E2 CONSUMERREPORTSINSIGHTS Health plans score high and low The health-care overhaul law


will trigger a seismic shift in healthinsurance.Early rumblings can be heard this fall as many people with employer-based in- surance enter the open-enroll- ment period, the time when they caneasily changeplans. The law’s first major changes


went into effect Sept. 23. For ex- ample, insurers cannolonger can- cel your coverage just because you get sick, impose financial barriers toemergencycareorputalifetime dollar limit onyour coverage. But those initial changesdonot


address consumer satisfaction with their coverage or plans’ suc- cess at treatment and disease pre- vention. To help fill this informa- tion gap, Consumer Reports pub- lished rankings produced by the nonprofitNationalCommittee for Quality Assurance, the main U.S. group that sets standards for health insurance, accredits plans, measures the quality of care they achieve and publicly reports its findings. The top three plans, each of


whichscored about 90 points ona 100-point scale, operate in New England. The best performer in the Washington area was Cigna HealthCare Mid-Atlantic, which earned86points, goodenoughfor 39th place among the 227 plans evalulated. Trends this year include the fol-


lowing: l Large companies domi-


nate.Many of the top performers are owned and/or operated by some of the nation’s largest insur- ers:Aetna,Cigna,Humana,Kaiser Permanente, UnitedHealthcare andWellPoint. That’s not surpris- ing. These big companies have more resources than smaller in-


Inpartnership with


For further guidance, go to ConsumerReportsHealth.org, More detailed information—including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products—is available to subscribers to that site.


AnyBODY Carolyn Butler


Is he just aging, or going through ‘manopause’? W


hen it comes to the pecu- liar burdens of woman- hood, menopause has to


be somewhere near the top of the list, right alongside childbirth and bikini waxes. But it seems that midlife hot


flashes, mood swings and dwin- dling libidos may not be entirely female concerns after all: Doc- tors, researchers and drug com- panies have begun making the case that men also experience a change of life. This male meno- pause—“manopause, ” if you will—is said to stem from an age-related decline in testoster- one, the hormone that plays a key role in everything from pu- berty to maintaining muscle strength and bone mass to sex drive. “What we see is that for men,


often beginning in their late 30s or early 40s, there is a gradual drop in testosterone of about 1 to 2 percent a year,” explains Robert Brannigan, a urologist atNorth- westernMemorialHospital in Chicago who has been research- ing the phenomenon. “It’s not as dramatic or as abrupt a change as is often the case in women, but there is this subtle shift in hormone levels that can result, over time, in a man crossing a threshold where he then has a deficit of testosterone.” This can result in a range of symptoms that “have a huge overall impact on day-to-day life,” he says, including depres- sion, irritability, low energy, de- creased muscle mass, weight gain, sexual dysfunction and even the occasional hot flash or night sweats. “We’re talking about a lot of


men here,” adds Brannigan, who estimates that at least 5 million U.S. men are affected by late-on- set hypogonadism, which is the clinical term for the condition. “Unfortunately, the vast majority are undiagnosed.” That’s partly because this


newly recognized condition is hard to identify given it’s laun- dry list of possible symptoms. But research published recently in theNewEngland Journal of Medicine definitively linked low testosterone levels to low sexual desire, and erectile dysfunction, and a poor morning erection, and concluded that these three symptoms must be present to di- agnose late-onset hypogonad- ism. The study, which tracked 3,369 European men between the ages of 40 and 79, also showed that low testosterone was only somewhat related to such physical and psychological problems as an inability to en- gage in vigorous activity, sadness


level that requires some inter- vention,” saysWexler. “And that men who should never have been screened, whose testosterone levels have nothing to do with how they feel, are now going to get supplementation, when we really don’t have a good body of scientific literature to tell us whether testosterone supple- mentation in aging men is even safe in the long run.”He wonders if the cost and risks of this hor- mone replacement are worth it, when the benefits are also large- ly unknown at this point. Northwestern’s Brannigan


says yes, largely because of the potential impact on a man’s quality of life. “The question is this: Do pa-


tients sit back and let these changes occur and deal with the change in how they feel and function, or do they actually pur- sue available treatments that in many cases can help?” he says, noting that he has had great suc- cess in his clinical practice with topical, injectable and implanted testosterone supplements as well as with medications that stimu- late the body’s production of tes- tosterone. Still, Brannigan stresses that


