http://maynardclark.spaces.live.com
The signature I sign in health care petitions is the signature that includes the clarification that I would support universal inclusion that is truly caring for health, not merely managing disease, and that I believed we could afford to guarantee THAT kind of healthcare as a fundamental right IF we include primary prevention that is behaviorally-oriented and evidence-based.
Ensuring healthy vegetarian (read vegan) meal options (along with suitable health education that sees the benefits of plant-based diets) for students, we cannot deliver the experiential knowledge of what health-supporting eating actually is (and providing a health-aware future for those young citizens going forward).
Showing posts with label budget. Show all posts
Showing posts with label budget. Show all posts
Sunday, September 13, 2009
Primary Prevention NOW !! [That's evidence-based health education for happier people and greater public cost-savings]
http://maynardclark.spaces.live.com
The signature I sign in health care petitions is the signature that includes the clarification that I would support universal inclusion that is truly caring for health, not merely managing disease, and that I believed we could afford to guarantee THAT kind of healthcare as a fundamental right IF we include primary prevention that is behaviorally-oriented and evidence-based.
Ensuring healthy vegetarian (read vegan) meal options (along with suitable health education that sees the benefits of plant-based diets) for students, we cannot deliver the experiential knowledge of what health-supporting eating actually is (and providing a health-aware future for those young citizens going forward).
The signature I sign in health care petitions is the signature that includes the clarification that I would support universal inclusion that is truly caring for health, not merely managing disease, and that I believed we could afford to guarantee THAT kind of healthcare as a fundamental right IF we include primary prevention that is behaviorally-oriented and evidence-based.
Ensuring healthy vegetarian (read vegan) meal options (along with suitable health education that sees the benefits of plant-based diets) for students, we cannot deliver the experiential knowledge of what health-supporting eating actually is (and providing a health-aware future for those young citizens going forward).
Monday, August 31, 2009
Men with hypertension may effectively reduce that hypertension with whole grains and bran
Whole grains, bran may fight hypertension in men
U. S. News & World Report as reported by HealthDay News, August 28, 2009 – By Steven Reinberg
Harvard researchers that found that whole grain foods and foods high in bran bring a boost to heart health. Although the study focused on men, data from the Women's Health Study is consistent with the results. Lead researcher Dr. Alan J. Flint, Harvard School of Public Health research scientist and project director of the Health Professionals Follow-up Study, comments.
http://health.usnews.com/articles/health/healthday/2009/08/28/whole-grains-bran-may-fight-hypertension-in-men.html
U. S. News & World Report as reported by HealthDay News, August 28, 2009 – By Steven Reinberg
Harvard researchers that found that whole grain foods and foods high in bran bring a boost to heart health. Although the study focused on men, data from the Women's Health Study is consistent with the results. Lead researcher Dr. Alan J. Flint, Harvard School of Public Health research scientist and project director of the Health Professionals Follow-up Study, comments.
http://health.usnews.com/articles/health/healthday/2009/08/28/whole-grains-bran-may-fight-hypertension-in-men.html
HealthDay
Whole Grains, Bran May Fight Hypertension in Men
New findings replicate similar data for women, experts say
Posted August 28, 2009
HealthDay Reporter
FRIDAY, Aug. 28 (HealthDay News) -- Men, want to keep high blood pressure at bay? Try reaching for whole grains.
That's the message from a Harvard study that found that whole grain foods and foods high in bran bring a boost to heart health. Although this study is among men, data from the Women's Health Study found similar results, the researchers say.
"Whole grains as a part of a prudent, balanced diet may help promote cardiovascular health," said lead researcher Dr. Alan J. Flint, project director at Harvard School of Public Health of the Health Professionals Follow-Up Study, on which the new analysis was based. "Higher intake of whole grains was associated with a lower risk of hypertension in our cohort of over 31,000 men," Flint said.
The report is published in the September issue of the American Journal of Clinical Nutrition.
For the study, Flint's team collected data on 31,684 men who participated in the Health Professionals Follow-Up Study. When these men were enrolled in the study, none had high blood pressure, cancer, heart disease or had had a stroke.
During 18 years of follow-up, over 9,200 men developed high blood pressure. The researchers found that men who ate the highest amount of whole grains were 19 percent less likely to develop high blood pressure compared with men who ate the least amount of whole grains.
In addition, men who ate the most bran reduced their risk of developing high blood pressure by 15 percent compared with men who ate the least bran, the study found.
Flint noted that these findings remained even after adjusting their data for other healthy lifestyle and diet factors. "When the associations persist despite these adjustments, as in the current analysis, it supports the conclusion that it is not due to these other factors," he said.
There have been several suggestions as to why whole grains seem to have an effect on blood pressure. These include improved insulin sensitivity, reduced food intake, lower blood sugar, better control of high blood pressure and less need for blood pressure medications, the researchers noted.
The authors say the findings could help in evaluating diet guidelines to help lower blood pressure.
Connecticut-based nutritionist Samantha Heller agreed that whole grains are an important part of a healthy diet.
"Whole grains have nutrients and antioxidants that are important for good health and they help manage insulin response," Heller said. "People who eat whole grains seem to have lower incidents of diseases like diabetes," she said.
