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Anew cost-cutting push by one of the nation's largest insurance companies is encouraging patients to engage in a controversial tactic: cutting their drug bills by cutting their pills in half. UnitedHealth Group's is now offering patients a chance to lower their copayments by buying a pill for twice the dose they need and cutting it in half. The program is voluntary and gives patients the opportunity to save as much as $300 annually in copayment costs per prescription. The move is being closely watched by the insurance industry, and experts say that if it is successful, other insurers likely will begin to offer pill-splitting options to their customers as well. One concern is whether insurers will eventually make pill splitting mandatory, forcing patients to essentially become their own pharmacist. Drug makers have long raised concerns about the health risks of splitting pills incorrectly, or attempting it with inappropriate drugs. But a slew of research demonstrates that for many medications, pill-splitting is entirely safe when done correctly. Because of a quirk in the way drugs are made and priced, many pills cost the same regardless of the dosage. For instance, drugstore.com sells a one-month supply of the cholesterol drug Lipitor in 20-milligram pills for $99. It also sells a month's worth of 40-milligram pills for about $99. One reason drug makers price drugs this way is to encourage patients to take the most effective dose without having to pay significantly more money than a lower dose. So a patient with a 20-milligram Lipitor prescription could buy a month of the higher-dose pills, cut them in half, and get two months' worth of Lipitor for the same price. The practice of pill splitting to save money has long been used by uninsured patients who have to pay for drugs out of their own pocket. And some insurance firms like Kaiser Permanente, provide information and pillsplitting devices to customers whose plans don't include drug coverage. The U.S. Department of Veterans Affairs has also pushed the practice. But the pillsplitting plan by UnitedHealth marks the first time a major insurance firm has encouraged the practice as a way for customers who already have prescriptiondrug coverage to lower copayment costs. Although pill splitting conjures up images of kitchen knives and cutting boards, numerous plastic devices have been developed to make the job easier and more precise. The devices range in price from about $3 for a simple drug-store version to $25 for one specially designed to easily split Viagra. UnitedHealth gives its patients a free splitter that looks a little like a small stapler. Open it and set the pill inside. Close it and a blade inside the device swipes through the pill. The easiest pills to split are relatively flat, round and scored with a line down the center. Odd shaped pills like diamond-shaped Viagra can be trickier, which is why specialty pill-splitters have gained popularity. In addition, splitters only work if a pill comes in double

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your needed dose -- they can't be used to cut a pill into thirds. The drug industry, which stands to lose billions if the practice is widely adopted, has long criticized pill splitting as unsafe, saying that patients may not get the exact dose if they start cutting pills in half. And some pills -- like extended release tablets or the migraine drug Imitrex -- won't work at all if they're cut in half. Capsules with powder or gel in them also can't be split. And the simple splitters might be too difficult to use for patients with vision problems, severe arthritis or dementia. In addition, since some elderly patients are burdened with several prescriptions, some experts worry that pill splitting will end up being a disincentive to comply with a doctor's prescription regimen, because it will involve splitting hundreds of pills each month. But some recent studies have debunked the safety concerns about splitting pills. Most recently, the American Journal of Cardiology in June examined voluntary pill-splitting of cholesterol drugs among nearly 4,000 patients seen by doctors at six Veterans Affairs centers in Florida. There were no differences in patient compliance, side effects or improvement among pill splitters and non-pill splitters. The pill-splitting push saved the VA more than $46 million in 2003, according to the journal report. UnitedHealth customers who split pills will cut their copayment costs in half, saving $12 to $25 per prescription, depending on the drug. For the insurance industry, pill-splitting has the potential of saving billions annually. The company says the plan has built-in safety measures. For instance, patients can split pills and save on copayments

“One concern is whether insurers will eventually make pill splitting mandatory, forcing patients to essentially become their own pharmacist.”

only with permission from a doctor. That way doctors can make sure that patients with dementia or other health problems that could interfere with accurate pill splitting don't take part. To prevent patients from splitting the wrong types of pills, only certain categories of drugs qualify, including cholesterol drugs, blood pressure drugs known as ACE inhibitors and Angiotensin Receptor Blockers, anti-depressants such as Zoloft and the anti-viral drug Valtrex. A company spokesman said the plan only includes drugs that have been shown in published studies or other research to be safe to split. UnitedHealth says the program was "extremely popular" when it was studied as a pilot test program among patients in Wisconsin, which is why the firm decided to launch it nationally. Half of a pill "is as safe as any normal pharmaceutical," says spokesman Mark Lindsay. "The clinical evidence clearly shows that under a doctor's supervision you can do this and have the same clinical effect and save consumers and employers a lot of money."

