Going on vacation can often be your favorite times of the year. You’re filling each day with fun activities, exploring new sights, eating new and exciting food, and just generally having a good time. 

Whether it’s a few day trips around your city, state or province, a relaxing visit to an all-inclusive resort in the Dominican Republic or a challenging, exciting trip backpacking across Europe, each vacation day’s schedule is likely brimming with things you’ll remember for years to come. But when you get back home, it’s easy to slip back into old, mundane and bad habits.

A day after you were relaxing on a legendary beach somewhere, you’re likely finding yourself getting up early, trying to keep your cool in a traffic jam on the way to work, eating a poor-quality lunch on the run, then back to work at a job you don’t enjoy until dinner, before finally crashing in front of the television and feeling miserable for the rest of the evening. Then you repeat the entire process over again. When you’re on a healthy vacation (we’re not talking about a weekend bender in Vegas here), keep an eye out for the positive habits you pick up, and try to keep with them all year.

When you’re having fun and doing things you enjoy, you’ll pick up good habits without hardly noticing them. When you incorporate these into your regular life, you’ll thank yourself for it, and those who are closest to you will also appreciate the version 2.0 of you.

Here are the top 10 vacation habits you should maintain all year long.

1. Treat Yourself
When you’re away from home, it’s easy to splurge on yourself. Often, you may say, “Well, I’m on vacation,” then buy yourself that new wardrobe or recreational item that you’ve had your eye on. Return home, however, and you’ll list off reasons why you shouldn’t. We’re not advocating reckless spending, but there’s something satisfying about treating yourself every now and then. When you see something you want, balance splurging and practicality by putting a little money aside until you can justify the expense. Then spoil yourself a little.

2.  Enjoy The Scenery
Have you ever noticed that when you drive somewhere regularly, you’re hardly aware of your surroundings? Or that as soon as you find yourself on a new road, you’re enjoying looking out the window? New scenery can be thrilling when you’re on vacation, but remember to enjoy the simple things when you’re back home, too. If you live in a picturesque area, take the time to get out and explore it.

3. Do Things You Enjoy
Vacations are typically full of entertaining activities — a typical holiday in a resort town may include swimming, lounging on the beach, golf, eating and drinking, and a day trip. What’s missing from this list? Things you don’t enjoy doing. When you get back home, strive to add more pleasurable activities to your day. You don’t have to cut out the less-thrilling ones, too, but doing at least one activity you enjoy daily will give you a break from the more monotonous parts of your day.

4. Relax and Breathe
When on vacation, you’re not afraid to take a deep breath, feel calm and enjoy a massage at your hotel or resort spa. Learning to relax — even through the simple act of breathing — can have health benefits, but also just feels good. Incorporating a monthly massage into life at home can help you unwind, and remembering to breathe in tense situations will also keep you calmer.

5. Trying New Food
Away from home, you may be more likely to be an adventurous eater, trying new and underrated cuisines with regularity. But when you get back into your kitchen, it’s easy to fall into the chicken-one-night, beef-the-next routine. Instead, allow yourself to be inspired by the new food you try on vacation, then visit a bookstore or surf the internet and learn how to cook similar types of meals.

_________________________________________________________________________

More From Ask Men:
Airline Travel Rules 

Vacation Rental Guide 

Get The Perfect Beach Physique 

Top 10: Beach Cities 

How To: Make The Most Of Your Vacation

_________________________________________________________________________

6. Walk
There’s a reason you often pack a pair of cross-trainers when you’re on vacation: You end up walking everywhere. Whether it’s the overwhelming desire to avoid sitting in a vehicle, explore or simply take a slower-paced approach, vacations are often rife with aerobic exercise. When you get back home, think about your everyday actions and how you can walk a little more. Can you take a short walk every evening after dinner? Walk to a bus stop instead of getting dropped off?

Or can you park at a distant end of your work parking lot and give yourself a couple extra minutes of fresh air and walking each day? If the answer is yes, try to walk some more and refresh your routine.

7. Get More Sleep
There are arguments to be made for and against sleeping in, but for this purpose, we’re not advocating sleeping until noon every Saturday and wasting half the day. Instead, try to get to bed a little earlier each weeknight and give yourself one weekend morning to sleep in an extra hour.

