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Fixin' Healthcare

Monday, January 30, 2006

The Lifestyle Chronicles - Before Pregnancy

The development of healthy lifestyle for a society requires starting at the beginning. That point is earlier than many might think The health status of young women in the childbearing years is of crucial importance. And, these young women need to understand healthy lifestyle to assure a healthy pregnancy and care for the child that will be their responsibility.

There is evidence that a child is more likely to be overweight if the mother was overweight before pregnancy. Young women need to be protected from exposure to toxins, especially those that hang around for a long time such as mercury. Physically fit, no smoking, healthy diet and managing stress are important prior to pregnancy.

I wonder if young women in our society realize that they are very special. What do public debates and attitudes teach them? Their lifestyles have far reaching significance and they should have special attention. Each community should examine how that is accomplished. In all cases it should start with the family but the family is only the beginning. In some communities the Girl Scouts address this issue. Schools, churches, clubs, neighborhoods. Let everybody feel the responsibility.

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The Lifestyle Chronicles - A Belated Introduction

The Lifestyle Chronicles are a series of presentations dedicated to the belief that the greatest influence upon health status is lifestyle. Lifestyle consists of everything that is done throughout each day; the habits, behavior and biological responses (physical and mental). Lifetsyle is influenced and learned from pregnancy through old age. It is never too late to change lifestyle but the most leverage for development and change comes earlier in life.

There are defined periods in the life of every individual that have differential influence upon development of lifestyle. These periods extend from the health status of the mother prior to pregnancy through pregnancy, infancy, childhood, aldolescence, young adults, middle age, senior citizens and the elderly.

These phases of the lifecycle and the components of human capital as described by David Brooks are evaluated in relation to each in order to assess the development of lifestyle. Taken together these are powerful determinants of lifestyle and health status.

Some of these thoughts have been introduced in previous posts. Implied but not stated as such is the great difficulty changing bad habits and unhealthy behavior later in life. Not only difficult, but also expensive. The health care system is built upon society's lack of attention, inabilities and failures to effectively address lifestyle.

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Saturday, January 28, 2006

The Lifestyle Chronicles - Lifecycles

The human lifecycle contains spans of time when it is possible to get the attention of people. For example, women during pregnancy are usually focused upon a healthy pregnancy and a healthy baby. Children from infancy to five and six years old require great care and attention because all evidence indicates they are sponges of interactive learning and highly receptive templates. It is possible to get the attention of children in elementary school but it requires some organization. And, getting the attention of young people in junior high through high school presents much more of a challenge.

These are windows of opportunity for building of purpose for individual lives that will yield great benefit for society. All of the resources available to a society should have some aspect devoted to those special times. One example is the high leverage yield from attention to children from birth to five or six years.

Retirement is being challenged anyway, so it might as well be put on the table. The concept of retirement belongs to a bygone era. Society cannot afford to lose the participation of people whose healthy and productive life span is more likely to be increased if they remain engaged and active. Eliminate the retirement age and utilize social security for people who really need it.

That is enough preaching, especially for a Saturday afternoon.

The Lifestyle Chronicles - Center Stage

The health policy wonks and Washington DC political devotees are abuzz about Health Savings Accounts (HSAs) because previews of the State of the Union speech indicate that will be featured. And, I'm sure the financial institutions and insurance companies are licking their chops. More like a studio production than an independent film. Does anyone really believe this will change anything substantive about health?

Ever since large amounts of money began flowing through the health care system and we began treating "sickness" as a national priority, health care has become the land of economic opportunity, political opportunity, literary (columnists and bloggers) opportunity and ego enhancement. HSAs will do nothing to improve health status or keep people healthy. Bush doesn't know anything about health because he has no one advising him about "healthy". It's strange in that he seems to try to pursue a healthy lifestyle. He should have faith in the strength of his convictions.

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Friday, January 27, 2006

The Lifestyle Chronicles - Good Soldier

Tommy Thompson had a good run as a public servant and by all the evidence he has performed well. As Governor of Wisconsin he got out front with an innovative approach to welfare that produced some results during the Clinton Administration. During his tenure as HHS secretary, he was a strong supporter of health promotion and preventive health care. Now, he is chair of the Center for Health Solutions at Deloitte Touche (you can't blame the guy for trying to make a little money before his star fades from view).

