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- Ron and Nancy McFarlane Distinguished Professor and Chair, Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
https://pharmacy.unc.edu/news/directory/drhoney/
Based on these conclusions and those of other studies I have reviewed from toxicologists pulse pressure wave qrs complex buy line torsemide, the question of nanoparticle risk from the mineral sunscreen actives is not a human health issue hypertension home remedies purchase torsemide with amex. Further pulse pressure fluid responsiveness generic 10 mg torsemide visa, in terms of the potential risk that titanium dioxide could generate free radicals in the presence of sunlight blood pressure medications list discount 20mg torsemide amex, it has been shown that adding antioxidants to the mix (whether they’re in your sunscreen or already naturally present in skin) eliminates this risk, and other research has established that both zinc oxide and titanium oxide are stable substances that don’t elicit free-radical damage at all. The nanoparticles actually kept the pinprick wound sites from becoming infected (Source: Ar tifcial Organs, February 2008, pages 167–174)! That would not be the expected outcome if nanoparticles of titanium dioxide were inherently harmful to skin cells. After selling us products to ward off oxygen’s effects on the skin (the word antioxidant means anti-oxygen), the beauty industry then turns around and sells us products that claim to provide oxygen to the skin. At the same time, the cosmetics industry also sells products that contain hydrogen peroxide (H2O2) or some other oxygen-releasing ingredient that supposedly delivers an oxygen molecule when it comes into contact with skin. It makes sense to wonder if the extra oxygen would just trigger free-radical damage and cause more problems for the skin. But if you were also using products that contained antioxidants, wouldn’t they “scavenge” up that free-radical oxygen The answer is that if the product could deliver extra oxygen to the skin it would indeed generate free-radical damage and, based on data from almost every imaginable published study on the subject, that’s bad for skin. Oxygen depletion is one of the things that happens to older skin, regardless of whether it’s been affected by sun dam age or any other health issue. Why or how that happens is a complete unknown, though it is thought to have something to do with blood fow and a reduction in lung capacity as we age. The earth’s atmosphere is 21% oxygen; the oceans, lakes, and rivers are about 88% oxygen. It is a constituent of all living tissues; almost all plants and animals, including humans, require oxygen to maintain life. Plus, none of this addresses the issue about oxygen generating more free-radical damage, which is one of the processes that makes the veins and capillaries of the body stop working effciently. That brings us to this question: How did the caprice of oxygen booths get started Oxy gen booths (hyperbaric chambers) are used medically to repair skin ulcers and wounds that have diffculty healing. According to the American Diabetes Association’s Diabetes Forecast (June 1993, page 57), “When you have a stubborn [wound] that won’t heal, the white blood cells that fght the infection in the [wound] use 20 times more oxygen when they’re killing bacteria. Also, the more oxygen your body has to work with, the more effciently it lays down wound-repairing connective tissue. Less oxygen means slower healing, and a [wound] that doesn’t heal could eventually lead to an amputation. So it seems that you should try to get extra oxygen in your blood when you have a foot ulcer, to bring the oxygen levels in the tissues around the ulcer up to normal, or even higher. The article contin ues, “But it is the inhaled oxygen, which is then absorbed by your blood after you breathe it, that speeds wound healing, not the oxygen drifting past the wound. You may have seen advertisements for devices that encase a person’s leg and deliver oxygen to the skin. This is not hyperbaric oxygen therapy, and it’s not effective—your skin doesn’t absorb oxygen that way. The notion that oxygen treatments affect aging, wrinkles, or any other skin malady is a joke. Nary a study exists anywhere to support those ideas, though there is a ton of research showing that the oxidative process generated by oxygen is partly responsible for wrinkles and skin aging in general. PrO P y l e n e gly c O l Propylene glycol (along with other glycols and glycerol) is a humectant or humidifying and delivery ingredient used in cosmetics, meaning it helps other ingredients absorb better into the skin. Despite research to the contrary, you can fnd Web sites and spam e-mails stating that propylene glycol is really industrial antifreeze and the major ingredient in brake and hydraulic fuids. As ominous as that sounds, it is so far from the reality of cosmetic formulations that almost none of it holds any water or poses real concern. It is true that propylene glycol in 100% concentration is used as antifreeze, but—and this is a very big but—in cosmetics