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Consumer Health

A Guide to Intelligent Decisions

9TH EDITION

STEPHEN BARRETT WILLIAM M. LONDON MANFRED KROGER

HARRIET HALL ROBERT S. BARATZ

9TH EDITION

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BARRETT LONDON KROGER HALL

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Make Good Decisions about Your Health Care The most comprehensive consumer health text available, Consumer Health: A Guide to Intelligent Decisions offers a panoramic view of the health marketplace. You’ll learn how to sharpen your critical consumer skills so you can distinguish valid health claims from those that are fraudulent or misleading. By offering science-based facts and guidelines, Consumer Health provides the tools you need to make smart decisions about health care products and services for yourself and your family.

Some of the many new and revised topics include:

Updated information on health care economics, refl ecting the most recent legislation and debates regarding insurance and mandatory coverage and how it affects you.

New and expanded material on complementary and alternative medicine, including the latest on fad diseases, “energy medicine,” accreditation standards, and diploma mills.

Current research and information on nutrition and weight management, including “detox” products, the Dietary Guidelines for Americans 2010, and the newly-designed MyPlate food guide.

About the Authors

Stephen Barrett, M.D., has been investigating and writing about consumer health issues for more than 40 years. His Quackwatch website serves as a clearinghouse for information on health frauds and quackery. He serves as Vice President of the Institute for Science in Medicine, is a Fellow of the Committee for Skeptical Inquiry, edits Consumer Health Digest, and is a peer-review panelist for several top medical journals.

William M. London, Ed.D., M.P.H., is a health educator and professor in the Department of Public Health at California State University, Los Angeles. He is also the associate editor of Consumer Health Digest, co-host of the Credential Watch website, and a member of the editorial board of the journal FACT (Focus on Alternative and Complementary Therapies: An Evidence-Based Approach).

Manfred Kroger, Ph.D., is Professor Emeritus of Food Science and Professor Emeritus of Science, Technology and Society at The Pennsylvania State University, where he has won several teaching awards. He is a science communicator for the Institute of Food Technologists and is scientifi c editor of its online journal, Comprehensive Reviews in Food Science and Food Safety. He is also associate editor of the Journal of Food Science and a scientifi c advisor to the American Council on Science and Health.

Harriet Hall, M.D., a retired family physician and colonel, served 20 years in the U.S. Air Force. Her administrative positions included chief of clinic services and director of base medical services. She now devotes her time to investigating questionable health claims and writing and lecturing about pseudoscience, quackery, “alternative medicine,” and critical thinking. She is a contributing editor to both Skeptical Inquirer and Skeptic magazines and a founding member and editor of the Science-Based Medicine blog.

Robert S. Baratz, M.D., D.D.S., Ph.D., an expert on quality of care, is president and medical director of South Shore Health Care in Braintree, Massachusetts, where he practices internal, oral, and occupational medicine. He serves on the medical faculties of Boston University and Tufts University and is used as a consultant by many regulatory and law enforcement agencies.

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CONSUMER HEALTH A Guide to Intelligent

Decisions

STEpHEN BARRETT, MD Author, Editor, Consumer Advocate Webmaster, Quackwatch Network

Chapel Hill, North Carolina

WiLLiAM M. LONDON, EDD, MpH Professor, Department of Public Health

California State University Los Angeles, California

MANfRED KROgER, pHD Professor Emeritus of Food Science

Professor Emeritus of Science, Technology and Society The Pennsylvania State University

University Park, Pennsylvania

HARRiET HALL, MD Retired Family Physician

Puyallup, Washington

ROBERT S. BARATz, MD, DDS, pHD President and Medical Director, South Shore Health Care

Braintree, Massachusetts

Ninth Edition

CONSUMER HEALTH: A gUiDE TO iNTELLigENT DECiSiONS, NiNTH EDiTiON

Published by McGraw-Hill, a business unit of The McGraw-Hill Companies, Inc., 1221 Avenue of the Americas, New York, NY 10020. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved. Previous editions © 2007, 2002, 1997. Printed in the United States of America. No part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written consent of The McGraw-Hill Companies, Inc., including, but not limited to, in any network or other electronic storage or transmission, or broadcast for distance learning.