Since whole grains also help manage weight, they seem to reduce the risk of heart disease, she said.
However, Dr. Harlan M. Krumholz, the Harold H. Hines, Jr. Professor of Medicine and Epidemiology and Public Health at Yale University School of Medicine doesn't think this finding has any implications for dietary guidelines.
"This epidemiologic study is an interesting academic study but lacks any policy implications," Krumholz said. "We do not know whether enriching your diet with fiber will have any benefit on the development of hypertension," he said.
More information
For more information on a healthy diet, visit the U.S. Department of Agriculture .
Sunday, August 30, 2009
Why doctors should inform their patients where the medicines comes from
My many readers will know - from my many blogs (one Yahoo! 360 blog, recently closed by Yahoo! - had 1.3 million readers) that (a) I am NOT A FAN OF NOMINAL RELIGIOUS IDENTIFICATION - (b) nor am I supportive of arbitrary defections of any kind to lower moral standards.
An infrequently recurring question on vegetarian medical discussion lists in including those on topical medical concerns, where some clinicians and medical trained professionals are signed up, is animal ingredients in common medications. Some great servants of the vegetarians community like the Michaels - Dr. Michael Greger and Dr. Michael Klaper, have tried to help us steer clear of common over-the-counter preparations with animal ingredients, as have some pro-animal organizations (not only PETA, but others, too). You'll noted that, to the discredit of both vegetarians and presumptive vegetarians who are clinicians who ought to know the products AND our ethical and moral scruples about animal byproducts, many clinicians - including nominal Hindus, nominal Jains, nominal Adventists, and others - have failed to engage in pro-active HELP and service to the vegetarian communities, though they MAY be uniquely qualified to do so. Is it laziness or a misshapen sense that their NEW 'higher calling' is professional loyalty, a a jingoistic chauvinism to their professional colleagues, even when the profession is doing the wrong thing.
Let's get one thing clear: NO product of ANY kind should have ANY kind of animal ingredient or byproduct in it.
Therefore, no MEDICAL product of ANY kind should have ANY kind of animal ingredient or byproduct in it.
There's wide-ranging ignorance of this moral truth, but medical and health professionals who are NOT ignorant have even less to say in their defense when they err than have those whose moral laziness merely REFLECTS the social backgrounds from which they come.
In a column in the New York Times this week, Randy Cohen fields a question from an anaesthetist.
Should the doctor ask a devoutly religious patient whether he minds that his anticoagulant (heparin) is derived from pigs?
In his reply, Randy Cohen suggests that the doctrine of informed consent requires the doctor to consider the non-medical preferences of the patient and to make sure Muslims, Jews, and vegetarians (like us) know where medicine to be used in their treatment is coming from.
That's a second best (or third best, or not good) standard at best, but that's what Randy Cohen offers. It's a standard that's been around, has been widely accepted by medical ethicists and others in our culture, and seems to work with little additional thought. After all, clinicians should have a laboratory 'sense of things' that would include routinely understanding the chemical nature of stuffs, stuffs used in clinical treatment.
Are you with us so far? Good!
So Randy Cohen, in his New York Times article a week or so ago, suggests that the doctor's role includes a duty to provide whatever information patients need in order to make decisions about, decide, and effectively manage or control their care. But some doubt that it is a doctor's responsibilityto take into account what they call "preferences" (because they don't clearly understand the moral status of animals d they dismissive discount or deny their personhood.
These deniers claim that the doctors' role is too greatly extended.
:
"Imagine a vegan who takes particular exception to drugs that have been tested in higher order primates. Is the doctor expected to ask about all possible preferences and provide corresponding advice about treatments that conform to these? If so, this seems to be unreasonably demanding."
Briton Wikinson goes on to distinguish what he terms "the normative force of different claims about information-giving" (in other words, different nuances have different moral claims and intellectual legitimacy):
"There is a difference between
1. what would be good for the doctor to do, and
2. what we should expect the doctor to do, and
3. what we should sanction the doctor if they don't do?
If your doctor knows that you are a devout religious adherent, and that you may have an objection to a medical product that they know contains animal products, the doctor should inform you that the drug she is about to prescribe is derived from pigs. It would be good for them do so (level 1 above)."
So far, so good.
"And if you ask your doctor - does this drug contain animal products then the doctor should (stronger - probably level 2, maybe 3) find out about the drug and let you know."
Here's where we can take issue:
"Whether we should expect them (2) if you haven't asked or sanction them (3) if they didn't tell you is less clear to me.
We might also note that there is another side to responsibility when it comes to personal preferences for different treatments. If your preference is idiosyncratic or unusual you, the patient, probably have a responsibility to find out which potential treatments may contain animal products, as well as to let your doctor know that you really don't want animal products (or blood products etc). On the other hand if the preference is very common within the population perhaps the onus should be on the doctor."
Finally, Wilkinson quibbles further:"As for the relevance of all of this for orthodox judaism, Randy Cohen notes that since Heparin is administered subcutaneously rather than orally it is apparently not proscribed."
Thinking here of being carried away kicking and screaming while refusing ill-intentioned treatment, I rephrase German Lutheran Pastor Martin Niemoller just a little:
First they came for the Muslims, but I wasn't a Muslim...
Then they came for the Orthodox Jews, but I wasn't an Orthodox Jew...
