Few people realize that one of these dangerous, rejected drugs, sibutramine, is now being given a second life: It is hidden inside some dietary supplements promising a “natural” solution to weight loss.

Sibutramine was pulled from the market by the Food and Drug Administration (FDA) in 2010 for causing heart attack and stroke. The supplements that continue to be laced with the risky drug come in many forms. They are sold as shakes, teas, powders, pills and gel capsules, often through online stores. Some, smuggled into the U.S. illegally, are marketed as traditional Chinese or other “alternative” medicines. Others take advantage of current weight-loss trends, resembling popular products such as green coffee, acai berries or herbal tea.

Consumers taking sibutramine-laced supplements may experience limited short-term weight loss, which gives the impression that the supplement is effective. But these effects are short-lived and come with the same risks that led the FDA to ban sibutramine almost three years ago. Worse, these supplements lack warning labels, contain unpredictable orgdoses of the drug and are sometimes laced with other dangerous active ingredients. Added risks such as these can make tainted weight-loss supplements far more dangerous than the sibutramine pills originally banned by the FDA.

The best way to avoid becoming a victim of laced supplements is to stay away from products that are promoted to help achieve effortless weight loss, whether they take the form of a powder, pill, tea, shake, energy drink or even an FDA-approved pill.

Sibutramine’s history

Sibutramine (once marketed as MERIDIA) received approval from the FDA in November 1997. The drug was approved for weight loss and maintenance when used with a reduced-calorie diet in those meeting the medical definition of “overweight.” Public Citizen immediately identified the drug as risky based on early evidence that it raised blood pressure and increased heart rate. This made the drug especially dangerous for people with hypertension, heart disease, congestive heart failure and other conditions common among people who are overweight. Based on this evidence, the April 1998 issue of Worst Pills, Best Pills News listed sibutramine as Do Not Use.

On March 19, 2002, Public Citizen petitioned the FDA to immediately remove sibutramine from the market for safety reasons. Publicly available material obtained from the FDA showed that from February 1998 to September 2001, there were almost 400 serious adverse reactions in patients taking the drug. The adverse reactions involved 19 deaths from cardiovascular causes, including 10 in people under the age of 50 — three of whom were women under 30.

In 2003, Public Citizen amended its petition with new information: An additional 30 cardiovascular deaths were reported while the FDA delayed taking action in the 18 months following the original petition, resulting in a total of 49 reported deaths.

In 2005, the FDA rejected Public Citizen’s first petition, opting instead to amend sibutramine’s labeling to warn patients that the drug could cause kidney damage. The agency continued to delay banning the drug for years, despite mounting evidence of serious safety risks.

The end for sibutramine finally came after the Sibutramine Cardiovascular Outcomes (SCOUT) trial, a large randomized, controlled clinical trial published in 2009 that found conclusive evidence of deadly harm to patients taking the drug. The SCOUT trial recruited more than 10,000 overweight and obese men and women with a history of cardiovascular disease. All participants received sibutramine for six weeks and participated in a weight- management program. After that, they were randomly assigned to receive either sibutramine or a placebo for the remainder of the study, with the average duration of exposure being 3½ years. The study demonstrated a 16 percent increase in risk of major adverse cardiovascular events (which included nonfatal heart attack, stroke and death) in patients treated with sibutramine compared to a placebo.

In addition to demonstrating once and for all that sibutramine was unsafe, the SCOUT trial also proved that the drug was not very effective, whether used for a short or long period. During the first six weeks, when all participants were taking the drug, they lost an average of just six pounds. Some of this weight loss may have been due to the weight-management program in which subjects also participated. The participants who were randomized to take sibutramine long-term lost just a few more pounds, for a total average weight loss of just 10 pounds after a year. Those randomized to placebo had even worse results: They gained back some of the weight they lost during the first six weeks and ended up with a total weight loss of just over four pounds after a year.

In 2009, Public Citizen submitted a new petition responding to the SCOUT trial and presenting its own analysis of adverse events from the FDA’s database, which included a total of 84 reports of death from cardiovascular causes in people taking the drug, 30 of whom were under age 50. Eventually, the FDA admitted that no patient should be put in the position of trading his or her life for a chance at minimal weight loss. Faced with these overwhelming results, the FDA removed sibutramine from the market in 2010, only after its earlier ban in Europe.

Sometimes you can’t keep a bad drug down

For most bad drugs, an FDA ban spells the end of sales, but the story has been different for sibutramine. The drug has found a new way to threaten American consumers by hiding away as an undeclared active ingredient in dietary supplements marketed for “natural” weight loss.

Sibutramine is an attractive choice for certain dishonest supplement makers because it produces small but not insignificant weight loss and its side effects are not obvious to consumers until it is too late. Lacing an ineffective product with sibutramine makes it seem like the product is really effective, boosting sales.

Since 2008, the FDA has identified at least 119 weight-loss products tainted with hidden active ingredients. All but five contained sibutramine or a related chemical compound, making sibutramine by far the most common drug to be hidden in weight-loss supplements.

Added risks

The sibutramine that now lurks in some dietary supplements is far more dangerous than the pills once dispensed at the pharmacy. This is because lack of adequate warning labels, inconsistent doses and other added undeclared ingredients increase the likelihood of side effects, overdose and harmful interactions with other drugs.

When sibutramine was still on the market, it carried a warning label that helped identify patients at particularly high risk for dangerous side effects (including those who were over 65, had high blood pressure or a history of cardiovascular disease, or were taking certain antidepressants). Sibutramine-laced supplements carry no such warnings, making it more likely that especially high-risk patients will take the drug unknowingly and be injured.

Sibutramine’s label also instructed doctors to carefully monitor patients’ blood pressure and heart rate, and to discontinue the drug if either spiked too high. Supplements are often taken without a doctor’s supervision, making it less likely that these early warnings will be caught before causing permanent damage.