Some ancillaries, including electronic and print components, may not be available to customers outside the United States.

RECYCLED

This book is printed on recycled, acid-free paper containing 10% postconsumer waste.

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ISBN 978-0-07-802848-9 MHID 0-07-802848-5

Vice President & Editor-in-Chief: Michael Ryan Vice President & Director of Specialized Publishing: Janice M. Roerig-Blong Publisher: David Patterson Executive Editor: Christopher Johnson Marketing Coordinator: Colleen P. Havens Development Editor: Darlene Schueller Senior Project Manager: Lisa Bruflodt Cover Designer: Studio Montage, St. Louis, Missouri Design Coordinator: Brenda A. Rowles Buyer: Sue Culbertson Media Project Manager: Sridevi Palani Primary Typeface:11-point Times Composition: Stephen Barrett, M.D. Printer: Quad/Graphics

All credits appearing on page or at the end of the book are considered to be an extension of the copyright page.

Library of Congress Cataloging-in-Publication Data

Consumer health : a guide to intelligent decisions / Stephen Barrett ...[et al.]. — 9th ed. p. cm. Includes bibliographical references and index. ISBN 978-0-07-802848-9 (alk. paper) 1. Medical care. 2. Health products. 3. Quacks and quackery. 4. Consumer education. I. Barrett, Stephen, 1933- RA410.5.C645 2013 362.1--dc23 2011039127

www.mhhe.com

Stephen Barrett, M.D., a retired psychiatrist who resides near Chapel Hill, North Carolina, has achieved national renown as an author, editor, and con- sumer advocate. In addition to heading Quackwatch, he is vice president of the Institute for Scientific Medicine and a Fellow of the Committee for Skeptical Inquiry (formerly called CSICOP). In 1984, he received an FDA Commissioner’s Special Citation Award for Public Service in fighting nutrition quackery. In 1986, he was awarded honorary membership in the American Dietetic Association. From 1987 through 1989, he taught health education at The Pennsylvania State University. In 2001 he received the Distinguished Service to Health Educa- tion Award from the American Association for Health Education. He has been listed in Who’s Who in America since 2001 and is also listed in Who’s Who in Science and Engineering, Who’s Who in Medicine and Health Care, and Who’s Who in the World. An expert in medical communications, Dr. Barrett operates 25 Web sites; edits Consumer Health Digest (a free weekly electronic newsletter); is medical editor of Prometheus Books; and is a peer-review panelist for several top medical journals. His 51 books include The Health Robbers: A Close Look at Quackery in America and seven of the previous editions of Consumer Health. His other major works include Dubious Cancer Treat- ment, published by the Florida Division of the American Cancer Society; Health Schemes, Scams, and Frauds, published by Consumer Reports Books; The Vitamin Pushers: How the “Health Food” Industry Is Selling America a Bill of Goods, published by Prometheus Books; and Reader’s Guide to “Alternative” Health Methods, published by the American Medical Associa- tion. His Quackwatch Web site, which serves as a clear- inghouse for information on health frauds and quackery, has won more than 70 honors and awards. Since moving to North Carolina in 2007, he has been swimming com- petitively and has won 25 state championship events.