Then they can for the ethical vegans, and I wasn't an ethical vegan...
Then they came for me, kicking and screaming (and what did they want to do surreptitiously to MY body, about which I would object?)...
Let's put it this way:
Ethicists, particularly bioethicists should be thankful (or, if they don't believe in thankfulness, count themselves fortunate) to HAVE observant Muslims, Orthodox Jews, careful SDAs, self-caring body-owning feminists, and us ethical vegans BECAUSE we help to clarify the case that humans DO object to anyone's surreptitiously sneaking objectionable methods into their treatment and materials and substances into our bodies - in the same way we object to the USDA's approval of GMOs, irradiation, chemicalized agriculture, and more.
We should be THANKFUL that the woman's movement in the West and around the world has joined this chorus of these serious moral objections, and we should WELCOME American Republicanswho are yelling at the top of their lungs:
"Just one moment! What's going to be IN this treatment? What's going to be IN this health care program?"
We psychophysical unities of every stripe, brand, variety, background, persuasion, and pattern of human dignity demand no less than a transparent and open discussion of all these issues, even if it means that some well-intentioned measures can't be ramrodding into law quite so quickly.
Those who KNOW there is objection should be especially eager to fund research into NON-objectionable methods of caring for and preserving human health and for restoring it when illness and disease emerge (and for reducing and eliminating pain and providing proper care and treatment when that's the limit of suitable medical intervention).
We all know that the status quo in healthcare is not good enough, but it's more than access to currently-available treatments and their funding that's a mess. What is also all messed up is the WAY our society thinks about health and healthcare. I can give Ted Kennedy credit for noting that we ought to be paying doctors for keeping patients well, but I only puzzle whether or not we have trained these physicians to KEEP people well (when so much emphasis is placed on listening to complaints and treating post-diagnosisconditions.
Why not listyen to us? Of coruse, they ARE listening to us, and if it flies and flies far, they can claim it as their own.
And who should we be to com,plain if they DO develop treatment modalities that are agree of animal exploitation and abuse, focus first on primary prevention, emphasize a strong role for individual responsibility for health andsocial support for enabling that personal responsibility (safe and suitable exercise facilities in all workplace regions and residential areas, designing urban and suburban areas for exercise, and eliminating all subsidies for animal agriculture and making fresh produce afforcable and safe; shifting emphasis from high tech medicine to wards the low-hanging fruit of primary prevention, etc.). After all, what does it mean sociologically to be a servant of the greater public good, the good of all society? It means to serve wisely and effectively; it does NOT mean taking the credit. In the long run, the HEALTH of the people is FAR MORE IMPORTANT than the healthcare delivery of the people UNLESS that healthcare delivery PREVENTS the problems in the first place.
It is BETTER to have NOT suffered at all than to have suffered ravaging illness and disease, then, after costly treatment funded socially, to have recuperated (at least temporarily). Treatment costs money directly AND in lost productivity AND in lost happiness AND in suffering AND in grief for significant others and workplace colleagues. Being HEALTHY IS a savings. That's "IN THE NATURE OF THINGS" for all of us.
If you're looking for healthcare delivery savings, it's in keeping people well; that's why we're shifting to the IDEA of paying healthcare providers differently: paying healthcare systems (not just the doctors) for keeping people well.
In the search for cost savings, Peter Orszag should be exploring primary prevention. Shouldn't we all?
But don't put those animal ingredients in MY treatment protocols (and if we're well, we're less at risk for the medical violation of our bodies).
And the lowest common denominator, and thus the cheapest path for pharmaceutical companies, is to make ALL medicaments FREE of all animal ingredients and byproducts.
The ethicist (note point 3 above) told us that those who object the most should object the loudest because they're the ones who are hardest for the dulled mainstream to hear. We need to make OUR cases that we want an ethical and above-board system of providing health services to our species that don't violate the inherent rights of persons - nonhuman AND human.
And it's better to proactively make the case early than to resort to attorneys 'post-diagnosis' (after our bodies - and bodily rights - have been violated).
Wednesday, August 26, 2009
Health reform: throwing good money after the bad
The Huffington Post, August 24, 2009 – By Marcia Angell
Dr. Marcia Angell, Harvard Medical School senior lecturer on social medicine and former editor-in-chief of the New England Journal of Medicine, discusses her views on how healthcare reform should be approached.
http://www.huffingtonpost.com/marcia-angell-md/health-reform-throwing-go_b_266596.html
The Huffington Post, August 24, 2009 – By Marcia Angell
Dr. Marcia Angell, Harvard Medical School senior lecturer on social medicine and former editor-in-chief of the New England Journal of Medicine, discusses her views on how healthcare reform should be approached.
http://www.huffingtonpost.com/marcia-angell-md/health-reform-throwing-go_b_266596.html
Health Reform: Throwing Good Money After the Bad
Read More: Barack Obama, Dr. Marcia Angell, Health Care, Health Care Reform, Health Insurance, Healthcare, Healthcare Reform, Marcia Angell, Massachusetts Health Care, Massachusetts Health Care Reform, Massachusetts Health Reform, Medicare, Obama Health Care, Obama Healthcare, Universal Health Care, Politics News
It's not just the right-wing crazies who oppose health reform. In addition, there are many sane Americans who worry about committing a trillion dollars to it. They have a point. We already spend more than twice as much per person on health care as other advanced countries, and our costs are rising faster. How much is enough?
