May 9th, 2008 by Dr. Val Jones in Celebrity Interviews, Health Policy
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This is a continuation of my interview with Mike Huckabee at the National Changing Diabetes Program conference in Washington, DC. In my previous post I asked Mike about his weight loss journey, and in this post I asked him some global questions about healthcare. My regular readers will appreciate that my digital voice recorder did not malfunction during this interview, though I did drop my Blackberry at one point out of sheer enthusiasm. Gov. Huckabee was the first to reach down and help me get it. What a gentleman!
Dr. Val: Your friend, Dr. Fay Boozman, said “We need to stop treating snake bites and start killing snakes.” Tell me what that means in practical terms.
Huckabee: Healthcare in America is reactive and is geared towards intervening in catastrophic situations, when what we should be doing is focusing on preventing them. The whole system is upside down. It’s like we’re focused on putting Humpty Dumpty back together again instead of keeping him from falling off the wall. Our healthcare system is based on a broken egg concept.
So the key thing that we have to change in healthcare is to focus our resources on prevention and a healthy lifestyle.
Dr. Val: You said that your hope was that “‘Healthy Arkansas’ will spread like a highly contagious but benevolent virus that could become the genesis of ‘Healthy America.'” Can you give me a virus update?
Huckabee: We did in fact launch “Healthy America” and it was the most successful Governors’ initiative in that we had more states participate in this than any other NGA (National Governors’ Association) initiative. Forty-three states launched state-based health initiatives for preventive health. Some were more aggressive than others.
We began the initiative because there was a new awareness of the need to change the healthcare model from intervention to prevention. The concept of Healthy America was to influence behaviors at work, at play, at home, and at school. These programs have been remarkably successful. For example, in the first year, the average productivity of state employees increased by $3400/year. And that’s not to mention the savings in healthcare costs. The average diabetic spends 8.3 days/year in the hospital. The cost of those days could pay for 7 years of diabetes counseling and medication. It’s as if the choice is between a new oil filter or a new engine – which do you think is going to be less expensive?
Dr. Val: Revolution Health is attempting to encourage behavior modification through social networking and online, physician-led programs. What do you think are the strengths and limitations of this approach?
Huckabee: First of all the strengths are more dramatic than you may realize. When we used the online approach in Arkansas, we did health risk assessments followed by online coaching for everything from smoking cessation to weight control. Online programs can be very successful because they’re instant and accessible 24 hours/day. The socialization becomes very important because peer pressure can be harnessed to challenge people to walk more steps or lose more pounds than the others in their group.
Online approaches aside, the key to improving health in America is to create an atmosphere of healthy behavior. This cultural change may take a generation to achieve, which is why most politicians don’t touch it. Politicians like to deal with issues that can be dealt with in an election cycle, not a generation.
However, America’s approach to littering, seatbelt laws, smoking, and drunk driving are four examples of real changes we’ve made in this country over time. The changes took place in three stages: attitude change, atmosphere change, then an action is changed.
Attitude change involves giving people information that changes the way they think about an issue. Atmosphere change means making unhealthy behaviors difficult to participate in (like taking away ash trays and putting up a no-smoking sign), and finally the government codifies into law the new behavioral norm.
The government is usually the last player, not the first, because people have to create the behavioral norm before the government can enact laws. If the government tries to mandate a personal habit, then the debate will not be over the merits of the approach, but over the personal liberties of people to do what they want to do. And in America, the government always loses that argument. So what you have to do is get enough Americans believing that taking care of themselves is the right thing to do, and then there will be the demand for government to put that into law.
We don’t have a healthcare crisis in America, we have a health crisis. And if we dealt with the health crisis we would resolve the healthcare crisis. The real reason we’re in trouble is because 80% of the money we spend on healthcare is a result of chronic disease. And that chronic disease is primarily the result of over-eating, under-exercising and smoking. It’s our lifestyle that’s killing us.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 8th, 2008 by Dr. Val Jones in Celebrity Interviews
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I had the exciting opportunity to interview Governor Mike Huckabee at a recent conference for the National Changing Diabetes Program. As most of you know, Mike lost 110 pounds through lifestyle interventions and has kept the weight off for over 5 years.
Since I’m leading a weight loss group, I was inspired to read his new book, “Quit Digging Your Grave with a Knife and Fork.” I really enjoyed his witty and down-to-earth, positive approach to health. If you can imagine Dave Barry and Norman Vincent Peele getting together to talk about weight loss strategies, you’d pretty much have Gov. Huckabee’s book. I highly recommend it.
