Is the folly of an RDA for vitamin D at least partly because it is a hormone?

I am also sure that different people absorb vitamins and hormones differently; and a person probably absorbs them  differently at different times, as well. Another reason an RDA won't work very well, if at all.

Any undiagnosed kidney problems/disease?

I've read that something like 25% of people have undiagnosed kidney disease and that this can impact the conversion rate of D to the active form.

I posit that the main factor that determines the resulting 25-hydroxy vitamin D level is dietary fat intake.

How do I find out how much I need?

After 2 years of every 6 months blood tests, I've settled on 10,000iu/day.

Found great price for 10,000iu gelcaps here: http://www.nutritionland.com/p10930/Healthy-Origins---Vitamin-D3-10000-IU-360-SoftGels.html

Caution...they tried to improperly charge me sales tax.

there are heaps of vitamin D isonomers, you don't know what proportions of the different isonomers and toxisterols are in the supplements and also they are quite fragile and really need a preservative like sodium sulfite which has become unfashionable

this problem of what vitamin D actually is has zero research done on it, let alone what is in supplements!

it's at least 20 years away before a reasonably informed RDA can be given

Genetics does have it's opportunity to alter things. The unactivated D's  binding receptor has to co-function with the retinoid-X-receptors and get to the D response element of our mutable genes to start transcription of activated D.

There are 8 D pathways and several known vitamin D receptor gene variations. The receptor variants show pronounced association with different population lineages. The level of circulating (measureable) activated D is affected - and then too the 1/2 life of active D is not a long cycle even in ideal metabolism.

In the kidney making active D, the 1,25(OH)2D3 type, needs the enzyme "CYP27B1" to respond to the parathyroid hormone.

Curiously the same enzyme in our macrophages induces synthesis of active D there (outside our kidneys). Certain noxious bacteria (not the parathyroid) in our system trigger Toll-like receptors that start this cascade. This too is a geneticly varied immune function.

The following is a comment on the Vitamin D Council's website where Dr. John Cannell discusses cofactors required for proper vitamin D metabolism:

"Vitamin D has co-factors that the body needs in order to utilize vitamin D properly. They are:

•magnesium
•zinc
•vitamin K2
•boron
•a tiny amount of vitamin A

Magnesium is the most important of these co-factors. In fact, it is common for rising vitamin D levels to exacerbate an underlying magnesium deficiency. If one is having problems supplementing with vitamin D, a magnesium deficiency could be the reason why."

http://www.vitamindcouncil.org/

My Vitamin D3, 25-OH, levels were 29 ng/ml so I took 4000 IU a day for a year and it rose to 39 ng/ml  (+10ng/ml change).

I'm shooting for 50ng/ml, so I'll do another year at 4000iu, at which point I think 2000iu/day will maintain that level.

Don't forget differences in nutrition.  Do they eat the same food? How much grains, fish, meat, and so on?

Paul mentions Vitamin K2 as a cofactor. These Vitamins don't work in isolation, but are part of the grand metabolism show.

Dr. Davis, what do most "conventional" Md's deam "toxic levels of vit d"?

Reason I ask, my girflriend has been supplementing with vit d. 2-4000 iu per day with some breaks here and there for the last 6 months.
Recent blood test she was told by her MD that vit d levels are way to high. We have been waiting for a week to have them give us the reading....hopefully they will call next week.

My levels are 63 ngl and I'm curious if many Md's would find that level too high.
Your feedback is very much appreciated and thank you for al you do.

Marc

@Martin Levac: vitamin D3 is not dependent on fat as a tranporter (D2 is however).

another reason for bad absorption could be undiagnosed (or silent) celiac. the absorpion of D mainly happens on the tips of the villi, and if they're damanged, absorption is massively disturbed.

another reason could be chronic infection, which can use up a lot of D in the concerned tissues/cells for fighting it, or increased degradation of 25-OH-D in the liver.

another question would be if one man's 25ng, is the same as another man's 25ng. could be that inividual levels in the blood are actually not really compareable at all due to genetics, and that the second man's 25ng is actually more like 100ng for him, and therefore the liver desperately tries to bring down the level.

What is the name of the test for 25-hydroxy vitamin D level? I found a lab that will do this test: Vitamin D 25 Hyrdroxy LC-MS  (Vitamin D 25-Hydroxy, D2 + D3 ).