The dosage of sibutramine in a laced supplement also is entirely unpredictable. A group of German researchers published a series of 17 phone calls made to poison control centers between 2005 and 2008, reporting adverse effects to patients who had taken a Chinese weight-loss supplement containing undeclared sibutramine. Sold on the Internet, the supplements contained almost twice the maximum daily dose of prescription sibutramine, which was legally available in Europe at the time. The patients, mostly young women under age 40, reported nausea, vomiting, headache, rapid heart rate and spikes in blood pressure. Two patients who also had been taking drugs for attention deficit disorder and schizophrenia had to be hospitalized for psychiatric treatment.

As if these problems were not enough, weight-loss supplements can be laced with other drugs in addition to sibutramine, including phenytoin (an anti-seizure medication), phenolphthalein (an experimental compound suspected of causing cancer), fenfluramine (a stimulant withdrawn in 1997 for causing heart valve damage) and ephedrine (another stimulant that causes cardiovascular risks). Such toxic cocktails represent a potential for harm that rises well above the risks that led the FDA to ban sibutramine in 2010.

If it sounds too good to be true…

Dietary supplements for weight loss are frequently promoted as miraculous “all-natural” or “ancient” remedies that are safer than FDA-approved drugs. Others are promoted using testimonials or the results of scientific studies. These claims are almost universally worthless. If you see any kind of claim promising an “easy” fix for weight loss, whether it comes from a “natural” product or an FDA-approved pill, you are looking at a product that is likely to do more harm than good.

Manufacturers of laced supplements often represent their products as being natural or derived from traditional medicine to take advantage of customers who believe that natural products are safer than conventional drugs. These claims should not be trusted: While a very small number of natural or traditional remedies do turn out to have benefits when tested with solid research, nothing is guaranteed to be 100 percent safe just because it was used over a long period and derived from living things.

Even “scientific” evidence cannot be trusted if it has not been subjected to adequate assessment, something that is generally only possible when the details of a clinical trial can be reviewed by the FDA or some other institution with specialized, highly trained reviewers. It is very easy to craft a shoddy scientific study that will “prove” that a product works. By contrast, good science tends to be expensive and may show that the product does not work or even that it is not safe. This means that few companies carry out high-quality safety and efficacy testing on their products unless they are forced to do so. Supplement makers are not required by FDA law to test their products for safety or efficacy, and as a result, many “scientific” claims by supplement makers are not based on rigorous scientific evidence. There are, however, some notable exceptions (see box below).

Weight-loss products should be met with special skepticism, because every weight-loss drug ever marketed has carried dangerous side effects. As Public Citizen’s Dr. Sidney Wolfe recently stated, “It is magical and delusional thinking for anyone to believe that a drug will turn off hunger without hitting other targets where it will do harm, usually to the cardiovascular system.” Dietary supplements are even less likely than drugs to provide the miraculous solution, because they are frequently not tested as rigorously.

What You Can Do

Do not purchase products that claim to offer miraculous solutions to health problems, whether the claims are said to be based in science or traditional medicine. Ignore personal testimonials by consumers or doctors claiming amazing results. A healthy dose of skepticism may actually save your life. The only safe, effective and sustainable way to lose weight is to eat less and exercise more. Sensible diet and exercise, maintained over a long time, will improve rather than worsen your cardiovascular risk.

Credit: AP

A new Harvard Medical School study reveals that immigrants’ contributions to Medicare generated a $115 billion surplus from 2002 to 2009; the American-born population sustained a $28 billion deficit over the same period, researchers found.

While immigrant and American-born individuals contributed roughly the same amount, immigrants, overall, received significantly less than they paid in because of age disparities between the two populations, as the New York Times notes: “The median age of Hispanics, whose foreign-born contingent is by far the largest immigrant group, is 27, according to the Brookings Institution. The median age of non-Hispanic whites in the United States is 42.”

The Times goes on to report:

How They Raise Premiums,
Deny Claims, and Refuse Insurance
to Those Who Need It Most

How the study was conducted:

To identify the worst insurance companies for consumers, researchers at the American Association for Justice (AAJ) undertook a comprehensive investigation of thousands of court documents, SEC and FBI records, state insurance department investigations and complaints, news accounts from across the country, and the testimony and depositions of former insurance agents and adjusters. Our final
list includes companies across a range of different insurance fields, including homeowners and auto insurers, health insurers, life insurers, and disability insurers.

Who Made the List

The Ten Worst
Insurance Companies

1. Allstate
2. Unum
3. AIG
4. State Farm
5. Conseco
6. WellPoint
7. Farmers
8. UnitedHealth
9. Torchmark
10. Liberty Mutual

Allstate—The Worst Insurance Company in America

One company stood out above all others. Allstate’s concerted efforts to put profits over policyholders has earned its place as the worst insurance company in America.
According to CEO Thomas Wilson, Allstate’s mission is clear: “our obligation is to earn a return for our shareholders.” Unfortunately, that dedication to shareholders
has come at the expense of policyholders. The company that publicly touts its “good hands” approach privately instructs agents to employ a “boxing gloves” strategy
against its own policyholders.1 In the words of former Allstate adjuster Jo Ann Katzman, “We were told to lie by our supervisors—it’s tough to look at people and know you’re lying.

CEO: Thomas Wilson
2007 compensation $10.7 million
(predecessor Edward Liddy made $18.8 million in compensation and an additional $25.4 million in retirement benefits)
HQ: Northbrook, IL
Profits: $4.6 billion (2007)
Assets: $156.4 billion8

There is no greater poster child for insurance industry greed than Allstate. According to CEO Thomas Wilson, Allstate’s mission is clear: “our obligation is to earn a return for our shareholders.” Unfortunately, that dedication to shareholders has come at a price. According to investigations and documents Allstate was forced to make public, the company systematically placed profits
over its own policyholders. The company that publicly touts its “good hands” approach privately instructs agents to employ a hardball “boxing gloves” strategy
against its own policyholders.”