You can e-mail Tara Parker-Pope at healthjournal@wsj.com

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wash your hands often. Carry hand sanitizer with you. I never heard of this one but rubbing your hands together very hard for a minute or so helps break up most of the cold germs. On the hand cleaners...be careful... some hand cleaners are flammable! If your hands are still damp with the cleaner and you go near a flame...you may ignite your hand. #2 Cover your mouth when you sneeze or cough. Because germs and viruses cling to your bare hands, muffling coughs and sneezes with your hands results in passing along your germs to others. So...when you feel a sneeze or cough coming, use a tissue, then throw it away immediately. If you don't have a tissue, turn your head away from people near you and cough into the air. Also, the back of your hand has less contact with surfaces than your palm, so that is another option. #3 Don't Touch Your Face Cold and flu viruses enter your body through the eyes, nose, or mouth. Touching their faces is the major way children catch colds, and a key way they pass colds on to their parents. Nail biters beware. #4 Drink Plenty of Fluids Water flushes your system, washing out the poisons as it rehydrates you. A typical, healthy adult needs eight 8-ounce glasses of fluids each day. How can you tell if you're getting enough liquid? If the color of your urine runs close to clear, you're getting enough. If it's deep yellow, you need more fluids. Warning: too much water can deplete your body of vitally important electrolytes. #5 Take a Sauna Researchers aren't clear about the exact role saunas play in prevention, but one 1989 German study found that people who steamed twice a week got half as many colds as those who didn't. One theory: When you take a sauna you inhale air hotter than 80 degrees, a temperature too hot for cold and flu viruses to survive. #6 Get Fresh Air A regular dose of fresh air is important, especially since many people go from air conditioned homes to air conditioned cars and to air conditioned work place. A/C dries you out and makes your body more vulnerable to cold and flu viruses, just as heat does up north. #7 Do Aerobic Exercise Regularly Aerobic exercise speeds up the heart to pump larger quantities of blood; makes you breathe faster to help transfer oxygen from your lungs to your blood; and makes you sweat once your body heats up. These exercises help increase the body's natural virus-killing cells. #8 Eat Foods Containing Phytochemicals "Phyto" means plants, and the natural chemicals in plants give the vitamins in food a supercharged boost. Take your vitamins, take Vitamin C and some people swear by Echinacea to ward off colds. Its your preference but work on those dark green, red, and yellow vegetables and fruits. Don’t forget the orange...it is full of Vitamin C. #9 Eat Yogurt Some studies have shown that eating a daily cup of low-fat yogurt can reduce your susceptibility to colds by 25 percent. Researchers think the beneficial bacteria in yogurt may stimulate production of immune system substances that fight disease. #10 Don't Smoke Statistics show that heavy smokers get more severe colds and more frequent ones. Even being around smoke profoundly zaps the immune system. Smoke dries out your nasal passages and paralyzes cilia. These are the delicate hairs that line the mucous membranes in your nose and lungs, and with their wavy movements, sweep cold and flu viruses out of the nasal passages. Experts contend that one cigarette can paralyze cilia for as long as 30 to 40 minutes. #11 Cut Alcohol Consumption Heavy alcohol use destroys the liver, the body's primary filtering system, which means that germs of all kinds won't leave your body as fast. The result is, heavier drinkers are more prone to initial infections as well as secondary complications. Alcohol also dehydrates the body -- it actually takes more fluids from your system than it puts in. #12 Relax If you can teach yourself to relax, you can activate your immune system on demand. There's evidence that when you put your relaxation skills into action, your interleukins -- leaders in the immune system response against cold and flu viruses -- increase in the bloodstream. Train yourself to picture an image you find pleasant or calming. Do this 30 minutes a day for several months. Keep in mind, relaxation is a learnable skill, but it is not doing nothing. People who try to relax, but are in fact bored, show no changes in blood chemicals. injury that needs to be treated by a doctor. #5 Persistent Coughing A cough that won't go away is usually just postnasal drip that may be treated with antihistamines. However, it could also be related to asthma or GERD, both of which can be treated by your doctor. In recent years, doctors have found an increase in a former childhood infection called pertussis (whooping cough in children). So if you have an unexplained cough for more than 2 to 3 weeks, your doctor may want to try an antibiotic to treat this type of infection. #6 Persistent Congestion and Headaches Colds and allergies that cause congestion and blockage of the sinus passages can lead to a sinus infection. If you have symptoms don't go away with usual medication, you may need to be treated with antibiotics. See your doctor if these symptoms persist. DON’T FORGET THE MENINGITIS WARNING What Are the Symptoms of Meningitis? The illness begins with simple, flu-like symptoms - sore throat, runny nose, nasal congestion, fever, and sometimes muscle aches. Very young children often react to the pain by arching their backs uncontrollably. Some forms of meningitis produce a dark red or purplish rash anywhere on the body. In babies, the swelling of the lining of the brain - the meninges -- may also cause the soft spot on the top of the skull to bulge. Specific symptoms include: • Fever • Severe headache • Stiff neck, shoulders or back • Pain with eye movement • Severe shooting pain down the back of the neck and sometimes along the spine, when bending the neck forward • Inability to tolerate bright light • A bumpy and splotchy dark red or purplish rash anywhere on the body (in certain types of bacterial meningitis) • Drowsiness and mental confusion • Vomiting • Seizures and coma • Paralysis on one side of the body in severe cases • In infants, a bulge of the soft spot on the skull • In infants, an eerie high-pitched cry Call Your Doctor If: • You develop the symptoms listed above -- particularly a combination of severe headache, stiff neck and painful aversion to light, seek emergency medical care immediately. • Your child develops the symptoms listed above, seek emergency medical care immediately. Research done VIA the Internet

