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Surgeon General’s Warning: Obesity Is A National Security Issue

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Dr. Richard Carmona

I’ve interviewed Dr. Richard Carmona (the 17th Surgeon General of the United States, and former EMT, nurse, and surgeon) several times on this blog and have been intrigued by his insights and approaches to health. In our most recent interview, he discussed obesity from a provocative new angle: national security.

Dr. Val: What do you mean that obesity is a national security issue?

Dr. Carmona: There are many competing interests on Capitol Hill – the war, the economy, etc. and obesity is something that just doesn’t get enough traction. When I was serving as Surgeon General, I realized that obesity was acting as an accelerator of chronic disease and was the number one health threat to our country. But after several failed attempts to get attention focused on this issue, I realized that I had to present the message in a unique way in order to get it to resonate.  It occurred to me that if I used different language to describe the threat, people would allow me to connect the dots and explain the problem fully.

Retaining EMS, police, firemen, soldiers, sailors, and airmen has been challenging because many of them  can’t pass their physical fitness tests due to obesity and sedentary lifestyles. Health is therefore inextricably tied to national security. Describing the health threat in these terms helped legislators to understand the complex ramifications of the condition.

Dr. Val: How rigorous are these fitness tests? Are we talking about soldiers not being able to run a 5-minute mile, or is it less challenging than that?

Dr. Carmona: The fitness tests are based on research from the Cooper Clinic in Texas and include a measure of aerobic capacity, strength, and flexibility.  There are standardized minimums based on gender and decade of age, and although I don’t have the exact minimums memorized for each age group, they’re very reasonable. We’re not talking about having to run a 5 minute mile. More like having to run a mile and a half in 15 minutes or having the flexibility to touch your toes in a seated position. As far as push-ups are concerned, the qualifying range is about 20-45.

Dr. Val: One of my blogger friends relayed a story recently about a surgeon who asked his hospital cafeteria to serve healthy options instead of fried food. They responded that no one would buy the healthy food and they’d go out of business – so economic necessity required that they continue to serve unhealthy food. What would you say to that surgeon?

Dr. Carmona: I’d invite that surgeon to come out to Canyon Ranch where we serve healthy gourmet meals every single day.  Our chefs are very innovative and entrepreneurial – they make healthy food taste delicious, and at a cost-effective price.  Americans need to learn how to make healthy food delicious. My friend Toby Cosgrove is a surgeon at the Cleveland Clinic, and he was able to spearhead a healthy food initiative there that has been very successful.  We strive to find new and creative ways to prepare healthy food at Canyon Ranch – and are always coming out with new recipes and cookbooks to keep people interested in healthy eating.

***

I caught up with Dr. Carmona at the STOP Obesity Alliance briefing about the new GPS  (Guide for Policy and Program Solutions) initiative. Please click here to learn more about the STOP Obesity Alliance.

Insomnia Treatment Tips From Actor Debi Mazar

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Debi Mazar

You may know actor Debi Mazar from her work in the movie Goodfellas, and from her role as Shauna on the HBO hit TV show, Entourage. But I know Debi as a busy mom who struggles with insomnia.  I caught up with her a few days ago to find out how she’s coped with those sleepless nights.

Listen to the podcast here:

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Dr. Val: When did insomnia first become a problem for you?

Mazar: Insomnia is surprisingly common. It affects 60 million Americans: 40% of women and 30% of men. My struggle with insomnia began in my mid to late 20’s when my professional and love life went into full swing. I ate well and exercised, but started having trouble falling asleep every night. I went to see a doctor because I didn’t realize that there were many things that I could do about it on my own.

Dr. Val: What are some of the non-medical treatments that worked for you?

Mazar: Cutting back on caffeine, sugar, and alcohol, and exercising only early in the day, having a healthy sex life, and getting myself on a sleeping schedule. I also tried to reduce stress levels in my life by not going to bed angry, by unplugging from TV and the Internet, and I made my bedroom a very cozy, dark environment that would be condusive to sleep. When you’re a mom, sleeping pills aren’t a good option because you might have to get up in the middle of the night. I have a full list of insomnia tips at bedsidebriefings.com

Dr. Val: I bet that insomnia is a common problem in Hollywood. Has that been your experience?