Conclusion

The insurance industry is in dire need of reform. For too many insurance companies, profits have clearly trumped fair dealing with policyholders. The industry has done all it can to maximize its profits and rid itself of claims.
Allstate CEO Thomas Wilson outlined the strategy when he said the company had “begun to think and act more like a consumer products company.”176 Allstate has enjoyed a return double that of the S&P 500, but its policyholders have suffered cancellations, nonrenewals, and punishing loss-prevention techniques. 177Wilson has been unrepentant: “Our obligation is to earn a return for our shareholders.” 178 Wilson is one of many insurance leaders who have lost
sight of their legal and ethical responsibility to policyholders. Now they answer only to Wall Street. The time is due for insurance reform that will level the playing field for consumers.

Three Pro-Consumer Insurance Reforms

1. Require Insurers to Work in Good Faith with Consumers

Many states have introduced, and some have passed, “Insurer Fair Conduct” bills which establish a private right of action by a first and/or third party against insurers for failure to act in good faith. Insurers must be held to fair conduct standards when evaluating and settling claims.

2. Require Prior Approval of Rate Increases

Require insurers to obtain commissioner’s approval of proposed rate increases of 10 percent or greater, and authorize interested parties to intervene in rate proceedings. In most states, insurers can raise rates without the approval of the Insurance Commissioner. Rates are either automatically approved absent action on the part of the Commissioner, or the Commissioner has no authority to
disapprove increases. The goal is to explicitly authorize— or even require—the Commissioner to hold a hearing prior to approval.

3. Establish an Insurance Consumer Advocate

States should ensure there is a consumer advocate either on the state’s Insurance Commission or within the office of the Insurance Commissioner. Some states have already done so. For example, in 1991, the West Virginia legislature created the Office of Consumer Advocacy, charged with representing consumers’ interests in health care issues. The Consumer Advocate is also authorized to represent the public interest in matters coming before the Insurance Commission.

To read more about the Worst Insurance Companies please click here to read the article by AAJ.

image from esurance.com

Rainy driving tips – Smart Motorist offers the following suggestions for safer driving in wet weather. In stormy conditions, it is more difficult to see other vehicles, road signs and the road itself. It is critical to make sure you can see and be seen.

• First and foremost: slow down! It takes longer to stop or adjust in wet weather.
• Stay toward the middle lanes – water tends to pool in the outside lanes.
• Maintain proper following distance (3 Second Rule). This needs to be increased in wet weather.
• Drive in the tracks of a car ahead of you.
• Don’t follow large trucks or busses too closely. The spray created by their large tires reduces your vision. Take care when passing them as well; if you must pass, do so quickly and safely.
• Be more alert when driving in wet or slippery conditions. Watch out for brake lights in front of you.
• Avoid using your brakes; if possible, take your foot off the accelerator to slow down.
• Turn your headlights on even in a light rain, or in gloomy, foggy or overcast conditions. Not only do they help you see the road, but they’ll help other drivers see you. If your car has daytime running lights you still should put them on, so vehicles behind you can see you better.
• Before it starts to rain, replace old or brittle wipers.
• Avoid off-road driving: it’s hard to judge the actual depth of puddles and you can easily become stuck, even in an SUV.
• Never drive beyond the limits of visibility. At night rainy roads become especially treacherous. The glare of oncoming lights, amplified by the rain on your windscreen, can cause temporary loss of visibility while substantially increasing driver fatigue. In rainy conditions pedestrians, livestock, and wildlife are extremely hard to spot and even harder to avoid.
• Never drive through moving water if you can’t see the ground through it; your car could be swept off the road.
• When driving through a puddle of uncertain depth, go slow. If it’s deeper than the bottom of your doors, turn around and find another route. Deep water can cause serious damage to a modern car’s electrical system.
• Avoid splashing pedestrians.
• If possible, stay off the road during heavy thunderstorms. Large flashes of lightning can temporarily blind and disorient drivers, and the accompanying high winds and heavy rain can create deadly driving conditions.

Slow down! This should be obvious but it also very important. People are so used to driving certain speeds on certain roads that sometimes they forget the need to slow down when inclement weather presents itself.

Before you go - Wet-weather driving demands gentle use of all the main controls – steering, clutch, brake and accelerator – and a larger allowance for errors and emergencies. When you begin a journey in rain, your shoes will be wet and liable to slip off the pedals. Scuff the soles on the rubber matting or carpeting of the car before you start the engine. All motorists should regularly check that their headlights, tail lights, brake lights and turn signals are working properly.

How are your tires? - Check your tires on a regular basis. Bald tires significantly reduce your traction on wet roadways, and offer little resistance to hydroplaning. When your tires run over water, the water is displaced and it needs somewhere to go quickly. The best place is between the treads of your tires. If your tires are bald, the water has no place to go and you end up riding on a layer of water, like a boat. (See Hydroplaning, below.)

Turn on your wipers - Replace your wipers regularly, at least once a year. Wiper blades in bad condition don’t clear water from the windshield very well and distort your view. Older vehicles may need to have the whole wiper arm replaced. The arms bend over time and sometimes can’t keep enough downward pressure to clear the windscreen, even with new blades installed. Wipers will often clear light rain from the windscreen with a few sweeps, then run on an almost-dry screen and leave smears of drying dirt. Don’t be afraid to use the windscreen washers liberally: the fluid is cheap (99 cents a gallon) and the safety benefit is high. Carry extra during the winter.

Don’t follow large trucks or busses closely. Splash and spray from these vehicles can obscure your vision, creating a potentially disastrous driving situation. Keep your distance, and your windshield wipers on, when other traffic is in front of you.

Turn on your lights - Whenever visibility is poor or it rains, headlights are a good way to let other drivers know where you are. It’s both helpful to other travelers and makes you more safe. Remember, you are not the only one affected by poor visibility. You may be able to see cars without their headlights on but others may not have vision or windshield wipers as good as yours. Many states require headlights to be turned on when it is raining or when visibility is reduced to less than 500 feet.