I am proud of him because he continues to carry the flag for preventive health care. And, he still occupies the bully pulpit. At a recent conference for CEOs, senior executives and human resources personnel, he called for a shift to preventive care. He is pushing the topic even if all the specifics of his agenda do not fly.

Raising the prices on junk foods in the cafeteria won't work; you might as well get the junk food out of there. I'm all for it but I doubt that requiring employees to exercise will accomplish much. On the other hand, charging smokers more for health insurance is a good start. By all means, increasing the use of IT will start health care catching up with the world but let's be careful about overpromising on the rate of return. Most health professionals would join the movement to IT for the convenience and expansion of capabilities. They are not so dumb or resistent to IT as might be thought.

Keep up the good work Mr. Secretary/Governor. Just be sure they spell your name correctly and they always include "preventive health care".

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Wednesday, January 25, 2006

The Lifestyle Chronicles - Medicare Part D

It was my intent to avoid commenting on the new Medicare drug benefit (Part D) beyond a brief response over at The Health Care Blog. So many others have already offered their opinion. Everyone appears to accept the basic premise that the program will benefit seniors but the design and implementation are a mess. With all due respect to my health policy colleagues, I must rise to the bait because my objection is to the basic premise. Medicare Part D is bad medicine and it is bad government.

Senior citizens in the US are the most overmedicated group of people in the world. Their lives and drugs are so intertwined that it is difficult to evaluate the original justification. The course of life is changed by dependence on drugs and the quality of life is lowered when taking drugs that are not necessary. Unfortunately, that situation often occurs and Part D will aggravate the problem.

It is sad but true that people have been conditioned to expect much from drugs. Physicians are trained to prescribe drugs and they have limited time to spend with patients who frequently and aggressively seek drug therapy for the perceived benefits.

For example, physicians know antibiotics don't have effect on viral infections. Yet, there is a lot of antibiotic therapy given for viral infections. I ask you, why is that? Antibiotics are potent medications with many potential adverse effects. The overuse of antibiotics is creating lethal infectious organisms that are resistent. This could be considered equivalent to another terrorist threat.

People seek medications to counteract conditions caused by their lifestyle rather than change lifestyle. "Heartburn" and "acid reflux" are so common that Prisolec and Nexium were the third and fourth most prescribed medications in 2003. In my experience over 90% of people with these conditions get relief when they cease eating highly processed "junk" food and drinking sodas. There has been an increase in esophageal cancer which some attribute to "acid reflux" but these drugs contribute to increased alkalinity that can be even more toxic to tissue.

Consider the people who get drugs and don't take them, the situations where the drugs have no effect or an effect unrelated to the problem, the situations where the wrong drug is prescribed and the adverse reactions to the drugs. My guess is that represents about 50% or more of the drugs prescribed.

Public health and medicine should be creating public awareness where drugs are considered potent agents with capacity to do good or cause harm. Drugs should be taken when necessary and changes in lifestyle will decrease the necessity to an extent that could reach 50% of all drugs and OTC preparations. Instead the government has thrown open the floodgates for bad medicine and I doubt most doctors will be able to resist the tide. Look for drug utilization to go up and health status to decrease.

Part D is bad government because the money could have been put into Medicaid with greater benefit to more people, including the senior citizens. Given the choice between Part D and nursing home care, my advice is to choose the nursing homes. Medicaid could cover the necessary drugs and doctors would be more circumspect about prescribing.

I advocate repeal of Part D and I am a senior citizen.

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Tuesday, January 24, 2006

The Lifestyle Chronicles - Overwhelming But Unavoidable

Lifestyle is not one thing or the only thing, it is everything.
Lifestyle is the process of living all day, everyday.
Lifestyle is influenced by what is learned at an early age.
Lifestyle is assessing risk and managing risk, if you want to live.
Lifestyle determines health status over a lifetime, like it or not.
  1. What is eaten - whole food with high nutritional value (vegetables, fruit. nuts, seeds).
  2. What is not eaten - highly processed "junk" food is toxic to metabolism.
  3. How much is eaten - fill 'er up with whole food containing high nutrition value.
  4. When it is eaten - smaller, more frequent meals and don't forget breakfast.
  5. Daily physical activity of sufficient duration and intensity - 10,000 steps with some hills.
  6. Adequate sleep - grandmother said seven to eight hours.
  7. Managing stress - avoid it or take a deep breath and a walk.
  8. Avoiding unhealthy behavior
    • smoking
    • reckless physical activity
    • illegal drugs
    • excessive prescribed medications
    • excessive OTC compounds and herbal preparations
    • exposure to toxins and infections

The Lifestyle Chronicles - Public Debates

What can be learned from public debates and points of high public attention? Appointments to the Supreme Court, abortion, assisted suicide, health insurance, the genome and cloning come to mind.

