Thursday, July 26, 2012
Tuesday, July 24, 2012
Mother Did Tell Me This
Friday, July 20, 2012
The Business of Medicine
Tuesday, July 17, 2012
Did Mother Tell Me That?
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?
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?
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.