Doing so gives your body the rest it requires and can help you feel less irritable and get over illnesses quicker. Getting an extra hour’s sleep also means fewer cups of coffee and caffeine side-effects, plus you’ll be more energized around the office.

8. Be Romantic
If you’re away with your wife or girlfriend, you might find the vacation mood gives you more time for romance and intimacy. Back at home, however, it’s a different story as you’re rushing to and from work, running errands on the weekend and trying to get to the gym twice a week. Suddenly, the romance that was part of the daily routine during your holiday has fallen by the wayside.

Perhaps a step back is in order, one into the romantic vibe you were feeling when you were on vacation. Put the run-run-run attitude on hold. Your significant other will thank you.

9. Chill Out
It takes a lot to ruin a vacation because it is, after all, a vacation. You’re almost automatically in a good mood and willing to let things roll off your back. So why are you flipping out at someone who cuts in front of you on the way home from the airport? A week earlier, a server may have tripped and dumped an entire tray of drinks on your table, but you shrugged it off with a laugh because you were in full chill mode on your holiday. Like you do when you’re on holiday, learn to dial things back a little the rest of the year. You’ll feel better, and those around you will, too.

10. Be Spontaneous
Whether it’s something exhilarating and dangerous like hang-gliding off a really high cliff or a bold food choice, you may find yourself more spontaneous away from home. Spontaneity breathes new life into your everyday routine, opening doors and giving you a chance to meet new people and find a new hobby. Think of the possibilities 12 months of the year instead of just two weeks.

Despite your busy schedule, take the time to try something new once a week. And be open when others suggest something spontaneous, too. Instead of automatically shooting down new ideas, give them a shot.

The Food and Drug Administration says it found traces of listeria at a Kellogg Co. plant in Augusta, Ga. during an inspection earlier this year.

In a letter released Tuesday, regulators say that the pathogen was found in several spots along the production line that come in direct contact with food. The FDA also noted other problems at the plant such as insects near areas where food is located.

Kellogg was not immediately available to discuss the letter.

Listeria is an organism that can cause serious and sometimes fatal infections in young children, elderly people and others with weakened immune systems. Symptoms include high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea.

The company is already struggling to recover from massive recalls of food products last year.

Scientists in Ireland accidentally discovered that frog secretions could potentially treat up to 70 diseases including cancer and diabetes, The Daily Mail reported.

The scientists, from Queen’s University in Belfast, Ireland, were doing research on the waxy monkey frog, which hails from South America, when they found proteins in its skin secretions hold properties that can control the growth of blood vessels. This is known as angiogenesis.

“By switching off angiogenesis and inhibiting blood vessel growth, a protein from the waxy monkey frog has the potential to kill cancer tumors,” said Professor Chris Shaw of Queen’s University. “Most cancer tumors can only grow to a certain size before they need blood vessels to grow into the tumor to supply it with vital oxygen and nutrients. Stopping the blood vessels from growing will make the tumor less likely to spread and may eventually kill it.”

Shaw said the researchers found that secretions from the giant firebellied toad – which is native to China and Viet Nam – actually stimulates blood vessel growth, and this could treat conditions like diabetic ulcers, strokes and repair wounds.

Click here to read more on this story from The Daily Mail.

BOSTON –  Implanting an intrauterine device (IUD) in the womb immediately after an abortion, instead of waiting 2 to 6 weeks, poses few risks to the woman, according to a new study.

Placing the IUD immediately increases the chance—but only slightly—that it will fall out within 6 months, the new study of 575 women has concluded.

Switching to immediate insertion “could prevent more than 70,000 unintended pregnancies annually in the United States,” the research team, led by Dr. Paula Bednarek of the Oregon Health and Science University in Portland, notes in the June 9 New England Journal of Medicine.

But federal law discourages that practice among low-income women covered by the Title X program. The requirement that no federal money be used for abortion services effectively blocks clinics from giving those women any kind of contraceptive on the same day and in the same facility where their abortion is performed, Bednarek told Reuters Health.

The study was designed to see if IUDs, implanted immediately after an abortion or miscarriage, would remain in place. The study also gauged the risk of infection or tears of the uterus. All the volunteers had been pregnant for 5 to 12 weeks.

The IUDs were bought by the Susan Thompson Buffett Foundation, which paid for the study, an arrangement that avoided the federal restrictions.