it is used in only the smallest amounts to keep products from melting in high heat or freezing when it is cold. In the minute amounts used in cosmetics, propylene glycol is not a concern in the least. Women are not suffering from liver problems (as some Web sites have asserted) because of propylene glycol in cosmetics. Department of Health and Human Services, within the Public Health Services Agency for Toxic Substances and Disease Registry, “studies have not shown these chemicals [propylene or the other glycols as used in cosmetics] to be car cinogens” (Source: Not only are they potentially carcinogenic, but they contribute to stripping the skin’s Natural Moisture Factor, leaving the immune system vulnerable. The only negative research results for this ingredient group indicate that large quantities given orally to rats can cause tumors. It is used as a plasticizer and is a key component in some fragrances because of its unique properties. Adult health is one thing, but since then growing research has shown a far more serious concern when children have a detectable amount of phthalates in their system. A study published in the medical journal Pediatrics (February 2008, pages 260–268) was shocking to many women when it found a link between baby skin-care products and phthalates being absorbed by the infant; the report concluded: “Phthalate exposure is widespread and variable in infants. Infant exposure[s] to lotion, powder, and shampoo were signifcantly associated with increased urinary concentrations of monoethyl phthalate, monomethyl phthalate, and monoisobutyl phthalate, and associations increased with the number of products used. This association was strongest in young infants, who may be more vulnerable to developmental and reproductive toxicity of phthalates given their immature metabolic system capability and increased dosage per unit body surface area. Their summary on this issue states that “New data on acute and short-term toxicity were consistent with previously available data. However, these effects seen in rodents are at much higher exposure levels than humans are likely to encounter and they are subject to the species difference in the metabolism of phthalate diesters. Other research concluded similarly, saying “that levels of concern are minimal to neg ligible in most situations” (Source: Reproductive Toxicology, August–September 2004, pages 761–764). Thus it is unlikely that humans are suffering adverse developmental effects from current environmental exposure to these phthalate esters. With respect to phthalates, however, evidence from relevant animal studies and from limited studies of non-reproductive tract impacts in hospitalized patients is suffcient to require phasing out the use of many of the phthalates. This explains why many cosmetics companies are actively seeking or have already begun using alternatives to phthalates. It could be argued that, at the levels presently used, phthalates pose no health risk. Although there is no concrete human evidence to suggest phthalates are harmful, the lack of studies in this area continues to leave the issue open to debate and perhaps does indicate that a “better safe than sorry” approach is wise. It seems that most of this issue is based on the incorrect reporting about a study at the Medical College of Georgia. It could retard healing and cause cataracts in adults, and can keep children’s eyes from devel oping properly. Keith Green, Regents Professor of Ophthalmology at the Medical College of Georgia, who received his doctorate of science from St. He told me in a telephone interview back in 1997 that his “work was completely misquoted. We did not even look at the issue of children, so that conclusion is completely false because it never existed. The Neways people took my research completely out of context and probably never read the study at all. No ingredient can be a systemic unless you drink the stuff and that’s not what we did with it. Another incredible comment was that my study was ‘clinical,’ meaning I tested the substance on people, [but] these were strictly animal tests. The letter is signed by a person at the University of Pennsylvania Health System and includes a phone number. That’s why it’s considered a standard comparison substance for measuring skin irritancy of other ingredients. In amounts of 2% to 5% it can cause allergic or sensitizing reactions in lots of people (Sources: European Journal of Dermatology, September–October 2001, pages 416–419; American Journal of Contact Dermatitis, March 2001, pages 28–32). But irritancy is not the same as the other dire, erroneous warnings foating around the Web about this ingredient! You may have seen advertisements for skin-care products claiming that they use stem cell research or can somehow stimulate stem cells to fght wrinkles. What is absurd about this claim is that while stem cell research for any human beneft is only in its infancy, in the area of wrinkles or skin care it is nonexistent. These ads are a classic example of how a cosmetics company can take serious science and manipulate it to sell products.