William M. London, Ed.D., M.P.H., is a professor in the Honors College and the Department of Public Health at California State University, Los Angeles. He

is also associate editor of Consumer Health Digest, co-host of the Credential Watch Web site, a consultant to the Committee for Skeptical Inquiry, a Quackwatch advisor, an advisor to the American Council on Science and Health (ACSH), a founding fellow of the Institute of Science in Medicine, a member of the review board of the American Journal of Health Behavior, and a member of the International Editorial Board of the journal FACT (Focus on Alternative and Complementary Therapies: An Evidence-Based Approach). He was an associate professor and chair of the Department of General Studies at Charles Drew University of Medicine and Science, where he led the initiation of the Master’s Program in Urban Public Health. He has also been an associate professor of health education at Kent State University; founding president of the Ohio Council Against Health Fraud; president of the National Council Against Health Fraud; faculty mentor in public health at Walden Univer- sity; professor of Health Sciences at Touro University International; associate professor and director of the Graduate Program in Health Care Management at Col- lege of St. Elizabeth; director of public health for ACSH; director of communications at Columbia University’s Mailman School of Public Health; and executive direc- tor of RAP, Inc., a nonprofit mental health and senior citizens service agency in Genesee County, New York.

Manfred Kroger, Ph.D., is Professor Emeritus of Food Science and Professor Emeritus of Sci- ence, Technology and Society at The Pennsylvania State University, where he has won several teaching awards. He is a science communicator for the Institute of Food Technologists and is scientific editor of its online journal, Comprehensive Reviews in Food Science and Food Safety. He also serves as associate editor of the Journal of Food Science, an ACSH scientific advisor, and a technical editor for Prometheus Books. He has conducted research in analytical chemistry (pesticide residues), food composition, fermented milk products, and dairy processing technology. Even though retired, he remains professionally active at Penn State and nation- ally and internationally. His university courses included

About the Authors

iii

food laws and regulations, toxicology, introductory food science, dairy technology, and a very popular university- wide general education course entitled “Food Facts and Fads.” His other professional activities include lecturing at public and professional meetings, expert testimony in court and at government hearings, and translation of German writings. In 1999 he was elected as a Fellow of the Institute of Food Technologists. In 2003, he served as the editor of the Proceedings of the 12th World Congress of Food Science and Technology.

Harriet Hall, M.D., is a retired family physician who resides in Puyallup, Washington. She served for 20 years in the U.S. Air Force, from which she retired in 1989 as a full colonel. In addition to practicing family medicine and flight medicine, she held administrative positions including Chief of Aerospace Medicine and Director of Base Medical Services. Since retiring, Dr. Hall has devoted her time to investigating questionable health claims and writing and lecturing about pseudo- science, quackery, “alternative medicine,” and critical thinking. She is a contributing editor to both Skeptical Inquirer and Skeptic magazines and writes the latter’s “SkepDoc” column. She is also a founding member and editor of the Science-Based Medicine blog; an advisor to the Quackwatch network; an editorial review board member for the Natural Medicines Comprehensive Da- tabase; a Fellow of the Committee for Skeptical Inquiry; and a founding fellow and board member emerita of the Institute for Science in Medicine. Her 2008 book, Women Aren’t Supposed to Fly: The Memoirs of a Female Flight Surgeon, describes how she became a pilot and helped bring about equality for women physicians in the Air Force. Her Web site is www.skepdoc.info.

Robert S. Baratz, M.D., D.D.S., Ph.D.,who contrib-uted mainly to the medical and dental chapters of this book, is an internist, dentist, and researcher who resides in Newton, Massachusetts. The founder of four companies, he has also served as medical director for two others in the medical device and pharmaceutical industries. He has been involved with issues regarding the safety and proper use of drugs and biomaterials since 1980. He has served on the medical and dental faculties of Northwestern and Tufts universities. Currently he serves on the faculty of Boston University School of Medicine, having initially been appointed in 1976. His broad knowledge of interactions of materials and the body has been sought by numerous licensing boards, regulatory agencies, universities, government agencies, insurance companies, and professional associations. He is also an expert in medical database applications and analyses. Dr. Baratz has worked for more than 25 years in dental and medical practice for private, public, and government entities, including the Department of Veterans Affairs, The Daughters of Charity, and Beth Israel Hospital in Boston. He has also worked for the Agency for International Development. Currently he is President and Medical Director of South Shore Health Care in Braintree, Massachusetts, where he practices internal and occupational medicine. He has also served as NCAHF President; a scientific advisor to ACSH; and President of International Medical Consultation Services, Inc., of Newton, Massachusetts. In 1992, the American Dental Association gave him a Presidential Citation for his work in advancing oral public health. He has been listed in Who’s Who in America, Who’s Who in the World, and Who’s Who in Science and Engineering.

