By David S. Martin
CNN Medical Senior Producer

Talking about health care costs in July, President Obama asked this question: “If there's a blue pill and a red pill, and the blue pill is half the price of the red pill and works just as well, why not pay half price for the thing that's going to make you well?”

Many ophthalmologists believe there is just such a blue pill out there. Only the red pill’s not twice as expensive. It costs almost 50 times much: $2,000 compared with about $45 for the alternative. And Medicare covers both.

What are the drugs? The expensive one is Lucentis. The other, Avastin. They’re not pills, really, but a medicine injected into the eye every four to six weeks to treat age-related, wet macular degeneration, a leading cause of blindness in seniors. With monthly injections, the annual cost difference is $24,000 versus $540.

It’s a difference that we, the taxpayers, underwrite. Lucentis cost Medicare $557.3 million last year, according to U.S. Centers for Medicare and Medicaid Services. That’s a figure that could rise as the population ages.

Many retina specialists think Avastin works as well as its more expensive rival, Lucentis, and roughly half of the wet macular degeneration patients are opting for Avastin, according to Dr. David F. Williams, president of the American Society of Retina Specialists.

Not surprisingly, Williams says, Medicare patients with supplemental insurance that covers the 20 percent co-pay are the most likely to choose Lucentis. (Medicare recipients ponied up $142.7 million in co-pays for Lucentis last year, according to government figures.)

Lucentis received FDA approval in 2006. The chemically similar Avastin was originally developed to treat cancer but its off-label use for wet macular degeneration predates Lucentis’ arrival on the market. To make this tale even stranger, both Lucentis and Avastin are made by the same company, Genentech, a division of the Swiss drug giant Roche. Can you guess which treatment the company advocates?

The National Eye Institute, part of the National Institutes of Health, is now conducting a head-to-head comparison of the two drugs. Initial results are expected at the end of next year.

Should the government require patients to choose the less-expensive drug? How about if the clinical trial shows no difference between the two?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By David S. Martin
CNN Medical Senior Producer

North of the Arctic Circle, the weather is unforgiving, the population is scattered and the distances are immense. At the University Hospital of North Norway in Tromsø, the northernmost teaching hospital in the world, doctors routinely use a helicopter ambulance and fixed-wing plane to transport the most serious cases for care – or to bring emergency care to the patient. It’s all about buying time.

During a visit Tromsø, we shadowed Dr. Mads Gilbert, who heads the Department of Emergency Medical Services at the hospital, a small city surrounded by water and mountains. He describes trauma care in this part of the world as “cold, dark, distance and dangerous.” The cold poses its own challenges, and Dr. Gilbert and the team see a lot of hypothermia from ski accidents and people who’ve fallen out of fishing boats falling into the water.

Dr. Gilbert was on call 24 hours a day all week when we were there. He is 62, a rangy man with the energy and enthusiasm of someone half his age.

“What we do with emergency medicine - be it airway breathing, chest compressions, bleeding control, treating hypothermia - is to slow or even stop the death process. So it’s really the struggle between life and death and I always feel like we’re standing on the shore with the tide coming up. We’re trying to pull people from the tide of death and onto the dry land of life,” Gilbert said with a flourish.

Hours after we arrived, his team scrambled in the middle of the night, putting on jumpsuits and helmets and climbing aboard the helicopter ambulance. The temperature was just a degree or two above freezing as the helicopter lifted off and a chilling rain soon began to fall. A young man was suffering from an uncontrollable seizure, and the local doctor wasn’t sure whether it was an allergic reaction or something more serious. The helicopter ambulance team brought the patient back to the hospital.

By sending the helicopter, Dr. Gilbert and his team were able to get the patient to the hospital an hour and a half more quickly than a traditional ambulance. When we left that night, the patient was stable and resting as he awaited further neurological exams.

Gilbert says he expects the emergency teams to make close to 900 missions this year on the two aircraft. Norway started the Statens luftambulanse (National Air Ambulance System) in 1988. The goal is to reach 90 percent of the Norwegian population within 45 minutes. The service - all of Norwegian health care for that matter –is paid for by the government, through taxes. Gilbert is an outspoken proponent of national health care. Back from a mission, Gilbert joked that he didn’t ask to see a credit card before allowing the patient on board.