To many, if not most Americans, these issues are abstract and academic. It is open to question whether these are debates that reflect the attitudes and values shaping life in America. However, one does wonder how courts and hospitals have come to rival family households and schools as centers of the community.

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Monday, January 23, 2006

The Lifestyle Chronicles - Lethal Habits & Addictions

The campaign against smoking goes on and on. It demonstrates the difficulty eliminating habits and addictions even when they are hazardous to health.

Last November the voters of Washington State overwhelmingly approved a ban on indoor smoking in public places. Additionally, the ban requires smokers who light up to stay at least 25 feet from the door of any such place. The ban was implemented in December. Officials in Washington say it is the toughest anywhere in the country to be adopted statewide. Smokers are complaining and businesses are trying to respond by building smoke shacks.

Spain has an antismoking law that went into effect this year. Smoking is banned in workplaces and restricted in many bars and resturants. The New York Times provided the opportunity to "vent" for one Spaniard who thinks this is an example of the state trying to regulate citizens' private lives and customs. He draws analogies with sunbathing, mountain climbing and the need for health warnings on automobiles. And, it is implied the government encourages smoking for the revenue generated through taxes. (I wonder if the editors really intended this when they gave him the rope.)

It is doubtful, even in Spain, that taxes on cigarette sales come close to providing for the health care costs attributed to smoking. However, it is one of those situations where the revenue should be restricted to health care and/or smoking cessation programs. So far, most states have not even restricted the tobacco suit funds for those purposes.

Education is the answer and it needs to start early. Reducing and eliminating unhealthy habits and addictions calls for society to cultivate cultural and social capital. Laws and law suits may help but they are hardly the solution. When there is no market, farmers will have no reason to grow tobacco or companies to manufacture cigarettes unless the government in its wisdom chooses to subsidize the effort.

Prevention is the toughness to survive and prevail. It is patience, persistence and constantly answering the bell for the next round.

Saturday, January 21, 2006

The Lifestyle Chronicles - Distractions

In his article on human capital, David Brooks writes of important cognitive skills that are not measured by IQ tests and can be improved over a lifetime. He may not have been referring to mental focus and attention span but it would fit the description. In fact, there is an added twist that society seems to have declined in this ability over the past generation.

The significance of the problem can be attested to by the large numbers of people assigned to the medical classification of Attention Deficit Disorder. For example, America consumes 80% of the Ritilan produced in the world.

Attention deficit is a problem for society and it is a condition that afflicts individuals. There are a number of plausible reasons given for the increase in the incidence and severity of this problem. Most of the people who suffer with the condition do not have a medical disorder and should not be treated with medications.

Information overload is always present. It becomes a problem when associated with an absence of mental focus and attention. Mental focus and attention may well fall into the category Mr. Brooks calls cultural capital that is developed very early in life. The eargerness to use drugs has been a distraction that has delayed the development of skills to prevent and relieve the condition.

Friday, January 20, 2006

The Lifestyle Chronicles - Learning

Not all people learn the same way so education must take a variety of forms. Information must be reliable and consistent, as far as the discovery of new facts will allow. Receiving information from respected authority is helpful. It helps to reinforce information and to put information to use. Entertainment and education are productive partners. People, including children, learn from their peers. Facts need interpretation that stimulate people to learn.

I spent years in school at a variety of universities and hospitals and many years working in academic medicine. Every good educator I have known did not teach as much as stimulate students to learn.

The Lifestyle Chronicles - Human Capital

The success of any activity or organization ultimately depends upon the people who are involved. Other resources such as money, space and technology are factors that draw attention but the highest relative value belongs to the people.

Evaluating people is an important activity for society. Evaluations are the source of many crucial decisions that influence the course of peoples' lives. US society is in a proplonged period of evaluating people predominantly upon skills and knowledge that can be measured by tests. There is justifiable concern that tests and testing have begun to transform society in unknown ways and in ways that may not be desirable.

David Brooks describes a concept he calls human capital that consists of five underlying components from which everything follows. The tests for skills and knowledge are only a superficial measure of human capital.

