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Your Weight May Be Influenced By Where You Live

New research suggests that people who live in “walkable” neighborhoods weigh about 6-10 pounds less than those who live in pedestrian-unfriendly communities. Scientists at the University of Utah calculated the body mass index (BMI) of about half a million Salt Lake county residents from a state drivers license database. They then compared the “pedestrian friendliness” of the zip codes associated with the various BMIs.

They found that people who live in more densely populated zip codes (designed to be more friendly to pedestrians) tended to have lower BMIs. This research has not yet been published, so I can’t comment on the details of the study. However, it makes intuitive sense that walking more can make people lighter on their feet.

The study authors mentioned that city planners used to design communities with pedestrian activities in mind, but since the 1950’s this practice has become less common. Many new  housing developments are built around the assumption that vehicles are the main form of transportation, making that a self-fulfilling prophecy.

Earlier this year I participated in an 8 week walking program promoted by the Department of Health and Human Services. At their recommendation, I purchased a pedometer with a goal of achieving 10,000 steps per day. It was an eye-opening experience for me (left to my own devices, I naturally walked about 2000 steps per day – and I don’t own a car). Americans simply don’t get the amount of exercise that they need to be healthy. We are seeing the result of our sedentary lifestyle in our country’s increasing overweight and obesity rates.

All I can say is that I’m struggling along with the rest of us – doing what I can to increase my activity level and walk as much as possible. I’m lucky to live in an area where walking is fun and easy to do. I have the utmost sympathy for those who are striving to become more active against the odds. Why not join my weight loss group and we can commiserate? There are over 2600 people in there, encouraging one another to get fit! Don’t let your zipcode determine your destiny.This post originally appeared on Dr. Val’s blog at

What Would The Ideal Health IT System Look Like?

I recently interviewed former Congresswoman Nancy Johnson about her views on health information technology (IT). She described her vision of an ideal IT solution, and what it should be able to do for physicians and patients. For the full interview, please check out my post at

Dr. Val: What would the ideal IT system look like?

Ms. Johnson: It would offer continuously updated evidence-based guidelines at the point of care for physicians. It would give patients clear information about what they should expect. It would enable physician social networks to promote learning and experience sharing with one another. It would promote continuous improvement of care practices, and track outcomes and results to continue refining healthcare delivery. Patients should be given check lists and preventive health guidelines, and be asked to provide feedback on any complications or unanticipated events.

If we could aggregrate deidentified patient information we would gain powerful insight into adverse drug events (or unanticipated positive effects) at the very earliest stages. It could be useful in identifying and monitoring epidemics or even terrorist incidents. This could advance medical science faster than ever before. Until we have all this information at our finger tips, we can’t imagine all the potential applications.

Dr. Val: Are you describing a centralized, national EMR?

Ms. Johnson: Not necessarily. But if systems are interoperable, it could function as one. I imagine it as a series of banks run by local administrators, but with the capability of sharing certain deidentified data with one another.

Dr. Val: Do you think the government should design this information system?

Ms. Johnson: No. You don’t want the government doing it alone. As much as I love the government and have been working in it for decades, it’s simply not good at updating and modernizing systems. You have to have a public-private partnership in this. The government should be involved to protect the public interest, and the private sector should be involved so that the system can be innovative, nimble, and easily updated.

Technology will bring us extraordinary new capabilities to manage our health, prevent illness, minimize the impact of disease on our lives, improve the ability of physicians to evaluate our state of health, allow us to integrate advances in medicine in a timely fashion, and quantify the impact of new inventions and procedures. All this, and IT will help us to promote prevention and control costs associated with acute care.

We have a high quality system now, but because it’s so disorganized, the patient doesn’t receive the quality they should. The incredible advances in technology that we have created should be available to all who need it. Unfortunately that’s not the case now.

If you look at Canada’s use of the specialist and specialist equipment along the US’s border with Canada, it says a lot about government run healthcare.

