.comment-link {margin-left:.6em;}

Fixin' Healthcare

Friday, December 30, 2005

Happiness and Health

Happiness and health are very much related. There was an interesting op-ed in the NY Times yesterday that would be appropriate anytime but especially at the start of a new year. Random acts of kindness without any thought of return except for how it makes us feel. Good advice.

Don't Think Twice, It's All Right - New York Times: "The trick is to go out of our way to be kind to others without thinking too much about why we're doing it. As a bonus, our kindnesses will make us happier. "

Thursday, December 29, 2005

The Age of Elves

I entered the field of medicine 46 years ago. It seemed to be a more simple time but I was younger. Our objectives were to diagnose and treat sick people. Technology was limited and good diagnosis relied upon the medical history, the physical exam, basic laboratory tests (CBC, urinalysis and electrolytes) and relatively unsophisticated X-ray. Clinical experience and deductive reasoning were valuable assets. Therapeutic modalities were limited, and there was appreciation for the healing and recuperative capabilities of the human body.

It was a time when the best training programs were at the large charity hospitals. To be admitted as a patient to one of these hospitals usually meant being 6+ sick on a 4+ scale. We performed the CBC and urinalysis on the ward. It was before Medicare and Medicaid and rapidly escalating health care costs. Marketing was unheard of and competition was a notion based upon egos (still true today). It was before hospitals became more like luxury hotels and hospital administrators has not yet become CEO's.

I have witnessed many marvelous things in medicine. My collegues constantly amaze me with what they are learning and how they apply that knowledge. There has been rapid development of technology that has vastly increased information about patients and diseases, as well as therapeutic capabilities. The rapid development of technology has been matched by rapid deployment that has occured in a widely distributed fashion without guidance of any health care plan.

The desire to cure disease is an issue with broad appeal that ultimately sustains the health care system and generates substantial resources. However, medicine has become big business. Marketing and business competition have become the norm. The local hospital is one of the largest employers in most communities. National budgets and the economy are heavily influenced by the health care system. And, business interests influence the development and expansion of medical care.

Political support is growing for reform of health system financing. If past history is any judge, reform will come by bits and pieces over time. Reform is made more difficult by the absence of a clearly articulated and widely accepted vision or plan for health care. Goals and priorities are frequently ad hoc and opportunistic. The rapid pace of change under these conditions is often inefficient and not effective.

Common infections that killed so many people 50 years ago such as tuberculosis have been replaced by AIDS and bird flu. Some of the infections of today are created by the advances in suppression of immunity and "superbugs" made resistent by the widespread use of antibiotics. Tuberculosis has reappeared sporadically and in clusters under these conditions. Treatment and cures of early stage cancer has improved tremendously but progress with late stage cancer remains slow. Yet, it is late stage cancer where most of the effort and resources are directed.

With all of the appeal of technology there is failure to recognize the human body as the most complex and sophisticated technology ever encountered. It is difficult to accept that lifestyle is the mechanism by which each individual manages and controls this technology. The human body with proper care and baring unforseen circumstances is capable of amazing things, including the achievement and maintainence of optimum health. Proper care includes daily physical activity, drinking water, eating foods containing the necessary nutrients, adequate sleep, managing stress, avoiding toxins such as cigarette smoke, unecessary medications and addicting drugs and avoiding risky behavior.

The major health issue for America today is not health insurance or insufficient resources, it is lifestyle and a culture that is inappropriately oriented to sickness. It is a matter of perspective and priorities. There will always be people who need medical care but this number can be and should be far less than it is today. Americans have expectations for medical care that are beyond what medical care is capable of at the current stage of development.

Health care is broad and expansive with the goal of achieving and maintaining optimum health. There is a growing body of scientifically verified and reliable information that defines healthy lifestyle and its value to optimum health status. In contrast to medical care there is not a well defined business model for health care. There is financial reward but it comes in the form of savings from medical care and increased creativity and productivity from a healthy population.

It all starts with individual responsibility and community commitment. A culture for health needs to grow and involve everyone in all aspects of community life. There are communities scattered throughout the US and the world that have started this effort.