Your sample size is small to warrant this conclusion, "Vitamin D is an individual issue that must be addressed on a person-by-person basis," no?

Dr. Davis,

Whether or not you agree with the specific value of the RDA, interindividual variation in requirement does not in any way invalidate the concept of the RDA, because the RDA is not meant to be a one-size-fits-all recommendation.

On the contrary, the RDA incorporates the concept of a distribution in requirements, and attempts to cover the needs of most people.  The IOM is pretty explicit about that.  

You could certainly argue that the current RDA is not sufficient to meet the needs of most people, but that's another issue.

Chris

Great post. I completely agree. Vitamin D is simply too complicated to be addressed in just one number. Most everyone's level of understanding is so superficial that it doesn't extend beyond that one number. When a number like that is created, it takes on more power than it should because most who access it don't know its faults and limitations.
I know someone who concluded that his bizarre behavior after drinking two bottles of apple juice was from "Too much Vitamin C." He had drank two bottles, each bottle had 2 servings, and each serving had 100% the daily value of Vitamin C. Beyond the giant sugar bolus, in his mind, he had just taken 4x the recommended amount of Vitamin C. Based on his level of understanding, he concluded he may have ingested a toxic amount of Vitamin C. He needed a scapegoat and he found one.
More damage is done by attempting to dumb down Vitamin D to one number than any benefit an RDA creates. It's simply too complex.  Frankly, it's pretty pathethic that Vitamin D deficiency remains rampant. It says an awful lot about our healthcare system that such a huge percent of the population remains Vitamin D deficient while taking far sketchier prescription drugs for the host of conditions associated with Vitamin D deficiency.

For people with money, insurance, and education, jit makes sense to look at each person's individual needs.  For everybody else, RDA sounds to me like a reasonable idea.

Dr. Davis,

Would blood calcium levels be an accurate indicator of sufficient Vitamin D intake?

Quailia,

We were thinking along the same lines... undiagnosed malabsorptive disorders could be responsible for alot of low levels in spite of supplementation.

Celiac alone affects approx. 1-133! throw in fructose malabsorbtion, UC etc. and no wonder we have an epidemic of low D levels.

@Qualia,

Do you mean to say that vitamin D3 is not fat soluble? Everywhere else it says D3 is fat soluble. Do you know something the rest of the world doesn't?

I wonder if I may be overdoing it with 5000IU for about half the year (Oregon). I eat natto and 3 cups of steamed spinach per day, so I should be ingesting all of the cofactors in substantial amounts.
I wonder if it would be more efficient to go to an endocrinologist in order to get this and a proper lipid panel done.

If the IOM has achieved any good at all, it is to further stoke constructive discussion around vitamin D.

I am quite impressed with the level of comments here. Compare that to the conversations we were having just 2 or 3 years ago. We've come a long way.

Vitamin D remains on my list of "most incredible health effects ever seen."

A belated thank you for all your articles on Vitamin D. I read about the importance of taking Vitamin D in many books but was never willing to go through the hassle of getting my levels checked.

Well, reading your blog several months convinced me to give it a shot. Turns out that it took 10,000 IU a day just to get me to 54 ng/ml. I am now on 14,000 IU a day to see if I can get into the 60 to 80 ng/ml range.

I have thus far managed to get through this winter without contracting a cold when half the people I work with are taking turns being out sick with one they've spread amongst themselves. By adding D and CLO (and making dietary changes), my total cholesterol dropped from 215 to 169, my HDL went up from 44 to 50, and my VLDL dropped from 24 to 9. My triglycerides dropped from 143 to 53. Given that I'm only halfway through my weight loss I expect greater improvements yet. Thanks again.

This is great, brilliant and knowledgeable post. I agree with your conclusions and will eagerly look forward to your next updates. Just saying thanks will not just be enough, for the wonderful clarity in your writing.

Here is "The Peoples Chemist" Vitamin D link:

http://thepeopleschemist.com/blog/the-vitamin-d-scam

Dr. Davis, I have had great lipid results, overall health benefits with going to a lower carb, paleo diet as well as supplementing with vitamin D getting to the the mid 50's mg/dl range from the low 30's on 8000 mg vitamin D for the last 2 years. Not sure if related, but one downside has been the 3 occurences of kidney stones in last 18 months. It seems the current recommendations for the stones implicates higher protein diets and increased vitamin D. Have you run into this with any of your patients, what is available to address this?