Gilbert and the other doctors at the University Hospital of North Norway have become perhaps the world’s leading experts treating cases of accidental hypothermia. To see their most remarkable rescue, a woman whose body temperature had dropped to 56 degrees, tune in to “Another Day – Cheating Death” this weekend, at 8 and 11 p.m. ET, Saturday and Sunday.

Has someone you know been airlifted to a hospital? What was the experience like?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By David S. Martin
CNN Medical Senior Producer

President Obama is scheduled to address a joint session of Congress tonight in an effort to breathe new life into his health care overhaul. Critics have gone after the cost of his proposal and claimed the president’s plan is a first step in a government takeover of health care. Central to this second charge is the specter of a faceless government bureaucrat standing between you and your doctor.

I thought of this the other day when a neighbor approached me, his voice shaking with frustration. He had just received a letter from Blue Cross Blue Shield, rejecting his application for health insurance. The letter was signed, if that's the word, "Sincerely, Underwriting Department L 24.”

What makes this case curious is that Blue Cross Blue Shield had been insuring my neighbor and his family for the past 15 or so years through his wife's state job. When she resigned to stay home with their 1-year-old, he never dreamed Blue Cross Blue Shield would not accept his application to purchase private insurance. After all, he thought, the insurance company was familiar with his family’s medical history. There are no expensive chronic diseases such as diabetes or expensive life-threatening ailments such as cancer on their record. My neighbor says he occasionally suffers from allergies. That’s it. His 1-year-old is healthy. To further confuse matters, Blue Cross Blue Shield accepted his wife and teenage daughter for health insurance.

The whole story sounded strange. I asked him if he’d mind if I called Blue Cross Blue Shield. Here is the response I got:

To protect the privacy of our members and their medical information, Blue Cross and Blue Shield of Nebraska (BCBSNE) does not comment on the specifics of individual cases. In general terms, however, each individual application for medical coverage is reviewed thoroughly and carefully, based on standard criteria which differs between individual and employer group business. BCBSNE accepts most applicants, but there are occasional denials based on health conditions and eligibility requirements.

I asked Blue Cross Blue Shield about L 24 and was told that’s not a person but the code for the form letter my neighbor received. As we listen to the president make his case for health care reform, we should remember “L 24” and know that the government does not have a monopoly on faceless bureaucrats.

Has a faceless bureaucrat ever stood between you and your doctor?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By David S. Martin
CNN Medical Senior Producer

If you’re like me, you try to exercise and eat a diet with lots of fruits and vegetables. The hope, of course, is that a healthy lifestyle leads to good health. It doesn’t always work out that way.

There are two things we don’t control when we sit down at the table or head to the gym. The first is our genes. We may have a family history of heart disease or Alzheimer’s. The second is the environment: The air we breathe, the water we drink, chemicals we ingest, all can have a subtle but profound affect on our long-term health.

This year, perhaps as never before, the federal government is recognizing this link between health and the environment.

The Centers for Disease Control and Prevention today launched the Web-based Environmental Public Health Tracking Network. The site is designed to track links between air and water pollutants and such chronic conditions as asthma, heart disease, cancer and childhood lead poisoning.

As of now, the tracking network only covers 16 states (California, Connecticut, Florida, Maine, Maryland, Massachusetts, Missouri, New Hampshire, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Utah, Washington, Wisconsin) and New York City.

The CDC plans to add five more sites this summer and hopes to eventually include all 50 states.

The tracking network will help the government respond more quickly to environmental health problems and also improve our understanding of the connection between environment and health, said Dr. Howard Frumkin, director of the CDC’s National Center for Environmental Health, in a news release.

That’s also what prompted the National Institute of Child Health and Human Development to embark on a 21-year study that will follow 100,000 children from the womb to adulthood. The agency began signing up study participants in January.

All this focus on the environment and health is a reminder that while we inhabit a globe, we don’t live in a bubble.

Has the environment ever made you sick?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By David Martin
CNN Medical Senior Producer

Michael Jackson’s sad and sudden death has brought the issue of physician qualifications to center stage.

Jackson’s personal doctor, Conrad Murray, was a cardiologist who was not board certified in cardiology. Board certification isn’t necessary to practice medicine, but many hospital systems require their doctors to be board certified in their specialties. Still, Murray had not been subject to any state or federal disciplinary in the last five years, according to HealthGrades, and Jackson reportedly got along well with him. That counts for something. In the coming days and weeks, investigators will determine whether doctors were prescribing narcotics for Jackson. For his part, Murray’s attorney has denied that Murray prescribed or administered the powerful painkillers Demerol or OxyContin to the pop star.