The Age of Elves has passed and we are well into the Age of Man and Woman. I have great faith that society is at the beginning of an era of improved health status that we did not even dream of back in those days 46 years ago on the wards of Grady Hospital.

Early Detection of Breast Cancer Saves Lives

The New England Journal of Medicine reported in October that the death rate from breast cancer fell by 24% between 1990 and 2000 for American women age 30 to 79 years. The incidence of the disease remained stable during that period. This trend has continued.

The study came from seven research centers. They concluded that almosy half the drop could be attributed to mammograms and early detection.

Soooo today is better than tomorrow.

Wednesday, December 28, 2005

Whole Food and Supplements

In general the necessary nutrients are best obtained from whole (unprocessed) food. With a few notable exceptions nutritional supplements are a secondary consideration to the diet.

A multiple vitamin once a day is reasonable insurance to a good whole food diet. After age 45 to 50 years there may be a decrease in stomach acid and intrinsic factor causing vitamin B12 to be better absorbed as a supplement than from food. This should be adequately compensated by the multiple vitamin.

Vitamin D deficiency is common in the United States. This may be associated with loss of calcium from bones. The intake of calcium and magnesium and physical activity also influence the status of bones. Recently, investigators at the University of California in San Diego have found an an increased incidence of colon, breast and ovarian cancer with low levels of vitamin D. Milk and orange juice are fortified with vitamin D and it is found in oily fish. Supplementation up to 1,000 IU is considered advisable and safe.

The typical diet has increased ratios of Omega-6 to Omega-3 essential fatty acids and there are many people who do not eat fish. Taking a fish oil supplement is advisable for those people who do not eat cold water (oily) fish such as salmon, tuna, mackerel, cod, sardines and cold water trout. Coromega is a form of fish oil that is not unpleasant.

Each day should consist of a whole food diet and 15 minutes of sunlight. During winter the 15 minutes of sunlight will not be enough in the northern half of the US.

Monday, December 26, 2005

An Example, Intended or Otherwise

As a grandparent I have become a better observer of children. The observation that has impressed me the most is how much children are observing those around them. Children appear to be imitating some adults and older children in developing their behavior patterns. It is also apparent that children are good at discerning inconsistency between what is said and what is done.

Of course, none of this is new to any parent or someone who is around children. However, it bears repeating when there is so much concern about healthy and unhealthy lifestyles. Children are sponges. Their eyes and ears don't miss much and they are learning all the time. Perhaps that responsibility can teach us to be better examples.

Children Learn by Monkey See, Monkey Do. Chimps Don't. - New York Times: "humans are hard-wired to learn by imitation"

Thursday, December 22, 2005

Let Them Eat Corn

The US policy for agriculture and health need to meet each other and determine if they are on the same team. The enormous surpluses of corn grown by the American farmer and paid for by the American government
(Mountains of Corn and a Sea of Farm Subsidies - The Archive - The New York Times) has placed corn at the center of the American diet.

And, a highly processed diet it is. Most Americans don't have any idea how much corn they are consuming because it is processed into so many products or fed to animals that serve as food. Nearly 10 percent of the calories Americans consume come from sweeteners in the form of high fructose corn syrup and for many children it is 20 percent.

The switch to corn sweeteners in the 1970's and 1980's is associated with the beginning of the epidemic of obesity and Type-2 diabetes mellitus. There is evidence that fructose is metabolized differently from other sugars contributing to the marked increase in the Metabolic Syndrome (abdominal obesity, high blood pressure, elevated triglycerides and depressed HDL cholesterol).

Then, factor in that corn oil is high in Omega-6 essential fatty acids and the ratio of Omega-6 to Omega-3 essential fatty acids has risen to five times the historical diet. The increased incidence of systemic hypertension and pain syndromes could be related to this dietary change.

It is hard to believe that American farmers grow any tobacco or that they receive government payments related to tobacco. Of course, when Americans stop using tobacco, farmers will no longer grow it.