Six months after insertion, the researchers found, IUDs had been expelled in 5 percent of the 258 women who had received an immediate insertion, compared to less than 3 percent of the 226 volunteers who had been required to wait. About four-fifths of the expulsions occurred within the first 2 months.

By that 6-month mark, more than 90 percent of the women who had immediately gotten their IUD were still using it, versus about three quarters who received a delayed insertion.

Five pregnancies occurred in the delayed insertion group, all among women who never received their IUD. There were no pregnancies in the immediate insertion group.

Side effects were rare in both groups. There were no tears due to IUDs, and five pelvic infections were reported in each group.

IUDs, which cost several hundred dollars plus whatever a doctor charges to insert them, generally have low failure and complication rates. While one in 11 first-time contraceptive pill users become pregnant in their first year, the first-year failure rate with an IUD is less than one in 100.

But the devices are underused, primarily because women have heard about the serious problems caused by the Dalcon Shield IUD in the 1970s, said Bednarek. That case led to stricter testing for the devices.

The new study, known as PAIR (for Post-Aspiration IUD Randomization), used either Bayer HealthCare Pharmaceuticals’ Mirena levonorgestrel-released IUD or Teva Pharmaceuticals’ ParaGard T380A copper IUD.

The researchers also found that if a woman expelled one IUD, she often expelled a replacement.
Among the 13 women in the immediate-insertion group who lost one device, seven asked for a replacement and five had expelled the second IUD by the 6-month mark.

“That’s something we’d like to understand,” Bednarek said.

There were six expulsions among women who got a delayed insertion; none requested a second IUD.

Heavier women were more likely to expel their IUDs, a finding that surprised researchers. “It wasn’t a strong risk,” said Bednarek, “but it was the only association we noticed in this study.”

Thirty percent of the women in the delayed-insertion group never came back for their IUDs at all.
Immediate insertion “will prevent unintended pregnancies,” said Bednarek. “It’s more convenient, it’s less expensive, it’s less painful all around, it’s good for the individual and it’s good for society. We just need to create a system that makes it more doable.”

iStock

Dr. Sue Zieman can almost set her watch by her disease: Twice a day, she gets a fever and the already arthritic joints in her arms and hands, legs and feet abruptly, painfully swell even more. During the evening flare, even the tendons in her feet puff up, rope-like worms just under her skin.

The rest of the day, her joints are so stiff that the once robust Maryland physician frequently uses a scooter to get around. Just shaking hands hurts the 47-year-old.

Inflammatory arthritis is disabling Zieman but exactly what kind and what caused it to attack suddenly is a mystery. Nor do her fellow doctors know what treatment to suggest next. She’s tried all of today’s arthritis medications with little relief.

Say arthritis, and people tend to shrug it off as a rite of passage of aging. The reality is much more complicated. Arthritis encompasses 100 different conditions and affects about 46 million people in the U.S.

Osteoarthritis — where cartilage gradually erodes with the wear-and-tear of aging — is by far the most common type.

But inflammatory types — such as rheumatoid arthritis, psoriatic arthritis, lupus — occur when something makes the immune system run amok and attack the body’s own tissues, eating away cartilage and eventually harming bone. It can strike at far younger ages.

Zieman’s saga highlights not just how much doctors still have to learn about arthritis, but how devastating a severe case can be.

“It totally stripped my identity,” says Zieman, whose illness cost her career as a cardiologist and her love of sailing. “I just don’t think people realize how debilitated you can be, and young.”

She uses humor to help cope, nicknaming her scooter Bella and joking that “I know I’m going to turn into a pumpkin each night” when that 7 p.m. flare sends her to bed.

Infections sometimes trigger inflammatory arthritis, and that’s what probably happened with Zieman. She’d just returned from a business trip to India in December 2008 when she came down with a fever, fatigue and pain in her shoulder and knee. Antibiotics didn’t help.

A month later, Zieman became short of breath and both legs swelled. An emergency hospital admission prompted a battery of tests for infections, even super-rare ones she might have encountered abroad. Again, nothing. Maybe it was cancer? Nope.

Then the joints in her wrists and hands began swelling. Soon she couldn’t lift a glass. Swelling and pain moved to her ankles and toes.

Her joints had the classic look of rheumatoid arthritis, a disease that affects 1.3 million Americans and that can begin with a low fever and fatigue.