Unlike the rest of us, Jackson had the means to employ a personal physician, the kind of round-the-clock care that is usually privileged preserve of presidents and potentates.

When we choose a doctor, we simply want someone who will see us when we’re sick, who takes the time to listen, who can draw on knowledge and experience to find the right treatment when we need it. We assume the doctor is licensed. We assume if the doctor had been endangering patients, we’d know about it.

A couple of recent reports call that into question.

Medversant Technologies, which provides Web-based management tools for hospitals and others, recently reviewed the credentials of more than 7,000 practicing doctors and found that 1 percent were unlicensed or had licenses that were suspended or terminated because of state or federal sanctions; 6 percent more had expired licenses.

And last month, Public Citizen published a report taking a closer look at the National Practitioner Data Bank, designed to protect patients from incompetent or unprofessional physicians.

Hospitals that revoke or restrict a doctor’s privileges for more than 30 days because of misconduct or ineptitude are supposed to report this to the federal data bank.

But Public Citizen says hospitals look for ways to avoid reporting doctors. Some hospitals allow doctors to take a leave of absence rather than discipline them in a way that would require reporting to the database, the non-profit group said in the report, while others impose sanctions of 30 days or less to avoid reporting.

In 2006, the American Journal of Medical Quality published a study that found 60 to 75 percent of reportable actions were not reported.

How thoroughly have you checked out your doctor’s credentials? Have you ever gone to a doctor who you found out later was unqualified or unlicensed?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By David Martin
CNN Medical Senior Producer

Twenty years ago, I went to Mercy Hospital in Wilkes-Barre, Pa., on a January night to cover the arraignment of Larry Cottam for the death of his 14-year-old son, Eric. The boy had starved to death. Arraignments are usually held in courthouses, but Cottam was too weak from malnutrition to leave the hospital. He sat in a wheelchair, an intravenous tube in his arm, his six-foot frame down to 139 pounds as he listened to the charges the Commonwealth of Pennsylvania was bringing against him. It was a strange scene.

His wife, Leona, was also charged in her son’s death. But that would come later. That night, doctors were too busy trying to save her life. She and their daughter, Laura, were elsewhere in Mercy Hospital, receiving treatment for severe malnutrition.

Larry Cottam was a former Seventh Day Adventist pastor and truck driver. He had been without work for months but didn’t believe in handouts for his reclusive family. He thought God would intercede on their behalf. The Cottams withered as they waited in vain at their two-story home on a dead end suburban street. Authorities said Eric ate his last meal 42 days before his death. The 5' 10" teenager’s body weighed 69 pounds.

I thought about the Cottams as I was reading a line in a statement to the media from Calvin P. Johnson, attorney for 13-year-old Daniel Hauser’s parents: “It is a violation of Spiritual Law to invade the consciousness of another without their consent.”

In Minnesota, where Danny was living before he and his mother fled, the state has a law requiring parents to provide necessary care to a child. Danny has Hodgkin’s lymphoma, but his parents do not think chemotherapy is the right treatment for the boy, Johnson said. In fact, Danny thinks chemo will kill him, according to the attorney.

At a hearing, Brown County District Judge John R. Rodenberg said the boy's "best interests" require that he receive medical care to combat his Hodgkin’s lymphoma. Chemotherapy has a 90 percent success rate with this cancer. Without chemotherapy, Danny’s doctor testified there’s a 95 percent chance the cancer will kill him.

Danny and his mother fled the state rather than comply with the court. They returned to Minnesota on Monday.

“This is a case of Love vs. Power. Love gives. Power takes,” Johnson wrote in his news release.

In the case of Larry and Leona Cottam, no one argued that couple didn’t love their children, nor did prosecutors question the sincerity of their religious convictions. But a jury convicted Larry and his wife, Leona, of third-degree murder just the same.

Last year, a Wisconsin girl named Madeline Neumann slipped into a coma and died after her parents chose prayer over medical treatment for the diabetic 11-year-old. The state charged her parents, Leilani and Dale Neumann, with reckless homicide. A jury convicted Leilani on Friday. Dale is scheduled to stand trial in July.