About the Authorsiv

More is known today about achieving and maintain-ing good health than ever before. Life expectancy is at an all-time high, and although there is still much room for improvement, health-related accomplishments have exceeded the fondest dreams of past visionaries. This progress has been partly due to a safer environ- ment that includes cleaner water, safer food, and better living space. Yet we hear plenty of news about the en- vironment that concerns us. Preventive and therapeutic medical care have advanced tremendously, yet we worry about the risks associated with immunization, cancer therapies, prescription drugs, surgery, and many other methods of treatment. How can we resolve our concerns and reap the benefits of modern scientific discoveries? The key is to become well-informed. The challenges involved are enormous. The health marketplace—the world of commercial activity for health-related products and services—is complex and dynamic. The Internet offers vast amounts of informa- tion, but much of it is not trustworthy. Health concerns can be overwhelming, especially for people confronted with medical crises. Quackery is more pervasive and far trickier than most people realize. (As noted by the late James Harvey Young, Ph.D., “Quacks never sleep.”) Health-care costs continue to rise despite numerous reform efforts. The rapidly growing older adult popula- tion faces a bewildering array of choices and obstacles for obtaining and paying for appropriate health care. It can also be difficult to determine what health care actu- ally costs and to obtain the best prices. In addition, many people lack access to adequate health care because of cultural, transportation, language, and economic barriers. Government and private agencies protect consumer rights in some ways but not others. The health-care industry is accountable to consumers to some extent, but quality is often elusive and abuses persist. Some scams are even facilitated by legislation and government policies. Consumer advocacy calls for justice and fair play in the marketplace. Yet many self-appointed “consumer advocates” do not act in the public’s interest. Although some are sincere and make a contribution, others engage in irrational business bashing or act from motives of per- sonal aggrandizement. Some business trade associations even pose as “consumer groups” and seek self-serving legislation.

Consumer Health offers a panoramic view of the health marketplace. It explains and supports the scientific methods that are essential for validating claims about how products and services affect health. It can help you to: • Understand how medical facts are determined and where

to get appropriate information and advice • Avoid wasting money on unnecessary, ineffective, or unsafe

products and services • Take care of yourself and minimize your need to spend

money on health products and services • Choose appropriate health products and services to meet

your needs • Get the most value out of your health dollars • Optimize benefits from encounters with health-care provid-

ers and facilities while minimizing the potential for harm • Assert and protect your rights • Set reasonable expectations for what health care can do • Evaluate how political issues affect access to health-related

innovations and accountability of marketers

The key to intelligent decision-making is to use relevant and accurate sources of information. Consumer Health is both an introductory text and a reference book on the opportunities and pitfalls of the health market- place. The various chapters offer hundreds of practical tips; the Appendix provides a comprehensive list of trustworthy sources. You will get the most out of the book by using the detailed Index to search for information and the Glossary for definitions of terms that might be unfamiliar. We also operate many Web sites that can supplement your coursework. Consumer Health Sourcebook (www. chsourcebook.com) provides hyperlinks to dependable online sources. It also links to Consumer Health Digest, a free weekly e-mail report of relevant news. Internet Health Pilot (www.ihealthpilot.org) is a gateway to ad- ditional trustworthy information. Quackwatch (www. quackwatch.org) and its many subsidiary sites provide comprehensive articles about quackery, health fraud, and consumer health strategy. All of these sites are accessible free of charge. Visiting them is a good way to enhance your learning experience.

Stephen Barrett, M.D. William M. London, Ed.D, M.P.H. Manfred Kroger, Ph.D. Harriet Hall, M.D. Robert S. Baratz, M.D., D.D.S., Ph.D.