But it wasn’t a slam-dunk diagnosis. Blood tests check for specific markers of the disease, such as a substance called rheumatoid factor, and Zieman’s results were negative, something that occurs occasionally.

More important, a variety of drugs hit the market in the last 15 years that can rein in the disease and target some of the immune cells doing the damage.

But drug after drug failed, and the illness was spreading to her elbows, knees, hips, even her jaw.
Within a few months, she was on leave from her cardiology job. She couldn’t walk up the stairs at home and moved to a one-floor apartment that’s walking — or scootering — distance from her new job in aging research at the disability-friendly National Institutes of Health.

She even had episodes of an irregular heartbeat, as inflammation struck part of the heart.
Then six months ago, she started having those bizarre twice-a-day flare-ups. When she joined some friends for a vacation in France recently, the flares just switched time zones.

That’s not typical rheumatoid arthritis, leaving in question Zieman’s diagnosis and what to do next.
While Zieman’s case is extreme, it’s not unusual for inflammatory arthritis to become debilitating so quickly, especially in young or middle-aged women, says Dr. Assil Saleh, a Washington rheumatologist and internist who, along with doctors at Johns Hopkins University and the NIH, treats Zieman.

When an infection is the suspected trigger, patients desperately want to know which bug even though it’s usually long gone by the time joints swell, leaving rogue immune cells in its wake.

“Now we’re left with a forest fire, and we try to extinguish it,” Saleh explains. Most cases of inflammatory arthritis “are not curable but they are treatable in this day and age.”

Zieman gets modest relief from very high doses of the steroid prednisone, along with injections of the drug Kineret that targets an inflammation-causing protein named interleukin-1.

She’s still hopeful scientists will point her to better treatment as she enters an NIH study. Researchers will videotape her evening flare-ups and try to measure what role that interleukin-1 is playing.

And while she wants to know what’s fueling her disease — “I’m as geeky as most cardiologists” — her bigger frustration is how few services help arthritis patients with daily functioning: “I need to know how to open the fridge.”

My colleague on the Fox Medical A Team, Dr. Marc Siegel, has written a crucial book called The Inner Pulse that explores why some patients summon the will to live and defeat illnesses that might otherwise have been terminal. 

He has borne witness repeatedly to the way that a patient’s intuition and spirit fuels that person’s recovery and he has refined ways to tap that “inner pulse” in service to extraordinary healing.

Tapping the inner pulse of patients is no less important when treating psychiatric illnesses, particularly depression. As I have practiced psychiatry over the last 20 years, it has become increasingly apparent to me that using medications to relieve depression is often tremendously helpful. Exploring the psychological roots fueling the illness is essential. But so too is reaching to the core of patients—to their inner pulse—to speak to and fan that eternal flame inside them that still sees an arduous journey to recovery as one worth taking and sees life as worth living.

It is very common for patients struggling with depression to ask me, for instance, whether they will “get better.” Since the data is so encouraging, I could tell them in a monotone that over 90 percent of people with major depression do indeed make a full recovery. But I never deliver the message that way, because I see our work together as being joined in battle against an adversary, and because that more energized vision of defeating depression can kindle a patient’s inner pulse.

Instead, I say what I feel about our work together, which is truly this: “I don’t accept defeat when I work with someone to overcome depression. If you don’t believe to the core of your being that we’re going to win at this, and win so completely that you are fully restored to health, then you should pick another doctor. Because I’m going to ask you to reach very deep inside and use every bit of energy you have to wrestle this depression to the ground, just the way I will.”

Indeed, the inner pulse of a patient will respond to the inner pulse of a physician—whether that physician be an internist or a psychiatrist. Such is the inexplicable, immeasurable synergy between doctor and patient.

Even if a psychiatrist were brilliant at ferreting out the psychological dynamics that made her patient vulnerable to depression in the first place, even if she were a brilliant psychopharmacologist, her being less than a gladiator in the arena of health versus illness would invite catastrophe. Patient and doctor must join life forces, not just share time, space and knowledge.

In psychiatry, the inner pulse is important not only in defeating depression, but in overcoming addiction, eating disorders and even obsessive compulsive disorder. What does it take, after all, to say no to heroin or alcohol, when psychological suffering will at least temporarily be the result?