Make no mistake, sky-high and rapidly rising costs are the core problem. If money were no object, it would be easy to provide full care for everyone. But even a perfectly designed system will fail if it is unaffordable, or rapidly becomes so.
So it's crucial to ask just why we are spending so much more than other countries. Where is all that money going? Yet, that question is seldom asked in the current debate, even though it's not logical to try to fix something without understanding why it's broken.
In the trenchant words of Deep Throat, let's follow the money. This year we will spend roughly $2.5 trillion on health care. Although about half that money comes from federal and state governments, most of the total is funneled to private insurers and entrepreneurial providers. Alone among advanced countries, we treat health care like a market commodity to be distributed according to the ability to pay, not like a social service to be distributed according to medical need.
For nearly two-thirds of Americans, we rely on hundreds of private insurance companies to set prices and benefits and pay providers. They profit by refusing to cover the sickest patients and limiting services to others. In fact, we have the only health system in the world based on avoiding sick people. Insurers cream 15 to 25 percent off the top of the premium dollar for profits and overhead (mainly underwriting) before paying providers.
Providers themselves have high billing and collecting expenses to deal with the Byzantine requirements of multiple insurers. The innumerable health facilities, both for-profit and nonprofit, also have high overhead expenses to cover their business costs, executive salaries, and the promotion of their profitable services. Altogether, overhead accounts for at least 30 percent of our health bill. If we spent the same percentage on overhead as Canada, we would save about $400 billion this year.
Our method of delivering care is no better than our method of paying for it. We provide much of it in investor-owned health facilities that profit by providing too many services for the well-insured and too few for those who cannot pay. Most doctors are paid on a piecework basis -- that is, fee-for-service -- which gives them a similar incentive to provide too many services for the well-insured. That is particularly true of specialists who receive very high fees for expensive tests and procedures (like cardiac angiography and MRI's).
Not surprisingly, our ratio of specialists to primary care providers is much higher than in other countries. There is no way to know exactly how much money is wasted in medically unnecessary tests and procedures, but it is probably on the order of hundreds of billions of dollars per year. Many people point to technology as a cause of our high health costs, but the culprit is not technology per se (all advanced countries have the same technologies), but the flagrant overuse of it for financial gain.
In sum, the answer to the question, "Where is all that money going?" is that much of it is diverted to profits and overhead, and to exorbitantly priced and medically unnecessary tests and procedures. Any reform that has a prayer of containing costs, hence being sustainable, must deal with these two massive drains.
Yet, most reform proposals would leave the present profit-driven and inflationary system essentially unchanged, and simply pour more money into it.
That's what is happening in Massachusetts, where we have nearly universal health insurance, but costs are growing so rapidly that its long-term prospects are bleak unless we drastically cut benefits and greatly increase deductibles and co-payments, or change the system. We're learning that health insurance is not the same thing as health care; it may be too limited in what it covers or too expensive to actually use. It is ironic that the President is said to have looked to Massachusetts as a model for national reform, even though the state has the highest health costs on the planet.
To control costs, the President is pinning a lot on electronic records, disease management, preventive care, and comparative effectiveness studies. But while these initiatives may improve care, they're unlikely to save much money because they don't deal with the underlying problem -- a system based on maximizing income, not maximizing health. Promises by for-profit insurers and providers to mend their ways voluntarily are simply not credible. Regulation of the present system is also unlikely to modify profit-seeking behavior very much, without a bureaucracy so large that it would create more problems than it solves.
Nearly every other advanced country has a largely nonprofit national health system that guarantees universal care. Even countries with private insurers, like Switzerland and the Netherlands, require uniform prices and benefits and limit profits. Not only are expenditures much lower in other advanced countries, but health outcomes are generally better. Moreover, contrary to popular belief, they offer on average more basic services, not fewer -- more doctor visits and longer hospital stays, and they have more doctors and nurses and hospital beds. But they don't do nearly as many tests and procedures, because there is little financial incentive to do so.
It's true that there are waits for some elective procedures in some of these countries, such as the U. K. and Canada (although hardly the long lines of desperately ill patients depicted by the Republicans). But that's because they spend far less on health care than we do. If they were to put the same amount of money into their systems as we do into ours, there would be no waits. For them, the problem is not the system; it's the money. For us, it's not the money; it's the system. We already spend more than enough.
Judging by the current debate, it would seem that Americans think they have nothing to learn from other countries, or perhaps that we are all alone in the world. Still, we might be willing to learn from parts of our system that are similar to systems in other countries. Medicare is a single-payer program very much like the Canadian national health insurance system. (Some of the more vociferous town hall meeting protesters seemed not even to know that Medicare is a government program.) The Veterans Health System is a socialized program very much like the U.K.'s national health service. Both deliver better care at lower prices than our private system.
I believe our best bet now would be to extend Medicare gradually to the rest of the population. We could begin by lowering the eligibility age from 65 to 55, then after a few years, drop it to 45, and so on. Medicare is the most popular part of our health system; unlike private insurers, it offers free choice of doctors, it covers all eligible beneficiaries for a uniform package of benefits, regardless of medical history or how much care is needed, and it cannot be taken away by job loss or illness.