To the Reader

v

Preface for Instructors

vi

As have previous editions, this ninth edition of Consumer Health emphasizes the opportunities and pitfalls in the health marketplace and aims to help students protect their health and their pocketbook.

Goal for This Revision The book’s fundamental purpose is to provide trustwor- thy information and guidelines to enable people to select health products and services intelligently. This edition culminates our review of thousands of books, journal articles, Web sites, agency reports, and feature stories, as well as our own original investigations and critiques. Readers will find the information useful in applying the caveat emptor (let the buyer beware) concept to the health marketplace. The underlying principles of consumer protection were identified in the Consumer Bill of Rights promul- gated by President John F. Kennedy and have guided the development of this textbook. President Kennedy declared that consumers have the right to purchase safe products and services, to be correctly informed, to freely choose products and services, and to be heard by the government and others when injustices occur. We strongly support consumer awareness and efforts to as- sert and protect these rights.

Intended Audience Consumer Health has been designed as a sole required textbook for consumer health courses. Selected chapters of the book (see “Publisher’s Notice” box) can also be useful as required or supplemental readings for other courses in health education; community health; public health; family and consumer sciences; consumer edu- cation; health psychology; medical sociology; human ecology; and social welfare. School districts will find Consumer Health useful as a reference for teachers and students as well as an aid in curriculum development. Professional health-care providers can use this text to prepare for public presentations and can make it avail- able in their offices for perusal by clients.

Timeliness of References Every topic in this book has been carefully researched. In most cases, the more than 1500 cited references

represent the latest authoritative information we could locate. Many more systematic reviews and meta-analyses have been cited in this edition than in previous editions. Some references may seem outdated. However, unless otherwise stated, we believe these still reflect the cur- rent marketplace. References more than 10 years old are included for historical reasons or because they provide insights or document the source of well-articulated quo- tations that are still timely. Some reports published long ago are the only ones available that address important concepts. Chapter 1 provides information on how to read cita- tions and locate the references cited in the text. Those that

Publisher’s Notice

McGraw-Hill Create™ Craft your teaching resources to match the way you teach! With McGraw-Hill Create, you can easily rear- range chapters, combine material from other content sources, and quickly upload content you have writ- ten like your course syllabus or teaching notes. Find the content you need in Create by searching through thousands of leading McGraw-Hill textbooks. Arrange your book to fit your teaching style. Create even allows you to personalize your book’s appearance by selecting the cover and adding your name, school, and course information. Order a Create book and you’ll receive a complimentary print review copy in 3–5 business days or a complimentary electronic review copy (eComp) via e-mail in minutes. Go to www.mcgrawhillcreate. com today and register to experience how McGraw-Hill Create empowers you to teach your students your way.

Electronic Textbook Option This text is offered through CourseSmart for both in- structors and students. CourseSmart is an online resource where students can purchase the complete text online at almost half the cost of a traditional text. Purchasing the eTextbook allows students to take advantage of CourseSmart’s Web tools for learning, which include full text search, notes and highlighting, and e-mail tools for sharing notes between classmates. To learn more about CourseSmart options, contact your sales representative or visit www.CourseSmart.com.

Preface for Instructors vii

may be especially useful for students seeking additional information are listed with boldface numbers. When citing material on Web sites, we report the publication date when the site identifies it. When no date is posted, we report when we last accessed the page.

Internet Integration Another important feature of this edition is its integra- tion with our Consumer Health Sourcebook Web site (www.chsourcebook.com). The “References” section of this site provides links to many full-text articles and to abstracts of most of the journal articles. Suggestions for course objectives, teaching/learning activities, a sample course outline, and links to hundreds of organizations that provide trustworthy information are also posted. We encourage students and instructors to subscribe to Consumer Health Digest, a free weekly e-mail news- letter edited by Dr. Barrett with help from Dr. London. (To subscribe, see www.ncahf.org/digest/chd.html.) At the publisher’s Web site (www.mhhe.com/bar- rett9e), instructors will find sample test questions and PowerPoint presentations to use with the book.