What does it take to resist making oneself purge food when doing so would temporarily relieve emotional pain? What does it take to force an obsessive concern out of one’s mind? It takes, among other things, raw determination. It takes the extreme fighter inside the patient and the extreme fighter inside the psychiatrist. It takes the inner pulse of each, bound together in a struggle that each understands at a fundamental, elemental, spiritual level must not, and shall not, be lost.

Dr. Keith Ablow is a psychiatrist and member of the Fox News Medical A-Team. Dr. Ablow can be reached at info@keithablow.com. His team of Life Coaches can be reached at lifecoach@keithablow.com.

Two recent events have dimmed some of the glow of marijuana, the world’s most widely consumed illegal drug. The first event is a study showing possible adverse effects of chronic marijuana use, presented at the recent annual meeting of the Society for Nuclear Medicine (SNM) in San Antonio, Texas.

According to the scientists who conducted the study, chronic use of marijuana causes a decrease in some brain receptors that bind with THC, the psychoactive chemical in cannabis. Using a PET scan to capture images of the brain, the study leaders found that chronic consumption of marijuana can lead to a decreased number of cannabinoid CB1 receptors specifically. These receptors play roles in pleasure, appetite, pain tolerance and other psychological and physiological functions throughout the body. The extent to which this may cause mental or physical troubles remains to be determined.

Employing PET scan imaging, the researchers examined the brains of chronic marijuana users, and found that CB1 receptor activity was reduced by as much as 20 percent. Upon cessation of marijuana use, receptor activity returned to normal, suggesting no lasting adverse effects. The study involved injection of a radioactive isotope into the bodies of chronic marijuana users, and then observing cannabinoid CB1 receptor activity via the PET imaging, which takes a nuclear image of biological activity.

The decrease of CB1 activity is known as “downregulation.” And while no specific adverse effects of this occurrence in marijuana users has been identified by researchers, there is a presumption among them that the decrease is not good.

Yet the downregulation of CB1 receptor activity may hold promise for those who are overweight. In sharp contrast to the ominous undertones of the SNM research, a tantalizing study conducted in Europe and reported in the British medical journal Lancet in 2005, showed that downregulation of the CB1 receptor in obese people can lead to a leaner body type. In that study, suppression of CB1 activity in obese subjects resulted in reduced waist size, improved blood levels of HDL-cholesterol and triglycerides, and improved insulin activity and overall reduction of symptoms of metabolic syndrome. This study suggests that downregulation of CB1 activity, at least in obese people, may be a good thing. So can pot help overweight people to slim down? The jury is out on that one.

Against of all of this science chatter about the negative or positive implications of reduced CB1 activity, another force is at work that may trouble pot smokers. The Dutch cabinet is moving to restrict access to the famed marijuana café’s of the Netherlands, limiting patronage to Dutch citizens, and forbidding access to foreigners. The Dutch bureau of tourism estimates that approximately twenty percent of all travelers to the Netherlands take advantage of the “coffee shops” that sell marijuana. Tourism officials in Amsterdam are fighting the proposed change of access, decrying that such a move would damage tourism to that city.

So what are we to conclude from all the activity around marijuana? There is an adage that the difference between a medicine and a poison is the dose. It is possible that very high use of marijuana may result in negative changes in overall function of the central nervous system, though this needs to be further established. At the same time, we may possibly have in pot a weight control agent. This seems to contradict the increase in appetite that most marijuana users experience. Further investigation into this is unquestionably needed.

Vilified by opponents and championed by users, marijuana remains a highly disputed drug. Studies show that occasional or medical marijuana use is far less harmful than use of either tobacco or alcohol, both of which are responsible for the deaths of hundreds of thousands of Americans each year. At present, not one marijuana-related death has ever been reported. Medical applications of marijuana, for pain, appetite and glaucoma are increasingly well established. And information from the U.S. government itself shows likely benefits of marijuana for the treatment of degenerative disorders of the nervous system.

The landscape for marijuana use is fluid, highly charged, and changing rapidly. Medical marijuana laws, medical marijuana dispensaries, and various scientific studies are pushing this medicine into the medical foreground, despite hue and cry from opponents. As investigators continue to explore the complexity of this age-old remedy and its use, we will likely discover more benefits and hazards associated with this highly popular drug.

