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Fixin' Healthcare

Tuesday, October 31, 2006

The Lifestyle Chronicles - Health Care With Leverage

In 2005, the University of Michigan Comprehensive Cancer Center piloted Body & Soul, an evidence-based health and wellness program tailored for African-American churches. The program consists of four components: 1. pastoral involvement, 2. educational activities to raise awareness about healthy living, 3. a worship environment that promotes healthy eating and 4. peer counseling.

Initial studies showed that after interventional efforts and support from peer counselors at local churches the fruit and vegetables intake increased from an average of three to four servings daily.

Body & Soul has been launched across the country in partnership with the American Cancer Society, the National Cancer Institute, the Centers for Disease Control and Prevention, the University of North Carolina and the University of Michigan.

The American Psychiatric Foundation will collaborate with school communities around the country to implement a program designed to encourage and equip teachers, coaches and other adults who work closely with teens to notice the warning signs of mental health problems and refer students for help in addressing these problems. During the 2006-2007 school year, the program will be implemented by 17 nonprofit organizations, schools and school districts. More than 4,000 teachers and other school personnel are expected to participate in collaboration with mental health professionals from their local communities.

Now, that's health care with leverage.

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Saturday, October 28, 2006

The Lifestyle Chronicles - Health Is Education

Earlier this year the National Governors Association reported on projects in states that promoted Healthy America. Recently, the Innovation in Prevention Awards at the National Prevention Summit highlighted successful initiatives in disease prevention and health promotion. In summary, there is an impressive effort underway in America to shift the health priorities of society from sick care to healthy lifestyle and prevention of illness and disease.

HHS Secretary Mike Leavitt announced the development of science-based comprehensive guidelines to assist Americans include adequate physical activity into their lives. The Physical Activity Guidelines for Americans will be issued in late 2008. These guidelines can be included in a program format for healthy lifestyle and HHS should fund including this in the curriculum for teachers in every school of education in the country.

Would the health status of Americans be better if all teachers were trained and supported to promote healthy lifestyle or if there was a 30 percent increase in the number of physicians? That is a question worthy of the Gates Foundation.

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Thursday, October 26, 2006

The Lifestyle Chronicles - A Doctor In Every Pot

Funny thing about projecting future needs as a straight line extension of the present. The only sure result is more of the same. Remember the 1960's and 1970's when the projected need indicated more physicians would solve the problems of health? Opps!

Presently, the American Association of Medical Colleges (AAMC) is calling for a 30% increase in the number of physicians and U.S. medical school enrollment in 2006 increased 2.2 percent over the last year. Are they correct in their assumptions? If they are, society is headed for a lot of sickness. Let's hope something changes in this equation to avoid sickness and achieve a better state of health. Will more physicians accomplish that?

The American Academy of Family Physicians has its own report calling for 39 percent increase in Family Physicians. This might be more justified than a 30 percent increase of all physicians but only if family physicians are better trained to practice health risk analysis and management. And, that practice needs to be on a higher plane than sick care.

It is good to know that the American Medical Student Association supports the American Academy of Family Physicians in their call for 39 percent increase in the number of family physicians. Goes to show the students are learning their politics.

A better use of resources would be to redefine primary health care with the goal of achieving optimum health status throughout communities. This might create need for additional primary care pracitioners but they would be of various types and function throughout the community as team members of an integrated health care system. The total number of physicians would decrease in accordance with less need for highly trained specialists to deliver sick care.

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Tuesday, October 24, 2006

The Lifestyle Chronicles - Vitamin D, We Hardly Know Ya

People don't eat protein, carbohydrate, fats, vitamins, minerals and phytonutrients; they eat foods that contain these things. Taking supplements might be beneficial if there is a deficiency. But, supplements don't satisfy appetite like food and it is difficult to determine how much of which supplements are needed. All in all, the best course of action is to eat a variety of whole (unprocessed) foods with special attention to vegetables, fruit, lean protein, whole grains and low-fat dairy.

There is a special situation concerning vitamin D. It is a hormone with receptors in almost every cell in the body. Its functions go far beyond absorption of calcium to include how cells grow and proliferate. Vitamin D has been associated with bone health, muscle development, gum health and loss of teeth, diabetes and insulin resistance, multiple sclerosis and cancers of the prostate, pancreas, breast and colon. It is implicated in immunity and associated with resistance to influenza, as well as recovery from tuberculosis. And, this list might not be complete. Not bad for a day's work by a vitamin.