  1. Cultural capital is the habits, assumptions, emotional dispositions and linguistic capacities that are unconsciously learned by age three years from family, neighbors and ethnic groups. Studies have determined that what happens in the family shapes educational achievement more than what happens in school and most of the gaps in college attendance and delay are determined by early family factors.

  2. Social capital is the knowledge of how to behave in groups and within organizations. It can mean knowing the basic rules of politeness.

  3. Moral capital is the ability to be trustworthy. Brains and skills don't count for much in the face of chronic tardiness or absence from the site of action (work, school, etc.).

  4. Cognitive capital means brainpower. This is usually measured by IQ tests but there are cognitive skills that are not measured by such tests and can be developed over a lifetime. Some people know how to evaluate themselves and their abilities, while others do not. The same is true for sensing what others feel.

  5. Aspirational capital is the ambition to achieve. Some capable people do not use their skills and capabilities, while others exceed their measured abilities.

There is a substantial body of knowledge about these components of human capital. The things that work are local, human-to-human contacts that transform individuals beginning at an early age. Much can be done to prepare people and society for a rapidly changing economy or whatever the future might offer.

The Lifestyle Chronicles will explore the crucial stages in the development of human capital and propose mechanisms to establish healthy lifestyle. The purpose will be to demonstrate a link between human capital, lifestyle and health status. The justification will be to improve health status at a fraction of the cost of the current health care system.

Tuesday, January 17, 2006

Eugene Stead, Jr., M.D.

Dr. Eugene Stead died on June 12, 2005. I did not know Dr. Stead personally but I knew of him as did almosr everyone of my generation in medicine. He started at Emory University but moved to Duke where he was chairman of the Department of Internal Medicine. He was an extraordinally gifted teacher who inspired students to learn and he had a national reputation as an educator. As evidence of his abilitiy, thirty-three of his trainees went on to become chairmen of the departments of medicine at their repective universities. There is no one I know of that equals the influence of Dr. Stead upon the development of academic medicine.

He is credited with a saying I have admired and it goes something like this - "I can teach medical students without the involvement of resident physicians but I cannot teach resident physicians without the involvement of medical students."

I did not know Dr. Stead personally but I knew of him and his work. His contributions are known and appreciated. He made a difference.

Monday, January 16, 2006

Young Women and Babies Are Pure Gold

If the US is to have a major impact upon health status in a short period of time, there must be more emphasis on healthy lifestyle and prevention of disease. If this impact is to be lasting, the emphasis must be placed upon children. All age groups should be included but the greatest potential comes with the young woman before pregnancy and children from birth to five years of age.

A recent study from Ohio State University published in the December 5, 2005 Journal of Pediatrics shows that a child is more likely to be overweight at a very early age if the mother was overweight or obese within one to two months before she became pregnant. Also, a child is at greater risk of becoming overweight if born to a black or Hispanic mother, or to a mother who smoked during her pregnancy. As much as five percent fewer children who were breast-fed were overweight, compared to bottle-fed babies.

The World Health Organization recommends that mothers feed their babies exclusively on breast milk for six months, and continue to offer it alongside other food for at least two years. Whether or not a woman follows these recommendations to their fullest, breast feeding affords a large number of health benefits to babies that extend into later life.

And, the health benefits of breastfeeding include the mother. A research team from Harvard Medical School found that one year of breastfeeding was associated with a 15% decrease in a woman's risk of developing Type-2 diabetes. The protective effect lasted for up to 15 years after a woman's last pregnancy and delivery. The production of milk requires a breastfeeding mother to use an average of 500 calories each day - the equivalent of running four to five miles.

Pat Faulkner in her comments on an earlier post suggested an educational program for pregnant women, and I agree. Such a program should include all women of childbearing age with reinforcement during pregnancy and the first five years of the babies life. Later we will consider the evidence of noncognitive and cognitive benefits from intervention during the first five years of life. A dollar spent here will yield large returns down the line.

Maybe we should let babies vote and cease voter eligibilty after age 65 years. Hmmm, I wonder....

Sunday, January 15, 2006

Learning From Nature

Nature has many lessons to teach about the problems that surround us. To paraphrase Felix Frankfurter, her decisions may be both final because they are absolute and absolute because they are final.

There was an interesting followup today in the New York Times about the recent reference to introduction of wolves in Yellowstone Park. An annual census found a precipitous drop in the population of wolves in the park. The census found 22 pups, compared with 69 last year, and the total count of wolves dropped to 118 from 171.