When choosing their dream specialty arteria facialis linguae discount torsemide 20mg otc, students should pay little heed to 7th hypertension purchase torsemide american express its cur rent or projected state of job opportunities blood pressure meter buy torsemide pills in toronto. Shortages and surpluses can change rapidly by the end of residency training hypertension 4019 torsemide 10 mg with visa, so place this variable low on your list of inuential factors. A study of medical students’ specialty-choice pathways: Trying on possible selves. Choosing general surgery: Insights into career choices of current medical students. Contemporary trends in student selection of medical special ties: the potential impact on general surgery. Numb and number: Once a hot specialty, anesthesiology cools as insurers scale back. Evidence of a current and lasting national anes thesia personnel shortfall: Scope and implications. Dur ing your hospital clerkships, you will overhear these and many more statements from residents and attending physicians. As you learned from Chapter 3, there are many important factors to take into account when choosing a medical specialty. Yet one very decisive variable—per sonality types within each discipline—was left out because it deserves a separate in-depth discussion. In fact, most medical students say they chose a particular specialty based on their gut feeling—meaning, often, how comfortable they feel with the doctors in that eld. Each specialty requires a set of skills, a circle of qualities, and a certain type of disposition. Some of these intangibles are unique to that area of medicine; others overlap across many disciplines. But these traits and affinities dene a physician’s personality—the factor that is perhaps the single most important consideration in choosing a medical specialty. Unfortunately, most students do not spend much time thinking about their 35 Copyright © 2004 by the McGraw-Hill Companies, Inc. Lectures, studying, and patient care all place huge demands on a medical student’s time. But at some point during medical school, take some time out for an honest assessment of your values, character, and temperament. By tak ing a closer look at the specialties that best match your personality type, you will gain valuable information to help you make your decision. Instead, it means identifying your distinctive attributes, val ues, and affinities and nding the natural comfort zone where your true prefer ences lie as a physician. Although it is especially important for doctors-in-training to select a specialty that is the best match with their personality, best match does not mean it has to be perfect. Take a hard look at the physicians you have met and make sure that your personality type is well represented (rather than underrepresented) in the specialty that interests you. The notion that opposites attract will probably not lead to a long, satisfying medical career. For instance, most physicians would not dispute the idea that empathic, laid-back medical students make better psychia trists, and strong-minded, authoritarian, no-nonsense ones should become sur geons. In these examples, students nd themselves most comfortable working side-by-side with other physicians who share their personality traits. When you get along well with your colleagues, patients end up receiving the best medical care possible. Many physicians have studied the relationship between a doctor’s personal ity and chosen specialty. A group of surgeons sought to determine whether there were differences in the characteristics and temperament of physicians in three types of medical careers: surgical, primary care (family practice, internal medi cine, and pediatrics), and controllable lifestyle specialties (anesthesiology, der matology, emergency medicine, neurology, ophthalmology, pathology, psychia try, and radiology). They tend to overlook the fact that surgery requires a certain type of person who can handle its tasks and challenges. At the same time, how ever, surgeons were less creative than their colleagues in controllable lifestyle spe cialties (who were found to be the most withdrawn and rebellious). This particular study, therefore, helps to support the idea that a physician’s satisfaction in a given spe cialty has a lot to do with personality factors, like temperament and sociability. Another landmark study surveyed a group of medical students to determine any relationships between personality type and specialty choice. Future obstetrician-gynecologists saw themselves as warm and helpful, but they were also emotionally vulnerable, uncomfortable around others, and very con cerned about appearances and making a good impression. Future pediatricians, who sought warm and close interactions with their patients, were the most ex troverted and sociable people. In contrast, the introverted students with fewer so cial connections—particularly the ones who had been in psychotherapy them selves—became psychiatrists. The study also found that students interested in surgery were more likely to be competitive, aggressive, and highly condent. They were the doctors-to-be who carried a strong conviction that their actions could rapidly inuence the course of events. When checking out all the different choices, medical students should keep in mind that more than one specialty could meet their preferences. For every per sonality type, it is possible to nd a satisfying