How to Save Money on Birth Control

If you live in New Hampshire, or some other state that is withdrawing Planned Parenthood funding, you may need to find an alternate source of affordable birth control, at least until the states get their heads screwed back on straight. In the meantime, please, don’t stop your birth control because you think you can’t afford it – the costs of not using it are much, much higher.

But what can you do to make the choice to use birth control even more cost effective?

Birth Control Pills

  • Buy them cheap locally.  Walmart, Target and Kroger sell very low priced birth control pills – only $4 to $9 a pack. It’s only a few brands (Trinessa, Sprintec and Trisprintec), but ask your doctor if it makes sense to switch if cost is a barrier for you.
  • Stick to generic and Tier-1 brands.  If your insurance covers birth control pills, try if possible to stick with tier 1 brands or generics – your co-pay will be much less.
  • Get a 90-day supply. Ask your doc to write for a 90 day instead of a one month supply, and use mail order instead of your local pharmacy – in most cases, you’ll get three months’ worth of pills for one co-pay.  If your insurer uses CVS-Caremark as their online pharmacy, your local CVS may dispense a 90 day supply for a single co-pay.

Nuvaring

  • The manufacturer has a coupon worth $15 off on up to 6 prescriptions

IUDs

Condoms 

  • Condom prices are quite reasonable at Target, Costco and Walmart  – as low as $8-10 for a 36 pack of some brands. While you’re at it, ask your partner to pay for them.
  • Trojan has coupons

Emergency Contraception

  • Don’t forget that the morning after pill is there if the condoms breaks or slips off. Plan B is offering a $10 off coupon on their website.

Depo Provera

  • Pfizer has several programs which could allow low income women who qualify to get free Depo Provera.

Spermacide

Today Sponge

  • Not as cheap as condoms, but less expensive if you join the Spongeworthy Club and buy in bulk.

Use Pre-Tax Dollars to Pay for Birth Control

  • Put enough money to cover your annual birth control costs into a health savings account with your employer and save on taxes while preventing unplanned pregnancy.

Got a tip for getting birth control cheap? Tell us in the comments section below.

 

 

New Hampshire De-Funds Planned Parenthood, Forcing Them to Stop Dispensing Birth Control

The New Hampshire state legislature has voted to defund Planned Parenthood’s pharmaceutical services, and Planned Parenthood Centers in that state have stopped dispensing birth control.

(Planned Parenthood) provides its services on a sliding scale based on income, with 70 percent of patients paying nothing or near nothing for birth control pills because they earn less than 150 percent of the federal poverty line.

What is New Hampshire thinking? Here’s what Raymond Wieczorek, a council member who voted against refunding Planned Parenthood’s state pharmacy contract, had to say –

“If you want to have a party, have a party but don’t ask me to pay for it.”

What Mr W doesn’t seem to realize is that the he will be footing the bill for the party in the long run if unplanned pregnancies result from this short-sighted move. And if it’s abortion he’s against, then de-funding birth control is just plain dumb.

 

Sandwiches with Goat Cheese, Red Peppers & Anchovies

In Catalan, they say it Entrepans amb Formtatge Fresc, Anxoves i Pebrot.

In Barcelona, one would make these sandwiches on a toasted baguette. Here at the cottage, I was in the mood to make bread, so instead we used Pan Cubano, fresh from the oven.

Nothing like rubbing a fresh tomato on warm bread, then drizzling it with olive oil, sprinkling a bit of salt and putting it together around a few anchovies and slices of goat cheese and warm roast peppers.

Down it with a cold beer, then hit the hammock for an afternoon nap.

Sandwiches with Goat Cheese, Red Peppers and Anchovies

This recipe is from the lovely Williams Sonoma – Barcelona cookbook. The book was a gift from the mother of a Barcelonan exchange student who stayed with us last year, so I figure that’s testimony enough to the recipes’s authenticity. Makes 4 sandwiches.

