Thursday, May 22, 2014
Doctors Perspective Who should pay for bad health habits?

By Dr. Anthony Policastro

When Obamacare was first being discussed in Congress, I wrote a series of articles. The gist of those articles was that we first needed to fix our current health care system and then we could see about insuring everyone to receive health care.  Our current system emphasizes paying for care for people with poor health habits. If someone does not care for themselves, they develop medical problems. Our current system rewards them by paying for those medical problems. I had two women come into my office when I was a hospital commanding officer in the Air Force. They had similar complaints about my doctors. The complaint was that their husbands had been seen in the office for a cough. They had been treated with medication for a basic cough and did not have chest x-rays. Later, they were found to have lung cancer.  The wives contention was that if a chest X-ray had been done at the time of the first visit, their husbands would still be alive. We know that by the time lung cancer shows up on chest x-ray, it is too late to treat it. In actuality, it was the husbands cigarette smoking that killed them. Now we have a recent study showing that chest CT scans can pick up lung cancer early enough to treat it. When lung cancer is detected on chest x-ray, the mortality rate is 100%. When it is detected early by CT scan, the mortality rate is only 80%.  Medicare is currently deciding whether to do chest CT scans on smokers. The cost to do so would be $9 billion to $27 billion over a five year period. That cost would be passed on to all Medicare beneficiaries. It would raise their Medicare premium by between $3 and $9 per month. Thus the 80% of Medicare beneficiaries who do not smoke will pay for chest CT scans for the 20% of the beneficiaries who do smoke. I see this as boiling down to two options. Option A is to have Medicare foot the bill. In order to do that, every Medicare beneficiarys monthly insurance would increase. We could then pay for chest CT scans to help 20% of the patients with lung cancer. The other 80% will die anyway. Option B is to look at the 20% of the population that smokes. The average smoker will spend $2,000 per year on cigarettes if he/she smokes one pack per day. The average chest CT scan costs less than $2,000. The smoker could then be given an option. He/she can pay for their own chest CT scan. If they choose to do so, they can reduce their mortality possibility by 20%. This is an opportunity for non-smoking Medicare beneficiaries to make themselves heard. If they live in Delaware, they should contact our congressional representatives about their thoughts. If they have friends and relatives in other states, they should encourage them to do likewise. This presents itself with one more example of how people are encouraged to have bad health habits. Someone else will pay for the harm that they do to their bodies. To me that does not seem fair. If you have comments about this column or suggestions for other topics, send an email to Dr. Anthony Policastro at

Deaths from fentanyl-laced heroin The Office of the Chief Medical Examiner has confirmed five additional overdose deaths related to fentanyl-laced heroin during March and April, bringing the total to six deaths in Delaware this year. Fentanyl, a synthetic painkiller that is 50 to 100 times more potent than heroin, is often mixed with heroin to produce a stronger high, according to the Centers for Disease Control and Prevention. The deaths involved four men and two women, ranging in age from 28 to 58. Four of the deaths occurred in New Castle County; two in Sussex County. During the last outbreak of fentanyl-tainted heroin overdoses in 2006, Delaware had seven confirmed deaths. When a user injects fentanyl-laced heroin, users often have trouble breathing or can stop breathing as the drug sedates them. If someone is too drowsy to answer questions, is having difficulty breathing, or appears to be so asleep they cannot be awakened, call 911 immediately. This number of deaths in such a short period of time qualifies as an epidemic, said Dr. Karyl Rattay, director of DHSS Division of Public Health. Because illicit fentanyl can come in white powder form like heroin, users dont know the fentanyl is mixed in. The fentanyl-heroin mix can be sold on the street with names like Thor, Black Dahlia, New Arrival, Thera Flu, 7 of Hearts, China White, Shine and New World stamped on the bags. If you or a loved one needs treatment, call 800-345-6785.