CARL WIENS FOR THE WASHINGTON POST


and fatigue. Still, the notion of male meno-


pause remains controversial. In fact, a recent article in the Drug and Therapeutics Bulletin that reviewed dozens of studies found that men’s testosterone levels do not always drop with age, that low levels in older men do not necessarily produceany specific symptoms and that men with normal hormone levels ex- perience many of the problems commonly associated with low testosterone, including sexual dysfunction, diminished strength and depression. Indeed, critics suggest that


most of the symptoms that have been blamed on “low T” are nor- mal consequences of aging. “It’s still controversial as to


whether low levels of testoster- one represent a medical prob- lem,” says JasonWexler, an endo- crinologist atWashingtonHospi- tal Center, who notes that issues such as a lack of energy and mo- tivation, poor memory and weight gain are “highly nonspe- cific” and can also be related to a slewof other medical conditions. . In most cases, he said, “I don’t think there’s a direct correlation between the way men feel as they get older and their testos- terone levels. So for me, there is great reluctance to call that a dis- ease.”


Such informed skepticism


hasn’t stopped some pharmaceu- tical companies from marketing the bejesus out of the concepts of low T and male menopause— and it hasn’t stopped men from seeking tests and receiving tes- tosterone prescriptions, which have skyrocketed from 2.4 mil- lion in 2005 to nearly 3.9 million in 2009, according to the con- sulting firm IMSHealth. “I think the problem is that


you have a captive audience,” says AndrewKramer, aUniversi- ty ofMaryland School ofMedi- cine urologist and surgeon. “When a commercial [for low- testosterone-related products] asks, ‘Do you have lower energy? Are you not sleeping as well? Is your libido down? Are your erec- tions not as good as they used to be?’ every man, of course, is like, ‘Yeah, that fits.’ ” The fear is that this sort of hy-


per-awareness will lead to an overscreening of the aging male population, either because pa- tients demand it or because doc- tors feel they must cover all their bases in this litigious age. “There is this potential setup


for men to be screened when they shouldn’t be, and for low testosterone levels that don’t represent a problem to be ‘dis- covered’ on lab testing and then get misinterpreted as being a low


men with prostate cancer, a his- tory of breast cancer or untreat- ed sleep apnea and those who are trying to conceive a baby shouldn’t use the synthetic hor- mone. “It’s not the answer for everybody, but I find that for many patients, it can restore or optimize how they feel on a day- to-day basis, and in many in- stances it’s not only impacting [a man] but also his relationship with an intimate partner, who is also a part of this equation.” Regardless of where they


stand on the matter, experts seem to agree on one thing: Though catchy and hard to ig- nore, terms such as “male meno- pause” and “manopause” send the wrong message. “ ‘Male menopause’ is a loaded


term, ” saysWexler. “It’s got so much baggage, this idea that there’s this condition that is somehow equivalent to the fe- male menopause. “There are definitely men out


there who have symptoms, who have low testosterone levels and can benefit from therapy, but the term ‘male menopause’ or ‘an- dropause’ implies that this hap- pens to all men as they age, like menopause happens to all wom- en as they get older, and that’s just not the case.”


6


YOUR TAKE Do you know someone with “manopause”?


www.washingtonpost.com/yourtake


Where does your plan rank? NCQA ranked severalWashington area health insurance plans:


Cigna HealthCare Mid-Atlantic Overall score: 86 | National rank: 39 Kaiser Foundation Health Plan of the Mid-Atlantic States Overall score: 84 | National rank: 73 MD-Individual Practice Association Overall score: 82 | National rank: 142 Aetna Health Overall score: 82 | National rank: 150 UnitedHealthcare of the Mid-Atlantic Overall score: 81 | National rank: 161 CareFirst BlueChoice Overall score: 81 | National rank: 172 Optimum Choice Overall score: 80 | National rank: 190


Overall score on a 0-100 scale (a higher number is better) is based on performance on 49 mea- sures encompassing consumer satisfaction, prevention, treatment and accreditation. National rank shows where each plan stands among the 227 ranked nationwide this year. A lower num- ber signifies better performance. Not all health plans seek NCQA accreditation, and some that do don’t submit enough data to qualify for a ranking. A complete national list of plans is avail- able at www.consumerreportshealth.org.