  • 2 medium or 1 large red pepper
  • 8 olive oil packed anchovy fillets
  • Baguettes, cut into 4- 6 inch lengths
  • 4 large slices goat cheese
  • 4 small ripe tomatoes
  • Salt and pepper to taste

Roast the peppers on a cookie sheet under the broiler, turning them so they char evenly on all 4 sides. Remove to a brown paper bag to cool, then peel them over a large bowl, saving the juices and discarding the stem, seeds and skins. Slice into 1/4 inch strips and set aside.

Slice the baguette into 6 inch slices, then again horizontally into halves. Pop under the broiler for about one minute till lightly toasted.

Slice each tomato in half, then rub the cut sides onto the toasted baguette surfaces until only the skins are left , then discard the skins. Drizzle the baguette halves with olive oil and sprinkle with salt and pepper to taste.

Divide the cheese slices among the bottom halves of the baguette lengths, followed by the red pepper slices and anchovies. Cover each with the top halves, and serve.

 

Yoga May Help Menstrual Cramps

In a nice little study* published in this month’s Journal of Pediatric and Adolescent Gynecology, yoga practiced throughout the luteal phase of the menstrual cycle diminished the severity of menstrual cramps. The poses used (cat, cobra and fish) were those that supposedly treat pelvic congestion.

Since the control group did not exercise, the study did not really control for the placebo effect of the yoga intervention, or for the fact that exercise has already been shown to decrease menstrual cramps. A better control group would have been given yoga poses that do not address the pelvic area (sort of like sham acunpuncture), and a third group could have used some other form of exercise, perhaps pilates.

Placebo effect or no, yoga is fun, the poses used are easy to do and if it diminishes menstrual cramps without the need for medication, I’m all for it.

* Effect of Three Yoga Poses (Cobra, Cat and Fish Poses) in Women with Primary Dysmenorrhea: A Randomized Clinical Trial

How to Get a Sooner Doctor’s Appointment

A friend of mine had a hard time getting in to see her doctor for an urgent visit last week. Reeling from an unexpected and sudden family upset, she was depressed and anxious, unable to sleep or function, and her therapist was advising an antidepressant.  She called her family doc, who works at a large hospital-based multispecialty group, and told the woman at the call center that she wanted to see the doctor on an urgent matter. She was given an appointment 6 weeks in the future.

Summoning her courage, my friend told the woman her story – and that she was really worried about herself and did not think she could wait that long.

“Sorry, that is the best I can do” was the reply.

Increasingly upset, my friend told the woman that if she had to wait that long, she just might kill herself in the interim.

“That’s your choice, Ma’m”, was the curt response.

“Thank you”, said my friend. “And what is your name, please?”

Silence. Then –

“Just a moment”.

“You can come Tuesday at 11:45 am”.

When my friend told her doc what had happened, he was appropriately appalled, and advised her that the if this ever happened again, she should ask to speak to his nurse or to him directly, an option my friend told me she had never even considered.

Which made me realize that not everyone knows what to do when, for whatever reason, they can’t get a soon-enough appointment with their doctor for an urgent matter.

What To Do If  Your Doctor’s Appointment Isn’t Soon Enough

We can talk some other time about what is happening to health care, why that secretary up there should be fired, or how call centers, for all their efficiencies of scale, can become too far removed from the action of a doctor’s office to function effectively. None of which will get you in to see your doctor.

So here’s some practical advice for when you need to get in to see your doctor on an urgent medical matter and his/her office staff gives you an appointment that you believe is too far into the future.

1.  Be up front about why you need the appointment, as my friend was. This will help your doctor’s staff to triage your appointment appropriately, and most of the time, will be all you need to do.

2.  Ask if you can see one of your doctor’s associates or the nurse practitioner sooner. It may be more important to you that you get seen that who actually sees you.

3.  Ask to speak to the nurse of office manager. Don’t let a secretary, as experienced as he or she may be, determine your medical fate.

4.  Ask for a call back from the doctor. He or she will get you in if needed. Or maybe the problem can be handled over the phone.

5.   Email your doctor. Direct communication works best if its available to you.;

6.   Contact patient services. If your doc’s practice is attached to a hospital or medical school, contact patients services at that institution and ask for their assistance.