Park biologists suspect a canine paravirus. There is a vaccination for paravirus and it can be treated, but the park biologists have decided to let nature to run its course. They could not catch every animal and this course of action allows the wolves to develop natural resistence.

This will be worth following for its impact upon the wolves and upon the ecology of the park. There has to be a lesson for us in the process and the outcome. As far as the elk are concerned the situation must be somewhat like salvation as in War of the Worlds.

Ah, Mother Nature, not always so sweet.

Saturday, January 14, 2006

Trophic Cascade

The Australian Commonworth Government launched a preventive health program to encourage doctors to advise patients on how to change their lifestyles to improve their health. The US Government proposes financial mechanisms that place medical choices and decisions in the hands of the consumer (patient). And, US corporations require employees to take a greater share in the financial obligations of medical care.

Good public policy should represent the values and priorities of the people it serves. Australia is taking steps to improve health status. In the US, Healthy People 2010 is the program to improve health status and it needs to be the top priority of health reform. Otherwise, change will be a financial manipulation with deterioration of health status.

Change in health care is a complex and difficult concept. Achieving concensus will be unlikely. There is need to seek the change that will create a trophic cascade. An example can be found in nature with the change in the ecology of Yellowstone Park after the introduction of wolves. Ten years later, the number of elk has decreased and they moved to higher ground. This has changed the vegetation in the park and increased the number of smaller animals, birds and fish. It is expected the change will continue and the number of factors involved will increase.

Health care reform in the US must be approached with the goal to improve health status of all citizens. Currently, this does not appear to be the case but the opportunity is there.


To take a licking and keep on ticking.

It is one thing to give a beating and think you are tough; it is quite another to take a beating and believe you are tough. History proves the true definition of toughness is the ability to take a beating. Survive, grow stronger and live to fight another day. Those who give beatings come and go but some of them always seem to be around.

Don't get mad, don't get even, just keep a'coming.

Patient, persistent, resilient and constant.

Thursday, January 12, 2006

A Boy Named Sue

I acknowledge that polls are designed and administered in a manner that produces reliable results, but the validity of polls addressing highly emotional and personal topics is questionable in my view. Under those circumstances people will often reserve negative views in favor of how they might wish things to be.

The poll conducted by the market research firm NPD Group and reported in USA Today indicates that people are more accepting of excess body weight. I do not have a formal poll but I discuss the topic of weight with at least 100 people each week who are overweight or obese. And, I take the opportunity to discuss the topic with people who are not overweight. These people are frustrated and perhaps resigned to excess weight, but they are not accepting of excess weight. People perceive that excess body weight is unattractive and a health hazard. They may be symphathetic but they are not accepting.

Two reports in the January 11th issue of the Journal of the American Medical Association offer further confirmation that overweight and obesity is a health hazard. Lijing Yan and collegues at Northwestern University linked overweight and obesity at age 31 through 64 years with hospitalization and death from coronary artery disease, cardiovascular disease and diabetes after age 65 years. Also, a large international study demonstrates that people worldwide with coronary artery disease, cerebrovascular disease and peripheral arterial disease often have risk factors such as obesity and hypertension that are undertreated and undercontrolled.

The challenge is not to sweep an obvious marker of unhealthy lifestyle under the rug but to find ways to solve the problem. The song recorded by Johnny Cash might be appropriate.

Wednesday, January 11, 2006


Today I feel as if a black cloud is hanging over me. First, I cannot post using Firefox Performancing (reason unknown) and the third day of four articles appeared in The New York Times that outline too well our problems with health care.

The first article on Monday is about expenditures on health care in 2004. "Total spending rose 7.9% to $1.9 trillion, or an average of $6,280 per person. That represents 16 percent of the nation's economy, the highest share on record."

The other three articles are about diabetes in New York City.

An estimated 800,000 people in the city have diabetes, more than one in eight. It is the only major disease increasing both in the number of new cases and the number of people it kills. As bad as diabetes is in the city as a whole, it is much worse in East Harlem where an estimated 16 to 20 percent of the population have the disease. That is one in five and the people die at twice the rate of the entire city. The impending crisis was recognized and in 1999 the first of four hospital centers was established to relieve and reduce the incidence of complications from diabetes. All of the centers are closed today due to lack of financial support.