No one likes the notion of the state imposing its will over deeply held spiritual beliefs, but are there times when the government should dictate what care a child receives – no matter what the parents say?

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By David Martin
CNN Medical Senior Producer

Some illnesses get their names from the first person to describe them, such as Alzheimer’s disease, named for German psychiatrist Alois Alzheimer. Others get their name from a famous sufferer, for example Lou Gehrig’s disease, named after the legendary baseball player who fell ill with the degenerative nerve disorder also known as amyotrophic lateral sclerosis. Still others get their name from their origin, like the West Nile Virus, a mosquito-borne illness that began in Africa and now infects horses, cattle and people as far away as the United States.

With influenza, there appear to be no clear rules how to name a strain, and that’s ruffled some feathers.

The most lethal flu ever, in 1918, became known as the Spanish flu. The deadly flu that initially swept across Western Europe didn’t originate in Spain, but England, France and Germany all had blackouts on news that might lower morale. They remained mum on the deadly influenza. Spain was neutral and had no such blackout. Spanish newspapers published stories about local outbreaks, giving rise to that country’s strong association with the deadly pandemic, which eventually killed 20 million or more not only in Europe but across the globe. Competing theories put the real ground zero of the Spanish flu either in Kansas or British training camps in France and England.

A few years back, when a potentially deadly flu began in Asia, it took the name of the source of the illness: avian influenza, or bird flu. People contracted the disease through contact with domesticated chicken, ducks and turkeys infected with the virus or surfaces contaminated with their waste. Hence the name. There were no outcries from the poultry industry, and the virus also known as H5N1 has kept the moniker “bird flu.”

When health officials dubbed the cause of the current outbreak “swine flu” because it contains pig genes, they sparked an uproar. The pork industry cried foul, claiming the name was misleading and bad for business (The new virus actually combines two human viruses, a pig virus and a bird virus). CNN received a flood of e-mails asking whether the virus can be spread by eating pork (It can’t). China and the Philippines stopped importing U.S. pork. Russia banned pork, meat and poultry from states where the outbreak had been reported. Egypt ordered the slaughter of that nation’s 300,000 pigs.

At an emergency Senate Appropriations Committee hearing on the outbreak last week, Sen. Tom Harkin, a Democrat from the pig-rich state of Iowa, focused not only on the size or spread of the outbreak but its name.

“But why wouldn't it be called an avian virus, if it has the avian genes as well as the swine genes?” Harkin asked Dr. Anthony Fauci, director of the National Institutes of Allergy and Infectious Diseases.

Fauci’s response: “When it has a pig gene in it, you generally call it a swine virus. The reason why we don't say swine, bird, human is that we don't usually see a triple reassortment. This is a very unusual situation.”

Last week, health officials in the United States renamed the virus at the heart of the global outbreak “2009 H1N1.” H1N1 is a scientific designation describing the physical characteristics of the virus. The European Union and World Health Organization followed suit. The WHO is now calling the virus H1N1 influenza A.

Despite the name change, the initial swine flu designation may dog the pork industry for some time to come – and may give health officials pause the next time they attach a name to a virus.

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By David S. Martin
CNN Medical Senior Producer

The details we heard this morning were vague but heartbreaking nonetheless: a 22-month-old from Mexico died from the swine flu in Texas. As a parent, the loss of a child is the worst imaginable tragedy. For those of us living in the United States, the toddler’s death lets us know that we do not necessarily have protection against this new virus that had until now resulted in deaths in Mexico but nowhere else.

There’s something else. Something history is warning us. The four deadliest pandemics in the last 120 years arrived at the end of a flu season, dissipated and then returned with a vengeance the following winter. That’s what happened in the deadliest pandemic ever: the so-called Spanish flu, which arrived in March 1918 but took its devastating toll in the winter of 1918-19. More than 20 million died worldwide. Worldwide flu outbreaks in 1889, 1957 and 1968 also followed this pattern. The virus’ second appearance in the winter was in each case much more deadly than the initial outbreak in the spring.

This history is no doubt on the mind of Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention in Atlanta, Georgia. At his briefing Tuesday, he said the CDC was considering making a swine flu vaccine. But it isn’t simply a matter of adding this vaccine to the seasonal vaccine offered each fall.