Lois Cross and Sean Cononie (Continued from page 4) The flu this year is going to be deadly! Colds and allergies that cause congestion and blockage of the sinus passages can lead to a sinus infection. If you have symptoms don't go away with usual medication, you may need to be treated with antibiotics. Generators $199 954-563-1501

Things to consider: #1 Difficultly breathing or chest pain Aside from the stuffy nose and some general muscle aches, a cold or the flu should not make you short of breath or cause pain in your chest. These could be symptoms of a more serious problem such as heart disease, asthma, pneumonia, or others. Contact your doctor or go to the emergency room. #2 Persistent Fever This can be a sign of a secondary infection in your body that should be treated. #3 Vomiting or Inability to Keep Fluids Down Your body needs fluids to stay hydrated. If you can't keep down fluids, you should see your doctor. #4 Painful Swallowing This is not normal. Although minor discomfort when you swallow can come from a sore throat, severe pain can be a sign of an infection or

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Are you willing to forget what you have done for other people and to remember what other people have done for you?

To ignore what the world owes you, and to think what you owe the world?

To admit that the only good reason for your existence is not what you are going to get out of life, but what you are going to give to life?

Are you willing to stoop down and consider the needs and desires of little children?

To remember the weakness and loneliness of people who are growing old?

To stop asking how much your friends like you, and ask yourself whether you love them enough?

To try to understand what those who live in the same house with you really want, without waiting for them to tell you?

To make a grave for your ugly thoughts and a garden for your kindly feelings, with the gate open?

Are you willing to do these things even for a day? Then you can keep Christmas.

Are you willing to believe that love is the strongest thing in the world-- stronger than hate, stronger than death-- and that the blessed Life which began in Bethlehem many years ago is the image and brightness of eternal love?

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24 Issues

(Continued from page 5)

ing in cars, because the few shelters are far from their workplaces or their children's schools. "Their stories are overwhelmingly sad," said Mayor Kristin Jacobs of Broward County. "They have had an extraordinary circumstance fall smack in the middle of life and put them in an environment where they never in their wildest dreams thought they would be. And they are mortified that they are there." They are people like Sandra Distefano, who gave birth three days ago to a daughter, Rita Marie, but on Thursday was back at the Red Cross shelter at McNicol Middle School in Hollywood. Mrs. Distefano said that her Pompano Beach home lost part of its roof and that she and her husband were waiting for a disability check so they could leave the shelter. "It's been rough on my nerves," Mrs. Distefano, 30, said. "I need somewhere to go where it's just my husband and I and the baby." Laura Howe, a spokeswoman for the Red Cross, said that unlike after Hurricane Katrina, the agency would not pay for victims to stay in hotels this time because other options were available. But the Red Cross will continue operating shelters in South Florida for as long as necessary, Ms. Howe said. Finding the homeless a place to live is especially tough in South Florida because the housing market, heavy on luxury condominiums, is among the nations priciest. The Federal Emergency Management Agency agreed this week to pay up to twice the fair market value of rent for storm victims here. The affected counties are also clamoring for FEMA to provide travel trailers and mobile homes, just as it did in other parts of Florida after last year's hurricanes and on the Gulf Coast after Hurricane Katrina. But trailers have just begun trickling in - FEMA hopes to install about 55 at a park in Broward County by the weekend - and officials said they were a last resort. "Would you rather have a 20-foot trailer or a one-bedroom apartment?" said Ricardo Zuniga, a FEMA spokesman. "An apartment is something that is more like home that really helps them recover." In all, more than 450,000 Floridians have applied for help from FEMA since the storm, including 176,403 in Broward County, 141,283 in Miami-Dade County and 82,985 in Palm Beach County. About $57 million in grants has been approved in the 13 counties hit by Hurricane Wilma, with the most, $14.5 million, going to Broward. Even many whose homes remain intact need help: thousands lined up this week for food stamps to replace groceries lost during power failures. Among them was K. E. Reynolds, 75, who said her home in Oakland Park had been dark for 16 days. "I live on an extremely fixed income," said Ms. Reynolds, who waited in a food stamp line in Pompano Beach with her cane and inhaler. "I go to the food bank as it is. I had to throw away everything in my refrigerator. I don't have the kind of money to replace it." The storm knocked out power to 3.2 million households and businesses, and many people, a large number of them elderly, went a week or more without it. But all but 10,000 customers had their electricity restored as of Thursday. Schools reopened last week in Miami-Dade County, and this week in Broward and Palm Beach Counties. Life is back to normal for most, but not for people like Annette Jackson Forrester, 44, who has been living at the Red Cross shelter at the McNicol Middle School with her husband and 6-year-old grandson. Ms. Jackson Forrester said that her apartment's ceiling had caved in, that the place was moldy because of flooding and that her grandson, an asthmatic with other health problems, could not live there. FEMA cannot inspect her home until Nov. 17, she said, but her patience has run out. "We need to be in our own place," Ms. Jackson Forrester said, starting to cry. "I'm tired. I'm tired." By ABBY GOODNOUGH

