March 13th, 2010 by DrDavidKroll in Better Health Network, True Stories
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A few weeks ago, I wrote a post about being stricken with pneumonia and my reflections on what it must be like for people who live continually with chronic illnesses. I was surprised by the response from many readers, quite a few of whom I’ve never seen comment here, who voiced understanding and even relief that a “normal” would take the time to reflect on what their life might be like.
Well, my illness is continuing even longer than my pulmonologist had expected and this has evoked for me a whole new layer of emotions. I write the following not for sympathy or concern, but rather for the Medicine and Health channel of ScienceBlogs to give voice to those much worse off than I who may not otherwise have a voice in our national health care dialogue. Read more »
*This blog post was originally published at Terra Sigillata*
February 24th, 2010 by Happy Hospitalist in Better Health Network, Opinion, True Stories
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As a hospitalist I sometimes come across patients who, for what ever reason, refuse to take the medications prescribed by their in-patient doctors. Some patients refuse out of fear. Some doctor told them years ago that taking medication X would make them worse. Some patients refuse out of ignorance of their disease process. Most of the time however, they just don’t understand why the medication is necessary. Some patients just refuse out of stubbornness. And some patients refuse because they have a really good reason.
However, when you’re dealing with critical illness and the only thing that’s going to save your patient’s life is a treatment plan they are refusing, sometimes you have to be in their face with reality. So how do I handle situations with patients who have the capacity to make poor medical decisions but refuse life saving medications? How do I convince my hospitalized patients to take their medications I’ve prescribed? Read more »
*This blog post was originally published at Happy Hospitalist*
October 28th, 2009 by Happy Hospitalist in Better Health Network, Opinion
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What we need is health reform, not health insurance reform. If we do nothing about health care inflation, we are all doomed. Every last one of us. Taking care of sick people is expensive. The only way to get rid of health care inflation is to stop spending money. At some point we will either have to
- decrease illness
- decrease treatment and/or
- decrease the cost of treatment
There are no alternatives. As an American which action plan would you rather see take hold? Realize that every cost action has a reaction. You can decrease disease by prevention. You can decrease treatment by bundling. And you can decrease the cost of treatment by making it more efficient or simply paying less until access becomes an issue. I am certain that keeping the financial stability of America will require all three. But the only one you as a patient have control over is #1. As a country, we can prevent 80% of diabetes, heart disease, stroke and cancer by taking care of ourselves with lifestyle modification. Read more »
*This blog post was originally published at A Happy Hospitalist*
January 27th, 2009 by drval in Announcements, Audio, Expert Interviews
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Better Health’s policy writer, Gwen Mayes, caught wind of an interesting new conference being held tomorrow in Miami. She interviewed Ken Thorpe, Ph.D., one of the conference organizers, to get the scoop. You may listen to a podcast of their discussion or read the highlights below. I may get the chance to interview Billy Tauzin and Donna Shalala later on this week to get their take on healthcare reform initiatives likely to advance in 2009. Stay tuned…
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Mayes: Tell us about the upcoming conference in Miami on January 28th called “America’s Agenda: Health Care Policy Summit Conversation.”
Thorpe: The conference will start a conversation on the different elements of health care reform such as making health care more affordable and less expensive, finding ways to improve the quality of care and ways to expand coverage to the uninsured. The conference is unique in that we’ve brought together a wide range of participants including government, labor, and industry for the discussion, many of whom have been combatants over this issue in the past.
Mayes: Will there be other meetings?
Thorpe: This is the first of several. There will others in other parts of country over next several months. President Obama and HHS Secretary Designee Tom Daschle have talked about engaging the public in the discussion this time around. So part of this is an educational mission and part of it is to reach consensus among different groups that have not always agreed in the past.
Mayes: What encourages you that these groups will be more likely to reach consensus now when they haven’t in the past?
Thorpe: The main difference is that the cost of health care has gotten to the point that many businesses and most workers are finding it unaffordable. In the past, most businesses felt that, left to their own devices, they could do a better job of controlling health costs by focusing on innovated approaches internally. What we’ve found, despite our best efforts, working individually we haven’t done anything to control the growth of health care spending. The problems go beyond the reach of any individual business or payer and we need to work collectively.
Mayes: How will health care reform remain a priority in this economy?
Thorpe: The two go hand in hand. As part of our ability to improve the economy we’re going we have to find a way to get health care costs down. Spiraling costs are a major impediment to doing business and hiring workers. To the extent we can find new ways to afford health care it will be good for business and workers.
