Informed Consent

Informed consent can be a means to provide patients with crucial information about the potential risks and benefits of a medical care procedure or window dressing to provide comfort and cover. It turns out the study involving CT scans on 50,000 patients with lung cancer at numerous hospitals cannot locate ninety percent of the consent forms. The missing forms show the difficulty with quality control for a study of this size and scope. It calls into question other aspects of the study and perhaps the conclusions. But, hopefully, it will give pause to examine the basic cause and method of informed consent. At its best, informed consent would have origins in community health that emphasizes health literacy. If consent is truly informed, it becomes the most effective tool for addressing the excesses and abuses of medical care. Every aspect of medical care has risks and benefits. Whether one outweighs the other depends upon each individual situation and it is never an easy decision.

Food Stamps For Sodas

One would think that food stamps would be used for food and drink that nourishes the body. That includes fruit and vegetable juices but, certainly, not sodas. I don't suppose we should be surprised the "soda lobby" objects to the restriction of food stamps for sodas but it is a commentary on the culture and health status in the U.S. This includes the broader issues of agriculture policy and the structure and function of health insurance. I only wish it were possible for the government to get back to the basics to support optimum health status for all Americans. That would require a transformation that may be starting with the community health initiatives across the country. Mayor Bloomberg could be on the right track. Let's see.

Accountable Care Organizations

A report from the Commonwealth Fund indicates that Accountable Care Organizations (ACOs) must be firmly centered around primary care, have informed patients and implement payment mechanisms that reward high quality care. Getting back to the basics. I'm encouraged by the good intentions but will wait to see what happens. Primary care is in short supply, educating patients has not been a strong suit for medical care and high quality care has many definitions.

Prevention and Public Health

The prevention and public health activities of the new health care law have come under attack as a slush fund for the HHS Secretary without congressional approval or oversight. Of course, I would feel so much more secure knowing I was under the protection of congressional approval and oversight but instead of eliminating prevention and public health activities they might explore how to improve and highlight this aspect of the law. Prevention and public health activities are the only things that might be designated as health care in contrast to medical care in this law. Congress and the administration would benefit from reading Mark Bittman's article on how to save a trillion dollars.

The Toxicity of Sugar

There is plenty of evidence that excess sugar, particularly fructose, in the diet leads to fatty liver, insulin resistance, obesity, diabetes, metabolic syndrome, artery and heart disease and cancer. And Americans consume a lot of sugar. Many people admit to a craving for sugar. Oh, well, there is always health insurance.

Medicaid Grant Program for Healthy Behavior

The health reform law contains a grant program for states to offer incentives for healthy behavior by Medicaid recipients. This would involve utilizing corporate-type wellness programs in the public arena. There are plenty of skeptics as to whether this can work. The suggestion to implement this through community health programs and community organizations is a good one. An increasing number of communities are pursuing community-wide health initiatives.

More Health For the Care, continued

Everyone needs health care, medical care is for those who need it. America has a medical care system that is big business and a rudimentary emphasis on health care. The result is 141 percent more money spent per person than the average OECD (Organization for Economic Cooperation and Development) country but below average rank among the group for health status. No one beats us on medical care but does this achieve the best possible health status? Evidently not.

Lessons Learned

1. A health system consists of health care and medical care.
2. Health care is healthy lifestyles, public health and other means to prevent disease, injury and disability so as to achieve the best health status possible for a community and every individual in the community.
3. Medical care is the diagnosis and treatment of illness, disease, injury and disability, one person at a time.
4. It is better to be fit and well than sick and injured.
5. The greatest and most valuable contribution to a long and productive life is good health.
6. Lifestyle is everything that transpires each day in a person's life and daily life is the greatest influence upon health status.
7. It is possible to alter daily life with knowledge, determination and consistent effort but most people need assistance to do so.
8. There are many forms of assistance but the most important are moral, group and community support.
9. The best health status possible cannot be achieved easily, if at all, by treating illness, disease, injury and disability, it is best to avoid them, if at all possible.
10. If an effort called health care reform serves only, or mainly, to increase what transpired in the past, it will not improve health status or contain cost.