Dr. Thomas R. Frieden, commissioner of the NY City Department of Health and Mental Hygiene is quoted about prevention and relief of complications of diabetes. He said that getting millions of people to change their habits will require some kind of national crusade.

Well, why not? Certainly, we spend enough money to launch several crusades. And, we will die waiting for insurance companies to wake up or the government to take any kind of effective action. Diabetes and a number of other major diseases can be prevented and relieved by a healthy lifestyle. Personal responsibility and commited community action are the most promising avenues for progress. It is low cost and it works.

The sea is at our backs. There really is only one way out. CHARGE!

Sunday, January 08, 2006

Wal-Mart To the Rescue?

Some aspects of Wal-Mart are difficult to admire. For example, low wages and the lack of benefits. These do not conform to our perception of standard practices. But Wal-Mart has developed a business model that that puts constant pressure upon excess cost in retail and many demonstrate their admiration by shopping there. At the very least, you can't blame them for doing what they are good at.

How, then, might Wal-Mart assist with the current problems of health care?

Slate offers some observations that deserve consideration. Wal-Mart does offer a cheap bare-bones health insurance policy but fewer than half of the employees sign up. The prices on health-related products and medications from their pharmacies are as low as you go in the market. Now, Wal-Mart is using its business model in an attempt to drive down the cost of health care plans. The author, Daniel Gross, speculates quite well that this effort is just a toe in the health care ocean. However, who better than Wal-Mart and their business model to further test this approach?

I would hasten to add that some insurance companies have tried this method of using large scale purchases to drive down prices and achieved only limited success. Whether any of us like it or not, health care is a business and it has a very well established political structure. To change health care requires a change in the culture as well as the business model. It is a massive undertaking and it cannot be done in one swift stroke.

Wal-Mart putting pressure on prices might be one leading edge to begin a change process but there might also be others. A neglected area of health care is lifestyle modification and prevention of disease. A scientifically-based and verifiable body of knowledge has accumulated that justifies approaching the problems of health care from this direction. Granted it is a long -term approach but it has the greatest potential for beneficial change and done properly it should be low cost.

Lifestyle modification and prevention of disease is not an easy task. It has to be built into the culture and the most promising way to do this is a community effort that involves every organization and individual. I would love to see Wal-Mart take a leadership role in that kind of project. It would be a good business decision.

Saturday, January 07, 2006

Choose Your Partners Well for Wellness

Staff at the University of Washington School of Public Health and Community Medicine surveyed US employers about coverage of clinical preventive services and reported their findings in the American Journal of Health Promotion 20(3), 2006.

The primry motivation for offering preventive care programs is to lower health care costs and reduce absenteeism.

Large employers (more than 500 employees) are more likely to offer preventive services.

Only one-third of employers used incentives to get employees to use the preventive programs. Large employers are more likely to use financial incentives (lower insurance premiums) and smaller employers gave time off to use the services.

Physical exams, immunizations and cancer and cholesterol screenings are the preventive services most often covered.

Only 20% of employers included relatively low cost services with high potential for financial return such as smoking cessation, reducing alcohol abuse, better nutrition, more exercise and flu shots.

The authors speculate as to why employers who seek financial return from preventive services are least likely to offer the services most likely to provide this return. Their speculation fails to note that the preventive services most often covered are medically oriented. The employers have relied upon providers who are not familiar with the goal and have no experience with the means to accomplish the goal.

Lifestyle modification programs are long-term in a short-term environment but they offer low cost means to high potential returns. The current crop of health care practitioners, hospitals and insurance companies are not prepared to assist with this task.

Friday, January 06, 2006

What Did You Say We Are?

Just about everything gets ranked by some group or another these days. Newsweek ranks colleges and universities. Hospitals and cardiac programs get ranked and those in the top 100 or so place their results on billboards. As Matthew Holt noted today even blogs get ranked. It is difficult to keep up with the critera for rankings and what it all means.

Reported in USA Today is the results of the ranking for the fittest and fattest cities by Men's Fitness magazine. So as to not keep you in suspense, Baltimore is the fittest city and the beef and potatoes crowd in Chicago get the nod as the fattest city. My daughter will be unhappy to hear that.

It is interesting that the contrasts are fittest and fattest. Is thinest a word? Nevertheless, many of the comments about Baltimore focused on food and not excercise. There is mention about the amount of public park space and the relatively small number of fast-food resturants.