There's no reason to blame this on health care legislation yet, it hasn't taken effect yet. It sounds like it is the usual coldhearted, profiteering insurance companies have engaged in.

Who needs Death Panels -- the insurance industry has been doing this stuff for years and will continue under Obamacare.

Wow. I'm stunned. I cannot believe they basically would come in to the hospital and ask you to let her die so they can save money...

-Goes to show how out of wack peoples' values have become these days.

As stunning as that was, it does bring up an interesting point:  if this patient is essentially refusing interventions aimed at reversal/control of disease, is it appropriate to have an end of life discussion with her?  Is she opting for palliative care or hospice type care?  What are her goals?  Pain management? ADL function?  Some quality of life issue?

I don't think that "bullying", scare tactics, coercive tactics, disease curative advocacy tactics  etc. are useful here.

Having a frank discussion about her health aims and her knowledge in order to partner in achieving her health/quality of life goals may actually be where the utility will be.

Great post.  Thanks for writing this.

I think the whole point of this episode is that Obamacare has nothing to do with "death panels" and that insurance companies have already been intervening (read: rationing) care for years.

This is the kind of situation that got so many people riled up, when the topic of "death panels" arose during the health care reform debates.

No one is willing to point this out  -- but if she is NOT willing to do anything to try to ameliorate her health, then perhaps "society" should not have to pay for her hospitalization.  

People are all up in arms about "oooohhh. Death panels!!" There is no human life that does not end in death. It is a REASONABLE economic consideration whether "society" (that is, you and I) owe anyone 'free' health care when they refuse to follow their medical practitioner's advice. (Yes, that means I pay for my own medical care, because I'm not insured, and I don't always agree with my doctor's advice.)  

No one is "owed" full medical coverage when they're not willing to participate in their own health.  And society (you and I) CANNOT afford to pay for everyone's health care. Period. It's not possible.  There is not that much money on the planet!  

I dislike the insurance companies -- but their attempt to protect their shareholders' money is a REASONSABLE financial decision based on rational grounds. Sorry that granny isn't able or willing to take care of herself, but we CANNOT afford to pay for everything for everyone.

This is nothing new.  Insurance companies exist to make money.  They're neither good nor evil.  They're not interested in patient care.  They're interested in taking in more money than they give back out.

Not sure what else you'd expect.

Wow. Reading this chilled my blood to the point that I wondered for a split second if you made it up (nothing personal, was just that shocked).

Shocking, and appalling.

Given the complexity of the health care legislation, is it really possible to say that it will make the situation with insurers better or worse?  Some provisions aimed at limiting cost could make the situation worse, but the standardization of plans that the exchanges are likely to cause could make the situation better.  From my point of view, it seems to hard to answer without going into the details, and I have yet to see a detailed analysis.  Does anyone know of one?

Even then, the full effects of the legislation is likely to be unpredictable due to the hybrid nature of our health care.  (See "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care" for a description of various health care systems and how ours compare).

I tend to agree that if she refuses to make attempts to improve her health that a real "end of life" discussion is warranted.  maybe that was had and that what precipitated the test requests.

If she has insurance, it is not "society" that should determine her care, it is her individual contractual right.  The insurance company is stuck with her and needs to pay for her care in accordance with the contract.  Trying to persuade her doctor not to prescribe the care he ought to is dealing off of the bottom of the deck.  

She should be compliant, of course, but I am certain she cannot be denied further care under the policy just because she made some poor choices in the past.

I think the reason "death panels" is such a scary concept (and insurance companies rationing care too) is that as individuals we want the right to the best care, and we thought we were getting it and paying for it through insurance.  Sadly, the entire system (as is and as will be) is skewed toward top-down decision-making, rather than patient empowerment (and responsibility).

If her regular doctor were someone other than Dr. Davis, the care she might have gotten might not have done any good anyway.  God sent her a rowboat as the flood waters lapped at her feet, and she did not get in.

As long as health insurance is a "for profit" business, this situation is bound to happen. Why should this surprise anyone ? Like any for profit business, they are in it for the money. It unfortunately for us, the paying public, involves our lives. I don't see anything changing unless the insurance industry is changed over to a non-profit one. Not likely to happen in the US.

". . or is this a taste of things to come as the health insurers fall under increasing pressure with the legislative changes underway?"