Mazar: I don’t consider myself to be part of “Hollywood” I’m just an average mom who worries about the world we live in and our economy. The news can cause a lot of anxiety – regardless of what you do for a living. It keeps us all awake at night. Of course, chronic insomnia can increase our risk of depression, weight gain, diabetes and hypertension.

Dr. Val: What is the most important thing for Americans to know about sleep?

Mazar: Sleep is the time when your body repairs itself, so sleep is essential for good health. Without it, we all fall apart.

Dr. Atul Gawande: Check Lists Are Critical To Improving Patient Safety

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Dr. Gawande

Kaiser Permanente sponsored a special event in DC today – Charlie Rose interviewed Dr. Atul Gawande about patient safety in front of an audience of physicians. Dr. Gawande is a young surgeon at Harvard’s Dana Farber Cancer Institute, has written two books about performance improvement, and is a regular contributor to the New Yorker magazine. I had heard many positive things about Atul, but had never met him in person. I was pleasantly impressed.

Atul strikes me as a genuinely humble person. He shifted uncomfortably in his chair as Charlie Rose cited a long list of his impressive accomplishments, including writing for the New Yorker. Atul responded:

I’m not sure how my writing became so popular. I took one fiction-writing class in college because I liked a girl who was taking the class. I got a “C” in the class but married the girl.

He went on to explain that because his son was born with a heart defect (absent aortic arch) he knew what it felt like to be on the patient side of the surgical conversation.  He told the audience that at times he felt uncomfortable knowing which surgeons would be operating on his son, because he had trained with them as a resident, and remembered their peer antics.

Atul explained that patient safety is becoming a more and more complicated proposition as science continues to uncover additional treatment options.

If you had a heart attack in the 1950’s, you’d be given some morphine and put on bed rest. If you survived 6 weeks it was a miracle. Today not only do we have 10 different ways to prevent heart attacks, but we have many different treatment options, including stents, clot busters, heart surgery, and medical management. The degree of challenge in applying the ultimate best treatment option for any particular patient is becoming difficult. This puts us at risk for “failures” that didn’t exist in the past.

In an environment of increasing healthcare complexity, how do physicians make sure that care is as safe as possible? Atul suggests that we need to go back to basics. Simple checklists have demonstrated incredible value in reducing central line infections and surgical error rates. He cited a checklist initiative started by Dr. Peter Pronovost that resulted in reduction of central line infections of 33%. This did not require investment in advanced antibacterial technology, and it cost almost nothing to implement.

Atul argued that death rates from roadside bombs decreased from 25% (in the Gulf War) to 10% (in the Iraq war) primarily because of the implementation of check lists. Military personnel were not regularly wearing their Kevlar vests until it was mandated and enforced. This one change in process has saved countless lives, with little increase in cost and no new technology.

I asked Atul if he believed that (beyond check lists) pay for performance (P4P) measures would be useful in improving quality of care. He responded that he had not been terribly impressed with the improvements in outcomes from P4P initiatives in the area of congestive heart failure. He said that because there are over 13,000 different diseases and conditions, it would be incredibly difficult to apply P4P to each of those. He said that most providers would find a way to meet the targets – and that overall P4P just lowers the bar for care.

Non-punitive measures such as check lists and applying what we already know will go a lot farther than P4P in improving patient safety and quality of care.

Atul also touted the importance of transparency in improving patient safety and quality (I could imagine my friend Paul Levy cheering in the background). In the most touching moment of the interview, Atul reflected:

As a surgeon I have a 3% error rate. In other words, every year my work harms about 10-12 patients more than it helps. In about half of those cases I know that I could have done something differently. I remember the names of every patient I killed or permanently disabled. It drives me to try harder to reduce errors and strive for perfection.

Atul argued that hospitals’ resistance to transparency is not primarily driven by a fear of lawsuits, but by a fear of the implications of transparency. If errors are found and publicized, then that means you have to change processes to make sure they don’t happen again. Therein lies the real challenge: knowing what to do and how to act on safety violations is not always easy.