Heavy rain - Heavy rain can overload the wiper blades, allowing an almost continuous sheet of water to flow over the screen. When visibility is so limited that the edges of the road or other vehicles cannot be seen at a safe distance, it is time to pull over and wait for the rain to ease up. It is best to stop at rest areas or other protected areas. If the roadside is your only option, pull off as far as possible, preferably past the end of a guard rail, and wait until the storm passes, seldom more than a few minutes. Keep your headlights on and turn on emergency flashers to alert other drivers.

Foggy windows - Rain or high humidity can quickly cause windows to mist up inside the car. In a car equipped with air conditioning, turn up the heat and direct the airflow to your defrosters with the AC switch engaged. (Many cars automatically engage the AC when switched to the defrost mode.) In a car without AC the procedure is the same, but you may need to open your side windows to get the air moving. Most modern cars have a built-in rear window defroster that easily clears a misted rear windscreen by heating up electrodes embedded in the glass. If you don’t have one, put your defroster on high and its hot air will eventually follow the inside of the roof down to the rear window. If the car has swiveling dashboard vents, adjust them so that the air flow strikes the upper edge of the side windows. The airflow will clear the side windows first, finally traveling to the rear of the car. If all else fails, a rag or article of clothing will work as well; you’ll just need to clear the window more often. Drivers should regularly clean their windshield and windows, both on the inside and outside, to help them see in good and bad weather. Smokers need to take extra care to make sure their interior windows are clear of a buildup of smoke residue.

Handling a skid - Losing control of your car on wet pavement is a frightening experience. You can prevent skids by driving slowly and carefully, especially on curves. Brake before entering the curves. Steer and brake with a light touch. If you find yourself in a skid, remain calm, ease your foot off the gas, and carefully steer in the direction you want the front of the car to go. This procedure, known as “steering into the skid,” will bring the back end of your car in line with the front. For cars without anti-lock brakes, avoid using your brakes. If your car has ABS, brake firmly as you “steer into the skid.”

Expressway driving - Leave lots of space between you and the car in front because it takes longer to stop. You’re supposed to leave a few seconds between cars in dry weather. Make sure you add space in wet weather because if you have to hit the brakes hard, your tires will lock up, you will hydroplane and you will most likely hit the car in front of you. If available, drive in the fast lane, where there are fewer cars and less oil deposited on the road. Also, because of the built-in slope of the road, water drains towards the slower lanes. Avoid lane changes, as water tends to build up between the tire ruts in the lanes.

Oily deposits - Watch for intersections because of the oil spots in the road. Rain is most dangerous when it falls after a long, dry spell on to roads that have become polished and smooth: the rain blends with oil and rubber-dust deposits on the road surface to form a highly dangerous skid mixture. That mixture builds up at intersections, where cars stop and start frequently. Be extra careful immediately after it starts raining because it takes a while for the worst of the dirt and oil to get washed off the road.

Driving Through Water - Where water has flooded onto the road, drive very slowly and cautiously. Never drive through moving water if you can’t see the ground through it: you and your car could be swept off the road, possibly finishing you both. Stop the car before entering the flooded area and check the water level ahead. Generally, if the water is deeper than the bottom of your doors or the bottom third of your wheels, it is inadvisable to attempt driving through it. Seek a detour rather than braving the flood and risking damage to your electronic control systems. Attempting to go through deep water can ruin any of these systems, creating a repair bill in the thousands of dollars.

At night it’s much harder to see water hazards. You’ll need good road observational skills to notice the difference between a wet road surface and flood water. Watch the contours not only of the road but also of fences, trees, hedges and buildings at the side of the road ahead. If they appear to be unnaturally low, slow down at once as the road is probably flooded. If you don’t slow down and hit flood water at speed, the effect is almost like hitting a wall: you will first lose control, then come to a violent stop, possibly injuring your passengers as well. Watch out for places where floodwater collects, particularly low-lying roads adjacent to streams, and dips under rail or highway bridges.

If you determine it’s safe to go on, proceed slowly and avoid making large waves in the water. If you have a manual transmission, engage first gear and keep the engine running fast by releasing the clutch just enough to partially engage gear and giving more acceleration than usual. This keeps the exhaust gases moving, helping to prevent water from entering your tailpipe. Vehicles with automatic transmissions should place the car in first gear and feather your brake, slowing the vehicle while at the same time keeping your revs up. Doing this for longer than a few seconds can seriously damage your vehicle and is not recommended. If you’re submerged too deeply, your engine will stall and water might enter your engine through your air intake, causing a condition known engine hydro-lock, forcing you to replace it.

What to do if you stall in deep water - If possible, have someone pull your vehicle out using a tow rope or cable winch. It may be possible to drive a manual transmission car out using the starter motor. You can make the job easier by removing your spark-plugs, thereby lowering your compression and making your starter turn more easily. Take great care not to let water enter the cylinders, as it will hydro-lock your engine, ruining it. This is a last resort for rescuing a flooded vehicle and is not recommended.

Check your brakes - If you successfully pass through a deep water hazard, test your brakes. They may be saturated, and only driving very slowly and braking lightly at the same time will generate enough heat to dry them out. Be sure they are pulling evenly on all wheels before building up speed again.

Re-posted from www.smartmotorist.com

HOW TO ADJUST YOUR CAR’S MIRRORS:

1. Adjust Your Seat (and steering wheel, and put on your seatbelt).

Proper adjustment of your seat will affect your view to the mirrors. You should be seated high enough to see the road and still reach all of the vehicle’s controls.

• Many newer vehicles feature tilt and telescoping steering columns to help you get more comfortable.
• Some new Ford Motor Company products (Ford, Mercury, and Jaguar) offer electrically adjustable foot pedals that allow short, medium, and tall drivers a comfortable driving experience.
• If you don’t have adjustable seats, and are still sitting too low, you should use a seat cushion, or better yet, have your mechanic raise your seat permanently.

