CONTACTS 
0201 - Kaiser Medical Center                415 929 4000
020101 - Dr. Kory Zipperstein, MD; Physician =415 202 2207 (advice)
020102 - Kory.Zipperstein@kp.org
020103 - Department of Dermatology =415 202 2000
020104 - 2350 Geary Boulevard, SF, CA  94115
0202 - Kaiser Permanente - Shadelands       925 906 2200
020201 - Walnut Creek, CA
020202 - Dr. Elia Racah, M.D.; Primary Care Physician =925 906 2040
020203 - stkejr@ncal.kaiperm.org
020204 - Primary Care =925 206 2040

SUBJECTS
Lamisil Fungus Treatment
Fungus on Feet, 000207
Toenail Fungus, 000308
Front-end Investment Difficult Managers to Make, Wideman

0606 -    ..
0607 - Summary/Objective
0608 -
060801 - Follow up ref SDS 8 8651, ref SDS 6 8651
060802 -
060803 - Received ref DRT 1 0001 from Kory offering to send a prescription
060804 - which any Kaiser pharmacy can fill.  If oral Lamisil is used, Kory
060805 - recommends trying the pulse therapy (i.e., 250 mg twice daily for 7
060806 - days each month for 3-4 months) because it will cost less.
060807 -
060808 -    Kory's first letter yesterday indicates treatment is successful
060809 -    50-80% of the time; and
060810 -
060811 -    ...improvement occurs for 8-18 months after finishing treatment.
060812 -    ref SDS 8 8651
060813 -
060814 -    Kory's second letter yesterday cites rare, health threatening
060815 -    side-effects including liver and bone marrow toxicity, and severe
060816 -    skin reactions. ref SDS 8 8448
060817 -
060818 -
060819 - Kory suggests today asking the primary care physician, Elia Racah, to
060820 - prescribe medicine.
060821 -
060822 - Kory's letter on 000329 noted the cost per pill is $5. ref SDS 8 3132
060823 -
060824 - Based on the proposed treatment plan of 2 pills per day for 3 - 4
060825 - months, this makes the cost...
060826 -
060827 -
060828 -       2 x 30 x 3 x $5  =   $900 for 3 months
060829 -
060830 -       2 x 30 x 4 x $5  = $1,200 for 4 months
060831 -
060832 -
060833 - This is a fairly significant "front-end" investment, particularly in
060834 - relation to tenuous results, also, reported yesterday. ref SDS 8 8651
060835 -
060836 - On 970818 people have a lot of difficulty making essential front-end
060837 - investments to avoid future problems. ref SDS 1 1897  Similar issue
060838 - arose on 000315 concerning willingness of people to work on solving
060839 - "world problems."
060840 -
060841 - More recently on 000315 people worried about the time required to
060842 - implement improvements that augment human capabilities, and one reason
060843 - developed was the level of front-end investment in relation to
060844 - prospective success. ref SDS 7 1914
060845 -
060846 -  ..
060847 - Submitted ref DIT 1 0001 asking...
060848 -
060849 -     Apart from appearance, is there any impact on health that suggests
060850 -     this remedy should be implemented?  Is it wise to invest $1000
060851 -     today, in order to avoid payout out $10,000 for consequences of
060852 -     not taking action?
060853 -
060854 -     Does the toenail issue relate in causal manner to the foot fungus
060855 -     problem previously reported?
060856 -
060857 -     Is there is there another choice of treatment that may be less
060858 -     certain, but, also, less costly?
060859 -
060860 - Tried to inject some humor by doing a parady of SDS, and citing cost
060861 - savings from adding intelligence to management, based on report from
060862 - US Army Corps of Engineers on 971008, ref SDS 2 2979, shown in the
060863 - record. ref DRP 1 0001
060864 -
060865 - Cite the record on 000315 about people giving up before benefits
060866 - occur. ref SDS 7 5712
060867 -
060868 - Cite Prometheus "liver" problem as example that SDS could be a health
060869 - hazard, ref OF 1 2214, reviewed on 991108. ref SDS 3 2356
060870 -
060871 - Cite "intelligence" from POIMS. ref OF 2 6649
060872 -
060873 -
060874 -  ..
0609 -
0610 -
0611 - 2008
0612 -
061201 - Received, ref DRT 2 0001 from Kory, responding to my letter sent
061202 - earlier today, ref DIT 1 0001, saying the cost of treatment is closer
061203 - to $225-290 for the pulse therapy regimen, and $420 for the single
061204 - daily dose for 12 weeks.  It is not medically necessary to treat
061205 - toenail fungus infections, addressing the issues at ref SDS 0 4356
061206 -
061207 -    Looks like the mistake I made in the calculation above is using 30
061208 -    days of treatment per month, assuming a continuous treatment, based
061209 -    on Kory's first letter received today, per above. ref SDS 0 0001
061210 -
061211 -    Kory's second letter yesterday says the treatment only runs once a
061212 -    week for 3 to 4 months, rather than every week each month.
061213 -    ref SDS 8 4030
061214 -
061215 -    So, the calculation is...
061216 -
061217 -       2 x 7 x 3 x $5  =   $210 for 3 months
061218 -
061219 -       2 x 7 x 4 x $5  =   $280 for 4 months
061220 -
061221 - ... which aligns with Kory's letter.
061222 -
061223 - Received ref DRT 3 0001 from Elia saying everything written by Dr
061224 - zipperstein is correct about oral lamisil. It works and is not on the
061225 - Kaiser formulary.
061226 -
061227 -
061228 -
061229 -
0613 -
0614 -
0615 - 2034
0616 -
061601 - Submitted ref DIT 2 0001 asking Kory to issue a prescription, per his
061602 - first letter this morning. ref SDS 0 0001
061603 -
061604 -     [000331 Kory called to set examination of problem. ref SDS 9 0001
061605 -
061606 -
061607 -
061608 -
061609 -
061610 -
061611 -
061612 -