Whether or not the rankings have any meaning, it is encouraging to see how various aspects of community life are brought forth as having an influence on fittness. It should stimulate Baltimore to live up to the ranking. As for Chicago, the gauntlet is down. This might be a good way for Mayor Daley to put some space between his troubles.

As for healthy lifestyle and achieving optimum health, the attention can't hurt.

Learning the Basics

"Local agriculture" and "sustainable environment" are terms that everybody needs to know. They are about how food is grown, how food gets to the table, a cleaner environment and conservation of energy. And, they are about healthy lifestyle and health.

Chef Alice Waters founded her resturant, Chez Panisse, in Brekeley, California more than 30 years ago and she has been a champion of these principles. In 1995, she established the Edible Schoolyard as a one acre graden at the Martin Luther King, Jr. Middle School in Berkeley. At the garden students help to plant and harvest fruits and vegetables, then cook and eat meals using their own produce.

The program has expanded into all 16 public schools in Berkeley, providing nutritious lunches for more than 9,000 students from kindergarten through high school. She believes the project will succeed if all the students in a school take part and they will take part if the food is delicious, as well as healthy. Also, she believes the project must be incorporated into the classroom studies of geography, history and the sciences. Where does food come from? How is it grown? What happens when you cook it?

The Promise Academy is a charter school in Harlem. Almost 90% of the students come from families poor enough to qualify for frse government lunches, and 44% are overweight. School officials regularly measure the children's weight and fitness along with their academic progress. Eating at the Promise Academy is more than just the food. Children learn to respect where food comes from and who serves it, as well as whom they eat with.

From Middlebury College and the University of Montana to public schools in Tallahassee, Florida, officials at more than 200 universities and 400 school districts are supporting a farm-to-cafeteria movement to build their menus around fresh local ingredients. The Department of agriculture has provided very little money for farm-to-cafertia programs but individual administrators are using sustainable agriculture as part of the new federal wellness initiative which requires school districts in consultation with parents, students and schools, to create a comprehensive wellness program with nutrition guidelines.

Thursday, January 05, 2006

Hospital Wars

On Tuesday USA Today reported that hospitals spent $100 billion dollars for capital inprovement over the past five years, a 47% increase fom the previous five years. Another report this morning in USA Today relates that the nation"s hospitals posted profit margins that reached a six year high in 2004 and indications are that 2005 was just as good. A report by the Center for Studying Health System Change found that hospital price growth slowed in 2004 for the first time in seven years. One-third of all health care spending in the USA is for hospital services.

An op-ed in the Wall Street Journal today lamented the closing of a for-profit hospital in Milwaukee after one year of operation. It was written by a cardiologist who had invested and was working in the hospital. He reported that the hospital was built and organized to care for patients with cardiac problems. It was his opinion that other hospitals and government regulation contributed to the closing.

I am reminded of something written by Peter Drucker. Efficiency is doing something right and effectiveness is doing the right thing. Sort of hard to sort them out sometime.

Tuesday, January 03, 2006

To a Hammer the World Is a Nail

The hospital industry has spent nearly $100 billion in inflation adjusted dollars in the past five years on new facilities, up 47% from the previous five years, according to the Census Bureau and reported by USA Today. The new hospitals feature private rooms, more technology and suburban locations.

Achieving the best health status possible by planning to be sick is comparable to the French defense strategy prior to WWII. The outcomes are expensive monuments to address historical circumstances.

If you had the dollars to spend and your goal was to achieve the best health status possible for your community, how would you spend the money?

Now There Is a Thought

Scotland has some of the worst health statistics in the United Kingdom. But, the current leader of Scotland's doctors has come up with an innovative and progressive proposal.

Every government spends a lot of money and most of it is expended in a loculated fashion. An overarching social policy that links all programs could accomplish more with the same resources. With that thought in mind, what could be more important to any society than the best health possible for its citizens?

You go, man and keep us informed.

Legislate For Better Health Says Leader Of Scotland's Doctors: "Many factors in society contribute to the public‘s health and by integrating health assessments into education and social policy, for example, every decision made would be an investment in the future health of our population. "

Monday, January 02, 2006

Placebo Effect

Research shows that expectations have psychological and physical influence upon health. Expectation of something pleasant is a major part of the pleasure, and pleasure is a significant aspect of happiness.

Expectations cause changes in the neurochemistry of the brain. This may be the reason for the placebo effect. Alternatively, it has been found that a pain medication does not work as well when Alzheimer’s disease eliminates the ability to expect the benefit.

