As reported last September, food fortification with folate does pose some risks. Indeed I don't support fortification programs generally and I consider the folate programs to be a very bad idea. Why is this?

Essentially, folate food fortification involves the enrichment of denatured, highly refined, frequently poor quality and high risk (triggering allergies and sensitivities) grains. These flours are dangerous enough and should be completely avoided. This is an extremely unpopular position to take because grains marketing through Departments of Agriculture and 'scientific' associations has assumed a health-righteousness that supports an erroneous orthodox view that grains are essential sources of nutrient needs. Unpopular to be sure, but a position I stand by nevertheless.

The SBA has a bunch of podcasts available on their site. I haven't had a chance to listen yet, but the titles sound enticing. Lots geared toward startups, including:

Check List for Starting a Business
Financing a Small Business
Creating a Business Plan

There are also transcripts for the non-casters.

Small Business Administration Podcasts

I just finished Lisa Rohleder’s book, The Remedy: Integrating Acupuncture into American Health Care. I’d discovered her book and Working Class Acupuncture, via the Integrator Blog a while back, and she was kind enough to shoot me a copy of the book to review.

If you’re NOT an acupuncturist, let me grab you before you go: this book is a good read for anyone in the CAM profession. If you’ve wondered from a business perspective about the viability of chasing solely mid-to-upper class dollars, or about how to transition to a volume practice, this book is a must read. If you’ve ever felt the ethical twinges of focusing all your efforts on the small demographic segment that can afford your services, Lisa makes a rational, sensible case for more broadly affordable health care.

Still here? Good. Rohleder’s position is that acupuncture as a profession is screwed (my words). Despite 4-5,000 new practitioners entering the market each year, the number in practice continues to hold steady in North America at about 15,000. Of those, many have second jobs and supportive spouses, or suffer from stress and burnout. Acupuncture is a profession in jeopardy.

The solution in The Remedy is to return, from a business perspective, to the Taoist roots of acupuncture. Before your eyes glaze over, let me tell you this is far simpler and more comprehensible than it sounds to the non-TCM practitioner. Essentially, it involves acupuncturists lowering their prices (to a sliding scale of $15-35 per visit), seeing more patients, and building a community-based practice.

In business terms, it means making your money on volume, not on high prices. In health terms, it means more accessible health care that works better.

If you’re a struggling (or not) CAM practitioner, I’m sure your first question is the same as mine: can you make a living lowering your prices?

As Lisa says in the book:

"Incidentally, I make a lot more money now than I ever did when I charged $65 per treatment.”

I believe it – volume business can be good business. Think of Wal-Mart.

It got me thinking, though, about the practical transition from higher-priced boutique clinic to volume practice. What if you’re on the financial edge right now? How do you cut your prices by 75% or so, and hang in there until the volume kicks in?

So I asked Lisa.

“Even people who were very nervous about losing money during the transition said that they initially made the same amount, and over time gradually began to make more. Those folks also reported that their job satisfaction went way up, and both their stress and total hours worked went way down, immediately after they made the transition, so they were happy.

One way around that problem might also be to have a hybrid practice for a while -- keep seeing the patients who want one-on-one, and just add "community hours" two afternoons a week. One initially nervous practitioner started out that way, and a year later her practice is 95% community acupuncture.

But I guess I would say that if a practitioner is truly freaked out about losing money, they probably shouldn't be doing this anyway. Passion is an important ingredient, and if you have more fear than passion, this is not for you.”

So let’s see. More money, more satisfaction, less hours worked. Sounds like the American (Acunpuncture) Dream.

A volume practice might not be for you, though, and that’s fine. My belief is that there’s a niche for everyone doing something that they love. Personally, I like the idea of volume and higher prices together, but that’s a challenging position to reach and hold in the market for any length of time, and it doesn't make services more accessible.

If you’re struggling or just plain curious, The Remedy is a good read. I know from our discussions that Rohleder’s got some strongly held anti-classism values, but they’re well presented – she can write, and well. This is a thought-provoking book, well grounded in solid business experience, with some cool Tao Te Ching verses along the way, which makes the book an interesting yin-yang package in itself.

If you’re interested in a copy of Lisa’s book, you can get it here:
http://stores.lulu.com/store.php?fAcctID=660094

Many patients being treated for various cancers develop anemia. Aranesp is approved by the FDA for the treatment of patients with anemia, which is caused by chemotherapy treatment of their malignant disease, rather than the underlying malignant disease itself. Essentially, it is a toxic drug which attempts to overcome some of the damage caused by other far more toxic drugs.

Amgen, the maker of Aranesp, conducted a large, multicenter, randomized, placebo-controlled study that showed Aranesp was ineffective in reducing red blood cell transfusions or fatigue in patients with cancer who have anemia that is not due to concurrent chemotherapy. The study also showed higher mortality in patients receiving Aranesp.

Safety-related drug labeling changes for November 2006 have just been posted on the MedWatch website. There is always quite a delay between making and notifying about the changes. There are probably some plausible reasons for this delay if you are sympathetic to bureaucratic thinking but I find it rather excessive.

The November 2006 posting includes 26 drug products with safety labeling changes to the BOXED WARNING, CONTRAINDICATIONS, WARNINGS, PRECAUTIONS, ADVERSE REACTIONS, and PATIENT PACKAGE INSERT/MEDICATION GUIDE sections.

The Summary page provides drug names and a listing of the sections changed and may be accessed via the following link.