*See full interview at*This post originally appeared on Dr. Val’s blog at

Medgadget and Dr. Val Meet Secretary Leavitt

Now this is an historic moment… I finally get to meet my hero medblogger Gene Ostrovsky, editor and webmaster of at a blogger conference tomorrow in Washington, DC. Gene is driving in from NYC and we’ll plan to have dinner with hubby and any other folks we can lure from the all-star conference:

Welcome and Introduction Drew Altman, President and Chief Executive Officer, Kaiser Family Foundation

Keynote Address The Honorable Michael O. Leavitt Secretary, U.S. Department of Health and Human Services

Panel Discussion Vicky Rideout (moderator) Vice President, Kaiser Family Foundation and Director, Kaiser Forum on Health Journalism and the News Business

Jacob Goldstein, Wall Street Journal

Michael Cannon, Cato Institute

Ezra Klein, American Prospect Magazine

John McDonough, Office of Senator Edward Kennedy and formerly of Health Care for All in Massachusetts

Tom Rosenstiel, Center for Excellence in Journalism

I’ve spent the last year and a half producing a weekly newsletter featuring the best of Medgadget’s posts – this one about the asthma inhaler “spacer piggie” is just one example of the innovative gadgets that Gene has enthusiastically gathered into one place for geeks like me. So it will be fun to meet the man behind the piggies… See you tomorrow, Gene.

Anyone else care to join us?

This post originally appeared on Dr. Val’s blog at

War Amputees And American Culture

At the recommendation of my dear friend and fellow blogger, Dr. Ramona Bates, I attended a lecture entitled, “Limb Labs: Getting Amputee Soldiers Back to Work After World War I.” The lecture was held at the National Museum of Health and Medicine on the Walter Reed campus in Washington, DC. Both lecturers (Beth Linker and Jeffrey Reznick) did a wonderful job of transporting the audience back in time, outlining the cultural beliefs and historical context of the day. This is what I gleaned from their commentary:

Roughly 100,000 men became amputees as a result of injuries from the American Civil War (1861-1865). At the time there was no government-sponsored program to fit amputees with prosthetic limbs, so veterans were on their own. Prosthetists catered to the middle and upper classes who paid cash for their custom prostheses. Veterans of lesser means could only afford a peg leg, and some would sell photos of their stumps (like baseball cards) to support themselves. Many veterans were not effectively reintegrated into the work force after their injuries, and were considered “charity cases” by the American public.

By the time World War I began, there was significant social stigma associated with amputation. Peg legs and hook arms were synonymous with “blood thirsty villains” like Captain Ahab from Moby Dick, and Captain Hook from Peter and Wendy. As America braced for a fresh round of young amputees, the government prepared occupational rehabilitation programs in an attempt to reduce deliquency among injured veterans. An entire PR engine was developed to set expectations that veterans would become “active workers, not charity cases.” And authors like John Galsworthy, began describing the vocational reintegration of war heroes as “sacred work.”

Around the turn of the 20th century, technology had advanced to allow mass production of various goods. Factories were created to produce large quantities of standardized items like clothing, and the corresponding reduction in cost revolutionized the standard of living for many poor and middle income Americans. Not surprisingly, enterprising individuals looked for ways to mass produce costly, custom products – and be the first to market with a new, affordable option.

Seizing on the opportunity that World War I created (i.e. a new market for prosthetic limbs), a couple of orthopedic surgeons recognized an opportunity to take over the prosthetic limb market by creating a “one size fits all” solution that they could sell to the government. The government was eager to avoid the costly mistakes of the Civil War (i.e. not having a plan for reintegrating young men into the work force), but couldn’t afford the prosthetist’s fee of $200 per custom prosthetic limb. The “E-Z leg” was born, and at a cost of only $20 per prosthesis, it seemed like a steal.

The E-Z leg solved a few problems for the government – 1) it allowed injured veterans to walk off the ships (instead of being carried on stretchers) that brought them home from Europe, thus minimizing the public appearance of the toll of war 2) it allowed them to offer cosmetically appealing prostheses, rather than peg legs, to amputees 3) it increased the vocational rehabilitation potential of veterans.

Of course, the “E-Z leg” didn’t have the best marketing ring to it, so it was rebranded the “liberty leg” and hailed as a triumph of modern technology. In reality, though, it wasn’t much of a functional improvement over a peg leg. In prosthetic design, a “one size fits all” approach ensures that no one gets a truly good custom fit. But psychologically, the veterans were pleased to have a cosmetically appealing limb, and most had no idea how much better a custom limb could be. The public was satisfied by the government’s generosity, not realizing that the government had actually budgeted $75/amputee at the beginning of the war. What happened to the $55 savings? We’ll never know.