Mayes: Health information technology is also an important aspect. What are the common stumbling blocks to moving forward?
Thorpe: There are three issues we have to deal with. First, we have to have a common set of standards for how the information flows between physicians and physicians, and with payers and hospitals. What we call interoperability standards. Second, we have to safeguard the information. Finally, cost is the biggest challenge because most small physician practices of 3 or 4 physicians don’t have electronic record systems in place. To put in a state-of-the-art system can cost $40,000 per physician and most cannot afford this expense. I think the stimulus bill will provide funds to help with these costs.
Mayes: There’s always growing interest in the patient’s role. How will this be addressed?
Thorpe: We have to find a better way to engage patients in doing better job of reducing weight, improving diet and those with chronic disease to follow their care plan they worked out with their physician. We also want to make it more cost effective for patients to comply with the plan. Patients who comply with health plans will have better outcomes at lower costs.
Mayes: Who’s on the agenda in Miami?
Thorpe: It’s at the University of Miami so it will be hosted by President Donna Shalala who was Secretary of HHS under the Clinton administration so she is well versed on health policy. Also attending is the head of PhRMA, Billy Tauzin, a former Congressman and former majority leader of the House, Dick Gephart. There will be some lay people as well for a nice cross section of consumers, labor, providers, business and others.
Mayes: How can people learn more about American’s Agenda and the conference?
Thorpe: The executive director of American’s Agenda is Mark Blum. He can be reached at 202-262-0700 or at America’s Agenda.org.
November 27th, 2008 by drval in Expert Interviews
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Happy Thanksgiving everyone - I thought I’d blog about food today, and to try to persuade you to trade that pumpkin pie for a glass of milk…
I learned some interesting things at the Dairy Science Forum on November 13th in DC. Dr. David McCarron presented some compelling data on the effects of the DASH diet on reducing blood pressure. The DASH diet is fairly high in dairy products (2-4 servings/day), fruits, and vegetables. In comparison with a low-salt diet (which reduces systolic blood pressure by an average of 1 point), the DASH diet can cause an average reduction in systolic blood pressure of ten points. If you have high blood pressure (and your kidneys are functioning normally) you probably shouldn’t worry all that much about the salt. It’s more important to stick with the DASH diet.
I interviewed Dr. McCarron about the role of dairy in blood pressure management. Here’s what he had to say:
Dr. Val: If salt isn’t the real enemy, and dairy can help to reduce blood pressure, why isn’t that message getting out?
Dr. McCarron: We have national nutrition policies in place that are old and out of date. The healthy eating paradigm - low fat, low sugar, low salt - was established 40+ years ago and when new evidence is obtained, it’s really hard to crack through that illusion of knowledge. There is excessive mistrust of new data because of the attitude that if it conflicts with our previous beliefs, it can’t be true. I believe that the Internet will be critical in allowing the evidence to bubble up. For example, a diet rich in dairy food is absolutely associated with a reduction in virtually all chronic medical conditions. We have data to support this for people of all ethnicities and from around the world. I think that consumers are looking for clarity and simplicity in their nutritional advice - and basically they need to know that a healthy diet requires 3-4 servings of dairy and 5-6 servings of fruits and vegetables/day. If you do that alone (along with regular exercise) you’ll be amazed by the results.
Dr. Val: What is the proposed mechanism by which dairy has all these positive effects?
Dr. McCarron: It’s almost impossible to nail down specific mechanisms because milk products contain so many ingredients (electrolytes, key vitamins, bioactive proteins, and essential fatty acids). Trying to understand which piece is impacting very complicated physiological control mechanisms within the body (that have 30-40 different vectors feeding into them) is extremely difficult. In fact, the permeatations make it almost impossible. We can’t come up with the proof that we do for drugs (which contain only one bioactive ingredient). What we do know, though, is that dairy is a vital component for chronic disease reduction and prevention. Unfortunately the policy people say, “you haven’t explained to me how this works, so I’m not going to consider it.”
Dr. Val: But what about the research suggesting that whey protein contains lactokinins that function similarly to ACE inhibitors (a type of blood pressure medicine)?
Dr. McCarron: That’s been known for over a decade. There’s no question that there are small peptides (proteins) in milk that have a positive impact on blood pressure, mood disorders, and weight reduction. The industry doesn’t want to talk about it because it makes milk sound like a drug, which isn’t effective marketing. Also the average consumer doesn’t have enough background to understand what that means (lactokinins have ACE inhibitor-like effects in vivo), so we need to simplify the message and disseminate it via the Internet.