Chris Kilham is a medicine hunter who researches natural remedies all over the world, from the Amazon to Siberia. He teaches ethnobotany at the University of Massachusetts Amherst, where he is Explorer In Residence. Chris advises herbal, cosmetic and pharmaceutical companies and is a regular guest on radio and TV programs worldwide. His field research is largely sponsored by Naturex of Avignon, France. Read more at www.MedicineHunter.com

HELSINKI –  Choosing the right formula could stave off infant diabetes, according to a new global study distributed Thursday.

The study showed that if a mother transitions from breastfeeding to “highly hydrolyzed formula,” which is broken down for easier digestion, the infant may have a lower risk of developing type 1 diabetes.

Type 1 diabetes can be fatal unless treated indefinitely with insulin.

The study, lead by Dr. Mikael Knip of the University of Helsinki, examined infants carrying an HLA genotype, which puts them at risk for developing diabetes later in life.

The trial, published in the American Journal for Clinical Nutrition, showed promising results in infants who underwent the transition from breastfeeding to the easily digestible hydrolyzed formula. By age five, the signs of diabetes in those children had decreased by 50 percent in comparison to children who moved from breastfeeding directly to foods such as cereals, fruit, or other types of formula.

“Short-term breastfeeding and early exposure to complex dietary proteins, such as cow milk proteins and cereals, or to fruit, berries, and roots have been implicated as risk factors,” for type 1 diabetes, the authors wrote.

Most available formulas have a base of cow’s milk, which can be difficult for infants to digest before their first birthday.

The study’s findings were confirmed in a follow-up analysis when the children were ten years old. The trial is currently occurring in 77 centers in 15 countries worldwide.

LOS ANGELES –  LOS ANGELES — Los Angeles Unified on Tuesday became the nation’s largest school district to stop serving flavored milk in a move to combat child obesity.

The school board voted to eliminate chocolate and strawberry milk from schools as of July 1.

LAUSD joins a growing number of school districts nationwide, including District of Columbia, Boulder Valley, Colo., and Berkeley, Calif., that serve only plain milk because of the added sugar contained in flavored versions.

The proposal by Superintendent John Deasy came after popular British TV chef Jamie Oliver criticized the district in recent months for serving flavored milks, saying they contain the sugar equivalent of a candy bar.

In one TV stunt, he filled a school bus with sand to represent the amount of added sugar LAUSD students consume in a year through flavored milk.

Some board members were rankled by the perception that the district was caving in to Oliver, who unsuccessfully lobbied the district to be allowed to tape shows in local schools.

“I really don’t understand why we’re letting a TV chef dictate our policy,” said board member Tamar Galatzan, who noted that many health advocates including the American Heart Association say the nutritional benefits of flavored milk outweigh the harm of added sugar.

Some advocates say that milk consumption drops when children are not offered the option of chocolate and other flavored milks.

She noted the district serves fruit juices containing 27 to 29 grams of sugar per serving, more than the amount of sugar in flavored milk — 20 grams in eight ounces of fat-free chocolate milk and 27 grams in fat-free strawberry.

Galatzan was the lone dissenter on the board.

The move was applauded by several proponents in the audience.

“Thirty percent of our kids are obese or are on track to diabetes,” said Jennie Cook of Food for Lunch, a coalition advocating nutritious school food, who has been pushing the district to eliminate flavored milk for the past year. “This is a social justice issue.”

Emily Ventura, a researcher with the University of Southern California’s Childhood Research Center, noted that a number of experts did not recommend flavored milk as a healthy choice. She said 6,000 LAUSD parents had signed a petition to eliminate flavored milk from the district.

Some school districts have opted for a middle road, using natural sweeteners like cane sugar, beet sugar and Truvia to sweeten milks instead of high-fructose corn syrup based flavorings.

But others say children should learn to drink plain milk.

LAUSD is the nation’s second-largest school district with about 688,000 students.

WASHINGTON –  Facing a life-and-death struggle with kidney cancer, Rita Moore took her prescription for a new kind of chemotherapy pill to her local drugstore.

She was stunned when the pharmacist told her the cost for a month’s supply would be $2,400, well beyond her income.

Medicare drug plans that cover seniors like Moore are allowed to charge steep copayments for the latest cancer medications, whose cost can run to tens of thousands of dollars a year. About 1 in 6 beneficiaries aren’t filling their prescriptions, according to recent research that has put numbers on a worrisome trend.

Officials at Medicare say they’re not sure what happens to those patients — whether they get less expensive older drugs that sometimes work as well, or they just give up. Traditionally, chemotherapy has been administered intravenously at a clinic or doctor’s office. Pills, a relatively new option, are thought to represent the future of cancer care.