When you add it up, it is a miserable picture. There is no way these aspects of Agricultural policy are in the national interest. The US government pays some farmers to contribute to poor health and the rising cost of health care. If there is any policy that should be based upon the health of the public, it is agriculture. Get agricultural policy right and the food processors will follow.

Wednesday, December 21, 2005

The Wellness Challenge

This morning I was reviewing the definition of wellness by the University of California, Berkeley Wellness Letter. It represents a challenge that is an active way of living.

Wellness goes beyond the conventional approach to health. Wellness is optimum physical and mental well-being, a preventive way of living that reduces - sometimes even eleminates - the need for remedies. It is a positive, day-to-day approach to a healthful way of life.

Tuesday, December 20, 2005

Interesting Doings

Couple of interesting reports in the Wall Street Journal today.

An editorial presented how some states are introducing changes in Medicaid. Florida proposes reform with consumer choice and competition. To compensate for the sick and disabled there is risk-adjusted premiums. An innovative aspect of the program is financial incentive to follow their doctor's medical plan that will include lifestyle changes and preventive health care.

Medicaid might be the best vehicle for testing plans to reform the delivery of health care. Florida will implement the changes next summer in two counties covering 200,000 medicaid recipients. Other states, including South Carolina, indicate they will experiment with changes. Everything doesn't have to be bet on one roll of the dice and the different approaches expands the opportunity to learn something useful.

Another article reports how Scotts Miracle-Gro Co. is using the carrot and the stick to address unhealthy lifestyle such as smoking. Assistance is offered to stop smoking and bonuses are given for not smoking. There is a $20 monthly surcharge on health benefits for smokers and the company is firing smokers. This sounds like a program that will benefit Scotts but may not do much to impact the overall rate of smoking. But it deserves study because there is not enough known about how incentives and penalties work to change health behavior.

Brain Static

Boy, I am tired.
I can't get to bed early.
I stay up late to get things done.
It's hard to get out of bed in the morning.
I don't have time for breakfast.
The job takes all of my time.
Did I lock the door?
There is an ice storm coming.
I've got to call mother.
I have to pay these bills.
The oil in the car needs changing.
I need gas.
It's laundry day.
I hate ironing.
What can I give them for dinner tonight?
I didn't thaw anything for dinner tonight.
Tommy has a dentist appointment after school today.
The kids have a soccer game tonight.
Tommy has a report due for school.
My in-laws are coming.
Who will win Survivor?
Did the Colts lose?
Tommy is getting heavy.
Tommy plays video games too much.
Damn, I'm getting heavy.
Boy, I am tired.
I must have attention deficit.

Monday, December 19, 2005

Pay Now or Pay Much More Later

Development of health promotion, preventive health care and early detection of disease will do much more than bring the health care system into balance, it will change the entire equation. To paraphrase the old Fram oil filter commercial, pay now or pay much more later.

Health insurance without health care reform is wasteful.
Using health insurance to reform health care is futile.
Medical care without health care is wasteful and futile.

Sunday, December 18, 2005

Sharing Risk

In the final analysis insurance is a mechanism to share risk and avoid financial catastrophe. This principle breaks down when others in an insurance pool engage in known risks that increase the cost of insurance. That is the situation with health in the US.

Health insurance for everyone is a necessity but what form that should take is difficult to determine under the current circumstances. Using health insurance to reform the health care system is a mistake. It has not been successful in the past and it will not be successful in the future.

The primary task is the development of a comprehensive health care system that links health promotion, prevention of disease, early detection of health problems and medical care. It is not as far away as may seem. When that task is acommplished or at least well underway, health insurance will be an entirely different consideration.

Meanwhile, sharing health risk with others whose lifestyle choices are known to be risky will continue to be unpopular.

BBC NEWS Health 'Get tough' on unhealthy - survey: "'Get tough' on unhealthy - survey "

Wednesday, December 14, 2005

Health Report Card

Another report on health status in the US is not encouraging. This one was produced by the American Public Health Association, the United Health Foundation and the Partnership for Prevention.