match with more than one area of medicine. If you are a visually oriented person, consider specialties like pathol ogy, dermatology, and radiology. For students who want to speak only the lan guage of medicine every day as a doctor’s doctor, radiology and pathology are ideal choices. Primary care specialties, like internal medicine and family prac tice, are great opportunities to have long-term, intimate patient relationships. If you prefer an action-oriented specialty that gives immediate gratication, then consider anesthesiology, any surgical subspecialty, and emergency medicine. Some areas overlap considerably—like the great variety of medical problems en countered in both family practice and emergency medicine. But at the same time, they can have signicant differences—like the long-term follow-up nature of fam ily practice versus the acute, stabilize-the-patient-and-move-on style of emergency medicine. The test enables you to learn more about how you perceive and judge others, whether in an occupational or social situation. It iden ties your strengths and weaknesses and shows whether you value autonomy or prefer interdependence. Your Dean of Students Office will use the valuable information for ca reer planning and development purposes—especially when it comes time to g uring out which specialty might be the best one for you. You can do an Internet search for these, or simply log on to the official site of the Center for Applications of Psychological Type at <. For a fee, they will send you the official test and provide personalized expert feedback over the tele phone about your results and how to use their interpretation. When taking the test, be sure to answer every question truthfully; honesty is the only way to yield the most accurate results and help you pick the most appropriate specialty. Each index represents one of the four basic preferences (de scribed by Jung) about how every individual perceives and processes external stim uli and then uses that information to make some kind of cognitive judgment. As part of one’s overall personality, this judgment guides behavioral preferences in any situation involving other people—like colleagues or patients. Introverts pre fer to focus their interest and energy on an inner world of ideas, impressions, and reactions. Instead, in troverts prefer interactions with greater focus and depth, with others who are also good listeners and who think before they act or speak. Extroverts, on the other hand, derive their energy from external stimuli and tend to focus their interest on the outside world. They simply pre fer being engaged in many things at once, with lots of expression, impulsiv ity, and thinking out loud. Sensing (S) versus Intuition (N): What kinds of stimuli do you prefer when collecting, processing, and remembering information Sensors are the ones who are drawn to the hard, immediate facts of life—practical details and ev idence that can be taken in through one of the ve senses. They are sensi ble, matter-of-fact people who look at the reality of the world around them, rely on prior experiences, and take things literally. Intuitives, on the other hand, look beyond the facts and evidence for meanings, possibilities, con nections, and relationships. They are more imaginative and creative people who like to see the big picture and abstract concepts. Using intuition often means relying on a hunch or gut feeling rather than past experience.
Low to arterial bleeding buy discount torsemide 20mg online mid-potency topical steroids are good for short-term treatment arrhythmia leads to heart failure 10mg torsemide mastercard, limited to blood pressure medication guidelines buy genuine torsemide on-line a 2–4 week duration hypertension guidelines buy torsemide cheap. It is recommended that their use be of limited duration to minimize the risks associated with topical steroids, such as collagen depletion and skin thinning. Topical steroids are more effective than calcipotriene (calcipotriol, or vitamin D3), pimecrolimus, and tacrolimus, but those treatments are associated with fewer long-term risks and are therefore recommended for long-term therapy when possible, perhaps when alternated with cortisones. Another negative of using cortisone is that with continued use it becomes less and less effective. Some research has shown it to be more effective than tretinoin (Renova and Retin-A). A positive feature of tazarotene is its ability to maintain clinical response after discontinuation of treatment. Side effects can include irrita tion, burning, and faking skin (Source: Journal of the European Academy of Dermatology and Venereology, July 2008, pages 859–870). Retinoids improve cell development and mitigate the damage caused by topical cortisones when used as a combination or alternating treatment. Finally, because of salicylic acid’s chemical relationship to aspirin, it has anti-infammatory properties and can reduce the redness and infammation associated with psoriasis. The primary concern in choosing a well-formulated salicylic-acid prod uct is to be sure the concentration is stated clearly on the product, and that the pH of the product is no higher than 3. However, there is no research showing it to have any beneft over and above being an emollient, which would be true of any plant oil. However, it has conficting research concerning its effectiveness despite its use during the last three decades. The most frequent