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Charlie Rose

Charlie Rose asked Atul the million dollar question at the end of the interview, “How do we fix healthcare?” His response was well-reasoned:


First we must accept that any attempt to fix healthcare will fail. That’s why I believe that we should try implementing Obama’s plan in a narrow segment of the population, say for children under 18, or for laid off autoworkers, or for veterans returning from Iraq. We must apply universal coverage to this subgroup and then watch how it fails. We can then learn from the mistakes and improve the system before applying it to America as a whole. There is no perfect, 2000 page healthcare solution for America. I learned that when I was working with Hillary Clinton in 1992. Instead of trying to fix our system all at once, we should start small and start now. That’s the best way to learn from our mistakes.

Joan Lunden Loves Personal Health Records

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Joan Lunden

Former Good Morning America host, Joan Lunden, is getting behind the personal health record industry. As the daughter of a physician, Joan grew up believing that she’d become a doctor one day. She told me that all that came to a screeching halt when she “realized that she didn’t like blood or stitches.” But Joan has always kept women and children’s health advocacy initiatives close to her heart.  She will soon be starring in a new Lifetime TV show called Health Corner. I caught up with her about her recent work with PassportMD.


Listen to the podcast here, or read a summary of our discussion below.

Dr. Val: Tell me about your experiences in taking care of your mom, and what led you to become involved with a PHR company.

Lunden: I lost my brother to type 2 diabetes a little over a year ago. As it happens, he had been managing my mom’s medical care, and so with his loss I needed to step in and take it over. Of course she lives on one coast and I live on the other. I’ve got 4 little kids (two sets of twins) and three young adult children. It becomes really daunting to keep track of everyone’s medical care. Around that time I met some folks from PassportMD, and when they showed me how easy it could be to keep everyone’s records in one place, I said, “this is exactly what I need.”

I think I’m really typical of a lot of women out there in what we call “the sandwich generation.” Today a high percentage of women with small children are working outside of the home. It’s really a lot to juggle – a career, raising a family, and getting everyone to the doctor on time – forget about getting YOU to the doctor on time. As good as we women are at nurturing others, we tend to be at the bottom of our own to-do lists.

What I really love about PassportMD is not just the organization (I can immediately see all my kids’ vaccination schedules for example) but the fact that I’m building a family medical history. It’s so important to know your family history so that you can engage in appropriate screening tests and take preventive health measures. This PHR even sends you reminders when its time for immunizations, mammograms, or other appropriate screening tests.

Dr. Val: As a doctor I’ve encountered resistance to PHRs from patients because they don’t want to have to enter all the data themselves. They’d like it to be auto-populated with their medical record data so that they don’t have to start from scratch. Has the PassportMD tool solved that problem?

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Actor Ben Vereen Speaks Out About His DiabetesVer

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Ben Vereen

I had the pleasure of speaking with Tony-award winning actor and Broadway star, Ben Vereen about his recent diagnosis of diabetes. Ben has had an extremely accomplished career, including recent guest appearances on NBC’s Law and Order, and ABC’s Grey’s Anatomy. He’ll appear in an upcoming Fox feature with Patti Labelle called, “Mama, I Want To Sing” so don’t miss it.

To listen to a podcast of our interview, please click here.


Dr. Val: Ben, how exactly were you first diagnosed with diabetes?


Vereen
: Unfortunately, prior to my diagnosis I didn’t recognize the signs of diabetes and didn’t understand what was causing my symptoms. I had dry mouth, frequent urination, severe thirst, sugar cravings and fainting episodes and didn’t realize they were all caused by diabetes. One day my daughter saw me pass out and she took me to the hospital. It didn’t take them long to figure out that my blood sugar was out of control. They kept me overnight and told me the next day that I had diabetes. I was shocked because I thought I was exercising regularly and eating well – it never occurred to me that I could have diabetes.

Looking back I realize that I had been told once (about 8 years ago) that I had “a touch of diabetes” but I thought it had gone away because of my good eating habits and exercise. I wish I had thought to follow up on that diagnosis and ask my primary care physician to check my blood sugar regularly.

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