Yes.

>>>  No one is willing to point this out -- but if she is NOT willing to do anything to try to ameliorate her health, then perhaps "society" should not have to pay for her hospitalization

-----

Well the irony here is that the prescription of many docs for being "compliant" (ie. eating whole grains and takings statins etc) actually makes their health WORSE and costs society more money in the end (all the while lining the pockets of big pharma.)

I agree in principle with your point about self-responsibility, but we have to be careful because few docs are as enlightened on this topic as Dr Davis are.

Hmm, well in many ways I *also* reuse to follow my medical practitioner's advice - by following a low carb diet, and refusing to take statins. So does that make me also "non-compliant" and ready for the death squad?

I'm not sure how insurance works for the elderly, but remember for my father he didn't have a choice.  Once he reached the age of 65 he had to join the government plan.   I remember, he wasn't too happy about it.  Was the insurance firm for your patient Medicare?  Is there other insurance?  Scary tale regardless.

Doesn't want to follow advice, change her diet, but likes to visit doctors a lot. Sounds like Elderly Munchausen syndrome.

No one has a right to health care and no one has a right to force care on another that refuses such care. Whether or not her decisions are "right" as judged by others is immaterial.

Doesn't this woman have Medicare (i.e., govt health insurance for the elderly)?  

Also, the health care law HAS taken effect as companies and insurance companies seek to adjust to its many diktats.  See today's news that McDonald's is thinking of dropping its (admittedly paltry) coverage and the "reform" has added much extra cost to many company bottom lines, not to mention additional tax reporting obligations.  Think what you will about the current system, but it will get worse with this reform.  Long lines, fewer specialists, no cutting-edge testing like the doctor advocates.  I know; I have lived in Canada.

Group health insurance policies are always beneficial and the premiums for health insurance quotations are lowest when opted for a group health insurance policy, since it’s important to cover the health first.

Thanks for being so transparent!  Do the drug companies offer you money to write prescriptions?  Have you heard about that from your colleagues?

Although I was frustrated by this (very nice) woman's inability or unwillingness to follow a preventive effort, my primary concern here is the aggressive effort to intervene by the insurance doctor.

This is not the only instance of the clamp-down they have been exerting; we've been seeing it in many others ways. For instance, for most of the routine tests we run, including lab work, we have to get the okay of the insurer. Sounds fine, except my staff spends hours every day on the phone telling the insurance person things like "Their last HDL was 67," or nonsense that has nothing to do with justification of testing.

Some of the comments here emphasize the problem of looking at health care of an individual as some sort of collective enterprise where society or some other collective claiming an interest should have its say in life or death decisions of the individual, rather than the individual, with the counsel of family and physician, retaining sole autonomy. For those of you advocating the right of the "collective," however viewed, to cast its vote on your treatment consider this: 1) by any objective standard, none of you took perfect care of your health, either, (glass houses & stones) 2) by even being on this website, you advertise your dissent from many prevailing opinions of "correct" medicine; maybe the collective would conclude that your suspect medical practices ought not to be rewarded with treatment in a crunch 3) e.g., maybe because you refused that statin & now you've had a CVA, nature ought to be allowed to take its course since you refused "best practice." I could say a lot more, but maybe you collectivists can figure it out from here.

Welcome to "Obama Care"....

Happens all the time, in one way or another. My mother was sent home from the hospital in hospice care with morphine prescribed for "shortness of breath" (she had lung cancer). Clearly they didn't think there was anything more they could (or TBH, probably wanted -- she was 84) to do for her, but I guess they couldn't quite conscience doing nothing for someone experiencing difficulty breathing.

Adopting unconventional approaches to health do not imply unconventional political or philosophical views. Please take these sorts of debates elsewhere.

Another Anonymous said:

"welcome to Obamacare"

This will be the outcry going forward even though it is patently false.

I say welcome to the culture of greed.


2007 Total CEO Compensation

Aetna - Ronald A. Williams: $23,045,834

Cigna - H. Edward Hanway: $25,839,777

Coventry - Dale B. Wolf: $14,869,823

Health Net - Jay M. Gellert: $3,686,230

Humana - Michael McCallister: $10,312,557

U.Health - Grp Stephen J. Hemsley: $13,164,529

WellPoint - Angela Braly (2007): $9,094,271

These people do not earn this money.  There is nothing about them that is that special or irreplaceable.
A whole lot of healthcare could have been provided in place of these bloated compensation packages.