But it would need some changes. Its costs are rising almost as fast as those in the private sector, despite the fact that its overhead is much lower, because it uses the same profit-oriented providers. If Medicare were extended to everyone, it should be in a nonprofit delivery system. In addition, fees would have to be adjusted to reward primary care doctors more and specialists less, or better yet, doctors should be salaried. There is now a bill in Congress that calls for exactly that -- H.R. 676 ("Expanded and Improved Medicare for All"), which was introduced by Rep. John Conyers of Michigan and has many co-sponsors. Unfortunately, given the power of the health industry lobbies, it's unlikely to make it out of committee without strong public pressure.
In economic terms, health care is a highly successful industry -- profitable, growing, and virtually recession-proof -- but it's a massive burden on the rest of the economy. I'm aware that phasing out private insurers would mean a loss of jobs. But I believe the job loss in that sector would be more than offset by job gains in the rest of the economy, which would no longer be saddled with the exorbitant costs of an industry that offers very little of value to justify its existence.
One thing is certain: We need a complete overhaul of our health system. Tinkering at the edges won't do it. Expanding coverage through government subsidies and mandates, as advocated by the president, won't either. Besides being a windfall for insurers and drug companies, that approach will just add to our soaring costs and be a temporary fix, at best. In my opinion, it makes no sense to throw good money after bad.
Marcia Angell, M. D., is Senior Lecturer in the Department of Social Medicine at Harvard Medical School. She was the first woman to serve as Editor-in-Chief of the New England Journal of Medicine, a post she stepped down from in June of 2000. She is also the author of the critically acclaimed book, Science on Trial: The Clash of Medical Evidence and the Law in the Breast Implant Case, as well as The Truth About the Drug Companies: How They Deceive Us and What to Do About It.
Monday, August 17, 2009
Google News Alert for: social medicine
obamacare proposal is not socialized medicineDelmarva Now
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... grown against "socialized medicine," including from elderly Americans, who appear to not know that their Medicare service is provided by the government. ...
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Dr Bir Singh is professor of community medicine (public health) at AIIMS. He is also secretary general of Indian Association of Preventive and Social ...
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Seniors Need Not Fear
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It behooves all of us to insist on asserting our human rights ...By claudio
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The Social Medicine Portal - http://www.socialmedicine.org/
Medicine and Social Justice: Should it be a crime to be poor, or ...
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two or three . net: Ronald Reagan warned us about Socialized ...
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In 1961, Ronald Reagan joined the American Medical Association in opposing the Democratic Party's attempt to force socialized medicine on the American people. President Reagan's advice is just as relevant today as it was then. ... He compares it to Social Security, and the limits intended for that program. Liberals, naive and, dare I say, deceived by the lies of Socialist serpents like Stalin, Marx, and Mussolini, were enchanted by Socialism then, and they still like it ...
two or three . net - http://www.twoorthree.net/
Conferring of Degrees 1953-2009 online « UoN Cultural Collections
By uoncc
Graduates from the Faculties of Arts and Social Science, Medicine and Health Sciences, Education, Music & Nursing (10.30am ceremony) Graduates from the Faculties of Architecture, Building and Design, Engineering, Science and Mathematics ...
UoN Cultural Collections - http://uoncc.wordpress.com/
Digital medicine : health care in the Internet era « TP Library's Blog
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Digital medicine : health care in the Internet era. August 17, 2009. Call No. : R859.7 Int.We This book will show how IT has made medical contact more accessible for some, at the same time highlighting the political, social, ethical, ...
TP Library's Blog - http://tplibrary.wordpress. com/
Saturday, August 15, 2009
Is there evidence anywhere of objective obligation beyond contextual or situational obligations?
I just listened this morning to the President's weekly radio address on healthcare (in making his case, President Obama, like Bill Clinton, Nancy Pelosi, and many Democrats, used individual case studies of persons whose chronic conditions are not covered by healthcare) and the Republican Response by Utah Senator Orrin Hatch (R-UT). (Ensuring access to affordable healthcare for all Americans is not a Democratic or Republic issue; it is an American issue" (key words here are the meaning of 'access' and 'affordable'). Hatch advocated 'reforming the market' by increased information on treatment options, wellness measures by quitting smoking and living a healthier lifestyle, and more.
| |
| President Obama Radio Address 8/12/09 | |
| |
| Republican Radio Address 08/15/09 |
I wish the Democrats would agree to this much - that living a healthier lifestyle is going to reduce overall costs for all Americans, however it's paid). Even Hillary Clinton made such comments during her research on national healthcare in 1993-1994. (The Clintons have a vegetarian daughter; I doubt that healthy living was the primary reason Chelsea Clinton went vegetarian in her preteens.)
We vegetarians and vegans aren't clear how we think or where we stand on these issues. Brilliant voices on both sides of this debate feed us oceans of information. Some preventive health voices (like Jeff Novick, Alan Goldhamer, et al) focus on how much money we could save on treating lifesdtyle-related conditions by shifting our society away from junk food, smoking and alcohol, and meat and animal products. To be sure, powerful interests impact the public mind through advertising and government subsidies to the wrong kinds of agriculture. Other voices gtell us that no change can be made until we have in place the systems that are financially dependent on keeping the American people well. Then and then only will the evidence become crystal clear to all Americans that it is in their individual AND collective interest to transform our lifestyles and everyday behaviors.