References:
NEJM, 1998 Effects of Dietary Patterns On Blood Pressure
Am J Hyper, 2004 McCarron and Heaney
JAMA, 2002 Pereria et al
Science, 1984, McCarron et al
JAMA, 1996, Bucher et al
October 7th, 2008 by drval in Expert Interviews, Medblogger Shout Outs
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Many thanks to my fellow blogger KevinMD who offered to host me during my period of blog homelessness. In this post, I interview Dr. Ken Thorpe about the real driver of healthcare costs:
About 75% of what we spend on healthcare is associated with chronically ill patients. That’s about 1.6 trillion dollars per year. Chronic disease accounts for the biggest source of spending in the healthcare economy, and it’s also the fastest growing – as more and more people are living with chronic illnesses. If we’re really serious about getting to the bottom of the healthcare affordability crisis, we’ll have to first address the chronic disease issue…
For the rest of the post, please click here.
September 14th, 2008 by drval in Health Policy
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I posted this at Medpolitics.com today… but it is displaying some weird code, so I decided to repost it here.
***
For the first time in recent memory the Republicans and the Democrats are on the same page on a healthcare issue: the problem of chronic disease. Former Surgeon General Dr. Richard Carmona told me that chronic disease contributes more to healthcare costs than any other single issue, and that many chronic diseases are preventable through diet and lifestyle measures. Both political parties seem to agree that America must become a “wellness” culture. However, they don’t exactly agree on how that may be achieved. The Democrats would expand the government’s role in stimulating healthy behaviors while the Republicans would use market forces and grass roots efforts to encourage personal accountability.
WHAT THE DEMOCRATS SAY ABOUT CHRONIC DISEASE:
An Emphasis on Prevention and Wellness.
Chronic diseases account for 70 percent of the nation’s overall health care spending. We need to promote healthy lifestyles and disease prevention and management especially with health promotion programs at work and physical education in schools. All Americans should be empowered to promote wellness and have access to preventive services to impede the development of costly chronic conditions, such as obesity, diabetes, heart disease, and hypertension. Chronic-care and behavioral health management should be assured for all Americans who require care coordination. This includes assistance for those recovering from traumatic, life-altering injuries and illnesses as well as those with mental health and substance use disorders. We should promote additional tobacco and substance abuse prevention. (“Renewing America’s Promise,” pg. 10).
WHAT THE REPUBLICANS SAY ABOUT CHRONIC DISEASE:
Prevent Disease and End the “Sick Care” SystemChronic diseases — in many cases, preventable conditions — are driving health care costs, consuming three of every four health care dollars. We can reduce demand for medical care by fostering personal responsibility within a culture of wellness, while increasing access to preventive services, including improved nutrition and breakthrough medications that keep people healthy and out of the hospital. To reduce the incidence of diabetes, cancer, heart disease, and stroke, we call for a national grassroots campaign against obesity, especially among children. We call for continuation of efforts to decrease use of tobacco, especially among the young. (“2008 Republican Platform,” pg. 38).
Whichever party is elected this November, one thing is certain – more emphasis will be placed on encouraging Americans to adopt healthier lifestyles. The Partnership to Fight Chronic Disease is doing its part to coordinate these efforts and raise awareness of lifestyle modification programs that work. As for me, I’ve traded my car for a pedometer.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 17th, 2008 by drval in Expert Interviews, Health Policy
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Ken Thorpe, Ph.D., is the Executive Director of the Partnership to Fight Chronic Disease, and is admired and respected by many of the “movers and shakers” in Washington. The outpouring of appreciation for his work was quite evident during the recent half day-conference entitled, “Fighting Chronic Disease: The Missing Link In Health Reform.” I had the chance to speak with Ken to get his thoughts on chronic disease and health reform.
Dr. Val: What are the most important things that the general public needs to know about chronic disease?
Dr. Thorpe: Two things. First of all, they need to know whether or not they have a chronic disease. For example, about a third of diabetics in the country don’t know they have diabetes. So Americans need to be screened appropriately for potential chronic diseases like cancer and diabetes.