Organization As in the eighth edition, the text is broadly divided into six parts: I. Dynamics of the Health Marketplace focuses on past and present problems. After defining the major consumer health issues, it discusses how the scientific method is used to determine medical truths, how con- sumers can separate fact from fiction, how frauds and quackery can be identified, and how advertising and other marketing activities influence consumer decisions. II. Health-Care Approaches covers basic medical care and the services of many types of practitioners and facilities. III. Nutrition and Fitness integrates what consum- ers need to know about the extremely important topics of nutrition, weight control, and exercise. Its chapters provide the necessary tools to distinguish science-based methods from fads, fallacies, and scams. IV. Personal Health Concerns provides a guide to preventing and managing health problems, including several in which self-care is very important. Separate chapters cover cardiovascular disease and cancer with an emphasis on the choices consumers face. V. Other Products and Services covers a myriad of other subjects that affect most, if not all, consumers. These include drug products, skin care and image en- hancement, contraceptive methods, vision and hearing

aids, other devices, death-related services, and health- care facilities. VI. Protection of the Consumer focuses on legal and economic issues involved in protecting consumers. These include health insurance, health-care financing, consumer-protection laws and agencies, and strategies for intelligent consumers.

Features and New Material All features from the eighth edition have been retained. Many chapters contain vignettes (“Personal Glimpses”) to stimulate reader interest and “Consumer Tip” and “Consumer Insight” boxes that emphasize key points. Many checklists and “It’s Your Decision” boxes reflect “real-life” decisions that readers may face. The “Key Concepts” box at the beginning of each chapter states what we believe are the most important lessons to be learned from the chapter material. Extensive searches of the scientific literature, court documents, and other relevant reports over an 18-month period have provided information to update the contents of this edition.

• Chapter 1 (Consumer Health Issues) introduces the im- portant issues facing consumers in today’s marketplace. New material about cognitive bias explains how distortions of thinking can lead to inaccurate conclusions and faulty judgment.

• Chapter 2 (Separating Fact from Fiction) describes how the scientific community strives to determine what is factual and how consumers face an often bewildering array of information that can be unbalanced, inaccurate, and even fraudulent.

• Chapter 3 (Frauds and Quackery) explains why people are vulnerable and tells how to avoid quack practices. New material notes how loss of faith in many of our once-trusted institutions has made quack claims seem more credible.

• Chapter 4 (Advertising and Other Promotional Activities) describes how sellers market their wares and notes how the multilevel marketing industry thwarted a proposed Federal Trade Commission rule intended to curb its misleading practices.

• Chapter 5 (Science-Based Health Care) describes the training and professional activities of physicians and many ancillary providers. It also incorporates U.S. Preventive Services Task Force’s latest conclusions about screening tests, including its skepticism about routine PSA testing.

• Chapter 6 (Mental and Behavioral Help) provides a com- prehensive guide to mental help and notes that psychiatrists are shifting away from psychotherapy. The section on ques- tionable practices and practitioners has been expanded and cautions against the use of poorly trained “life coaches.”

• Chapter 7 (Dental Care) provides a comprehensive dental guide and warns against the increasing use of questionable

Preface for Instructorsviii

screening devices and expensive cosmetic dental proce- dures intended to create a “perfect bite.”

• Chapter 8 (The “CAM” Movement) describes a multitude of theories and practices that remain unsubstantiated and lack a scientifically plausible rationale. It also notes the failure of accrediting agencies to control the spread of unscientific teachings in professional schools (including medical schools).

• Chapter 9 (A Close Look at Chiropractic) spotlights the in- fluence of chiropractic on the consumer health marketplace and summarizes the latest research on spinal manipulation.