2. Adjust Your Interior Rearview Mirror:

The positioning for the inside rearview mirror is fairly obvious; you should be able to see out of the rear window from the driver’s seat. Be sure the day/night switch found on most rearview mirrors is in the day position during daytime operation. The night setting reduces the headlight glare from cars behind you and helps you see better.

• Auto-dimming rearview mirrors: If you drive at night, you’ve undoubtedly experienced it – annoying and often dangerous glare from the headlamps of vehicles traveling behind you. While normal rearview mirrors are equipped with a day-night switch, automatic dimming mirrors darken to reduce glare from the headlamps of vehicles approaching from the rear. The brighter the glare, the darker the mirrors become, making nighttime driving safer. About 10% of vehicles sold in the US are currently equipped with this valuable safety feature. Usually auto-dimming mirrors can’t be ordered separately and are only available as part of expensive luxury group packages.

• Be aware of the SUV glare: In addition to other hazards posed by sport utility vehicles(SUVs) and trucks, their headlights are usually mounted at the same height as most normal car’s rearview mirrors. When an SUV travels behind a car, the glare from its headlights is reflected off these mirrors directly into the driver’s eyes. Dr. Alan Lewis, president of the New England College of Optometry, has done extensive research on the effects of glare. He found that during nighttime driving, headlight glare from vehicles traveling behind you can temporarily blind you, increasing your reaction time by up to 1.4 seconds, even after the source of the glare is removed. The time it takes to stop your vehicle, or to avoid someone in the oncoming lane, is doubled if you succumb to temporary glare blindness.

3. Adjust Your Exterior Rearview Mirrors:

Incorrect:Adjusting them so you can see the side of the car on the inside edge of the mirror. You are creating HUGE blind spots. Consider the view when the side view mirrors are set up as just described. Essentially, you have created “tunnel vision” to the rear. Your side view mirrors overlap much of what your inside rearview mirrors sees and you’ve also created blind spots.

Rule of thumb: If you can see even a glimpse of the sides of your car in your outside mirrors, they are turned too far inwards.

Correct: For the driver’s side mirror: Place the side of your head against the window, then adjust the mirror until the side of your vehicle comes into view. For the passenger’s side mirror: While sitting in the driver’s seat, lean to the right so that your head is in the car’s center line. Adjust the mirror until the side of your vehicle comes into view. With this setup, you almost completely solve the blind spot problem. It takes a little while to get used to, but it is an improvement.

The following graphic shows the sightlines from your rear view and side view mirrors and how to adjust them (the car is facing to your right):

Be safe out there while you are driving, and as always, wear your seatbelt, and don’t drive while drunk or distracted!

What do you think? Do you have any tips or tricks???

Article Source: www.SmartMotorist.com

The rule of thumb: Start by paying off all higher interest debt first, like credit cards or student loans with rates of more than 5%. Make all minimum loan payments, no matter what the rate. If you have a 401(k) match at work, maximize it. Then, invest according to your goals.

Here’s why:

All Debt is Not Created Equal

The average American student graduates with a $26,500 loan. This level of debt can be scary, but it’s really the kind of debt that is important. For example, if you have high interest debt in the form of credit cards or personal loans, pay those first. Be sure to avoid making costly mistakes that may cause your debt to pile higher, like missing repayments.

Being in debt is not always a bad thing, however. Debt that helps you increase your assets—like education to improve your career skills or purchasing property that will increase in value over time—can help you get ahead faster if managed in the right way.

Let me explain: if you have a low interest student loan (think less than 5%), then it might make sense to start investing before accelerating pay-off. Paying your loan off is like getting a guaranteed rate of return equivalent to the rate on your loan. Guarantees are good, but they come at a cost that you need to judge based on your other goals. For example, by investing towards a safety net, you give yourself options in case of unexpected expenses. Or, by investing toward a long-term goal like retirement or building wealth, you may come out ahead because more years in the market give you more time for compound interest to work its magic.

However, student loans in more recent years tend to be higher (~6%-8%). In this case, you are best to pay off your student loan first and invest as a second priority (view types of student loans).

Don’t Leave Free Money On the Table

If your employer offers a 401(k) match or similar incentive, be sure to take it. You won’t get a similar return on your money anywhere else.

Choosing Your Retirement Account

In addition to your 401(k) (your employer sponsored account), you can invest in an IRA. For people starting out in their careers, a Roth IRA is a great idea. It keeps some flexibility should you need the money later—but gives you the maximum tax advantage (because for now you’re paying so little tax on that money, it’s great to fund the after-tax Roth IRA).

When it comes to saving, retirement should always be among your top goals. The effects of compounding can be huge so the earlier you start, the better. The amount you can put toward retirement will differ depending on your stage of life. People in their early 20s should simply aim to create savings habits, while those in their late 20s should aggressively save 20% of each paycheck.

One last thing: This is a personal issue. As with all things finance, money is deeply personal. If you sleep better at night knowing that your student loan is being paid down, then by all means do that first.

Find the original Article on Lifehacker

By: Jon Stein 05-15-2013

Do not forget Super-storm Hurricane Sandy that hit the eastern United States late last year 

NYTimes.com

Or more recently the  Tornadoes that struck North Texas on May 15, 2013

abcnews.com

It could happen to you be prepared to protect your rights.

In the aftermath of any natural disaster, homeowners and small business owners can take steps to protect their rights and ensure that just and fair insurance claims are paid. The American Association for Justice has put together a few tips to keep in mind to protect your rights under your insurance policy:

• READ YOUR POLICY CAREFULLY: You should know exactly what is covered and how to appeal a denial by your insurance company.

• MAKE YOUR OWN ESTIMATE: Obtain and submit to the insurance company your own estimate of what it would take to repair the damaged property as soon as reasonably possible.

• BE VERY CAREFUL FILLING OUT FORMS: Even if you make an honest mistake your insurance company may seize on that as a reason to retroactively deny your coverage.