proof that they are not there. Nobody can conceive or imagine all the wonders there are unseen and unseeable in the world. You tear apart the baby’s rattle and see what makes the noise inside, but there is a veil covering the unseen world which not the strongest man, nor even the united strength of all the strongest men that ever lived could tear apart. Only faith, poetry, love, romance, can push aside that curtain and view and picture the supernal beauty and glory beyond. Is it all real? Ah, Virginia, in all this world there is nothing else real and abiding. No Santa Claus! Thank God! He lives and lives forever. A thousand years from now, Virginia, nay 10 times 10,000 years from now, he will continue to make glad the heart of childhood.

About the Exchange

Francis P. Church’s editorial, “Yes Virginia, There is a Santa Claus” was an immediate sensation, and went on to became one of the most famous editorials ever written. It first appeared in the The New York Sun in 1897, almost a hundred years ago, and was reprinted annually until 1949 when the paper went out of business. Thirty-six years after her letter was printed, Virginia O’Hanlon recalled the events that prompted her letter: “Quite naturally I believed in Santa Claus, for he had never disappointed me. But when less fortunate little boys and girls said there wasn’t any Santa Claus, I was filled with doubts. I asked my father, and he was a little evasive on the subject. “It was a habit in our family that whenever any doubts came up as to how to pronounce a word or some question of historical fact was in doubt, we wrote to the Question and Answer column in The Sun. Father would always say, ‘If you see it in the The Sun, it’s so,’ and that settled the matter. “‘Well, I’m just going to write The Sun and find out the real truth,’ I said to father. “He said, ‘Go ahead, Virginia. I’m sure The Sun will give you the right answer, as it always does.’ ” And so Virginia sat down and wrote her parents’ favorite newspaper. Her letter found its way into the hands of a veteran editor, Francis P. Church. Son of a Baptist minister, Church had covered the Civil War for The New York Times and had worked on the The New York Sun for 20 years, more recently as an anonymous editorial writer. Church, a sardonic man, had for his personal motto, “Endeavour to clear your mind of cant.” When controversial subjects had to be tackled on the editorial page, especially those dealing with theology, the assignments were usually given to Church. Now, he had in his hands a little girl’s letter on a most controversial matter, and he was burdened with the responsibility of answering it. “Is there a Santa Claus?” the childish scrawl in the letter asked. At once, Church knew that there was no avoiding the question. He must answer, (Continued from page 8)

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and he must answer truthfully. And so he turned to his desk, and he began his reply which was to become one of the most memorable editorials in newspaper history. Church married shortly after the editorial appeared. He died in April, 1906, leaving no children. Virginia O’Hanlon went on to graduate from Hunter College with a Bachelor of Arts degree at age 21. The following year she received her Master’s from Columbia, and in 1912 she began teaching in the New York City school system, later becoming a principal. After 47 years, she retired as an educator. Throughout her life she received a steady stream of mail about her Santa Claus letter, and to each reply she attached an attractive printed copy of the Church editorial. Virginia O’Hanlon Douglas died on May 13, 1971, at the age of 81, in a nursing home in Valatie, N.Y.

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