Let's look at H. Edward Hanway at Cigna as the poster child of egregiousness.  He makes just under a half million dollars EVERY WEEK!!!!  Now a half million dollars would buy a nice house (since it's not buying healthcare).  Something that many people would like to be able to afford on a 15 or 30 year mortgage.  But not H. Edward Hanway, he can pay cash for his house and buy himself another one every week if he wants.  That granny has to die early so H. Edward Hanway can have a new house every week is a small price to pay don't you think?

So Anonymous who blames this on Obamacare, do us a favor and stay home on election day.  We can't afford YOU!  Sheesh

Welcome to a taste of the coming Obama-care health era. This case is an example of something that no one will even raises an eyebrow about. Ahhhhhhh, the people's paradise. The joys of socialism, right here in America.

And Apra, you're mistaken about the legislation not haven taken effect yet.

Socialism? What a laugh. The "Affordable Care Act" is corporate welfare in the same way Medicare Part D was corporate welfare. Big Pharma got theirs, and now the insurance industry will get theirs. (like they were suffering before)

And let's not forget Big Agra who gets to design the food pyramid with all those "heart healthy grains" at the top.I'm really surprised the corn industry couldn't buy a place for HFCS in the corporate pyramid.

It's not socialism, it's an oligarchy, get used to it.

Why am I not surprized?  If more doctors spoke out when insurance companies do this kind of thing, I'd be willing to bet that the insurance companies would soon stop doing it.

Why don't you draft up a declaration in highly detailed form, and submit it to your state's Trial Lawyers' Association for future use?  The hardest thing to do in law is prove that an insurer has a "pattern" of acting badly.  You  could provide the starting point.

Dr. Davis,

Aren't you "intervening" in the care of this patient?  Aren't you taking her (or her insurance company's money) for treatment that she rejects?

Maybe this is a patient you should decline to treat. Sounds like if she is a lovable old lady there is a doctor who will assist her in the way she wants, clearing your schedule to accept patients who want your style of care.

Sounds harsh, but why try to push someone into something they don't want?  She's heard you, and doesn't want to listen. she wants to live her life they way she wants.  that "living" includes her eventual death.

That's the way it goes birth-life-death. We don't typically choose our birth, and we're sometimes asleep during our life and death.  Still though, choice is ours.

The real issue is that a great many Americans cling desperately to absolutely horrible diets. I'm not even talking about that vast gray area of controversy, but of those who only occasionally eat fruit or vegetables and consume mostly wheat or corn, truly a third world diet.

How does one motivate someone who clings desperately (in a quasi-religious cultish fashion) to something that not only may hurt them in the distant future, but actually does hurt them right now? Many celiacs continue to eat wheat even though they experience immediate symptoms.

It is as though Americans have confused the diet they may need to continue living healthy lives with an imposition on their freedom of expression.

happens all the time in Neurosurgery my friend.  Welcome to our world.

I'm Canadian. Like most of Europe, we have national health care. If you are ill, you get care. It is only primary care.  Each Province has its own flavor so in some cases drugs are covered across the board and in other cases, like Ontario, it is only in hospital and if you don't have a drug plan and need expensive drugs....you are no better off than in the US. Anyone with financial means can,and does, go out of country if they want.  The government will pay for private care out-of country if they have emergency needs where a patient is at risk.

Friends of mine from Boston visited recently (I lived there for 5 years) and I was surprised to hear the question of economic value for treatment of an at-risk patient come up.

Insurance companies get no say in who gets health care, it is Universal and is part of who we are as a nation.  

Having a profit layer in the middle does not sound like a good place to be. Sure people are covered, but the insurance company forced to take on "bad risk" will look to minimize the loss potential.

Trev

Noting here a number of comments about the pushing of “heart healthy grains" on an unwitting public, I was intrigued this morning by the host of the Rachael Ray show (CBS)devoting a whole program on this very topic. While demoEdit  John Townsend said...nstrating various grain-based dishes, Rachael quite unabashedly pronounces that grains in the diet are very healthy, reducing the risk of heart disease by 25%, followed by a gleeful applause endorsement by the TV audience.
She provided no backup source, nor an explanation of how this is so. This sort of irresponsible
“pushing” of what is clearly a doubtful contention by celebrities of this ilk on mainstream media is appallingly reprehensible.