• REMEMBER WHO ADUJSTERS WORK FOR: The adjuster is the face of the insurance company. Treat the adjuster as though they were the insurance company, making all requests and complaints to them as well as the insurance company directly.

• COMMUNICATIONS IS THE KEY: There is no such thing as too many communications to the insurance company or the adjuster; written communications are best. See next tip.

• PUT EVERYTHING IN WRITING: Calling your insurance company is likely to be a frustrating experience, and you will not be able to prove anything that a company representative tells you over the phone. Keep records of all bills and correspondence. Email and text messages count!

• THE FIRST ESTIMATE IS NOT ALWAYS RIGHT: The estimate that the adjuster provides you is rarely adequate. If you feel the estimate you received is not correct, challenge it in writing.

• PHOTOGRAPHS: Photographs. Photographs. Photographs. Take pictures of everything. It is actually a very good idea to take a video of all of your house so you can have a log of your valuables. So, when the insuace companies ask you to log all the items you can just view the video to exactly describe what was in the home.  

• CONTACT YOUR STATE INSURANCE DEPARTMENT: They may be able to help you. But they will not represent you in a private matter, so if all else fails you may need to consult with an attorney.

• DO NOT CASH A PREMIUM REFUND CHECK: If your insurance company rescinds your insurance they may send you a refund for the premiums you paid. Cashing it may be interpreted as accepting their decision.

• AND MOST OF ALL, DO NOT GIVE UP: Insurance companies count on you giving up. Fight for your rights. Contact an experienced attorney such as the attorneys from Stephens & Stephens. 

On Jan. 10, 2013, the Food and Drug Administration (FDA) issued a drug safety communication concerning most sleeping pills containing the drug zolpidem because of new data showing that the levels of drug remaining in the blood the morning after use may be high enough to impair activities requiring mental alertness, including driving. Though the drug’s newest formulation, INTERMEZZO, was not specifically included in the FDA’s safety communication, the FDA twice rejected it for approval due to these same concerns.

INTERMEZZO was approved in November 2011 as a formulation of zolpidem that dissolves under the tongue. Until its formulation, the idea behind insomnia drugs was to assist one in getting to sleep at his or her normal bedtime. INTERMEZZO differs from the rest of the group in that it is for people who wake up in the night and still have four hours left before they are to rise in the morning. As such, it is designed to work for a shorter period of time than typical sleeping pills. But even with its shorter action time, INTERMEZZO presents some of the same serious safety concerns as earlier formulations of zolpidem.

Overview of zolpidem

Zolpidem originated in 1992 as the familiar and controversial sleeping pill AMBIEN, and it has since morphed into four more variations (see table).

AMBIEN and the four formulations that followed it all contain the same chemical, zolpidem tartrate. The differences between the five formulations are either in the length of time the drug is effective (extended time or limited time) or mechanism of delivery (oral tablet, oral spray or sublingual tablet).

Zolpidem is one of the three so-called “Z drugs” used to treat insomnia (the other two being eszopiclone [LUNESTA] and zaleplon [SONATA]), all of which are categorized as Do Not Use on Public Citizen’s WorstPills.org. They all belong to a drug class called nonbenzodiazepine hypnotics.

“Nonbenzodiazepine” means that the drugs are allegedly not like VALIUM or similar drugs. (Most of the benzodiazepines are also categorized as Do Not Use. One listed as Limited Use is oxazepam [SERAX].) Although zolpidem and the other Z drugs are not benzodiazepines, they have many of the same effects of this family of drugs, including the potential to cause dependence. The WorstPills.org website provides a wealth of information on the use of these drugs.

Formulations of Zolpidem Tartrate

*Do Not Use

A history of safety concerns

In September 2008, Transcept Pharmaceuticals, Inc., submitted its original application to the FDA for drug approval of INTERMEZZO. This was followed by an FDA rejection in October 2009 due to concerns about mental alertness, including an impaired ability to drive the morning after the drug was taken. These safety concerns were related to high levels of the drug remaining in the blood the next morning.

The company resubmitted its application and was again turned down by the FDA, in July 2011, because the FDA reviewers remained concerned about the same safety issues.

However, two months later, on Sept. 14, 2011, the FDA review team, along with two of the FDA’s top management staff, met with the pharmaceutical company. Two weeks later, on Sept. 27, 2011, the FDA received a new submission from the company. At this point, the director of the FDA division that reviewed INTERMEZZO stated that the team was “convinced by the sponsor’s re-analysis and presentation of the pharmacokinetic data.”

The result was that INTERMEZZO was finally approved on Nov. 23, 2011, despite limited efficacy and the many safety concerns associated with its use. Some of the risks of all formulations of zolpidem include:

• Impairment of alertness and motor coordination. In a driving study for INTERMEZZO, next-day driving was statistically significantly impaired at three hours after taking the drug and, while not statistically significant, was poorer than placebo at four hours after taking the drug. These risks are especially relevant to women, whose bodies eliminate zolpidem more slowly than men.
• Severe anaphylactic reaction. Reactions have occurred in people allergic to zolpidem or its ingredients and include swelling of the face, lips and throat, which can cause difficulty breathing and swallowing. (Nausea and vomiting also are signs of such allergic reactions.)
• Next-day memory loss of activities performed the night before. These can include texting, making and eating food, engaging in sex, and sleepwalking.
• Worsened depression or suicidal thinking.
• Respiratory depression.
• Drug abuse and dependence. There have been post-marketing reports of drug abuse, dependence and withdrawal. Those with a history of addiction to drugs or alcohol are at increased risk and should be carefully monitored. To avoid adverse effects of abdominal and muscle cramps, vomiting, sweating, tremors and convulsions, it is important to not abruptly stop taking zolpidem.
• Harmful interactions with alcohol and other drugs. Patients are advised not to drink alcohol the day they plan to take the drug as alertness is impaired. Impaired alertness also can occur when patients are also taking imipramine (an antidepressant), chlorpromazine (an antipsychotic) or ketoconazole (an antifungal).
• Fetal harm. There were abnormalities in fetal bone formation in the skull in studies in rats and rabbits.
• Neonatal withdrawal. Babies born to mothers taking hypnotic drugs may be at risk for withdrawal symptoms.
• Breastfeeding risks. Zolpidem is excreted in human milk, putting infants at risk.
• Harm to geriatric patients. Geriatric patients experienced an increase in falls. Of 30 non-U.S. patients receiving zolpidem formulations and reporting falls, 28 (93 percent) were 70 years of age or older.