Another interesting aspect of vitamin D is how we get it and in what amounts. A person with light skin wearing a bathing suit and no sunscreen out in the summer sun for 30 minutes can generate 20,000 IU of vitamin D. Otherwise, most multiple vitamins contain 400 IU and 1/4 cup of canned red (sockeye) salmon has 480 IU.

Do you think my grandmother knew that cod liver oil contained omega-3 fatty acids and vitamin D when she poured it down my throat? Probably not. She and other members of that generation knew kids who got vitamin D were sick less often.

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Monday, October 09, 2006

The Lifestyle Chronicles - Trauma Care

Major contributions to the care of trauma victims have come from military medicine. Much of the knowledge concerning stabilization of wounds, transport of the wounded and subsequent definitive treatment have come from the experience of the military.

The Pentagon reports that 20,687 of the U.S. military have been wounded in Iraq as of October 6th with 9,352 injured too seriously to return immediately to active duty. Legs and arms are especially vulnerable because they are not shielded by body armor.

Dr. Amy Wandel reported that the amputation rate in Iraq is 20 percent compared to 76 percent during the Vietnam War. The technology to reconstruct nerves, arteries and veins followed by closure of large soft tissue wounds have allowed bone healing and return of function.

Accidents and trauma injury will always be with us and many of them will be serious. These advances will save lives and preserve function.

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Sunday, October 08, 2006

The Lifestyle Chronicles - Know Your Way To Health

It does not require much observation to realize the American health care system has become oriented to drug utilization. This has reached a point where it is no longer unreasonable to question whether health status might improve if there was less use of prescription drugs.

The Just Say "Know" to Prescription Drugs Campaign is an effort to address this issue. During the month of October the campaign coalition will attempt to get a million people to download a form that allows them to evaluate the drugs they are taking.

Whatever the results, the campaign has something of value to teach. Hopefully, it will lead to even more productive efforts regarding this vital but badly abused aspect of health care.

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Friday, October 06, 2006

The Lifestyle Chronicles - Holey, Moley

The NY Times editors are concerned about the doughnut hole in the Medicare prescription drug program. Their concern is based largely upon the inequality created among senior citizens by this peculiar aspect of the program. That opinion is well and good as far as it goes. And, there is little argument as to the lack of rationale from a medical or insurance perspective.

It would be better if the editors would concentrate on the doughnut. With or without a hole, the Medicare prescription drug program strikes at the heart of the health care system. It is more about catering to sickness than achieving and maintaining optimum health status. And, don't use physicians as your guide. They are taught and know more about writing prescriptions than they do about nutrition and physical activity. By far, it is easier to write a prescription than to inspire someone to change.

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Thursday, October 05, 2006

The Lifestyle Chronicles - Hospitals And General Motors

The state of New York and the feds have agreed to eleminate excess hospital capacity and develop alternative health care options to lower cost. Now, there is a plan that might make a difference. It is not a final solution but it is progress. Hopefully, the result will be lower cost and there is no danger of an adverse effect upon health status.

Keep up the good work, boys. Progress is hardly ever smooth or easy and this is a job that has to be done.

What do hospitals and General Motors have in common?

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Wednesday, October 04, 2006

The Lifestyle Chronicles - A Disturbance In The Force

Soy beans low in linolenic fatty acid so they will be more suitable for processing. What will they think of next? Maybe they could put a label for omega-3 or omega-6 fatty acids on the bean. Or, they could just let the metabolism sort it out and cover the difference with health care reform. The Empire is more familiar with disease than health.

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The Lifestyle Chronicles - Remodel Or Rebuild

An old cancer drug costs $4,200 per dose and makes a surgeon a billionare. Why am I not surprised? But, it saddens me. Distinguishing between the good, the bad and the ugly has become very difficult. No current proposal for health care reform will solve these problems.

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Monday, October 02, 2006

The Lifestyle Chronicles - Solutions And Problems

Interesting article by Steven Gray in today's Wall Street Journal reporting on the development of a soy bean low in linolenic acid. Seems the food industry looks upon the beans as a way of avoiding trans-fat while retaining the other qualities of soybean oil.

Lenolenic acid is highly polyunsaturated, which makes it susceptible over time to being oxidized and becoming rancid. Treating with hydrogen avoids this but the process creates trans-fatty acid. A soybean low in lenolenic acid helps to solve the problem.

Alpha-lenolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are omega-3 fatty acids, which play an important role in reducing the risk of heart disease, amomg other things. Solving one problem creates another, but such is life in these times.

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