Orientation and Direction

A year goes and another comes. Reviewing the past is often done to put a fine point on progress but I do not look back to measure progress. Orientation and direction are what I seek. It is a matter of what and why more than where, when and how much or how far, but it is a road map nonetheless. Progress is of little value if it is not in the correct or desired direction, as well as the right distance or amount. When the unknown exceeds the known, as it so often does, process occupies the center of attention with the expectation that process, properly executed, will lead to a designated goal. But the value of process is determined by periodic evaluation of orientation and direction. It is easy to be lost and not know it.

Looking back for orientation and direction can refresh the wisdom gained from experience and cultivate the humility that comes with recognition of life as a mystery. The correct or desired direction can change and the change can be subtle at the start but drastic over time. For example, it can make a huge difference whether the goal of a health system is the best health status possible or the best medical care possible.

After fifty-one years of active involvement in various aspects of the medical profession, I seek orientation and direction to understand better the basis of good health and the role medical care serves in achieving and maintaining good health. It might seem after fifty-one years to be an odd quest but the issues are complex and I surely believe the answers have eluded American society with tragic consequences.   

Pass the Health, Hold the Doctor

It is a common assumption that health status depends upon the availability of doctors and hospitals. I can understand that doctors and hospitals want people to believe health status depends upon their services. Also, medical schools would be in favor of producing more doctors, as well as the hospitals and communities that want to start medical schools. Let us not forget that medicine is an industry but it is an industry oriented to sickness. Is sickness, even sickness well treated, the best pathway to better health status? Perhaps it might be better to plan on less sickness.

A recent study of Texas Medicare claims data revealed a disparity in colonoscopy screening between white, black and Hispanic populations with whites receiving more screenings. In those communities with more doctors, the disparity was even greater in favor of white patients. Placing aside the question as to whether the number of colonoscopies is necessary regardless of race and ethnicity, this is one of many studies showing that more doctors frequently do not yield the desired result. That is to say the result desired by patients and the community.

Meanwhile, the data continues to accumulate that better health status depends on much more than doctors and hospitals. Some communities have come to realize improving health depends upon things involving life in the community. Kansas City, Kansas is an example but there are a growing number of other communities seeking more health for the care and sense there is a more effective way.      

Obesity Rate Declines In New York City Schools

There are those who believe that obesity cannot be controlled. And there are those who believe that government should not serve in a "nanny" capacity. Of course, that depends upon what defines a "nanny" government. But unhealthy lifestyles and poor diet are a plague on the individual and society. It is not easy to control the situation but it can be done. The efforts in New York City schools appear to be yielding results. The number of obese NYC school children declined by 5.5 percent over the past five years. Other cities and towns can follow the example. It will save lives and it will save money.

More Transformation

My last post touched upon the concept of transformation. Some might think it is an introduction to the transformation of medical care but it is an introduction to the transformation of society to achieve improved health status of the population and the individuals within the society. Medical care, even reformed medical care, cannot do that. It is time for the United States to wake up and accept the implications of the health outcomes resulting from a health system usurped by medical care.

The United States spends more on medical care and derives less benefit from it than almost every other industrialized nation. Meanwhile, social support programs, public health and primary prevention are afterthoughts of a medical care system. What are the outcomes? The US ranks in the bottom half of comparable nations for life expectancy and infant mortality. But we are winners when it comes to obesity and chronic metabolic diseases. These problems are not cured but many of them can be prevented.

An interesting viewpoint is presented by combining what countries spend on medical care with spending on social services, like rent subsidies, employment-training programs, unemployment benefits, old age pensions, family support and other services that can extend and improve life. In that analysis the US no longer leads among comparable nations. "America is one of only three industrialized nations to spend the majority of its health and social service budget on health care." And in the US that health care budget is overwhelmingly spent on medical care. The study revealed that countries with high health care spending relative to social spending had lower life expectancy and higher infant mortality than countries that favored social spending.

Changing this situation will not be easy. Far from it. Reallocating medical care funds to social services is a start. That alone will change society. But addressing the social, commercial and political environment that promotes unhealthy lifestyles resulting in much of the chronic disease requires transformation of American society. Without it we are becoming a nation of metabolic cripples. 

Transformation

Disruption in society imposes upon people the necessity to learn how to live in new and changing conditions. Although many of these conditions are external to people, transformation, when it comes, comes from the changed mind-sets of people. When enough people reach a similar alteration in mind-set, the collective response becomes a driving force in a new direction generating momentum and inertia. Some call this paradigm shift but many things are labeled paradigm shifts that do not transform society. Transformation of a society is rare and it results in a different and sustained way of life. 

Home Health Care

All of the tools for home health care are available. Now, we need health care personnel who are prepared and ready to use them. Dr. Resnik is correct that the most recent period of health care was controlled by hospitals, insurance companies and pharmaceutical companies. Health professionals are molded to function in that environment but that environment has peaked out with diminishing health status for increasing expenditures of money and effort. There will be a period of adjustment while the public accepts this new reality and the training plus organization of health professionals catches up. 

Vegetables and Fruit and Strokes

Chemical reactions are constantly occurring inside human cells. These reactions create what are called free radicals, which are unpaired electrons. These little devils are chemically reactive and capable of causing tissue damage. Vegetables and fruit contain antioxidants that neutralize these free radicals. Ah ha, a high technology right at our finger tips.

A Swedish study reveals that a diet high in vegetables and fruit is associated with reduced incidence of stroke even in those with a prior history of heart disease. Interestingly, several studies have demonstrated that supplements containing antioxidants do not offer the same protection. Maybe it is the antioxidants in vegetables and fruit, maybe it is other compounds and maybe it is all of the above, but reducing the incidence of strokes is among many reasons to eat more vegetables and fruit. You already knew that, didn't you?

Commercial Fruit Juice

Consumer Union, the publisher of Consumer Reports, analyzed fruit juices, mostly apple and some grape, in the grocery stores and found high levels of arsenic plus some lead. This speaks to the issue of pesticides used by fruit growers. Ten percent of the samples contained arsenic levels higher than the federal standard for drinking water and one-quarter tested for lead higher than the FDA standard for bottled water. Generally, commercial fruit juices are very sweet and much of the nutritional value decays over a period of days after juicing. It is better to use whole fruit and wash it well with a vinegar solution and you can prepare your own fruit juice.