• Chapter 10 (Basic Nutrition Concepts) incorporates the latest Dietary Guidelines for Americans and the USDA Food Guidance System (Choose MyPlate) and tells where to get trustworthy nutrition information and advice.

• Chapter 11 (Nutrition Fads, Fallacies, and Scams) includes up-to-date evaluations of dietary supplement products and herbal products and background material on promoters of nutritional misinformation.

• Chapter 12 (Weight Control) notes the alarming increase of obesity in the United States and discusses appropriate and inappropriate weight-control measures.

• Chapter 13 (Fitness Concepts, Products, and Services) reviews the fundamental concepts typically addressed in personal health courses, but also includes important details about practitioners, information resources, products, ser- vices, popular misconceptions, and scams.

• Chapter 14 (Personal Health and Safety), which is a new chapter, focuses on health promotion, injury prevention, risk perception, self-care, and the management of asthma, diabetes, high blood pressure, and other chronic condi- tions. It also notes how information from the Internet and elsewhere can help or undermine prudent behavior. A new section warns against the widely circulating myths that undermine public health efforts.

• Chapter 15 (Cardiovascular Disease) contains new and updated information about risk factors for coronary heart disease and stroke and provides guidelines for reducing the risks.

• Chapter 16 (Cancer) covers cancer causation, prevention, diagnosis, and prognosis and contrasts science-based and dubious treatments. The new topics include vaccination against the human papilloma virus (HPV) and dubious information sources.

• Chapter 17 (Drug Products) includes new information about commonly used nonprescription (over-the-counter) drugs and how to save money on drug costs.

• Chapter 18 (Skin Care and Image Enhancement) covers a wide variety of topics related to skin care plus new material about image-enhancement schemes and frauds.

• Chapter 19 (Sexual and Reproductive Health) covers products and services related to sexual and reproductive functions. It includes new and updated information about birth control, birthing options, and hormone-replacement therapy, and prevention of sexually transmitted diseases.

• Chapter 20 (Health Devices) contains updated information about device regulation and expanded coverage of question- able devices that have been flooding the health marketplace. New topics include spinal decompression machines, “de- toxification” devices, and alleged performance enhancing bracelets.

• Chapter 21 (Coping with Death) provides current informa- tion on advance directives and organ donation and cautions about stem-cell clinics and “biologic age” testing.

• Chapter 22 (Health-Care Facilities) notes how the delivery of health-care services is changing and describes the salient features of various options. It also provides advice on how to choose among the various alternatives.

• Chapter 23 (Health Insurance) describes the basic types and features of health insurance and outlines the major provisions of the Patient Protection and Affordable Care Act.

• Chapter 24 (Health-Care Financing) provides the latest available statistics on national health expenditures, states why insurance reform has been desperately needed, and describes the decades-long struggle to control costs and increase access to medical care.

• Chapter 25 (Consumer Laws, Agencies, and Strategies) details the regulatory and educational activities of the U.S. Food and Drug Administration and the FTC; describes physician regulation; and indicates what consumers can do to help improve the health marketplace.

• The Appendix provides comprehensive lists of agencies and organizations that offer trustworthy information. The Consumer Health Sourcebook Web site links to most of them.

• The Glossary clarifies important jargon used in the book and defines other terms of interest to health consumers.

Acknowledgments The authors thank John E. Dodes, D.D.S., who reviewed the dental care chapter; Walter A. Zelman, Ph.D., of California State University (Los Angeles), who offered helpful suggestions for the chapters on insurance and health-care financing. The photograph on page 154 is reproduced with permission from Aurora & Quanta Productions, Portland, Maine. The VIPPS logo on page 358 appears with permission of the National Association of Boards of Pharmacy. Our project coordinator, who guided production and permitted this text to remain a powerful voice, was Vicki Malinee of Van Brien & Associates. Freelance editor Sarah West, of Belleville, Illinois, did her usual superb job of copy editing. We also thank the many instructors who continue to provide suggestions for new research and topics to include in the text.