What if the community of vegan voices demanded that those vegans who advocate BOTH animal rights and universal healthcare coverage become an effective unified voice in the current US healthcare discussions??
We vegetarians and vegans aren't clear how we think or where we stand on these issues. Brilliant voices on both sides of this debate feed us oceans of information. Some preventive health voices (like Jeff Novick, Alan Goldhamer, et al) focus on how much money we could save on treating lifesdtyle-related conditions by shifting our society away from junk food, smoking and alcohol, and meat and animal products. To be sure, powerful interests impact the public mind through advertising and government subsidies to the wrong kinds of agriculture. Other voices gtell us that no change can be made until we have in place the systems that are financially dependent on keeping the American people well. Then and then only will the evidence become crystal clear to all Americans that it is in their individual AND collective interest to transform our lifestyles and everyday behaviors.
What if the community of vegan voices demanded that those vegans who advocate BOTH animal rights and universal healthcare coverage become an effective unified voice in the current US healthcare discussions??
Orrin Hatch included that issue (living a healthier lifestyle is going to reduce overall costs) along with payment reform in his talk, but the Republicans have been VERY slow to offer any structural change UNTIL the prospect of 'the public option' began to appear.
The notion of individual obligation and collective obligation emerges in public debates frequently. The current 'healthcare' debate (about public responsibility = obligation) is one such instance where the public is dealing with philosophical issues about obligation in ethics. Military conscription, taxes, public transportation, and much much more depend on answering questions about moral, political, and social obligations in public life and personal living.
Am I alone in thinking that the Democratic Party has become a haven for 'anything goes' morally (hands off my body, etc.), while contradicting itself in its abstract ethical argument when talking about public provisions of social goods?
Lert me give an individual illustration. Years ago, I had headed north from Boston to participate in an anti-nuclear rally. It was politic at the time for the head of NOW to appear there, where she was among the few to be interviewed. She appealed to the Constitutionally-guaranteed freedom of assembvly and the inherent right of protest implied in such rights to justify the protesters at Seabrook. By the time I arrived home, she had already appeared at an anti-abortion rally where she urged the local Boston police to round up the protesters and cart them off to the local jails for unlawful assembly.
Oh, my! Can you see how careful conceptual analysis of speech and ethical analysis really ARE important in public discourse - and in developing public policies?
How do we hold court publicly on open public issues such as responsibility for health (not merely 'responsibility for healthcare) and responsibility for personal and public safety?
Monday, August 10, 2009
Are the Competing Healthcare Proposals ALL the Wrong Diagnosis?
Dr. Andrew Weil: The Wrong Diagnosis
 AP/J. Scott Applewhite |
Dr. Dean Ornish: Resuscitating Health Care Reform
Meaningful health reform needs to provide incentives for physicians and other health professionals to teach their patients healthy ways of living rather than reimbursing primarily drugs and surgical interventions.
Dr. Dean Ornish
Medical Editor, The Huffington Post, Founder and President of Preventive Medicine Research Institute
Posted: August 10, 2009 12:01 AM
Resuscitating Health Care Reform
Read More: Dean Ornish, Dr Dean Ornish, Health, Health Care, Healthy Eating, Healthy Lifestyle, Nutrition, Preventative Healthcare, Prevention, Living News
Health reform is in danger of failing because the focus has been too much on who is covered and not enough on what is covered. Health care reform is primarily about health insurance reform, with the main battle being over coverage and the payment system.
Of course, we need to provide coverage for the 48 million Americans who do not have health insurance. It is morally indefensible that we have not already done so.
But we also need to transform what is covered. If we want to make affordable health care available to the 48 million Americans who do not have health insurance, then the fundamental causes of many chronic diseases need to be addressed -- which are primarily the lifestyle choices we make each day -- rather than only literally or figuratively bypassing them.
If we just cover bypass surgery, angioplasty, stents, and other interventions that are dangerous, invasive, expensive, and largely ineffective on 48 million more people, then costs are likely to increase significantly at a time when resources are limited. As a result, painful choices are being discussed -- rationing, raising taxes, and/or increasing the deficit -- and these are threatening the public acceptance and thus the viability of health reform.
Meaningful health reform needs to provide incentives for physicians and other health professionals to teach their patients healthy ways of living rather than reimbursing primarily drugs and surgical interventions. If lifestyle interventions proven to reverse as well as prevent many chronic diseases are reimbursed along with other strategies for improving cost-effectiveness across the U.S. healthcare system, then it may be possible to provide universal coverage at significantly lower cost without making painful choices, and the only side-effects are good ones.
The U.S. "health-care system" is primarily what Senator Harkin [D-Iowa] calls "a sick-care system." Last year, $2.1 trillion dollars were spent in this country on medical care, or 16.5% of the gross national product, and 95 cents of every dollar were spent to treat disease after it had already occurred.
Heart disease, diabetes, prostate/breast cancer, and obesity account for up to 75% of these health care costs, and yet these are largely preventable and even reversible by changing diet and lifestyle.
