk. If you are in most countries they don’t go through the whole food safety process that milks go through such as pasteurization and homogenized milk. They drink raw milk. I drank cow and goat milk before which didn’t go through any extra processes. The taste is different and according to experts, it contains better nutritional properties because you are not messing with its natural process. There is no injecting the cow with hormones, antibiotics, or putting them on a certain diet to increase the quality or the quantity of the milk produced. In this news story, they are trying to restrict raw milk from being in stores for health reasons. Some people got a bad case of raw milk that sent them to the hospital and now the agriculture police don’t want any in stores. I mean, any food handled without proper care is going to be poisonous to the body, doesn’t matter whether it passes through many safety processes or you just plain drink it straight from a cow.
It is the people’s choice whether they want to drink raw milk or not. You can get bacteria or diseases from anyone, don’t matter if they drink raw milk or not. Raw milk has more nutritional value than processed milk. It does have less of a shelf life. However, whether to consume it or not is up to the people. I mean not everyone can drive to a farm for fresh milk and if they are so worried, put a label on it to indicate a person’s right to drink the raw milk knowing that it might be hazardous to their health. They should be aware, I am assuming many people drink it based on having knowledge of what it is they are consuming. Restricting raw milk to certain places can hurt the people economically and take away their right to choose.
Mandating ultrasounds before abortion…
Abortion is a controversial topic for a lot of people. Some people see it as killing a living being. Others see it as a means to improve the health of the woman. As long as abortion is therapeutic meaning it is performed to save the life of a woman mentally or physically, for terminating pregnancies if the baby is going to be born with congenital disorders and who’s health is fatal or will lead to morbidity, and to prevent multiple births, if those births will be harmful to the woman and child.
Although many people yearly have abortions, more than a million according to the Alan Guttmacher Institute Statistics (AGI) in 2006-2007, it is their choice to make. Now, some states want to enforce viewing of ultrasounds before abortion even if the patient doesn’t want to see it. If they are comfortable with the abortion, there is no need to enforce ultrasound images on them when they don’t want to view it. Medical personnel can give them the choice to view ultrasounds to make sure they are making the right decision. However, it shouldn’t be mandatory. It would be uncomfortable for both the doctor and the patient. A person has the right to view or not view what they want. When they made the decision, they thought it through to prevent future complications. However, a life is a life, and anyone will preserve it even if it is against their better judgment. So if they view an ultrasound when they don’t want to see it, their judgment might be impaired due to wanting to keeps the life growing inside of them.
Instead of preventing abortions, they should educate people beforehand about the consequences of getting pregnant. Most of the reports from the Center for Disease prevention and control (CDC) indicate most of the abortions are done to girls less than fifteen years of age. There is something wrong with that number. Either people aren’t educating these kids or their parents just don’t care and it results in them getting an abortion. Instead of mandating ultrasounds for abortion after the cause, mandate educational approaches for prevention of the cause.
Although many people yearly have abortions, more than a million according to the Alan Guttmacher Institute Statistics (AGI) in 2006-2007, it is their choice to make. Now, some states want to enforce viewing of ultrasounds before abortion even if the patient doesn’t want to see it. If they are comfortable with the abortion, there is no need to enforce ultrasound images on them when they don’t want to view it. Medical personnel can give them the choice to view ultrasounds to make sure they are making the right decision. However, it shouldn’t be mandatory. It would be uncomfortable for both the doctor and the patient. A person has the right to view or not view what they want. When they made the decision, they thought it through to prevent future complications. However, a life is a life, and anyone will preserve it even if it is against their better judgment. So if they view an ultrasound when they don’t want to see it, their judgment might be impaired due to wanting to keeps the life growing inside of them.
Instead of preventing abortions, they should educate people beforehand about the consequences of getting pregnant. Most of the reports from the Center for Disease prevention and control (CDC) indicate most of the abortions are done to girls less than fifteen years of age. There is something wrong with that number. Either people aren’t educating these kids or their parents just don’t care and it results in them getting an abortion. Instead of mandating ultrasounds for abortion after the cause, mandate educational approaches for prevention of the cause.
To live or let go?