adverse effects that occur during methotrexate therapy are abnormal liver function test results, nausea, and gastric complaints. The most feared adverse effects are liver damage and the suppression of bone marrow activity. However, liver problems associated with methotrexate are related to a high cumulative dose. This means that rotating types of therapy, or using methotrexate intermittently instead of continuously, can reduce the risk. Most people tolerate low-dose methotrexate therapy relatively well, provided they work closely with their physician and watch carefully for adverse effects and drug interactions during treatment. In skin diseases, cyclosporin acts by reducing infammation in the skin and also reducing cell proliferation by blocking immune factors that may be generating the problem. Studies have shown cyclosporin to be effective and well tolerated in short-term treatment of severe psoriasis (Source: American Journal of Clinical Dermatology, 2001, vol ume 2, issue 1, pages 41–47), though not as effective as newer options such as etanercept or infiximab. Temporary side effects of cyclosporin can include headaches, gingivitis, joint pain, gout, body-hair growth, tremors, high blood pressure, kidney problems, and fatigue. Of serious concern is the National Toxicology Program’s Eighth Report on Carcinogens (1998), which warns that cyclosporin is “known to be a human carcinogen based on studies in humans. How oral retinoids work in the treatment of psoriasis is not completely understood, although they are thought to block the overproduction of skin cells. The substantial amount of data on the clinical effectiveness of these treatments, either alone or in combination with other therapies such as sunlight or etanarcept, makes them great options. All systemic retinoids have the strong potential to cause major fetal abnormalities, including neurological and skeletal deformities. For the patient, its use may potentially cause liver and cholesterol problems, which are just a few of the side effects. It is essential that effective contraception be used for at least one month before and throughout treatment. However, because etretinate can remain in the blood for up to three years after treatment, birth control must be continued for an indefnite period of time following therapy. It has not yet been determined how long it is necessary to wait before becoming pregnant after you stop taking etretinate to ensure that none of the drug remains in your system (Source: As a result of the risks associated with etretinate, particularly the length of time it can stay in the system, acitretin and isotretinoin are considered safer choices, and are just as effective for severe psoriasis (Source: Journal of the American Academy of Dermatology, November 2001, pages S150–S157). Severe fetal abnormalities do occur if a woman is or becomes pregnant while taking either acitretin or isotretinoin (Accutane), but because these drugs don’t remain in the system for long after you are fnished with treatment, no long waiting period is required before becoming pregnant. Specifcs regarding how long to wait after treatment before considering having a baby should be discussed with your physician. When applied topically, it is considered one of the primary options for the treatment of psoriasis affecting the nails. It is one of a new generation of nonsteroidal medications recommended for psoriasis. The frst drug of this class was Protopic, which contains the active ingredient tacrolimus. That means you can start using it when symptoms show up and stop using it when the symptoms go away. When symptoms recur, you start once again, and you can keep up with that pattern of application forever. If you have had warts, herpes, or shingles in the past, Elidel can trigger recurrences. Despite the serious side effects, there is no question that research shows this drug to be successful in treating atopic dermatitis and psoriasis. And the sooner you use it when symp toms occur, the quicker and better your skin will respond. It is also called “photochemotherapy” because Psoralen functions similar to other types of chemotherapy used for cancer treatment. It is considered extremely effective and patients can remain clear of lesions for about three months. One of the differences between acne and seborrhea is that in seborrhea the increased oil production is often accompanied by a scaly, thickened skin, especially on the scalp, and the oil itself can have a strange, viscous texture. However, in seborrhea—and sometimes in acne—the sebum (a frm, waxlike substance in the pore that liquefes into oil on the surface of the skin) in the sebaceous gland accumulates, causing the gland to become swollen and flled to the brim. When this overproduced sebum is covered over by skin, it forms a small, frm mound called a whitehead. When the sebum is exposed to air (not covered by skin) and the duct flls with dead skin cells, the sebum turns dark from oxidation and the blemish becomes a blackhead. The size of the eruption, the texture of the oil, and the faky skin are what differentiate seborrhea from acne. The scalp, sides of the nose, eyebrows, eyelids, behind the ears, and the middle of the chest are the areas most commonly affected. Other areas, such as the navel and the skin folds under the arms, breasts, groin, and buttocks, may also be involved. The swelling, breakouts, and accompanying yellowish, greasy-appearing