As for our interview, I’ll split the Q&As into two posts. This first post is about Mike’s personal journey, the second is about his view of healthcare. One thing’s for sure, after meeting Mike Huckabee in person, I can say that I’ve joined the team of folks who wear the “I heart Huckabee” t-shirts. He is a softspoken, kind-hearted, honest man with a quirky sense of humor and a gift for parables and analogies. Enjoy his thoughts below…
Dr. Val: It seems to me that your weight loss journey began the day when you sat in a chair at the State Capitol, and it broke under your weight (in front of a group of government officials). Do you think that successful weight loss usually begins with an “ah-ha moment” like yours?
Huckabee: I don’t think it’s always the case that people have that level of epiphany. Most people who are overweight know it – every time they bend over to tie their shoes and can’t, every time they need a seat belt extender on the airplane, etc. they realize that there’s a problem. Unfortunately, though, their response is often one of helplessness. They believe that they just have to live with their weight problem instead of believing they can do something about it.
Sometimes an epiphany can make people really angry, and cause them to say – “I don’t care what I have to do, I need to change.” Most people have made numerous attempts to lose weight and have tried many different diets, but they don’t understand the real problem. It’s a lifestyle issue, not a program issue. Diets fail because they have a beginning and an end. You’ve got to see this as change not so much of the menu but of your mind. Don’t focus on losing weight – that’s a big mistake. Focus on the things that make you healthy and then the weight takes care of itself. You may never be the skinniest person, but you’re better off healthy than you are skinny.
Sometimes I find that when people make weight loss their goal they lose weight but they’re not healthy because they haven’t done it in a healthy way. They haven’t combined activity with the weight loss. They’ve just starved themselves, and that’s not health.
Your health is like a dashboard. If the only thing you ever look at is your speedometer, and you don’t look at the oil gauge and the water gauge, you can get into serious trouble. You think, “hey, I’m going the speed limit” but that’s not the point. That’s how fast your car’s going, not how well it’s running. Health is the same way – you can’t just focus on weight, you’ve got to look at your cholesterol levels, hemoglobin A1C, blood sugar, and blood pressure as well.
After I broke the chair I went to see my doctor and he ran some tests that confirmed I was a diabetic.
Dr. Val: What did your doctor say to you at that point?
Huckabee: My doctor gave me a talk that changed my life. A lot of doctors simply say, “you’re a diabetic, here’s some medication, try to lose some weight and do some exercise.” But my doctor looked me in the eye and said, “you need to understand that if you don’t make a lifestyle change, you’re in the last decade of your life, and let me describe the decade…”
Quite frankly if he had just said that I was in my last decade I might have said, “Hmm, that’s not good, but you know what? I bet a drug company will solve this problem for me in the next few years. That way I can eat what I want and do what I want and just take a pill and everything will be fine.”
But that’s not what he told me. Instead he told me the truth, and he said “let me describe the decade…” And in great detail my doctor began to explain what diabetes would do to my body, organ by organ – my vision, my extremities, my heart. He made it sound like a slow, lingering death. And right then and there I vowed to come up with a different exit strategy for my life.
I gave up sweets and fried foods and began to exercise. You have to understand that this was a huge turning point for a southern boy. I used to say that exercise is for people who have nothing better to do with their lives than to get on a treadmill and play the role of a hamster. But I became one of those people that I used to make fun of – I’ve already completed four marathons. But most importantly, I haven’t needed any medications in 5 years and my doctor says that it’s as if I never had diabetes at all.
Dr. Val: You wrote, “If you really hate yourself when you’re fat, you’ll also hate yourself when you’re thin.” What did you mean by that?
Huckabee: Well, you have to be honest and tell people that their weight is a reflection of their personality. There is something inside of them that let them get completely out of control. It may have been a feeling of inadequacy, or some guilt – every person is different. But usually something is underlying the weight problem. It may be the fear of not having anything to eat next week. But something has to give a person that reckless abandon. Just because you change the physical aspects of your life, doesn’t mean that your emotional, mental, and spiritual aspects are going to change.
Dr. Val: How do you get to the bottom of what’s driving unhealthy behaviors?
Huckabee: I know that for me it was when I started to ask myself, “why is it that I’m triggered to overeat?” Some of it was childhood memories – it was the comfort that food brought. As a child, the few privileges I had were related to food. So food was always a reward. I received affirmation from dessert and would indulge myself to re-experience those childhood memories. I know that sounds awfully elementary but these things get imprinted on us. When we’re adults and someone is cruel to us or something bad happens, we affirm ourselves with food so that we can feel as if we’re a good person again. But once you come to terms with this, you regain control. You can tell yourself you’re alright and you don’t need food for comfort or affirmation.