Our research, and the work of many others, have shown that our bodies often have a remarkable capacity to begin healing, and much more quickly than we had once realized, if we address the lifestyle factors that often cause these chronic diseases. Medicine today focuses primarily on drugs and surgery, genes and germs, microbes and molecules, but we are so much more than that.
Many people tend to think of breakthroughs in medicine as a new drug, laser, or high-tech surgical procedure. They often have a hard time believing that the simple choices that we make in our lifestyle -- what we eat, how we respond to stress, whether or not we smoke cigarettes, how much exercise we get, and the quality of our relationships and social support -- can be as powerful as drugs and surgery, but they often are. Often, even better.
These choices are especially clear in cardiology as an example of this larger issue. Large-scale studies have shown that changing lifestyle could prevent at least 90-95% of all heart disease. 1 Thus, the disease that accounts for more premature deaths and costs Americans more than any other illness is almost completely preventable, and even reversible, simply by changing lifestyle.
In contrast, many people are surprised to learn that bypass surgery and angioplasty don't work very well. In 2006, for example, according to the American Heart Association , 1.3 million angioplasties and stents were performed at an average cost of $48,399 each, or more than $60 billion. In addition, 448,000 coronary bypass operations were performed at a cost of $99,743 each, or more than $44 billion -- i.e., more than $100 billion for these two operations.
Despite these costs, a major randomized controlled trial found that angioplasties and stents do not significantly prolong life or even prevent heart attacks in stable patients (i.e., in most patients who receive them). 3 Earlier randomized controlled trials of coronary bypass surgery found that this procedure prolongs life in only a small fraction of patients -- those with left main coronary artery disease or equivalent and left ventricular dysfunction (ejection fraction less than 30%). A recent randomized controlled trial in diabetics found that neither bypass surgery nor angioplasty prolonged life or prevented heart attacks. 4
Lifestyle changes also can be reframed not only as preventing chronic diseases but also as reversing the progression of these illnesses -- i.e., as intensive non-surgical, non-pharmacologic interventions.
What we eat, how we respond to stress, whether or not we smoke cigarettes, how much exercise we get, and the quality of our relationships and social support may be as powerful as drugs and surgery in treating (not just preventing) many chronic diseases.
Our studies showed that people with severe coronary heart disease were able to stop or reverse it by making intensive lifestyle changes, without drugs or surgery, and these findings have now been replicated by several others. 5 There was some reversal of heart disease after one year and even more improvement after five years, and there were 2.5 times fewer cardiac events when compared to a randomized control group. 6
Almost 80% of patients eligible for bypass surgery or angioplasty were able to safely avoid it by making comprehensive lifestyle changes instead, saving almost $30,000 per patient in the first year when compared to a matched control group. 7 In a second demonstration project with Highmark Blue Cross Blue Shield, these comprehensive lifestyle changes reduced total health care costs in those with coronary heart disease by 50% after only one year and by an additional 20-30% in years two and three when compared to a matched control group.
Thus, the disease that accounts for more premature deaths and costs Americans more than any other illness is almost completely preventable, and even reversible, simply by changing lifestyle. We don't have to wait for a new breakthrough in drugs or surgery; we just need to put into practice what we already know.
Reimbursement is a major determinant of how medicine is practiced. When reimbursement changes, so do medical practice and medical education.
Some question whether or not prevention saves money, asking whether these approaches actually prevent or only delay the onset of disease. Part of the reason that preventive approaches are usually scored by the Congressional Budget Office (which estimates the overall costs of any legislation) as significantly increasing costs is that lifestyle changes are viewed only as primary prevention -- paying money today in hopes of saving money later.
But even primary prevention saves money, although the cost savings per person are not as high as when intensive lifestyle changes are offered as treatment to those who are already sick. For example, three years ago, Steve Burd (CEO of Safeway) realized that health care costs for his employees were exceeding Safeway's net income--clearly, not sustainable. I consulted with him in redesigning the corporate health plan for his employees in ways that emphasized prevention and wellness, provided incentives for healthful behaviors, and paid 100% of the costs of preventive care.
Overall health care costs decreased by 15% in the first year and have remained flat since then. Many other worksite wellness programs have shown cost savings as well as a happier and more productive workforce. This approach is bringing together Democrats and Republicans, labor and management.
In each of these studies, significant savings occurred in the first year -- medically effective and cost effective. Why? Because there is a growing body of scientific evidence showing how much more dynamic our bodies are than had previously been believed.
The same intensive lifestyle changes that may reverse the progression of coronary heart disease may also slow, stop, or even reverse the progression of early-stage prostate cancer 8, whereas conventional treatments such as radical prostatectomy and radiation may not prolong life except in the small percentage of patients who have the most aggressive disease. 9
These lifestyle changes also may beneficially affect gene expression in only three months, turning on genes that prevent disease and turning off genes that promote heart disease, prostate cancer, breast cancer, and other illnesses. 10 Often, people say, "Oh, it's all in my genes, there's not much I can do about it." For many people, it captures their imagination to know that changing lifestyle changes their genes for the better.