Expectations and hope are intertwined. People need hope and expectations to be happy and to lead healthy lives. The fact that it is in your mind does not eliminate the benefit, and your expectation just may come to pass.

Which Diet?

The “diet time” of the year has arrived. Most people come out of the holidays with the feeling they ate too much and exercised too little. Perhaps the scale has “jumped up” a few pounds. A sense of panic sets in with thoughts of dieting, joining a gym or jogging. Urgency is a prevailing mood.

The stimulus and motivation for action is good. To begin now rather than later is good. However, steady and consistent action produces results. Patience and persistence win every time. Start physical activity slowly and build up as your body tells you, but push a little more each day. Develop a detailed plan for each day and stick to it. Life is a marathon, not a sprint.

There are a wide variety of diets, each advocating some element of truth. Each may be partially right but the diet and the results cannot be sustained. Calories, carbohydrates, fat grams and protein are isolated as the “key to success”. The usual thoughts about a diet are cutting back, doing without, depravation, not eating and starving. Everyday I see people who tell me that in the past when they wanted to lose weight all they had to do was reduce their eating. “Now, it doesn’t work. My metabolism is shot or nonexistent”. The more Americans attempt to diet, the more overweight they become.

The perception about metabolism functioning poorly is correct as far as it goes. At least people recognize that metabolism is at the core of the problem. Metabolism is the energy-producing and structure-building function of the human body. It is a complex and highly sophisticated biological function; a furnace, an engine and a factory. The objective is to achieve a normal metabolism, which will result in optimum health status and a desirable body weight. Achieving that objective requires giving the metabolism the proper fuel and building blocks (raw material), increasing physical activity, adequate sleep and managing stress.

Think of a diet as an eating program. Eating foods and drinking water that the metabolism needs to do the job required. It is not just a matter of carbohydrates, protein and fat, it is vitamins, minerals, fiber and phytonutrients (i.e. leutin, lycopene, carotenoids). This complex mixture of nutrients is contained in unprocessed food that our ancestors ate for hundreds of thousands of years. Lean protein (low in saturated fat), vegetables, fruit, seeds, nuts and water are the basis of a healthy diet and there are lots of choices to provide for variety.

People are correct when they feel their metabolism is functioning at low level. Highly processed foods contain excess calories without the proper nutrients for the metabolism to function as needed. And, highly processed foods contain substances that directly interfere with proper functioning of metabolism. Excess sodium, excess sugar (usually fructose from corn syrup), excess omega-6 essential fatty acids, saturated fat, chemically altered fats, chemicals (i.e. artificial sweeteners) and drugs/medications have become major aspects of American life.

Chemically altered fats (vegetable oils) were created to avoid the elevation of low density (bad) cholesterol resulting from saturated fat in the diet. The altered fats did not protect from elevation of low density cholesterol and they lowered high density (good) cholesterol. Many obese people will have elevated liver enzymes associated with fatty infiltration of the liver. The British Medical Journal recently reported on obese children with fatty liver and cirrhosis.

Plan to eat whole (unprocessed) foods and avoid highly processed food in that order. Use that body of yours; it was built to move. Make a contribution to the needs of others and enjoy life.

Sunday, January 01, 2006

Misdirected Conclusions

It does help to know the cause of something in order to prevent it and avoid improper treatment.

The notion is widespread that carpal tunnel syndrome is caused by prolonged computer use. That conclusion has generated sales of computer accessory products to prevent and relieve the condition. And, I'm certain there have been workers compensation awards based upon that assumption. The Harvard Medical School reports that computer use up to seven hours daily does not increase risk for carpal tunnel syndrome.

Computer Use Does Not Cause Carpal Tunnel Syndrome: "A new Special Health Report from Harvard Medical School refutes the common assumption that computer use causes carpal tunnel syndrome. Instead, says this report edited by Harvard-based hand experts, carpal tunnel syndrome is caused by the compression of the median nerve in the wrist. This compression may occur because of heredity, body weight, fracture, or even pregnancy-but not computer use. "

Better and Better

The information about eating fish and omega-3 essential fatty acids keeps getting better and better. Research from Japan reported in the December issue of the journal Chest showed that a diet rich in omega-3 essential fatty acids (fish, canola oil and walnuts) can have anti-inflammatory effects and improve exercise capacity for patients with chronic obstructive pulmonary disease (COPD).