The seasonal flu vaccine for the winter of 2009-10 is already in production, and the government has already chosen which three flu strains to protect us against. The swine flu isn’t among them, and the process doesn’t allow for simply adding a fourth strain to the mix. That means a swine flu vaccine would have to be separate shot.

If a separate swine flu shot became available this fall, would you take it?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By David S. Martin
CNN Medical Senior Producer

Planted along the wooded road leading to Hazelden’s main campus in Center City, Minnesota, are three wooden signs, each bearing a single word: Easy. Does. It. Treating addiction is seldom easy, though.

Angela Puckett came here after an overdose of alcohol and painkillers nearly killed her. She had spent her life as a self-proclaimed party girl. She arrived at Hazelden hoping 28 days there would begin her road to recovery.

In “Addiction: Life on the Edge”, which airs Saturday and Sunday, April 18 and 19 at 8 p.m. ET and 11 p.m. ET, CNN Chief Medical Correspondent Dr. Sanjay Gupta profiles Puckett and three other addicts trying to rebuild their lives. During the year CNN followed them, one relapsed, showing just how difficult recovery can be.

On a campus that resembles a small college, patients at Hazelden go to individual and group therapy, attend lectures, and reflect. Puckett was lucky. Her insurance covered Hazelden, where the typical stay costs $26,000. Only half of insurance plans pay for residential rehab.

Four years after she arrived at Hazelden, Puckett is back at work and back as a devoted mother to her son. “I know I’d be dead if it wasn’t for Hazelden,” Puckett told CNN. “Hazelden gave me my life back.”

“Addiction: Life on the Edge” also profiles:

* Lucy Gross, a 17-year-old who attends one of a growing number of high schools specially designed for addicts in recovery.

* Walter Kent, a retiree who ended four decades of addiction to alcohol by taking a pill.

* Nic Sheff, a young writer who chronicled his addiction to methamphetamine and other drugs and the toll it took on his family in the book, “Tweak.”

The federal government estimates there are 23 million Americans who abuse drugs or alcohol, costing more than $500 billion in healthcare, criminal justice and lost productivity.

Do you think insurance companies should be required to cover drug or alcohol treatment? How about residential treatment like Puckett’s?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By David S. Martin
CNN Medical Senior Producer

This week you’re going to hear a lot about the dangers of poisoning, especially for children. It’s National Poisoning Prevention Week, and more than half of the 2.4 million calls to poison control centers involve children under age 6. One toxin that doesn’t usually prompt calls to a poison control hotline – a hidden toxin – may surprise you.

According to the American Academy of Pediatrics, the most dangerous potential poisons are medicines, cleaning products, antifreeze, windshield wiper fluid, pesticides, furniture polish, gasoline, kerosene and lamp oil. One substance you probably won’t hear much about this week is lead. After all, U.S. oil companies began phasing out leaded gasoline in 1975, and the government banned lead in paint in 1978. But lead poisoning remains a threat that can tragically lower the trajectory of a child’s life.

For an upcoming Dr. Sanjay Gupta special looking at toxic chemicals in the environment, we interviewed Dr. Philip Landrigan, chairman of the Department of Community and Preventive Medicine at Mount Sinai Medical School in New York. In the 1970s, he was a young field investigator for the Centers for Disease Control and Prevention, traveling around the country and around the world, often on a few hours notice, chasing epidemics. Dr. Landrigan flew to El Paso in 1971, at the urging of the county health department, to look into the potential dangers to children living near a lead smelter. At the time, lead was generally considered to be what Landrigan calls an “all or none” disease. If you weren’t exposed to levels that caused coma or death, you were fine. Researchers didn’t realize lower levels could have a profound consequence on a child’s life. Landrigan and his colleagues found children living closer to the smelter had higher the levels of lead in their blood. More troublesome still, they found higher blood-lead levels meant lower IQs, lower attention spans and more disruptive behavior. This and other groundbreaking work marked the beginning of the end for lead in paint and gasoline. Doctors now consider no amount of lead as safe.

Still, old paint remains. The CDC found one in seven children under 5 are at “high risk” of lead exposure because they live in older housing. And the risk isn’t limited to toddlers chewing paint chips. Sanding and scraping old paint on walls and old window as part of a home renovation can kick up lead dust, which can cause brain damage - even in the womb, a tragic outcome for parents trying to get a room ready for the new baby.

Have you taken any precautions against lead in your home?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.