Efficacy

In clinical trials, the measured outcomes for those taking the drug compared with those taking a placebo sublingual tablet were rather small. The one study done in a sleep lab, in which sleep times could be carefully monitored, showed that women taking a 1.75-milligram (mg) dose of INTERMEZZO after awakening during the night fell back to sleep only 12 minutes sooner than those taking a placebo. Men in the study who took a 3.5-mg dose fell back to sleep 16 minutes sooner than those taking a placebo.

What You Can Do

Given some of the risks presented by zolpidem and by sleeping pills in general, it is probably a good idea to try nondrug approaches to getting to sleep before approaching your doctor for a pharmaceutical solution. Avoid the use of caffeine, nicotine and alcohol, especially after noon. Establish a routine for getting ready to go to bed, including relaxation techniques. Pursue regular physical activity, such as walking or gardening, but avoid vigorous exercise too close to bedtime.

If you and your doctor decide that you would benefit from a prescription for sleeping pills, which you should use for only short periods of time, consider oxazepam. See the “Sleeping Pills and Tranquilizers” section of WorstPills.org for information on safer use of this drug.

Worst Pills Best Pills Newsletter article April, 2013

A recent study published in the Annals of the Rheumatic Diseases (Annals) strongly suggests that RA patients treated with tumor necrosis factor (TNF) blockers, a class of very potent immunosuppressive drugs most commonly used to treat RA, also have an increased risk of developing the viral skin infection shingles. The study also showed that this risk appears to peak at approximately one year after starting the drugs.

Patients prescribed these drugs should be aware of the risk of shingles and associated complications. In addition, patients age 50 or older should strongly consider vaccination with the shingles vaccine, ZOSTAVAX, to protect against this risk prior to starting such RA therapy.

Overview of TNF blockers

TNF blockers are a family of biologic drugs that interfere with the naturally occurring, hormone-like substance TNF, which plays a central role in immune system function. These drugs are considered disease-modifying anti-rheumatic drugs (DMARDs). In contrast to anti-inflammatory drugs such as nonsteroidal anti-inflammatory drugs, DMARDs not only relieve symptoms but also may slow or even modify the rheumatic disease process itself.

Five TNF blockers are available in the U.S. (see table), administered by injection at intervals ranging from one to eight weeks between doses. In many patients, these drugs can cause a dramatic improvement in symptoms by blocking the action of a TNF, believed to play a role in joint inflammation and damage. Elevated levels of TNF are found in the joint fluid of RA patients.

Until recently, most doctors reserved the use of DMARDs for the most severe RA patients who failed to respond to other therapies. Now, many physicians use DMARDs earlier and more aggressively in the hope of slowing disease progression and damage to joints. One of the oldest, still widely prescribed DMARDs, methotrexate (TREXALL), is often recommended as the first DMARD to be used for patients with moderate to severe RA. Patients failing to adequately respond to methotrexate typically are switched to more aggressive treatment with TNF blockers.

As with many drugs with dramatic benefits, TNF blockers also can pose serious risks because they interfere with the body’s immune mechanisms for fighting infectious diseases and destroying cancer cells. Thus, the Food and Drug Administration (FDA) has required information about increased risks of infections (such as tuberculosis) and cancers (such as lymphoma) to be included in black-box warnings on the labels for these drugs, as well as in FDA-approved Medication Guides that are to be provided to patients.

TNF Blockers Available in the U.S.

* Do Not Use for Seven Years
** Limited Use

Overview of shingles

Shingles is also known as herpes zoster and is caused by the varicella-zoster virus, the same virus that causes chicken pox. (Chicken pox was a once-common infection in the U.S. prior to the development of the children’s varicella-zoster vaccine.)

After a person recovers from chicken pox, small amounts of the varicella-zoster virus remain dormant within spinal sensory nerves for life. Shingles may occur later in life when the dormant virus reactivates and spreads from one or more nerves to the skin. The infection is characterized by a rash that initially appears as groups of multiple red bumps and evolves into small blisters and pustules. The lesions generally appear in a narrow band on one side of the body. Known as a dermatome, this band is the area of skin connected to the sensory nerve in which the dormant varicella-zoster virus reactivated.

Besides the rash, pain is the most common symptom of a shingles infection. In approximately three-quarters of cases, the pain begins days to weeks before the appearance of the rash. This pain, which may be constant or intermittent, occurs in the same areas of skin affected by the subsequent rash. A minority of shingles patients also experience headaches, fever, malaise and fatigue.

A common complication of shingles, occurring in approximately 10 to 15 percent of cases, is post-herpetic neuralgia, which causes chronic, often severe pain in the same area of skin that had the rash. The risk of developing post-herpetic neuralgia increases with age, and patients over age 60 are at greatest risk of this complication. Patients who are immunosuppressed also are at higher risk of developing post-herpetic neuralgia.

Other complications of shingles include blindness due to shingles infection in areas of skin around the eyes that can spread to the cornea, meningitis, encephalitis (brain infection) and secondary bacterial infection of the skin pustules.

The shingles vaccine, ZOSTAVAX, reduces the risk of having shingles by about 50 percent — as well as reducing the risk of major complications, including post-herpetic neuralgia by two-thirds, if a shingles infection does occur — without serious side effects. This vaccine, approved for use in adults age 50 and older, is different than the one given to children to prevent chicken pox. ZOSTAVAX includes live varicella-zoster virus that has been modified so that it can no longer cause active infection. In people anticipating immunosuppression, the vaccine should be given at least 14 days to one month prior to starting immunosuppressant therapy.