THEWASHINGTON POST


surers do for quality improve- ments, often ones that target spe- cific NCQA measures. Even so, plans owned by big insurers also appear at the bottomof the rank- ings. l Smaller plans compete.


Most of the 25 top-ranked individ- ual HMOs are fairly large, but some, such ConnectiCare inMas- sachusetts and Connecticut and GrandValleyHealthPlaninMich- igan, have fewer than 40,000 en- rollees. l You can’t rely on brand


alone. Planswith the same brand name canvary inquality and even be owned by different companies. For example, some of the nation’s 39 Blue Cross Blue Shield plans are among the top-ranked. But a few are at the bottomof the list or not rankedat all.


l Quality doesn’t ensure sat-


isfaction. The fact that a plan scores highly overall or produces superior results in treating pa- tients or preventing disease doesn’tguaranteeitsmembersare satisfiedwith theway they experi- ence the plan or its doctors. This year, 10 of the 100 top-ranked plans, including Kaiser’s Califor- nia, Colorado, Mid-Atlantic and Northwest plans, had low scores on a composite measure of con- sumer satisfactionbutmuchhigh- er scores on preventive care and disease treatment.


Howto pick a good plan In2014, themajor provisions of


the new health-care law kick in. Insurers will be required to offer comprehensive plans and accept all customers regardless of any


preexisting conditions.AllAmeri- cans will be required to have health coverage (subsidized for lower-income households) except in cases of severe financial hard- ship. Until then, though, insurerscan


operate by many of the old rules. You’llwant to avoid plans that are thin on coverage, exclude certain services or refuse to publicly re- portonconsumer satisfactionand health-care outcomes. Here are ways to evaluate a


health-insuranceplan: lMake sure everything’s


covered. Insurance should cover hospitalization, doctor visits, emergency services, diagnostic tests and prescription drugs.Veri- fy that there are no major exclu- sions listed. l Askyouremployer.Yourhu-


man resources department may be able to help you choose an appropriateplan. l Consult HealthCare.gov, a


site managed by the federal gov- ernment. Some 5,500 products fromabout 1,000 insurers are list- edbystate.Thesiteis scheduledto add cost information and plan- comparisontools as ofOctober. l Run the numbers. With the


employee share of group insur- ance continuing to rise, your jobis to select a health-insurance plan that balances cost, coverage and quality of care.Onebasic trade-off to consider is this: A higher de- ductibleorout-of-pocket limit can lower yourmonthlypremium. l Check the detailed rank-


ings. At www.consumerreports- health.org, subscribers can com- pare up to five plans and getmore detailedinformationaboutplans. © Copyright2010.ConsumersUnion of United States Inc.


EZ EE


KLMNO


TUESDAY, OCTOBER 5, 2010


The Checkup 6Excerpts from washingtonpost.com/checkup


Adapted from The Post’s daily health blog


Why you should care aboutwhether yourwaiter is eligible for sick leave A report released by theD.C.-based Restaurant Opportuni-


ties Centers United says, among other key findings from its survey of more than 4,000 restaurant workers nationwide, that “nearly 90 percent of workers said they did not receive paid sick days.As a result, two-thirds of respondents said they hadworked while sick in the previous year, preparing, cooking and serving food.” Ick. The restaurant workers’ organization is one of many


advocates across the country pushing for passage of the Healthy Families Act, whose provisions include requiring employers to provide sick leave. A poll released this summer showed that most Americans favor such a law. In 2008, the District became the secondU.S. city (after San


Francisco) to pass a law requiring most employers to provide paid leave that workers can use to attend to their own or a family member’s illness. The report features case histories of low-wage workerswho


tell of times they have reported to work while ill. Here are some excerpts: “Many times you can’t afford to take the day off because


you’re sick, and all the time, especially this season and in the spring, a lot ofmy co-workers they were sick, sneezing in the food. They were disgusting. But you know, what can they do? They cannot afford to take the day off.”—Female, Maine, four years in the industry, server “You gonna be sneezing over people’s food and stuff like


that and if you wanna put a mask on or try to cover yourself up or whatever then it’s bad for the business.” — Female, New Orleans, 23 years in the industry, server “There is no sick time, you come to work either way. If you


don’t come you don’t get paid, and if you stay off too long you get fired.” — Male, Michigan, five years in the industry, line cook I don’t know about you, but I’ve suddenly lostmy appetite. Jennifer LaRue Huget