Second, if you do have a chronic disease, there are simple ways to manage it. Management needs to be coordinated through a primary care physician. Basic things like blood pressure and blood sugar need to be monitored on a regular basis. Diet and exercise are also a critical compenent of chronic disease management. The good news is that most chronic illnesses are manageable, but patients need to be actively engaged in their health. Medication compliance and consistent lifestyle modification under the care of a PCP is the way to go.
Dr. Val: What should people know about the Partnership to Fight Chronic Disease?
Dr. Thorpe: We want to get patients (or “consumers”) involved as a voice for healthcare reform. Patients are the key to making our healthcare system simpler, less-expensive, and less administratively complex. We believe that health reform is possible. We must not become frustrated with our inability to fix everything today, but if we start with the right set of issues and really work collaboratively to solve them, we really can make life better for patients and physicians.
The patient community should go to our website and learn the facts about chronic disease and help to educate their local politicians and community leaders about it. I would encourage them to spearhead community-based interventions to promote weight loss and prevent obesity. We just released a book about “best practices” for achieving healthy behavior modifications. It is full of local program ideas to help prevent chronic disease – and it’s all based on initiatives that have a proven track record of success. Our best practices book is an ideal guide to community-based interventions that can make a difference.
Dr. Val: You say that we need a different delivery model to treat chronic disease. Can you explain that?
Dr. Thorpe: Chronic disease management requires a team-based model. Nurses, social workers, and mental health providers should work with patients at home. We need a more proactive model where we engage patients in managing their disease so that we can prevent unnecessary flare ups. For example, with diabetes, if you don’t control your blood sugars on a daily basis, you’re far more likely to go on to require a limb amputation. Our current delivery system does not allow this type of management – interacting with nurses at home, for example – because nobody pays for it. So we need a different payment model and a different delivery model.
Dr. Val: Do you think that online health websites can make a difference?
Dr. Thorpe: I think that online programs should engage people in education – so that they can understand the connection between weight, diet, exercise, smoking, and chronic illness. Only 15% of the population understands the gravity of these issues and how it affects the cost of their health insurance.
Online sites that allow people to track their progress (and chart how they’re managing their disease) may also help people to become more actively engaged in their healthcare.
Dr. Val: How can we encourage people to adopt healthy behaviors?
Dr. Thorpe: Incentives always work. We have to give better tools to people who want to change their behaviors. We have to make it easier for them to manage their health at their places of work. For example, some employers conduct health risk appraisals with their employees and then put together care plans and even have a nurse practitioner available at the work place to check on progress. That way the employees don’t have to take time off work to see the physician after hours.
We can also make a difference in schools – we need consumer advocates to continue to demand healthier school lunch programs and increased physical activity for kids. Consumer advocacy at the community level is critical to our success in the prevention and management of chronic disease.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 11th, 2008 by drval in Health Policy
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Tom Daschle, former Senate Majority Leader from South Dakota, was the keynote speaker at the Fighting Chronic Disease: The Missing Link in Health Reform conference here in Washington, DC. His analysis of the healthcare crisis is this:
US Healthcare has three major problems: 1) Cost containment. We spend $8000/capita – 40% more than the next most expensive country in the world (Switzerland). Last year businesses spent more on healthcare than they made in profits. General motors spends more on healthcare than they do on steel.
2) Quality control. The US system cannot integrate and create the kind of efficiencies necessary. The WHO has listed us as 35 in overall health outcomes. Some people ask, “If we have a quality problem, why do kings and queens come to the US for their healthcare?” They come to the best places like the Mayo Clinic, the Cleveland Clinic, or Johns Hopkins. They don’t go to rural South Dakota. We have islands of excellence in a sea of mediocrity.
3) Access. People are unable to get insurance if they have a pre-existing condition. 47 million people don’t have health insurance. We have a primary care shortage, and hospitals turning away patients because they’re full.
His solutions are these:
- Universal coverage. If we don’t have universal coverage we can’t possibly deal with the universal problems that we have in our country.
- Cost shifting is not cost savings. By excluding people from the system we’re driving costs up for taxpayers – about $1500/person/year.
- We must recognize the importance of continuity of care and the need for a medical home. Chronic care management can only occur if we coordinate the care from the beginning, and not delegating the responsibility of care to the Medicare system when the patient reaches the age of 65.
- We must focus on wellness and prevention. Every dollar spent on water fluoridation saves 38 dollars in dental costs. Providing mammograms every two years to all women ages 50-69 costs only $9000 for every life year saved.
- Lack of transparency is a devastating aspect of our healthcare system. We can’t fix a system that we don’t understand.
