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Fixin' Healthcare

Thursday, July 26, 2012

Unnecessary and Excessive Medical Care

This article is an example of unnecessary and excessive medical care in response to a minor injury involving the ankle of the author's daughter. It is a large and important problem. I am surprised it took the author so long to recognize what was happening. When you are a hammer, the whole world is a nail. The author might explore a similar situation at a low cost public clinic or when Medicaid is involved. 

Tuesday, July 24, 2012

Mother Did Tell Me This

Few things in life are as important as good health or more misunderstood. The will to live, constant thought about the world around us, anticipation of the future, lifestyle choices, contribution to the public good, health and vitality are inter-related and dependent each upon the others. Those are human resources and they depend upon family, society and community institutions to cultivate and properly use them. When this opportunity is missed the result can be devastating. Lifestyle is more than a behavior pattern, it is everything surrounding and involving a person that influences, contributes to and causes behavior patterns. Health is more than absence of illness, disease and injury; it is the mental and physical well-being of people, society and communities possessing the capacity and the will to live. These are things dependent upon beliefs and values.

Friday, July 20, 2012

The Business of Medicine

The story about the development and utilization of medications for the treatment of anemia is a glimpse into the business of medicine. To call it misguided intention is to be charitable but this example shows how the practice is abused at every level. Please take notice of the involvement of lobbying and Congress. I would like to think their intentions were good but I am too old for that. Even those who speak for the patients jumped the track.

Tuesday, July 17, 2012

Did Mother Tell Me That?

Nature, metabolism and life are extremely complex. Add the equally complex, dynamic interaction between each of them and it defies understanding.

Long causal chains, impatience to see results and insensitivity to the passage of time are critical factors in understanding ourselves and others. Individuals and society exist at any given moment balanced within nature and the world where the balance is controlled by a vast array of forces. These forces vary in strength and relationship to each other, and they are in a constant state of flux. It is a complex existence with many unknown factors and it is dependent upon a will to live that affirms life as possessing intrinsic value.

Skepticism promotes the need to think about the balancing forces of life and adapt to change. The complexity and lack of complete knowledge about life can blunt optimism and generate pessimism that erodes the will to live. When the boundary of rational thought encounters the mystery of life, the will to live depends upon belief systems, values, art, faith, religion and mysticism.

Health and well-being are among this mix and no one ever said it would be easy to achieve and maintain them. But it can be done.

Thursday, July 12, 2012

Is A Calorie A Calorie, Or Not?

It is well known that weight loss is difficult to maintain. Some of this difficulty is attributed to decrease in energy expenditure as the body loses weight. A recent study indicated that after losing weight people who ate a high protein, high fat, low carbohydrate diet (low glycemic load, low glycemic index) burned more calories (energy expenditure) than those who ate a high carbohydrate, low protein, low fat diet (high glycemic load, high glycemic index). The two diets contained the same amount of calories. A third diet with the same amount of calories but with balance between the carbohydrates, protein and fat was in the middle for energy expenditure but somewhat closer to the high protein, high fat, low carbohydrate diet. The carbohydrates in the third diet consisted of less starchy vegetables and grains (moderate glycemic load, low glycemic index). The difference in energy expenditure between the high protein, high fat, low carbohydrate and the highest carbohydrate, low protein, low fat diets was statistically significant and the authors indicated this difference represented the equivalent of one hour of moderately intensive physical activity.

To their credit the authors did not extrapolate wildly from the findings. They mentioned that a calorie may not have the same metabolic effect between different diets in the situation they studied. The study did not address micro-nutrients. A disturbing observation was the increased cortisol excretion, elevated C-reactive protein (inflammation) and decreased insulin sensitivity with the high protein, high fat, low carbohydrate diet.

A critique of the study by Dr. Jules Hirsch was published in the NY Times. He begged to differ with the authors about a calorie not being a calorie and suggested other reasons for the findings; the principle one being loss of water with a high fat, high protein, low carbohydrate diet. Also, he observed that without decreasing the fat content there is no decrease in obesity.

It is easy to miss the goal of decreasing obesity and improving health when submerged among all the details. Nutrition, metabolism and lifestyles are complex and the public often gets confused. Hey, everyone gets confused from time to time and experts do not always agree.

Tuesday, July 10, 2012

If Not Now, When?

The U.S. has a large and complex healthcare system and the Affordable Care Act has increased its size. There is a small and perhaps significant effort to expand prevention but much of that is secondary prevention, which remains within the mind-set of medical care. Meanwhile, the greatest health challenge remains primary prevention. Perhaps medical care and attention to secondary prevention leads to better health but the path continues to pass through or near sickness and disease. Sickness and disease are never as good as avoiding them and the question arises as to whether avoiding them can be achieved in the medical care mind-set. Keep in mind that not all improper and over-use of medical services is the result of patient choices. Medical care is an industry and industries tend to expand their business.

I cannot put myself in the position of defending South Carolina, my home state, in refusing the Medicaid provision of the Affordable Care Act. However, they do have a point about the improper and over-use of medical care. The Rand Study of the Oregon Medicaid lottery does not create confidence that medical care results in better health. I will grant that a sense of security is beneficial but it might be better if that sense of security was associated more with a healthy and productive life than sustaining a state of sickness.

My wish is that the states had plans to address the problem. Simply saying no will not work and increasing medical care as we know it has not worked. Somewhere, sometime there needs to be consideration of a health system that includes medical care but is not dominated by medical care. Economic well-being, education, public and community health and primary medical care are important elements the states should be addressing. If that is what the states have in mind by advocating block grants for Medicaid, I am all for them. But they need to have specific plans with improved health status as the goal and commitment to measuring progress.

Teenagers and Antidepressants

Two thoughts in this article strike me as worthy of more consideration. One is the doctor who prescribed sleeping pills and told Mrs. Bolton-Fasman to get a hold of herself. Perhaps he was doing what doctors do but neither course of action was helpful. Second is the opinion of Mrs. Bolton-Fasman to use all the resources available when the situation requires it. But powerful medications have consequences as well as benefits. Keep in mind Mrs. Bolton-Fasman's other consideration that parents need to "square off" down the road on the decision to use drugs.