Overview of the Annals study

Beginning in 2001, the British Society for Rheumatology (BSR) initiated the BSR Biologics Register (BSRBR) to prospectively evaluate the long-term clinical outcomes, including the incidence of rare and unexpected adverse events, of RA patients treated across the U.K. with TNF blockers and other similar biologic drug therapies.

BSRBR recruitment of RA patients treated with either etanercept (ENBREL) or infliximab (REMICADE) started in 2001, and recruitment of patients prescribed adalimumab (HUMIRA) began in 2003. The planned subject enrollment for each patient group was 4,000, which has been attained for all three drugs.

The BSRBR also included a prospectively enrolled comparison control group of active RA patients who were not treated with TNF blockers or other similar biologic drugs, but instead received nonbiological DMARDs, such as methotrexate.

Patients previously treated with any TNF blocker or other biologic drugs were excluded from the study.

At the time of initial enrollment in the registry, all patients provided a complete medical history and underwent a baseline physical exam. Patients and their physicians completed follow-up medical questionnaires every six months for three years. Patients also maintained a diary to record hospitalizations, adverse events and new prescriptions for three years.

Results of the Annals study

For the recent Annals study, data on new skin infections, including shingles, were analyzed for 11,881 RA patients taking TNF blockers and 3,673 control patients.

There were 275 cases of shingles in patients receiving TNF blockers (incidence rate of 1.6 infections per 100 patient-years, which is an estimate of the number of infections that would occur if 100 RA patients were each treated for one year with these drugs) and 45 cases in the control group patients (incidence rate of 0.8 infections per 100 patient-years). Twenty shingles infections (7 percent) in TNF-blocker patients were classified as severe, whereas only one case of shingles (2 percent) in a control patient was severe. Six of the severe infections in the TNF-blocker patients as well as the one severe infection in the control-group patient involved the eye.

After controlling for multiple confounding factors (including age; sex; severity and duration of RA; disability scores; baseline steroid use; smoking status; other diseases, such as diabetes and emphysema; and year of entry into the study), patients treated with any of the three TNF blockers were 70 percent more likely to contract shingles than control patients. The researchers estimated that for every 128 patients treated for one year with a TNF blocker, one additional case of shingles occurred.

RA patients treated with infliximab had the highest risk of shingles, with a 2.2-fold greater incidence than control patients. The risk in etanercept patients was 1.7-fold higher, and adalimumab-treated patients had the lowest risk (1.5-fold higher incidence compared with those in the control groups).

Finally, an analysis of the risk of shingles over time revealed that the level of risk peaked at one year of treatment and then gradually decreased.

What You Can Do

If you are an RA patient age 50 or older in whom treatment with a TNF blocker is being considered, you should discuss with your physician whether you should receive the shingles vaccine prior to initiation of the drug. Low-dose steroids or methotrexate, both frequently prescribed to RA patients prior to TNF blockers, are not contraindicated to the shingles vaccine. If the vaccine is to be given, it should be administered two to four weeks prior to starting any TNF blocker.

Regardless of whether you receive the shingles vaccine prior to starting a TNF blocker, you should be alert for signs of the shingles rash. If you develop shingles, see your health care provider immediately to discuss whether an antiviral drug active against the varicella-zoster virus should be initiated. This is particularly important if shingles develops on the face near the eye, because such treatment is needed to prevent eye infection and possible blindness.

For any shingles rash, you should monitor the affected areas for signs of secondary bacterial infection, such as spreading areas of redness, warmth and tenderness. If these signs develop, you should contact your physician promptly to determine whether you need antibiotics for a bacterial skin infection on top of the shingles.

Worst Pills Best Pills Newsletter article May, 2013

It was reported recently that Toyota has quietly made a change in most of its models that could save lives if a car’s accelerator sticks open. Significantly, this doesn’t involve the actual model at the center of the litigation comprised of Toyota’s unintended acceleration lawsuits. We wrote about the $1.1 billion settlement elsewhere in this issue. Toyota has modified the start-stop buttons in most of its models so they will shut off the engine after three quick pushes, or after being continuously pushed for two seconds. Those are two big changes from the old policy that required a continuous three-second push to shut down the power.

The start-stop button was cited as a factor in the crash that killed an off-duty California Highway Patrol officer and three family members outside San Diego more than three years ago. The investigation found that in a panic situation, a button required a much longer push than intuitively would be expected to turn off the engine. But, as most of our readers will likely recall, Toyota officials defended the older version at the time, saying it was important to make sure that drivers or their passengers didn’t turn off the car inadvertently by brushing against it.

A few remaining Toyota or Lexus models – at press time Toyota hadn’t specified which – are yet to get the change to a two-second push. The change to the two-second push started a year ago, according toToyota spokesman Brian Lyons who relayed this information to USA Today. All Toyota and Lexusvehicles, starting in August 2010 will now have buttons that will shut off the engine after three quick pushes. This is a major improvement for a driver in a panic situation. Lyons told USA Today that the changes made to vehicles with the start-stop buttons resulted in part from recommendations from a committee of the SAE, once called the Society of Automotive Engineers. It’s important to note that only cars with the buttons will be affected by the change. Those models have the “electronic key” ignitions instead of the traditional kind in which you insert a metal key and twist to start the engine.

In their efforts to reach a preliminary settlement of its unintended-acceleration lawsuits, Toyota has said it would pay to have a “brake override” feature added to its pedals of many of its non-hybrid models. If a driver pushes the brake and accelerator in quick succession, as if in a panic, the engine speed will be cut to idle. All of Toyota’s hybrids already have this feature. It’s also now standard on allToyota and Lexus models, regardless of whether they are hybrids or not. I have to wonder why it tookToyota so long to make the needed changes, considering what it had to know about the hazards and dangers caused by sudden acceleration of its cars.

Source: USA Today