The report combines 18 health indicators including smoking, infant mortality and immunization coverage. Overall health improved by an average of 1.5 percent a year during the 1990s but the rate of increase has slowed to 0.3 percent since 2000. Tobacco use remains the biggest preventable cause of premature death in the United States, resulting in some 440,000 deaths from a variety of diseases each year. The number of smokers has fallen by almost a third since 1990 to the current level of 20.8 percent of the population but most of that decline came in the early 1990s with no significant drop between 1993 and 2003.

The United States has an average life expectancy of 69.3 years. That figure is exceeded by 28 other countries, including Britain, France, and Germany, and is some five years less than in Japan. The U.S. infant mortality rate is more than twice that in Japan.

The health record is also related to social and economic factors such as poverty and high school graduation rates. It found the number of children living in poverty increased in 25 states since the 2004 report, and that the high school graduation rate fell to 68.3 percent this year from 72.9 percent in 1990.

The report ranks the health of each U.S. state. Minnesota ranked number one for the second year in a row. The worst ranking went to Mississippi, where the number of children in poverty increased 15 percent last year, and 29.4 percent of the population was obese.

Dr. Reed Tuckson, vice president of the United Health Foundation, attributed the slower rate of health improvement to obesity and smoking. He called upon individuals and communities to adopt healthier lifestyles.

Here we are back at individual responsibility and community commitment.

What If

I was wondering how things would be if Medicaid had preceeded Medicare. What if children had been placed first instead of senior citizens? What if there was a health care system that included medical care but was not dominated by medical care? What if health care was based upon primary prevention services, identification and management of health risk, and early detection of health problems? What if all people (everyone) participated in such a health care system with access to early medical care when it is necessary?

Then, I read about the proposal from the Illinois Governor to provide health care to all children.

"Every single child ought to have health care. If a child needs to go to a doctor, that child ought to be able to go to the doctor," Blagojevich said. He added that health insurance programs for children should target both middle-class and low-income families. "They work, and despite their best efforts, they cannot take their children to the doctors. That's not right in my view," Blagojevich said (Chicago Tribune, 12/13).

Susan Sontag's son recently wrote in the NY Times Sunday Magazine about his mother's struggle with terminal cancer. Several cancer specialists observed that with current knowledge early detection is the most productive course of action.

The focus needs to be on "diagnostics rather than therapeutics," Hartwell said. "If you catch a cancer at Stage 1 or 2, almost everybody lives. If you catch it at Stage 3 or 4, almost everybody dies. We know from cervical cancer that by screening you can reduce cancer up to 70 percent. We're just not spending enough of our resources working to find markers for early detection."

Mark Greene, the John Eckman professor of medical science at the University of Pennsylvania and the scientist whose lab did much of the fundamental work on Herceptin, the first important new type of drug specifically designed to target the proteins in the genes that cause cells to become malignant, agrees with Hartwell. The best way to deal with cancer, he told me, is to "treat early, because basic understanding of advanced cancer is almost nonexistent, and people with advanced cancer do little better now than they did 20 years ago."

Not so crazy, after all.

Tuesday, December 13, 2005

Older With Hope For the Future

Life expectancy in the US increased to 77.6 years in 2003 from 77.3 in 2002, according to a report released on Thursday by the National Center for Health Statistics at CDC. However, about half of U.S. residents ages 55 to 64 have high blood pressure, and two in five are obese. NCHS researchers examined data collected by the agency and other health agencies and organizations. Deaths from heart disease, cancer and stroke all decreased by between 2% and 5% in 2003. Researchers also compared data for U.S. residents ages 55 to 64 in the early 1990s with data from baby boomers, who are currently in that age group. According to the report, 42% of U.S. residents who were ages 55 to 64 in 1990s had high blood pressure, compared with 50% of baby boomers, and 31% of those in the 1990s group were obese, compared with 39% of baby boomers.

That is good news but with a note of caution. The implication is these statistics might become worse in the future. True, but to be forewarned is to be forearmed and there are means to change extrapolations for the future. More people and organizations are recognizing the ability to change that future with lifestyle and preventive health care.