Noting here a number of comments about the pushing of “heart healthy grains" on an unwitting public, I was intrigued this morning by the host of the Rachael Ray show (CBS)devoting a whole program on this very topic. While demonstrating various grain-based dishes, Rachael quite unabashedly pronounces that grains in the diet are very healthy, reducing the risk of heart disease by 25%, followed by a gleeful applause endorsement by the TV audience.
She provided no backup source, nor an explanation of how this is so. This sort of irresponsible
“pushing” of what is clearly a doubtful contention by celebrities of this ilk on mainstream media is appallingly reprehensible.

Thankgoodness I don't live in the USA - that's all I can say !

". . or is this a taste of things to come as the health insurers fall under increasing pressure with the legislative changes underway?"

You nailed it.

The redeeming feature of the free market is when one company is being a jerk, customers can take their business elsewhere. If they are big enough jerks they get sued and have to change their policies or at least get bad publicity.

When the government is in charge of insurance, there is no elsewhere, they can arrest you for not paying your permium, they cannot be sued, and no amount of bad publicity will make them clean up their act.

It’s annoying how some people such as f0xpawz use an otherwise importantly informative
web-site and discussion board as a bully pulpit for their unlettered views on subjects entirely
irrelevant to what the site is all about. This kind of behavior is straight up unseemly and offensive.

I this happened to my mother last year.  

The hospital and then nursing home staff were clearly driving her into the ground with bad food and defective medicines.  The doctor was a social climbing medical deity, the head nurse a borderline psychotic.  

I was able to find more knowledgeable, broad minded doctors, cut the meds, improved the food, aded supplements over the nursing home's many obstructions, and we eventually escaped without mortality.  Mom got better, after eliminating a number of drugs and their horrid side effects (including nausea and vomiting, Parkinsonism).

All the nursing homes in the locale exhibited the (sub)standard American diet syndrome.  I have since come to view US nursing homes as death traps.

Also my wife's cousin died in UK last year under NHS cost control.  Her sister, an American MD, on the phone, recognized her sister had a systemic infection that needed IV antibiotic, stat.  NHS guidelines delayed treatment.  Dead in 48 hrs.

I this happened to my mother last year.  

The hospital and then nursing home staff were clearly driving her into the ground with bad food and defective medicines.  The doctor was a social climbing medical deity, the head nurse a borderline psychotic.  

I was able to find more knowledgeable, broad minded doctors, cut the meds, improved the food, aded supplements over the nursing home's many obstructions, and we eventually escaped without mortality.  Mom got better, after eliminating a number of drugs and their horrid side effects (including nausea and vomiting, Parkinsonism).

All the nursing homes in the locale exhibited the (sub)standard American diet syndrome.  I have since come to view US nursing homes as death traps.

Also my wife's cousin died in UK last year under NHS cost control.  Her sister, an American MD, on the phone, recognized her sister had a systemic infection that needed IV antibiotic, stat.  NHS guidelines delayed treatment.  Dead in 48 hrs.

Well, it’s amazing. The miracle has been done. Hat’s off. Well done, as we know that “hard work always pays off”, after a long struggle with sincere effort it’s done.
-----------
marqgibs
Savings

I found your blog very informative about insurance policies and plans.

I get angry every time I hear a don't-wanna-be-a-socialist RED-stater griping and complaining about "Obamacare" and how they don't want to be forced to pay for other people's bad health choices.  Then they bleat about death panels.  Have these kind souls ever BEEN without insurance?  Boy, I sure have.  Nothing says "death panel" like "sorry, we require payment up front and by the way, you don't qualify for Medicaid."

Paying for someone's dumb decision to leave their front door unlocked at night when they suffer a burglary and have to call the cops?  No problem.  Paying for someone's dumb decision when they fall asleep in bed with a lit cigarette and need the fire department?  No problem.  What's the difference then?

I do not understand and I will never understand.  Yet they go on about "death panels" and "un-American" and so on and so forth.  What, are fat people and chronically ill people not alive or something?  Or not American?

I am really shocked to read the whole post. In my opinion the real cause is the increasing number of fraud that people are doing by showing false information so that they will get the claim. This just results into the poor people who are true, suffers a lot.

To: Dana Seilhan

VERY WELL said!