HEALTH SCAN FOOD Myths about eating


EATING WELL, OCTOBER ISSUE Eating Well magazine tries to separate science from


silliness with “The 13 Biggest Nutrition and Food Myths Busted.” The No. 1 myth: Eggs are bad for your heart. According to the article, by Joyce Hendley, the chief heart disease culprits are saturated fat and trans fats, which have a much greater impact on raising blood cholesterol than the (still substantial) cholesterol in egg yolks. Also, she writes, calories eaten at night are not more fattening than those eaten early in the day. Yep, that doughnut is still heading directly to you-know-where whether you eat it at 10 a.m. or 10 p.m. Sorry.


AUTISM A fairly independent life


THE ATLANTIC, OCTOBER ISSUE The first person ever to receive a diagnosis of autism is still


alive — a stunning fact considering that today, an autism spectrum disorder affects one in every 110 American children, according to the Centers for Disease Control and Prevention. In an article about Donald Triplett, we learn that he is 77 years old, lives fairly independently in Forest,Miss., and enjoys golf and travel. Authors John Donvan and Caren Zucker broaden the scope of their profile to determine which lessons doctors and parents can learn from Triplett’s case.His hopeful story is an example ofwhat can go right for those one in 110 kids when they become adults.


—Rachel Saslow QUICK STUDY NUTRITION


Replacing processed with whole-grains foods may help lower blood pressure


THE QUESTION Eating whole grains has been linked to better health.Might that include a positive effect on blood pressure? THIS STUDY involved 206 healthy but overweight adults, most in their early 50s, who had been eating a “refined diet” (including refined, or processed, cereals and white bread). They were randomly assigned to continue the refined diet or to replace three servings of refined foods with three servings of whole-wheat foods, or to substitute with one serving of whole-wheat foods and two servings of oats daily. After three months, systolic blood pressure (the first, or top, number) had fallen five to six points (measured as millimeters of mercury, mmHg) for those eating whole-grain foods, compared with about a one-point drop for the others. WHO MAY BE AFFECTED? Adults who are concerned about their blood pressure and who eat foods containing grains. High blood pressure can contribute to heart disease, heart attack, stroke, kidney disease and more. In refined foodstuffs, such as white rice and white flour, the bran and germ have been removed in the milling process. The entire kernel is used in whole-grain products, making them a better source of fiber and other nutrients. The study authors suggested that lowering blood pressure by eating three servings of whole- grain foods daily could reduce the risk of coronary artery disease by at least 15 percent and stroke by 25 percent or more. CAVEATS The study data did not include precise measure- ments of participants’ intake of sodium and potassium, which could affect blood pressure. The mechanism by which whole grains may contribute to blood pressure decline was not determined. FIND THIS STUDY October issue of the American Journal of ClinicalNutrition. LEARN MORE ABOUT high blood pressure at www.nhlbi. nih.gov/health.Learn about the health benefits of whole-grain foods at www.hsph.harvard.edu/nutritionsource (click “what should you eat,” then “whole grains” in the first nutrition tip). — Linda Searing


The research described in Quick Study comes fromcredible, peer-re- viewed journals. Nonetheless, conclusive evidence about a treat- ment's effectiveness is rarely found in a single study. Anyone consid- ering changing or beginning treatment of any kind should consult with a physician.


Thursday in Local Living The MisFits look into how to get exercise during your commute. Eat, Drink & Be Healthy explores the Carb Lovers Diet.


HEALTH & SCIENCE


Editor: Frances Stead Sellers • Assistant Editors: Margaret Shapiro, Nancy Szokan, Kathryn Tolbert • Art Director: Brad Walters • Editorial Aides: Charity Brown, Rachel


Saslow • To contact us: E-mail: health-science@washpost.com Telephone: 202-334-7575 Mail: The Washington Post, Health, 1150 15th St. NW, Washington, D.C. 20071 • Advertising Information: Shawn Mckenna-Deane, 202-334-5750, mckenna-deanes@washpost.com


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