scales make this skin disorder hard to miss. Seborrhea is identifed by excessive yellowing, thickened scaling, accompanied by excessive oiliness, and is possibly triggered by a yeast organism (yeast is a type of fungus) present in the hair follicle (Source: British Journal of Dermatology, March 2001, pages 549–556). Seborrhea can occur at any age, but typically it is seen in infants, when it is called “cradle cap. Prescription medications for the treatment of seborrhea include ciclopiroxolamine 1% in a cream base. This is an antifungal that has been shown to be effective in a well-controlled study (Source: British Journal of Dermatology, May 2001, pages 1033–1037). Topical met ronidazole (Noritate, MetroLotion, MetroGel, and MetroCream) can also have signifcant positive results, and are very effective in the treatment of seborrhea (Source: Journal of Family Practice, June 2001, volume 50, issue 6). An oral medication, terbinafne, has been identifed as benefcial in the treatment of seborrhea as well (Source: British Journal of Dermatology, April 2001, pages 854–857). A very good fragrance-free moisturizer with zinc pyrithione is DermaZinc Cream; it is available from Topical steroids are often of limited use because they can cause thinning of the skin. All of these medications, either alone or in combination, are options for achieving the best results. At one point in my life almost 80% of my body was affected, and the resulting itching and scratching, sores, ir ritation, and discomfort were more awful than I can put into words.
Syndromes
- Hallucinations
- When did it start? How long did it last?
- Possible nerve problems
- Applesauce
- Activated charcoal to soak up aspirin in the stomach
- Feed more often or express milk manually or with a pump. Electric breast pumps work best.
I do understand that we have a good many people who are invisibles heart attack lyrics one direction buy 20mg torsemide fast delivery, as has been said arrhythmia heart episode generic torsemide 10mg without a prescription. These are people who do not have credit files at all or they have no credit score that can be measured simply because they have what I consider credit—they pay light bills blood pressure qualitative or quantitative cheap torsemide 20mg fast delivery, gas bills blood pressure up and down all day 20 mg torsemide with visa, water bills, and phone bills—but they do not have these things scored. We are looking forward to moving forward on this and having this opportunity for persons with this alternative credit to have their credit properly scored. When it comes to money, there are some people, if I may say it this way, who do not believe in ‘‘First National;’’ they believe in ‘‘first mattress. Just because they do not participate in the process and the system to the same extent that we do, it does not mean that they are not creditworthy. And my hope is that we can find a way to make sure that they can complete the process, but do it in such a way that they can pay their bills and they too can have credit. In the past two Congresses, we have worked with colleagues on both sides of the issue to make sure that this important issue is addressed. In fact, last Congress the House passed a similar bill, the Medical Debt Relief Act of 2010, with overwhelming bipartisan support. Medical debt affects many hardworking Americans who have been diagnosed with an illness or involved in an accident, the results can be devastating. Even small medical debts are causing large problems for consumers and are stifling our economy. I know it seems like it is somewhat rare to get a chance to come together on a bipar tisan basis to do something good for the American people. I just want to say very briefly that millions of people have dam aged credit scores. In addition, there are an estimated 35 to 50 million people who are credit invisible. I think this bill can take us a long way toward solving this problem and really helping many families in our coun try to have an accurate credit score. Another concern is that there are about 50 million people whose credit scores are lower than they would be or should be if all of their credit information was included. Credit invisibility affects all kinds of Americans; all Americans really in some way. For example, African Americans, Latinos, young people, immi grants, and women whose credit has been in their late husband’s name often are credit invisible. People who for religious or personal reasons do not borrow money with interest rates are affected. Our bill clarifies that utility and telecom firms can report their customers’ on-time payments. And I find the data important and reliable and overwhelmingly to the benefit of customers. Borrowers who benefit from improved access to the credit main stream are going to be better off. And they can save money on in surance and debt and increase their wealth by accessing affordable credit. Lenders benefit by being able to better assess risk because they have more information and they can more profitably and soundly extend credit to segments previously viewed as risky. So, let me just wrap up by saying that I am very happy to be working on this bill. A per son’s credit report has become as important as their resume, per sonal reputation or integrity. Unfortunately, our credit data may be susceptible to mistakes by creditors, credit bureaus or simply human error. Also, many hardworking Americans continue to