**Up next, Mike speaks out about healthcare**This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 6th, 2008 by Dr. Val Jones in Patient Interviews
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Cameron J. Mitchell was diagnosed with a glioblastoma multiforme (or GBM, an aggressive form of brain cancer) over four years ago. The prognosis for this tumor is usually grim, as most people succumb to it within 4 to 18 months of diagnosis. However, Cameron got involved in a clinical trial for a promising new therapy and has beaten the odds. Since Revolution Health was founded partly in response to Dan Case’s battle with a GBM (and I had the opportunity to participate in the Race for Hope to benefit Accelerate Brain Cancer Cure last weekend), I thought it would be great to highlight Cameron’s story. Cameron also happens to be a close friend of one of our staff at Revolution Health.
Dr. Val: Tell me about how you were diagnosed with a brain tumor. What symptoms did you have? What led up to the diagnosis?
First of all as you can imagine getting the news is like being hit by a truck. You think, “this just can’t be happening to me.” And of course the “why me?” scenario comes into play.
My initial diagnosis came after having a bout of seizures, both grand mal and partial. After a series of tests and procedures they determined that the ongoing problem was the result of a brain tumor. The typical protocol requires 6 weeks of radiation along with oral chemotherapy followed up with a visit to your oncologist to determine a plan of action.
Dr. Val: How did you find out about the Duke clinical trial?
Being that the “plan of action” did not have a very favorable outlook I asked my oncologist, “What would you do in this case?” He suggested I contact the Duke Brain Tumor Center. He actually made the initial call. Later that night I received a call from Dr. Henry Friedman saying that they could help. By the end of the week I received a call from Dr. John Sampson telling me that he was working on a specific clinical trial. As long as I could meet some prerequisites I would be eligible to participate. A lot of thought and pondering goes into that decision: “Is it the right one?” “What if it does not work?” But at that point nothing else had been proven, so my wife and I decided that I have nothing to lose to give it a chance.
Dr. Val: What have the treatments been like for you? Do you have any advice for other patients with GBM?
The treatments are an ongoing, once a month procedure, and I travel from Michigan to North Carolina for them. So it definitely is a huge sacrifice but at for very worthy cause. Having MRIs every two months can create a lot of anxiety not knowing if the tumor is back or not.
The four main pieces of advice I could give to new GBM patients are: 1) Get as much as information as you can. Ask lots of questions. 2) Keep a positive attitude (SO IMPORTANT). 3) Keep a strong group of supporters like family, friends and especially spouse. 4) Remember that this is NOT your fault.
There are a lot of very good sites out there on the internet for advice. But one thing to keep in mind, some of them are a little outdated. The better sites allow you to ask questions.
Dr. Val: What advice do you have for family members and loved ones of those diagnosed with a GBM?
Family members must be informed about what is going on. Under absolutely no circumstances should they be left out in the cold. Most patients find out early that their spouse has at least as much (if not more) difficulty dealing with this disease as the patient.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 5th, 2008 by Dr. Val Jones in Uncategorized
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I’m excited to be attending The Big Sleep Show in Chicago this Friday and Saturday, as Revolution Health is the Title Sponsor of the expo. I’ll be perched in a special sponsor booth, giving out frozen yogurt – so to all three of my Chicago-based blog fans: please meet me there!
To prepare for the event, I interviewed Reid Blank, Chief Executive of the Big Sleep Show, about sleep debt in America and how it impacts physicians. Enjoy the audio podcast or read his responses below.
Dr. Val: A recent poll at Revolution Health indicated that our viewers’ #1 health concern was “getting enough sleep.” Tell me a little bit about how America is doing with sleep debt, and how we compare to other countries.
Reid: As far as I can tell, America is not getting any better where sleep debt is concerned. Most Americans fall short of their ideal sleep requirements by an hour to an hour and a half per night. We have too much going on in our lives and sleep is the easiest thing to exclude. This is probably why the energy drink business has taken off like crazy – it’s now a 3.5 billion dollar industry – and it’s really growing in popularity among 18-23 year-olds. So we’re all looking for ways to solve our sleep debt.
In terms of other countries, there is not a lot of research comparing sleep debt between them, but it does seem that Asians are as sleep deprived as we are. In Europe they may be a little less so.
Dr. Val: There has been a lot of debate about how much sleep is enough. What’s your take on that?
Reid: It’s a little bit obvious, but basically you need as much sleep as feels right for you. On average we need about seven and a half to eight hours, but sleep needs follow a bell curve, so some people can get by on less than others.