- Best practices – we need to adopt them.
- We need electronic medical records. We’re in 21st century operating rooms with 19th century administrative rooms. We use too much paper – we should be digital.
- We have to pool resources to bring down costs.
- We need to enforce the Stark laws and make sure that proprietary medicine is kept in check.
- We rely too much on doctors and not enough on nurse practitioners, pharmacists, and physician assistants. They could be used to address the primary care shortage that we have today.
- We have to change our infrastructure. Congress isn’t capable of dealing with the complexity of the decision-making in healthcare. We need a decision-making authority, a federal health board, that has the political autonomy and expertise and statutory ability to make the tough decisions on healthcare on a regular basis. Having this infrastructure in place would allow us the opportunity to integrate public and private mechanisms within our healthcare system in a far more efficient way.
What do I think of this? First of all, I agree with much of what Tom said (especially points 2-7) and I respect his opinions. However, I was also very interested in Nancy Johnson’s retort (she is a recently retired republican congresswoman from Connecticut).
Nancy essentially said that any attempt at universal coverage will fail if we don’t address the infrastructure problem first. So while she agrees in principle with Tom Daschle’s aspirations and ideals, she believes that if we don’t have a streamlined IT infrastructure for our healthcare system in place FIRST, there’s not much benefit in having universal coverage.
As I’ve always said, “equal access to nothing is nothing.”
I also think of it this way: imagine you own a theme park like Disney World and you have thousands of people clamoring at the gates to enter the park. One option is to remove the gates (e.g. universal coverage) to solve consumer demand. Another option is to design the park for maximal crowd flow, to figure out how to stagger entry to various rides, and to provide multiple options for people while they’re waiting - and then invite people to enter in an orderly fashion.
Obviously, this is not a perfect analogy - but my opinion is that until we streamline healthcare (primarily through IT solutions), we’ll continue to be victims of painful inefficiencies that waste everyone’s time. It’s as if our theme park has no gates, no maps, no redirection of crowd flow, no velvet-roped queues, and the people who get on the rides first are not the ones who’ve been waiting the longest, but the “VIPs” with good insurance or cash in the bank. It’s chaotic and unfair.
Quite frankly, I think we could learn a lot from Disney World - and I hope and pray that next year’s healthcare solution is not simply ”remove the gates.”
What do you think?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 7th, 2008 by drval in Health Policy
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I recently attended a half day conference, “Fighting Chronic Disease: The Missing Link In Health Care Reform” sponsored by Emory University and the Partnership to Fight Chronic Disease (PFCD). It was an extremely well run event with an all-star political cast: Tom Daschle, Dick Gephardt, Dr. Mark McClellan, and Nancy Johnson were present. The key medical players included Dr. Nancy Nielson, president-elect of the AMA, and Dr. Otis Brawley, CMO of the American Cancer Society.
The purpose of the conference was to raise awareness about the cost of chronic disease - it accounts for at least 75% of healthcare spending, and 80% of that could be avoided with lifestyle interventions. Shocking, isn’t it? Any discussion of reducing medical costs needs to begin at ground zero - getting Americans to adopt healthy diet and exercise habits.
One of the most entertaining panelists was Chris Viehbacher, the president of North American Pharmaceuticals at GlaxoSmithKline (GSK). Chris is a gifted speaker with a charming Canadian accent - and could probably be the head of a debate team. We had the chance to speak about lobster fishing in Nova Scotia during one of the breaks since we share a common Maritime heritage. He offered some amusing analogies about our healthcare system, and made some points that bear repeating here:
“Half of the people in the US have some sort of chronic illness. Health insurance is like having car insurance when 50% of people are having accidents. Of course nobody can afford it.”
“We need to keep employer-based healthcare because when employers have ’skin in the game’ they have the incentive to promote healthy behavior at a local level. Monolithic government programs aren’t good at influencing people at the individual level. Employers know each of their employees by name, they are invested in their lives, they provide childcare services and other benefits to them, and each employee’s health affects their bottom line. Employers are a critical force for promoting and facilitating healthy behaviors.”
“Alternative energy sources aren’t that interesting when gas is $1/gallon. But when gas hits $4/gallon suddenly everyone is very interested in alternative energy. The same goes for healthcare. It takes a cost crisis to bring it to everyone’s attention. And now the audience is listening.”
I’ll be cherry picking some other interesting tidbits from the conference in my next few blog posts. I hope they bring you some good food for thought.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