Mind you, these tactics are not appropriate if you’re just trying to make things more convenient for yourself. In fact, they may actually backfire, since you may annoy the office staff for a non-urgent reason.  In that case. your best bet is to turn on the charm and worm your way in. Even better, call daily looking for cancellations, and be willing to come at the last minute if something opens up.

Take a different approach for a new patient appointment

If you’re looking for a sooner new patient appointment, you’ll need to take a different approach, since your doctor and his nursing staff are under no obligation to take your call if you are not an established patient. The office manager may be willing to speak with you, however, so it’s worth a try asking him/her to call you back. If it is a specialist you’re trying to see, ask your referring doctor’s office to facilitate the appointment. If the practice is affiliated with a hospital, contact the physician referral service – they should know which practices have availability so you can get your urgent matter handled. Calling daily in the mornings looking for a cancelled spot is also worth doing. If you’re friendly enough, you’ll make best friends with the office staff, and they’ll remember you next time a cancellation occurs.

If all this fails, seek care in an urgent care center in your area, or, as a last resort, the Emergency Room of your hospital – but only if it’s a real emergency.

Summer Corn Pudding

Most recipes for corn pudding get published in the fall, evoking images of the Indians and the Pilgrims gathered around the Thanksgiving table. These recipes are a great reason to use the leftover corn you had put in the freezer in July and then forgot you had until you found it while cleaning out the freezer in November.

Here’s what I say – forget the frozen corn. Make the corn pudding in July using sweet corn fresh off the ear. And don’t waste the recipe on leftover corn – buy the corn special just for this recipe. It’s worth it. Serve it with reheated ribs and barbecue sauce that you had found in the freezer. Add green beans, and if the weather is right, it can become your first rooftop dinner of the season.

Oh and did I mention I didn’t actually make this? Mr TBTAM did! But I helped reheat the ribs and set the table.

Corn Pudding
(Modified from Fonda San Miguel: Thirty Years of Food and Art, by Tom Gilliland, Miguel Ravago, and Virginia B. Wood, in Epicurious)

If you make this, I recommend cutting the peppers in a large dice rather than strips above, because the strips make it hard to cut the pudding onto squares, which is why it sort of just looks like a delciious clump on the plate…

2 pounds fresh corn kernels
Whole milk as needed (up to a cup)
6 eggs, separated
1/4 cup sugar
6 tablespoons butter, softened
3/4 cup all-purpose flour (substitute corn flour for a gluten free option)
1 teaspoon kosher salt
cayenne pepper to taste (about a pinch or more to taste)
1 teaspoon baking powder
1 cup (4 ounces) shredded Cheddar cheese
1 poblano chile, roasted, peeled, seeded, and cut into 1/4-inch strips
Half of a red bell pepper, cut into strips

Preheat oven to 350 degrees. Lightly grease a 13-by-9-inch baking dish with butter or oil. Puree the corn in the food processor with just enough milk to make a smooth puree (we used a little over a half cup). With the machine running, add egg yolks, one at a time, and process 30 seconds after each addition. Keeping machin running, add the sugar a little at a time and process until mixture is lighter in color and sugar is dissolved, about 3 minutes. Add butter and process until smooth. Transfer to a large bowl. In a separate bowl, combine flour, salt, and baking powder; fold into corn mixture. Beat egg whites until soft peaks form and fold into corn mixture, alternating with the shredded cheese. Pour into baking dish and top with strips of chile and red bell pepper. Bake in preheated oven for 45 minutes, or until golden brown. Serve warm or at room temperature.

An Even Easier and Less Fattening Corn Pudding

We got the whole idea of making corn pudding from my mother in law Irene, who made this much simpler and just as delicious recipe, also from Epicurious. I’m making Irene’s version next time – it’s also less calories..

Gardenias

I wish you could smell these gardenias, whose aroma is a truly one of nature’s gifts.

These gorgeous blossoms were brought to me by one of my Greek patients, who grows them on her terrace in Astoria.  Every June she brings cuttings for me when she comes for her annual exam.

This year, she tells me one of her gardenia pots broke and rather than her having to replant the bush, do I want it for my garden?