On that note, researchers at the Yale School of Medicine report the rates of chronic disability in older Americans has been substantially overestimated by about forty percent (December 12th Archives of Internal Medicine). America and older Americans need to stop thinking of age as a special category with decreased potential. Productive contributions to society, enjoyment of life and optimum health should be considerations until the very end of life. No one should ever give up joyous anticipation of the future.

Sunday, December 11, 2005

Where is the Outrage?

Danger is not always obvious and obvious danger is not always the greatest risk. Great empires have decayed with no threat from foreign enemies.

Some dangers can injure or kill no more than small groups but the exposure is high; automobile accidents, for example. Earthquakes, tsunami's, pandemics and weapons of mass destruction can kill large numbers but the risk of occurence is low. Then, there are those dangers like climate change and lifestyle that kill slowly, everyone is exposed and the risk is extinction.

The world is an integrated place and no danger can be considered isolated from another. Humans have survived because of the ability to learn and adapt to the conditions present in the world. It may be that the dangers created by humans are the most difficult to understand. Lacking understanding makes the danger appear more remote and the responses more disruptive to current circumstances.

History teaches that the decay of great empires was rooted in lifestyle. The vitality and ability to respond to danger came from the value system and lifestyle of individuals that gave common purpose to the civilization and culture. Unhealthy lifestyle destroys because people can no longer see the value of changing and the ability to adapt is lost.

Saturday, December 10, 2005

A Gentle Wind Bringing Change

Health care in the United States has begun a transformation that is expanding and shifting the focus from diagnosis and treatment of illness and disease to health promotion and cost effective prevention. Scattered communities throughout the US and the world have initiated activities and projects moving in this direction. It is too early to determine exactly how this will proceed but there are several trends that deserve consideration.

The traditional medical model functions best within very narrow boundaries that encompass illness and disease. Outside of these boundaries the medical model is grossly inefficient and even dangerous. For example, the overuse of medications increases the incidence of serious side effects. Also, it is apparent that public health as it currently functions has limited leverage to exert the leadership for the type of change that will remodel the health care system.

The opportunity lies with communities that want to redefine themselves and raise the level of health status for all citizens. It requires the ability to explore, create, evaluate and implement new models for health promotion and disease prevention. The community becomes the laboratory and every institution and individual is a participant and partner.

This is a process that must avoid duplication and creation of unecessary overhead. It can be a powerful force that is based upon attitude and perspective rather than buildings and equipment. The linking and engagement of individual responsibility and community commitment will change everyone over time in untold ways.

Tuesday, December 06, 2005

Learning Lifestyle, Continued
  1. Motivation is the ignition for a biological machine
  2. Get a grip - establish goals and practice patience and persistence
  3. Live today and plan in detail for tomorrow and the next day
  4. Plan each day for what you must do, what you should do and what you want to do
  5. Be honest about must do, should do and want to do
  6. Don't waste a day because of a bad moment - every day and parts of a day count
  7. Make small changes over time - it will make a big difference
  8. Clean up your environment - organize and discard
  9. Commit to feeling good - when you feel good, you do well
  10. Compliment someone each day
  11. Walk 10,000 steps each day - get a pedometer, it will motivate you
  12. Sleep seven to eight hours each night
  13. Avoid eating while standing up, watching television or riding in a car
  14. Always eat off a plate - china, if possible
  15. Eat smaller, more frequent meals - it helps appetite and metabolism
  16. Express the style that identifies you

Style is about you and life

  • it is maturity, responsibility, self worth, relationships, passion and dreams
  • it is work, play and accomplishments
  • it is being thoughtful, elegant, casual, unique and belonging
  • it is the power of one, the power of many, the power to be all you can be and to know it
  • it is health, function, endurance and energy
  • it is to be captivating, compelling and motivating
  • it is to be an example and memorable

Beauty is in the eyes of the beholder, Style is in your mind's eye

Above all, enjoy a life with Style

Sunday, December 04, 2005

Medication Culture

Young, Assured and Playing Pharmacist to Friends - New York Times reports how the medication culture in the US contributes to the drug culture. There has evolved a view of psychology and health as problems that can be solved with pills. Certain feelings indicate the use of certain pills. Taking medications to perform better academically occurs from elementary through graduate school. The experiences are shared by trading medications and passing medications on to others. Examples are given of individuals who bounce from Xanax to Ritalin to Adderall to Prozac to alcohol and cocaine.