have difficulty establishing credit histories, which is a necessary compo nent to establishing good credit. Laws requiring personal credit reporting and credit history are too important to not get right the first time. Robert Schoshinski, the Assistant Director of the Division of Privacy and Identity Protection at the Federal Trade Commission. Thank you, Chairwoman Capito, Ranking Member Maloney, and members of the subcommittee. It is my honor to present the Federal Trade Commission’s testimony on the important issues of consumer reports and credit scores today. The Fair Credit Reporting Act is the law that governs the oper ation of our Nation’s consumer reporting system. Today, consumer reports are used by issuers of credit, insurance companies, employers, landlords, and others to make critical eligi bility decisions affecting consumers. The information contained in an individual consumer’s report will affect the eligibility and cost of various consumer products and services that most of us would consider to be essential parts of the activities of modern life. I would like to highlight three aspects of the Commission’s testi mony in my comments. In the credit context, for example, complete and accu rate consumer reports enable creditors to make informed decisions benefitting both creditors and consumers. For example, consumer reporting agencies must make reasonable efforts to assure the maximum possible accuracy of re ports, and must maintain procedures through which consumers can dispute and correct inaccurate information in their files. These important rights permit consumers to know what is being reported about them and to evaluate whether their files contain inaccurate or incomplete infor mation that they should dispute. Second, the issue of thin files or consumer files with limited or no credit histories can limit the ability of credit providers to assess the subject consumer’s creditworthiness. In 2003, Congress asked the Commission to study whether common financial transactions not generally reported to the credit reporting agencies would be useful in determining the creditworthiness of consumers. The report concluded that there was a sizable consumer population that was difficult to evaluate for credit purposes because they have thin files or no credit history. The Commission found that the types of consumers with thin files included young people living on their own for the first time, people who established credit through their spouse, recent immi grants, and people who either do not use credit or who rely on al ternative credit sources. The report discussed arguments for the inclusion of alternatives to traditional data and credit files, such as rental payment infor mation, utility payment information, and cellular phone payment information, and identified private efforts under way to collect and report these types of alternative data. Third, I would like to address the treatment of medical debt in credit reporting and credit scoring, which continues to present unique challenges. Medical debts can be reported as derogatory items on consumers’ credit reports, even after such debts have been paid, adversely affecting a consumer’s credit score. As the Commission’s testimony describes, some have questioned the appropriateness and value of medical debt in assessing and predicting credit risk. In some cases, the debt may result from a billing dispute or misunderstanding between the consumer and their insurer. Additionally, some argue that medical debt is often an unexpected one-time expense, and thus may not be a good indi cator of a consumer’s general creditworthiness. On the other hand, some argue that because such debts can pro vide accurate information about consumers’ financial obligations and payment histories, they should be included in credit reports. The Commission continues to monitor developments in the re porting of medical debt. Again, I apologize for the delay, but we should have clear sail ing hopefully for the rest of the hearing. In terms of how credit scores are developed, are they all devel oped by third parties like the credit bureaus Or do financial insti tutions also develop their own sort of in-house scoring models And I know there is a representative from the industry on the second panel who may be able to address it. My understanding is that credit reporting agencies develop scores, but that they are—the lenders or the others who are using the scores may ask for specific weight to be given to different fac tors in the credit reports. One of the questions I have, and this is just a random question, but you always hear about things staying on your credit report for 7 years. It decided that things beyond 7 years are ei ther stale or not indicative anymore at that point. But that is just what Congress determined when they passed that section of the Act. Having been obviously a consumer who has looked at my credit report, it really is frustrating that you cannot— you can satisfy these negative parts of your credit score and you really do not get credit for it for 5 years later or something like that. And another thing, I think—and I will also go to the other panel on this—the communication issue in trying to talk to a credit bu reau, to try to work on your credit score, is not easy. So, there are provisions in the Act that require the credit report ing agencies to do certain things.
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