I am so there.

Stay tuned in a week or so for some shots of her terrace garden, which I cannot wait to see.  I am confident that it will put mine to shame.

Supreme Court to Docs – You Have No Privacy

The Supreme Court has sided with Big Pharma in their challenge to the Vermont Law limiting the pharmaceutical Industry’s access to physician prescribing information.

The nation’s high court handed down a verdict Thursday in the Sorrell v. IMS Health case, striking down by a 6-3 vote a 2007 Vermont law that that bans the practice of data mining — the sale and use of prescriber-identifiable information for marketing or promoting a drug, including drug detailing — unless a physician specifically gives his or her permission to use the information.

Apparently, Big Pharma’s right to “free speech” trumps my right to privacy. How getting access to my prescribing information has anything to do with free speech is beyond me.  In the twisted logic of the pro-business, anti-citizen Supreme Court –

Speech in aid of pharmaceutical marketing… is a form of expression protected by the Free Speech Clause of the First Amendment.

The Vermont Law Did Not Go Far Enough

By limiting its restrictions on data sharing to Pharma marketing, Vermont set itself up for the SOCTUS decision by making it appear that they were unfairly singling out marketing uses from other uses of prescribing data.  In my opinion, I don’t think anyone should have my prescribing data without my permission.

The AMA’s Role in Releasing  Physician Prescribing Information

The Vermont Law would not have been necessary were the AMA not selling physician information (the so called AMA Physician Masterfile) to the data mining companies, who then merge the files with pharmacy data and sell it to Big Pharma so they can use it to track physician prescribing patterns and target their marketing messages. Lucky docs don’t even have to be an AMA member for them to sell their data.

Now, the AMA is coming in like the White Knight, supporting physicians’ right to restrict access to their data –

While the AMA supports the appropriate disclosure of prescriber data, the AMA firmly believes that every physician has the unequivocal right to decide whether his or her individual prescribing data is shielded from pharmaceutical detailers. To help physicians exercise that right, the AMA created the Physician Data Restriction Program (PDRP), which enables physicians to “opt out” of such disclosure quickly and easily, while still allowing their data to be available for academic and governmental research.

“The PDRP is available to all U.S. physicians – both AMA members and nonmembers. Since its launch in 2006, nearly 28,000 physicians have used the PDRP to restrict their data….Interested physicians can register online or by calling (800) 621-8335.

Please. They’re the ones selling our data in the first place.

Looks like the wrong lawsuit was filed in the first place. It’s docs who need to be suing the AMA.

________________________________________________

Additional Reading

Medblogger Response to the Ruling

Dr Wes “When Speech Trumps Privacy“

Grand Rounds is HOT

The theme is summer at this week’s Grand Rounds, being held today at Shrink Rap. Some great posts there in this round up of the best of this week’s medical blogosphere.

NDI – You’re Blinding Me with Science!

How much fun am I having this weekend? I get to sing in the orchestra pit with the band, accompanying the dancers of the National Dance Institute in the 2011 Event of the Year – A Sense of Wonder. My kids danced with NDI when they were in middle school, and now I’ve been drawn back into this wonderful world through singing.  (Thanks, Gary, for the invite!)

NDI, founded by NYC ballet dancer Jaques D’Ambois in 1976, brings dance and music to public school students in NYC, across the US and around the world. The high standards Jacque and his artistic team of professional choreographers and musicians demand from their dancers, along with the professional sets (one year they were designed by Red Grooms!) means that the Annual Event is like no children’s school performance you’ve ever seen. This is not ballet, or modern dance – it’s NDI dance, a unique blend of fun and movement that any kid who loves to move can learn and excel doing.

This year’s NDI Event theme is Science, and the kids dance marvelously as they celebrate frackals, the immune system, DNA replication, robots and the miracle of the sun.

For me, the best part is getting to be one of the girl back up singers in She Blinded Me With Science. Our version is a bit tamer than the orginal but just as much fun.

If you’re looking for a great show for yourself and your family, come on by – we’ve still got two more shows to go. And if you do, be sure to stop down to the pit afterwards and say hi!