The most overmedicated group of people in the world are senior citizens in the US. Medicare will now help pay this bill, which will become much larger. Not to worry that a large number of children lead unhealthy lifestyles and do not receive proper care. Oh, well, the kids can always be put on drugs. It will not make them any healthier but they may feel better and contribute to sales for the pharmaceutical companies.


Just remember about the walking, 10,000 steps daily is the goal. Start slowly and build up, every step counts.

Stop whinning, the soreness in your lower back and knee will get better as you get tougher. Physical activity is just about the only thing you can do to improve the health of joints. The pain in your rear end will get better as you get the load off it. You will relieve the constipation of your colon, brain and spirit.

Get a plan. Try it, you will like it. Beats Prozac everyday.

If you need a friend, get a dog. Don't come to me. My kick will increase the discomfort in your backside.

Saturday, December 03, 2005

The Place To Start

Americans will try any fad diet that comes along and blame stress for their lack of success. Any herb or compound that promises mirace results gets a try. A variety of sleep medications are used to counter poor sleep habits. Yet, with all of this lack of insight, physical activity is the least understood aspect of healthy lifestyle.

Physical activity is the most important aspect of healthy lifestyle. Nothing comes close to physical activity for influence upon the entire spectrum of metabolism. Physical activity moderates the stress hormones, relieves depression, promotes sleep, increases sensitivity to insulin, reduces low density (bad) cholesterol, increases high density (good) cholesterol, improves cardiopulmonary endurance, and on and on. Physical activity provides discipline for the other aspects of healthy lifestyle.

Start slowly and build gradually. There is a tendency to do too much too quickly, but the most significant problem is that people woefully underestimate the amount of physical activity required. The government standards are pitifully low and the majority of Americans do not come close to meeting them. Take the long-term view and set the sites higher. Refer to the post on November 23rd about 10,000 steps daily. Without this degree of effort you will never be successful or pleased with the results.

Health News Article Reuters.com: "Many Americans choose couch over treadmill"

Thursday, December 01, 2005

Learning Lifestyle

Children of every age exhibit unhealthy lifestyles associated with chronic diseases that are increasing at an alarming rate. Promoting optimum health for all children is a complex undertaking that is complicated by an adult society caught in the spiral of unhealthy lifestyle pulling the children with them into the vortex. Physical inactivity, poor nutrition, poor response to stress and excessive use of medications are some of the features of lifestyle with dire consequences for children. To ignore this situation is to risk limiting the potential for society.

The problem will not be corrected quickly and no single intervention will reverse the process. Unhealthy lifestyles are a societal issue and the solution will be forged by the community. Healthy lifestyles for children and adults are best built upon a foundation of meaningful experiences. Motivation and enthusiasm count for a lot.

Conditions that shape physiology and influence health begin during pregnancy and extend through early childhood. Inadequate fetal nutrition can make people more vulnerable years later to obesity, cardiovascular disease, hypertension, diabetes and problems with immunity. Among other things, breast feeding influences immunity, allergies, childhood obesity and development of hypertension in adult life. Preparing young women for pregnancy and the care of infants is a responsibility that cannot be left to chance.

Children learn best as participants rather than spectators and peer groups are an important influence upon development. This is especially tue when learning the basics of healthy lifestyle. Preparing and eating nutritious food and growing vegatables are effective ways to learn nutrition. Tending a garden is physical activity. Playing physically active games and accomplishing tasks that require manual labor are exercise. The learning process is enhanced when the task is significant, when there is a sense of accomplishment and when the task is entertaining. A sense of belonging to a community associated with service to others is an effective teacher of purpose and healthy lifestyle.