Moore, 65, was operated on in February for an advanced form of kidney cancer. She said both her cancer and kidney specialists agreed that a drug called Sutent probably offered the only chance to keep the disease in check. It’s a capsule taken at home.

But she was unprepared for what happened when she went to fill her prescription.

“I cried,” said Moore, who lives in a small town in central California. “What can you do when the only thing out there that can maybe give you some quality of life is unaffordable? I was devastated. I didn’t know what to do.”

Private insurance companies that deliver the Medicare prescription benefit say the problem is that drug makers charge too much for the medications, some of which were developed from taxpayer-funded research. The pharmaceutical industry faults insurers, saying copayments on drugs are higher than cost-sharing for other medical services, such as hospital care.

Others blame the design of the Medicare prescription benefit itself, because it allows insurers to put expensive drugs on a so-called “specialty tier” with copayments equivalent to 25 percent or more of the cost of the medication.

Drugs for multiple sclerosis, rheumatoid arthritis and hepatitis C also wind up on specialty tiers, along with the new anti-cancer pills. Medicare supplemental insurance — Medigap — doesn’t cover those copayments.

“This is a benefit design issue,” said Dan Mendelson, president of Avalere Health, a research firm that collaborated in a recent medical journal study on the consequences of high copayments for the new cancer drugs.

Cost-sharing should only be used to deter wasteful treatment, he explained. “It is hard to make the argument that someone who has been prescribed an oral cancer medication doesn’t need the drug,” added Mendelson.

The study last month in the Journal of Oncology Practice found that nearly 16 percent of Medicare beneficiaries did not fill an initial prescription for pills to treat cancer, a significantly higher proportion than the 9 percent of people with private insurance who did not follow through.
Forty-six percent of Medicare beneficiaries faced copayments of more than $500, as compared to only 11 percent of patients with private insurance. Among people of all ages, 1 in 4 who faced a copayment over $500 did not fill their prescriptions. Cancer is more prevalent among older people.

“Obviously, we’re leaving a lot of folks off the bus, standing at the curb, if they can’t afford the medications,” said Dr. Lowell Schnipper, who chairs the American Society of Clinical Oncology’s task force on the cost of cancer care. It advises doctors to discuss costs with patients up front, to avoid surprises.

Medicare officials say there are currently no plans to rework the design of the prescription benefit.

But “nobody is more concerned about access than we are,” said Dr. Jeff Kelman, Medicare’s chief medical officer.

For many seniors, Kelman suggested, the situation is not as bleak as what Moore encountered. For example, the prescription plan is designed so beneficiaries who are poor or near poverty face only token copays. For the rest, President Barack Obama’s health care law gradually closes the coverage gap known as the “doughnut hole.” This year, the new law provides a 50 percent discount on brand name drugs for those in the gap.

The gap starts after Medicare recipients and their insurance plan have spent $2,840 on medications. After that, seniors are responsible for roughly the next $3,600. Once total spending reaches about $6,440, Medicare’s catastrophic coverage kicks in and beneficiaries pay only a small amount.

Yet the health care law could be struck down by the courts or repealed if Republicans win the White House and Congress next year. Even if the law stands, assistance after seniors end up in the gap doesn’t take away the initial shock at the pharmacy counter.

“The underlying problem is with the basic structure,” said Joe Baker, president of the Medicare Rights Center, a New-York based advocacy group. “Even before you get to the doughnut hole, you’ve got a problem.”

One solution would involve requiring drug plans to lower copayments for cancer pills. But the trade-off is likely to be an increase in premiums for all beneficiaries.

Rita Moore had to try to find her own way out of the dilemma. She lives in Corcoran, Calif., and still works as resident manager of an apartment building for seniors.

Moore decided to apply to Pfizer’s prescription assistance program for patients who can’t afford Sutent and other drugs the company makes. Pfizer approved a year’s worth of free medication, but it took about two months to collect and review all the medical and financial paperwork.

“They were very helpful, but it wasn’t a fast process,” said Moore. In the meantime, she wasn’t being treated. The cancer spread and is now close to her spine and her body’s main artery.
“This is kind of strange,” Moore said. “After you’ve worked all your life, you get something catastrophic and you run into news like your drugs are going to cost $2,400.”