Dr. Ewaida joins Nanticoke Hospital Nanticoke Health Services welcomes Dr. Nader Ewaida, MD to its active staff as a hospitalist, a physician who specializes in the care of patients while they are in the hospital. Dr. Ewaida completed medical school at Ain Shams University in Cairo, Egypt in 1999. He completed his internship at Howard University, Washington, D.C. in 2004 and his internal medicine residency at Mountainside Hospital in Montclair, N.J. in 2006.

Dr. Ewaida is board certified in internal medicine. He is a member of the American Medical Association, American College of Physicians and the Society of Hospital Medicine.

New skin cancer initiative The bright, sunny days of summer are ahead and its time to plan for a happy, healthy season. To emphasize May as Melanoma/Skin Cancer Detection and Prevention Month, Delawares Division of Public Health (DPH) has launched, a website offering information on skin cancer prevention and early detection. Activities will also include a Delaware high school signature contest for students to pledge to wear SPF 15 or higher sunscreen.  For more information, contact the Delaware Division of Public Healths Comprehensive Cancer Control Program at 302-744-1020 or visit or

Funding available for CNA Are you interested in becoming a Certified Nursing Assistant? Sussex Tech Adult Division was recently awarded funding through the Delaware Workforce Investment Board to fund a limited number of seats for classes beginning after July 1. If you are interested in joining the health care field and earning a State of Delaware Certificate as a Certified Nursing Assistant, call the Sussex Tech Adult Divisions office to see if you qualify for assistance. Cntact Joyce Kunde at 856-9035.

Nanticoke offers CPR class Nanticoke Memorial Hospital will offer community CPR classes to anyone interested in learning CPR at 8 a.m. on Friday, May 23, at the Nanticoke Training Center located on Water Street in Seaford. Participants will learn how to perform the basic skills of CPR on adults, children, and infants and how to help an adult, child or infant who is choking and use of the AED. This classroom-based, video, and instructor-led CPR course offers families, friends, and community members the opportunity to learn CPR and need a course completion card. Classes are open to participants ages 12 and up. This program is specifically designed for those who prefer to learn in a group environment with feedback from an instructor.  The target audience is those who have a duty to respond to a cardiac emergency because of job responsibilities or regulatory requirements. Cost is $45. Payment and registration is required by no later than five business days prior to the class. Late registrations may be accepted if seating is available. To register and to obtain a listing of class dates/times, contact the Nanticoke Memorial Hospitals Training Center office at 629-6611, ext. 8919. Pre-registration is required.

Driving cooperative for seniors A proposed driving cooperative, Sussex Senior Transportation Cooperative, could solve transportation problems that older Sussex County residents face. The program would follow a national model, Independent Transportation Network America, to provide rides for a suggested $1 per mile for seniors throughout the county. Retired Millsboro educator Nancy Feichtl is working with a steering committee on the initiative. Contact Feichtl at 245-8979 or for more information.

Community lymphedema talk The Cancer Support Community will present Understanding Lymphedema - Past and Present at 2 p.m. on Tuesday, June 10. Camilla Carter, physical therapist and lymphedema specialist, will explore lymphedema management after cancer surgery. The Sussex facility is located in Suite 312, The Medical Arts Building at the Beebe Health Campus, 18947 John J. Williams Hwy., Rehoboth. All programs at CSC are offered to people affected by cancer and their loved ones free of charge. Call 645-9150 to register.

Child Loss support program A six-week support group for adults, Healing after the Loss of a Child, will be offered by Delaware Hospice on Tuesdays, 6 to 7:30 p.m., from June 3 through July 8, at Christ Lutheran Church, 315 N. Shipley St., Seaford. This six-week educational support group is open to parents and grandparents who are grieving the loss of a child. Gathering with others who are also grieving such a loss, whether school-aged or adults, can be beneficial. Midge DiNatale, group facilitator, will also share coping methods that she found helpful in her own grief journey after losing her son. There is no fee for this service, however, registration is requested.  Register by Friday, May 30, by contacting Midge DiNatale, GC-C, bereavement counselor, at 856-7717, ext. 4120 or 300-2179, or