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Should Drugs do double duty

Nervous about giving a big presentation? Your doctor might prescribe a blood pressure drug like generic propranolol to calm you. Can't sleep? You might leave the doctor's office with a prescription for generic trazodone, an antidepressant often used for insomnia.

But neither drug is approved by the Food and Drug Administration to solve these problems, according to Consumer Reports. Doctors routinely (and legally) prescribe drugs "off label" -- that is, for conditions not approved by the FDA -- for any use they see fit. Most don't tell their patients.

The results of this practice are alarming. A recent analysis in the journal JAMA Internal Medicine revealed that more than 80 percent of off-label prescribing by doctors lacked strong scientific evidence. And patients were 54 percent more likely to experience some kind of harm as a result, compared with those taking the same drug for an approved use.

"Surprisingly, many doctors may not even realize a drug is not approved for the condition they're prescribing it for," says Lisa McGiffert, director of Consumer Reports' Safe Patient Project. "It's no wonder so many people are harmed."

Drug companies have been forbidden to promote drugs to consumers (and doctors) for non-FDA-approved uses since 1962. That's when Congress strengthened the agency's regulatory power after the thalidomide tragedy, when samples of the unapproved drug were given to pregnant women in the U.S. to treat morning sickness -- leading to birth defects.

But FDA rules prohibiting advertising on TV, in magazines and elsewhere for unapproved, off-label uses could soon change. Last November, the agency held a two-day hearing to gather input on whether to give drug and medical-device companies more leeway in promoting off-label use of their products. It was prompted by two recent federal district court rulings that found truthful promoting of off-label use to be a form of protected free speech.

The pharmaceutical industry is lobbying to lift the off-label marketing ban. But a new nationally representative survey of 1,011 adults by Consumer Reports found that 84 percent of people don't want drug companies to be allowed to advertise drugs for a use that hasn't been approved by the FDA.

How You Can Make a Difference

When considering new medication, ask your doctor whether it's been approved for your condition, suggests Consumer Reports Medical Director Orly Avitzur, M.D. "If not, ask why he or she recommends it."

Here are some other tips:

-- Go to the National Institutes of Health's DailyMed website (dailymed.nlm.nih.gov), search for the drug, then click "Indications & Usage" to see whether your condition is listed.

-- If it's an off-label use, ask whether good research supports using it for your condition.

-- Find out whether your health insurer covers payment for off-label use. Some may require evidence of effectiveness or failure with conventional treatments, especially if the drug is expensive.

"Always make sure someone has thoroughly explained the risks and benefits of a medication to you, as well as other options," Avitzur says.

To learn more, visit ConsumerReports.org

5 ways to stop senior citizen scams

One in 10 Americans age 60 and older experience some form of physical, emotional, financial or even sexual abuse over the course of a year, according to the National Center on Elder Abuse, based in Alhambra, California. One in 2 adults with dementia has been victimized.

"Older people are vital, contributing members of our society," noted Kathy Greenlee, assistant secretary for aging and administrator of the Administration for Community Living. "The abuse or neglect of any one of them diminishes us all."

Financial elder abuse, in which a senior citizen is coerced, bullied or tricked into relinquishing hard-earned assets, is the most common form of elder abuse and the fastest-growing, according to Consumer Reports. Yet by one estimate, only 1 in 44 victims report the crime.

Most of the abuse is committed by family members or people the senior knows. Scams by strangers, though less common, often happen more quickly and can result in bigger financial losses. A conservative estimate of annual losses is $3 billion, according to a study published in 2011 by the MetLife Mature Market Institute.

How to Protect Seniors

Consumer Reports offers these five ways consumers can help ensure the safety of the elderly:

1. Regularly call or visit. Be suspicious if a senior citizen has a new "best friend," becomes socially isolated, never seems to be available or able to come to the phone or is hesitant to have contact with others unless a caregiver is present. This could indicate that someone has undue influence on the senior's behavior and decision-making.

