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Nasal polyp Nasal polyposis is a disease of the nasal and paranasal mucous membranes. It is characterized by edematous, semi-translucent masses arising from the mucosal lining of the middle nasal meatus. The presenting symptoms of nasal polyposis are nasal congestion, difficulties in breathing, post-nasal drip, and loss of sense of smell. The etiology is multifactor, and the exact pathophysiology is unknown. However, T-cells and their cytokine profiles in nasal polyps are of clinical significance, as the use of topical anti-inflammatory agents, such as corticosteroids, may have a beneficial effect because of their ability to down-regulate the genome of all inflammatory cells. This decreases cytokines and chemokines known to be derived from lymphocytes, eosinophils, and other inflammatory cells that are part of the inflammatory events in nasal polyposis.30 These results in reduced symptoms of rhinitis, improved nasal breathing and reduced size and number of polyps, although INS appears to have less effect on improving sense of smell. Thus, corticosteroids form the mainstay of medical treatment. Surgery is reserved for severe and non-responding nasal polyposis patients.
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Hospitals are the central component of a communities health care infrastructure. NJCA has a core commitment to keeping them accountable to their communities through inspection, public disclosure and bona fide community oversight. For many years, New Jersey Citizen Action and its members have fought against the privatization of hospital services as it is generally the case that once privatized, hospital administrators put profits before the people they serve. Bergen Regional Medical Center is a case in point. In 1998, over the protests of NJCA and many others in the health care advocacy community, Bergen County turned over the management its public hospital, Bergen Pines the hospital's name was changed to Bergen Regional Medical Center ; , to the for profit private management firm Solomon Health Services. Today, seven years after the privatization scheme, Bergen County taxpayers are receiving a lesson on the dangers of privatization and, once again, NJCA is at the forefront of the issue. When the County handed over the hospital reins to Solomon it provided them with two loans as part of the Lease and Operating Agreements between the Bergen Co. Improvement Authority BCIA ; , and Solomon Health Services, totaling $33 million. The loans were largely interest free, and the larger of the two loans $27 million came from money already due the hospital prior to privatization. Article 8 of the NJ Constitution forbids the use of public funds for private use. It also forbids the type of contract the BCIA and Solomon used, which permitted use of the money at the 'sole discretion' of the Solomon partners, with no accounting mechanism for where or how the funds were spent On August 29th, New Jersey Citizen Action filed a lawsuit against Bergen County, BCIA, BRMC and Solomon Health Services. We are calling for the recuperation of the $33 million in nearly interest free loans. Plaintiffs in the case include NJCA, Regina O'Neill, a former member of the Community Oversight Board of BRMC, Julie Otto, a family member of a former patient at BRMC, and Maryann Milligan, the SecretaryTreasurer of the Health Professionals and Allied Employees, which represents 400 nurses and health professionals at BRMC. "These loans allowed Solomon, a for profit company, to use $33million in taxpayer and health care dollars at their sole discretion, diverting these funds for private profit, " said Phyllis SaloweKaye, Executive Director of NJCA. "We can find no monitoring of these funds, or documentation to prove that these funds were used for patient care or the public benefit in fact, we are paying interest on public bonds used to fund these loans, adding insult to injury." NJCA is concerned that Solomon's owner's have diverted the loan proceeds for their personal use by overdrawing from the Medical Center's accounts and by creating a number of affiliate companies which have charged prices to the Medical Center that are more than $114 million above their fair market price. NJCA is also seeking an end to all future profit distributions to Solomon affiliates or principals until there are sufficient assets to repay the loans. TAKE ACTION: Visit the E-Action center on the NJ Citizen Action website to write a letter to the Bergen County Freeholders to demand county taxpayer dollars back. njcitizenaction or write to Bernadette P. McPherson, Freeholder Chairwoman, at bmcpherson co.bergen.nj.
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He litany of population senescence should by now be familiar to every student of geriatrics or health policy. In the United States, as in most developed countries, the proportion of people age sixty-five and over was 4 percent at the turn of the century, currently comprises 12 percent of the population, and will reach 20 percent in the next three decades. The Medicare generation consumes nearly a third of all medications, and those over age eightyfive the group comprising the highest proportion of medically frail citizensare the fastest-growing 1 demographic segment in the country. Proportionately greater numbers of very old people will further intensify their disproportionate use of medications, particularly for chronic illnesses. Simultaneously, the cost of medications, which have been and remain the single most cost-effective element in the health care system, has begun to rise dramatically, outstripping even the fast-track rate of increase of the overall health care consumer price index CPI ; during the 1980s. The economic prominence of hospital care and physician fees attracted the attention of payers, regulators, and irate consumers throughout the 1980s. Now, with a decade of quick-fix attempted solutions behind us and only limited success, attention is being drawn to targets in the health care system that are further down on the dollar-ranking scale. One of these targets is drug therapy. Medications are of central importance in geriatric care, with the vast proportion of clinical encounters culminating in one or more prescriptions. Because drugs remain uncovered by most insurance plans for most elderly, they also loom large in the economic experience of older citizens, 2 representing one of their highest out-of-pocket health care expenses. Much of the current and impending storm over medication costs is being driven by the mounds of photocopied pharmacy receipts mailed by retirees to their congressional representatives, along with irate cover letters decrying this most visible aspect of the high cost of health care. Pharmacologically, many elderly have less physiological reserve and greater sensitivity to the effects of drugs; similar age-related changes appear to occur for them in the political economy of health care as well. Pharmaceuticals are an attractive target for policy intervention because of the readily identifiable drug industry. Hospitals are decentralized, often with strong community roots. Physicians, too, are decentralized; while many Americans are upset about what doctors in general do, most still think the world of their own physician. Yet few communities outside New Jersey have a corner drug company. The meretricious excesses of some companies such as Ayerst's "frequent prescriber bonus program, " which gave doctors free airplane tickets for putting their patients on Inderall ; have begun to poison the well of public trust. Thus and lexapro.
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