Nowadays, we can’t even die peacefully without someone arguing over your life or death, mentally or physically. We all have a time to go, some sooner than others. Yes, you should die of natural causes, not by the help of something or someone else. In hospitals, you’re being kept alive by machines, so is it that you are on the brink of death, but something is keeping you here. Personally, I don’ think it is our decision to argue whether a person should live or die, especially a person who is immobile for 17 years. I don’t get why the government and other people related to this force this issue, maybe for political reasons. There are too many questions surrounding this, that I myself don’t even half an opinion. I mean other people who are alive and well are starving to death without any help from anyone. But the one who is dead mentally and physically are being force fed to live. I don’t see the logic in this. Yes, everyone should live, but let go, if someone who is related to them made a decision or themselves made a decision before their vegetative state to let them survive on their own without machines. It is much harder for the family than for the public to let go. It's not like they are making an irrational judgement. Each case is different and unique, what applies to one may not apply to the other. We don’t know how long someone might be in a coma. After a period of time, if you think to let go, let go. There are miracles out there of people waking up after spending years in a coma. That miracle might not be for everyone.
How tight is Airline Security in 2009?
Boca Raton, FL is home to Kenton Weaver, a 13 year old boy who suffers from autism. Kenton has always loved airplanes and dreams for one day becoming a pilot.
According to Southwest Airlines, the boy “presented a valid ticket for travel and underwent security to board his flight”. In addition, the Transportation Security Administrations Web site states that under federal law, “only travelers 18 and older are required to show identification”. Southwest continued to state that minors are allowed to travel alone as long as an “Unaccompanied Minor” is completed. It was not confirmed whether or not this form was completed.
Coloring Book Helps to Teach Kids About Tragedy
A coloring book with burnt out cars, buildings on fire and tornadoes does not sound like a coloring book that many parents would give to their children to color. However, this coloring book was posted on the Federal Emergency Management Agency’s web site.
Insurance Company Denies Claim After a Woman’s Husband is Murdered
Last year, Curtis McCraw was gunned down and murdered. The insurance company in which he has a $25,000 life insurance policy with is denying the claim which would be paid to his widow Stephanie McCraw.
Stephanie McCraw filed a suit against the Insurance Company stating the reason they denied the claim was because her husband had Hepatitis C. According to McCraw’s lawyer, “The policy is not specific as to whether there is a difference as to how you die. It does not event say you won’t get paid if you have a pre-existing condition”.
Curtis McCraw was gunned down last April outside of a housing project. The police declared his death a case of murder and was declared dead at the scene. Even though the police declared his death a murder the Insurance Company continues to fight the claim.
President, Michael Lowe of the company stated that “The law in Tennessee is clear that the cause of death is not relevant. What is relevant is whether the insured truthfully informed the company of his health at the time of his death”. The president continued to explain that under law the company has two years to contest the information that was provided to the company from the insured. If the company finds that the insured did not fully disclose his health history, the company has the right to rescind the policy.
At my previous job, I worked for The Hartford Insurance Company. The Hartford Insurance Company is a very ethical and trustworthy company whose best interest is their customers. Therefore, it blows my mind that a company would try and weasel there way out of this claim. It is clear that the man was gunned down and murdered. That was his cause of death not hepatitis. The actions of the insurance company could severely affect their reputation, especially in this type of economic climate. I would suggest that the insurance company pony up and pay the poor woman. If the company suspected that the customer was lying about his health, the company should have requested a blood test to be completed.
Stephanie McCraw filed a suit against the Insurance Company stating the reason they denied the claim was because her husband had Hepatitis C. According to McCraw’s lawyer, “The policy is not specific as to whether there is a difference as to how you die. It does not event say you won’t get paid if you have a pre-existing condition”.
Curtis McCraw was gunned down last April outside of a housing project. The police declared his death a case of murder and was declared dead at the scene. Even though the police declared his death a murder the Insurance Company continues to fight the claim.
President, Michael Lowe of the company stated that “The law in Tennessee is clear that the cause of death is not relevant. What is relevant is whether the insured truthfully informed the company of his health at the time of his death”. The president continued to explain that under law the company has two years to contest the information that was provided to the company from the insured. If the company finds that the insured did not fully disclose his health history, the company has the right to rescind the policy.
At my previous job, I worked for The Hartford Insurance Company. The Hartford Insurance Company is a very ethical and trustworthy company whose best interest is their customers. Therefore, it blows my mind that a company would try and weasel there way out of this claim. It is clear that the man was gunned down and murdered. That was his cause of death not hepatitis. The actions of the insurance company could severely affect their reputation, especially in this type of economic climate. I would suggest that the insurance company pony up and pay the poor woman. If the company suspected that the customer was lying about his health, the company should have requested a blood test to be completed.
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