2. Provide respite for a caregiver. Caregivers who are stressed financially and emotionally can sometimes steal the assets of those they are supposed to be caring for. Monitor the caregiver and ensure that person gets enough rest.

3. Set up safeguards at the bank. If you're concerned about your relative's financial decision-making, set up a small account at a local bank for her. That account could, for instance, include a debit card and checking with a spending limit of, say, $300. That way, any other finances can be saved in a separate, more secure account.

4. Arrange for limited account oversight. Ask financial institutions to send statements and alerts to a trusted person who has no direct access to the senior's accounts, so that person can check for fraud. Another option is to try EverSafe, a web-based service that consolidates all of a senior's accounts and checks daily for suspicious activity. Consumer Reports found one of its services, called EverSafe Essentials, generally worked as promised. It costs $7.49 per month for one person.

5. Block solicitations. Opt out of commercial mail solicitations. You can arrange for a ban of five years at a time with the Direct Marketing Association's mail preference service. To eliminate unsolicited offers for credit, go to optoutprescreen.com. To eliminate robocalls, try a call-blocking device or Nomorobo, a free service that's available through some landline providers. Consumer Reports found it to be quite effective.

To learn more, visit ConsumerReports.org

Getting the best TV for your buck

Looking to buy a big-screen set for the big game? Consumer Reports put together some general guidelines to help you understand what features to expect within three budgets.

Budget TVs

40" to 43": $170 to $400

49" to 55": $250 to $700

60" and up: $500 to $1,100

Don't need a super-fancy TV loaded with features? You can still get a basic set that delivers great picture quality at a surprisingly low price. The key with an entry-level set is to focus on the few features you care about and understand what you can live without.

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What you get. Unless you're shopping for the largest screen sizes, you'll probably be choosing a regular 1080p high-definition screen rather than a higher-resolution 4K Ultra High Definition (UHD) TV. Which is fine, because that extra resolution isn't really noticeable until you get into the jumbo sizes -- 65 inches or larger.

What you don't get. If you do manage to score a 4K TV at a budget price, its performance will probably be lower than that of a higher-priced set. Entry-level televisions may also lack the more advanced color- and picture-processing technologies found in more sophisticated sets. And some don't come with smart TV capability.

Midlevel TVs

40" to 43": $350 to $550

49" to 55": $650 to $1,200

60" and up: $950 to $2,300

Mid-priced sets almost by definition represent the sweet spot of the market. These models usually offer the best balance of price, performance and features.

What you get. High-resolution 4K screens are now common on mainstream sets. You can also expect some level of high dynamic range (HDR) capability, technology that boosts the contrast between the lightest and darkest images a TV can produce with HDR-enabled content. On pricier sets, Consumer Reports' testers have found that HDR can reveal richer detail and more dramatic highlights, but the results aren't always so impressive in this price tier.

Most TVs 40 inches and larger are now smart TVs and come with built-in Wi-Fi for connecting to home networks.

What you don't get. Companies reserve their highest performance features for top-of-the-line models. So sets in this range usually don't have very effective HDR performance, precise local dimming or the most advanced video processing.

Top-Tier TVs

40" to 43": $400 to $800

49" to 55": $750 to $3,000

60" and up: $1,600 to $6,000

These TVs are the priciest in a company's lineup and offer the best performance and all the latest features. Many also have slim profiles and designs with ultra-thin bezels.

What you get. This year, sets from major manufacturers are all 4K models with 120Hz refresh rates and bright screens that highlight HDR content. You'll also get more of those contrast-enriching local dimming zones as well as the brand's most sophisticated video processing, which can produce sharper images and better results when converting lower-resolution 1080p content to 4K resolution. Consumer Reports notes that top-tier sets are where manufacturers roll out their most sophisticated smart TV systems and more advanced remote controls. These remotes often have built-in microphones for voice-controlled searches.

What you don't get. You get everything -- except a low price.

To learn more, visit ConsumerReports.org

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