One thing’s for sure, the orthopedist owners of E-Z leg made out like bandits. John Galsworthy became so disillusioned with his push for “sacred work” that he wrote, “Empty promises and rhetoric of heroism… The war killed the self-importance, faith and idealism in me.” He never spoke of vocational rehabilitation for war veterans again.


As I watched the NBC nightly news yesterday, I noted an interview with a young Marine recovering from bilateral leg amputations (caused by an IED explosion in Iraq) at Walter Reed. When asked if he was worried about walking again he simply replied, “I don’t worry about that. With the artificial legs they have these days, I’ll probably be better than ever.”

And I thought to myself, “the more things change, the more they stay the same.”This post originally appeared on Dr. Val’s blog at

Dr. Antonia Novello, 14th Surgeon General of the United States, On Creating A Healthcare Navigation System For Cancer Patients

I had the chance to interview Drs. Carmona, Satcher, and Novello about the current state of America’s war on cancer.  I’ll post each conversation in a separate blog entry. This post explores Dr. Novello’s views on creating a healthcare navigation system for patients with cancer.

Dr. Val: How are cancer patients navigating the system currently?

Dr. Novello: They are relying primarily on their oncologists to help them navigate. But even though oncologists want to help their patients as much as possible, the reality is that they are taking care of thousands of patients at a time and simply don’t have the bandwidth to assist with the level of detail necessary.

Cancer is extremely complicated and patient care is not just about diagnosis, staging, and treatment. It also includes tests for genetic markers, coordination of genetic counseling, finding appropriate clinical trials for the patients to participate in, locating a continuity of care supervisor, rehabilitation services, scheduling chemotherapy, radiation, and surgical treatments.

Cancer doesn’t happen in a vacuum – patients also have other medical conditions that need to be managed along with the cancer diagnosis. In addition, one must create a comprehensive follow up plan for survivors, including scheduling of surveillance tests to identify possible recurrences. If a cure is not an option, then palliative care and hospice services must be coordinated. In addition to that, patients must create a living will, designate someone to have power of attorney over their care, and prepare for the legal aspects of their passing. This is why a diagnosis of cancer can be overwhelming to most people, and they are in desperate need of a structured program to help them navigate the complexities and to ensure that the ball is not dropped anywhere along the way.

Dr. Val: What’s the best way to help cancer patients more successfully navigate the healthcare system?

Dr. Novello: We need to create a simple, comprehensive, and accurate way to offer guidance to all Americans with cancer so that they can get the best care possible. You know how some hospitals have painted lines on the floor to help people to navigate from A to B in the building? Well we need this kind of line system for cancer care.

Ellen Stoval at the National Coalition for Cancer Survivorship, Lance Armstrong and his Foundation, members of the Institute of Medicine and the Centers for Disease Control and Prevention, and members of the President’s Cancer Plan at the National Cancer Institute, have formed a coalition to delineate the features of an ideal cancer patient navigator system. Senators Kennedy and Hutchison are preparing a bill for congress – it would ensure that Medicare covers a cancer patient navigator service. It remains to be seen who will build the service, and how it will be distributed.

Dr. Val: What are the key elements of a cancer patient navigator system?

Dr. Novello: The coalition is unanimous in their opinion that the navigator must provide culturally sensitive, clear information in the native language of the patient. A cancer patient navigator should include assistance with:

Diagnosis: Every patient needs to know the name and stage of the cancer that they have.

Treatment: The treatment plan (including chemotherapy, radiation, and/or surgery) that is recommended for them.

Scheduling: A schedule of all their appointments.

Pain Management: A comprehensive plan for pain management so that the patient is not denied access to narcotics if needed.

Psychosocial Services: Access to psychosocial services to assist with coping strategies for depression and family and marriage counseling.

Insurance Assistance: a plan for financing the cost of treatment – specifically an insurance advocate who can help the patient understand and maximize their insurance benefits, and if they’re uninsured, a way to get coverage for the care they need.

Peer Support: A list of support groups that can assist the patient with their emotional needs.

We need everyone to support this upcoming bill so that all cancer patients will have access to a navigation tool that will help them get the care they need in a timely fashion. Successful navigation of this healthcare system can mean the difference between life and death for cancer patients.

Dr. Novello is the Vice President for Women and Children’s Health Policy at Florida Hospital in Orlando, Florida.

*See the National Call to Action on Cancer Prevention and Survivorship*This post originally appeared on Dr. Val’s blog at

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