Dr. Val: Are there any tests to help people figure out if they’re getting enough sleep?
Reid: Yes, the Epworth Sleepiness Scale is a good sleep debt questionnaire. Actually, at the Big Sleep Show we’ll be debuting the Glidewell Rapid Sleep Screener which is a web-based tool that allows people to find out (within a couple of minutes) whether or not they’re at risk for a sleep disorder. The National Sleep Foundation and the National Center on Sleep Disorders Research also have great websites where people can determine their level of sleep deprivation or whether or not they have a sleep disorder.
Dr. Val: I see that Google has special nap pods available for their employees. Do you think this is a good idea?
Reid: Absolutely. Napping is a great way to address sleep problems and can help to counter fatigue. Every day from 3-5pm we all have a “circadian slump” which is why there are siestas in Latin American cultures and “high tea” (the caffeine in the tea probably counter acts sleepiness) in England.
The National Sleep Foundation sponsored a poll recently and found that as many as 30% of employers were open to the idea of an employee nap program, but only 15% had any appropriate facilities for it. There’s still a bit of a disconnect between wanting to offer employee naps and being able to implement such a program.
Dr. Val: I’d like to see napping programs implemented in surgical residencies. Ha, ha.
Reid: Don’t laugh. At Alertness Solutions we worked with the Veterans Administration hospitals to conduct some pilot programs to put napping in the hospitals. As far as I know initial trials were very successful and they’re working on implementing napping now.
Dr. Val: As a physician, I was sleep deprived through much of my residency training. Some studies suggest that sleepy doctors are not a threat to patients. Do you agree with that?
Reid: Wow, I’m not aware of those studies but I suppose there’s always a counter argument. We’re all human beings and we operate on the same basic principles. We’re not biologically geared to stay up all night and sleep during the day. Shift work makes you tired and makes you prone to errors and accidents.
Some folks with large egos may feel that they’re resistant to fatigue. It’s like “The Right Stuff” syndrome where pilots and astronauts are beyond fatigue. Surgeons and doctors may share that attitude as well.
Dr. Val: Right, surgeons don’t experience the “circadian slump.” What is the Big Sleep Show and how will attendees benefit?
Reid: The Big Sleep Show is the first ever consumer health expo that’s solely devoted to sleep and alertness. It addresses a gap between the education that’s available and the access that consumers have to it. The show puts consumers face-to-face with experts both on the healthcare side and the industry side. They can attend dozens of workshops on a variety of topics such as how napping improves brain function or how you can be prettier by sleeping better.
Dr. Val: If people can’t attend the conference, how can they best educate themselves about their sleep concerns?
Reid: The nice thing is that we are debuting in Chicago but the plan is to create a model show that we can offer in other major cities across the country. We’ve been getting email from people around the country (and even Canada) who want to know how to host a sleep show in their own city. There are a lot of resources on our website, and I also highly recommend Revolution Health, The National Sleep Foundation and the National Center on Sleep Disorders Research.
*Listen to Dr. Val and Reid Blank discuss sleep*
*Join Revolution Health’s “Can’t Sleep Cafe” with neurologist Dr. Steve Poceta*
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 5th, 2008 by Dr. Val Jones in Health Policy, Health Tips
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Do you know your state’s momScore? Revolution Health and I have teamed up with leading medical experts and mommy bloggers to create a new health index just in time for Mother’s Day: the momScore.
Check out this fun interactive map that ranks states by 10 key maternal health variables*:
- Access to prenatal care
- Availability of childcare services
- Number of insured moms
- Maternal mortality
- Affordability of childrens’ health insurance
- Air quality
- Family paid leave policy
- Infant mortality
- Risk of pregnancy complications
- Violent crime rate
We also created a combined average of these variables (weighted according to expert perceived importance) to get an overall ranking. So, do you know where it’s best to be a mom in the United States?
Apparently, Vermont ranks most favorably (on average) in all of these variables. Don’t live in Vermont? Check out how your state compares.
Would you like to discuss your state’s rankings with others or debate the momScore? You can post your comments in our interactive momScore community. This is a really exciting opportunity to discuss women’s health issues in a fresh new way. I hope that the momScore will challenge states to strengthen their efforts to keep moms and babies healthy. At the very least, we’ve made a lot of Vermonters quite smug.
*Variables are based on state reporting to the Environmental Protection Agency (EPA), the Centers for Disease Control and Prevention (CDC), and the United States Census Bureau, as well as leading non-profit organizations such as the Kaiser Family Foundation and the American College of Obstetricians and Gynecologists. For more information about momScore methodology, click here.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