Last year, my colleagues and I published the first study showing that these intensive lifestyle changes significantly increase telomerase, and thus telomere length, in only three months. 11 (Even drugs have not been shown to do this.) Telomeres are the ends of your chromosomes that help control aging -- as your telomeres get longer, your life gets longer. (Like all research, these relatively small studies need to be replicated in larger randomized controlled trials.)
Lifestyle changes are not only as good as drugs but often even better. For example, a major study showed that lifestyle changes are even more effective than diabetes drugs such as metformin in reducing the incidence of diabetes in persons at high risk, with lower costs and fewer side-effects. 12
"Prevention" often conjures up false choices -- "Is it fun for me or is it good for me? Am I going to live longer or is it just going to seem longer if I eat and live healthier?" Because these mechanisms are so dynamic, most people find that they feel so much better, so quickly, it reframes the reason for making these changes from fear of dying (which is too scary) or risk factor modification (which is too boring) to feeling better.
Many patients say that there is no point in giving up something that they enjoy unless they get something back that's even better -- not years later, but days or weeks later. Then, the choices become clearer and, for many patients, worth making. They often experience that something beneficial and meaningful is quickly happening.
The benefit of feeling better quickly is a powerful motivator and reframes therapeutic goals from prevention or risk factor modification to improvement in the quality of life. Concepts such as "risk factor modification" and "prevention" are often considered boring and they may not initiate or sustain the levels of motivation needed to make and maintain comprehensive lifestyle changes.
In our experience, it is not enough to focus only on patient behaviors such as diet and exercise; we often need to work at a deeper level. Depression, loneliness, and lack of social support are also epidemic in our culture. These affect not only quality of life but also survival. Several studies has shown that people who are lonely, depressed, and isolated are many times more likely to get sick and die prematurely than those who are not. In part, this is mediated by the fact that they are more likely to engage in self-destructive behaviors when they feel this way, but also via mechanisms that are not well-understood. For example, many people smoke or overeat when they are stressed, lonely, or depressed.
What is sustainable is joy, pleasure, and freedom, not deprivation and austerity. 13 When you eat a healthier diet, quit smoking, exercise, meditate, and have more love in your life, then your brain receives more blood and oxygen, so you think more clearly, have more energy, need less sleep. The latest studies have shown that your brain may grow so many new neurons that it may get measurably bigger in only a few months -- this was thought to be impossible only a few years ago. Your face gets more blood flow, so your skin glows more and wrinkles less. Your heart gets more blood flow, so you have more stamina and can even begin to reverse heart disease. Your sexual organs receive more blood flow, so you may become more potent -- the same way that drugs like Viagra work. For many people, these are choices worth making -- not just to live longer, but also to live better.
In other words, the debate on prevention often misses the point: the mortality rate is still 100%, one per person. So, it's not just how long we live but also how well we live. Making comprehensive lifestyle changes significantly improves the quality of life very quickly, which is what makes these changes sustainable and meaningful.
Unfortunately, anything involving lifestyle changes gets held to a different standard. Drugs and surgery are not required to show that they save money in order to be covered, only that they work. Lifestyle changes often work even better, and at lower cost.
Finally, it's worth pointing out that what's good for your personal health is good for the planet's health; what's personally sustainable is globally sustainable. For example, eating a diet high in red meat increases the risk of heart disease and many forms of cancer. It also increases global warming: livestock cause more global warming than all forms of transportation combined due to methane production, which is 21 times more powerful a greenhouse gas than carbon dioxide. 14
As Senator Harkin said, "To date, prevention and public health have been the missing pieces in the national conversation about health care reform. It's time to make them the centerpiece of that conversation. Not an asterisk. Not a footnote. But the centerpiece of health care reform."
If we don't, then the escalating costs and resulting painful choices -- rationing, raising taxes, and/or increasing the deficit -- are threatening the public acceptance and thus the viability of health reform.
- Yusuf S, Hawken S, Ôunpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study). Lancet. 2004; 364: 937-52.
- Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics 2009 update. A report from the American Heart Association statistics committee and stroke statistics committee. Circulation. 2009;119:e1-e161.
- Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1-14.
- The BARI 2D study group. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009;360:2503-15.
- Ornish DM, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary atherosclerosis? The Lifestyle Heart Trial. Lancet. 1990; 336:129-133.
- Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998;280:2001-2007.
- Ornish D. Avoiding Revascularization with Lifestyle Changes: The Multicenter Lifestyle Demonstration Project. American Journal of Cardiology. 1998;82:72T-76T.
- Ornish D, Weidner G, Fair WR, et al. Intensive lifestyle changes may affect the progression of prostate cancer. J Urol 2005;174:1065-1070.
- Barry MJ. Screening for Prostate Cancer -- The Controversy That Refuses to Die. N Engl J Med. 2009;360:1351-4.
- Ornish D, Magbanua MJ, Weidner G, et al. Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proc Nat Acad Sci USA 2008;105:8369-8374.
- Ornish D, Lin J, Daubenmier J, et al. Increased telomerase activity and comprehensive lifestyle changes: a pilot study. Lancet Oncol 2008;9:1048-1057.
- Diabetes Prevention Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403.
- Ornish D. The Spectrum. New York: Random House/Ballantine Books, 2008.
- United Nations Food and Agriculture Organization's report, Livestock's Long Shadow. Accessed on April 16th, 2007.
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