June 11th, 2008 by Dr. Val Jones 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.
May 20th, 2008 by Dr. Val Jones in Expert Interviews
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I met Dr. Harding at a press conference announcing the expansion of the Give an Hour initiative and really enjoyed our candid conversation about the unmet mental health needs of veterans of the war in Iraq and Afghanistan. It is sobering to know that many hundreds of thousands of soldiers are returning to the U.S. with traumatic brain injuries and post traumatic stress disorder. They volunteered to give up their lives for us, will we volunteer to care for them?
An interview with Richard K. Harding, M.D., professor and chair of the Department of Neuropsychiatry and Behavioral Science and an adjunct professor of pediatrics at the University of South Carolina School of Medicine.
Dr. Val: You mentioned that this quote means a lot to you: “One does not escape war by leaving the war zone.” Can you explain what you mean by that?
Dr. Harding: I was referring to my own experience with children rescued from Vietnam and transported to the U.S. Here, 6000 miles away and in a perfectly safe place with lots of support and food, they were still dealing with the trauma of the war zone. And I’ve seen this all along in my career, especially taking care of the National Guard folks in South Carolina. I’ve seen people become depressed and anxious and use substances to try to deal with the recurring thoughts provoked by combat experiences. They have profound changes in how they see the world. These are healthy people who were doing well in their jobs and family life. And then when they come back, they have a considerable amount of anxiety and worry and a loss of optimism about the future. In a way, the war follows them home.
Dr. Val: How do you help your patients to gain maximal recovery?
Dr. Harding: The best treatment begins with an accurate diagnosis and good access to care. There have been some major road blocks in terms of dependents trying to use TRICARE insurance, so access has been limited for family members who need services.
A good diagnostic workup by someone who knows what he’s doing is really important. Military personnel need to see a therapist who has had experience with PTSD [post-traumatic stress disorder] and other combat-related mental health issues.And they also need to get into a good treatment program that is tailored to their needs. Some people need psychotherapy, and others need psychotherapy plus medications. Some may be so severely depressed that they need to be in the hospital temporarily.
Dr. Val: There have been reports of different rates of mental health disorders in different arms of the military. For example, 50 percent of National Guard personnel report mental health issues, whereas only a third of Marines report the same. What’s that about?
Dr. Harding: Well we don’t know why, but I can speculate. If you are a trained military infantry combat soldier, you’ve been through a lot of training. You are camping out in the woods, you’ve been shot at, you’ve been through all kinds of simulations. You also belong to a tight group of individuals with whom you’ve been working for a long time, and your family has support at the military base in which you live.
That’s a lot different than a National Guard outfit composed of citizen soldiers. They’re suddenly asked to come in — not just one or two weeks out of the year — but to deploy to Afghanistan for 15 months. These people are lawyers, doctors and so forth, but they are often put on frontline assignments as soldiers. Unfortunately, they don’t have the same training and experience as the professional soldiers, so they’re more subject to emotional trauma. In addition, their families back home are scattered all over the state and don’t have the same backup and support that a family on a base would have. Spouses are often isolated when their partner is deployed.
Finally, the stigma associated with mental illness makes the military personnel less likely to get help early on because they’re worried that it will limit their opportunity for promotion.
Dr. Val: I heard that the question about mental health treatment was recently removed from the security clearance questionnaire. Is that evidence of the Army’s attempt to embrace and normalize mental health treatment?
Dr. Harding: It’s a very important symbolic victory. There is still a problem with stigma, but the Army is responding to this concern. There’s a tendency to think of mental health issues as a sign of weakness. Tough Army guys aren’t supposed to have emotional problems. They feel that they’re letting down other people if they admit to problems. You’re supposed to be able to pull yourself up by the proverbial “bootstraps.”
Dr. Val: It strikes me as somewhat adaptive, though, to choose that kind of attitude in a combat situation.
Dr. Harding: Yes, it may be. Seventy-five percent of military personnel make it through without mental health problems. They show amazing resiliency when you think about it. I’d like to think that I’d have that kind of resiliency too, but I don’t know. You don’t know until you’re in the situation. When good people try to do tough things, some will inevitably fall into the injury category. What we have to do is get recovery going and the “physical therapy” in the mental sense started as early as possible to help them get back to full capacity.
Dr. Val: What’s the most important message that you’d like to relay to a general public audience about mental health services and veterans returning from Iraq and Afghanistan?
Dr. Harding: Services are available, but you have to ask for them. You have to raise your hand and admit that you have difficulties and need help. It’s also important to do this early on before you leave military service because you won’t necessarily get the same amount of care once you’re back in the workforce.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 15th, 2008 by Dr. Val Jones in True Stories
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I spent my senior year of college abroad in Scotland. Between the fall and spring semesters I went on a ski trip to Austria, and in usual Val fashion did something klutzy out of enthusiasm. I was racing down a slalom course in a snow storm and was so excited to have finished without missing a wicket that I looked up at some bystanders to give them a thumb’s up and I tripped on a clump of snow and fell down. Unfortunately my binding didn’t release and I ripped some ligaments off my knee. I heard them pop too. It was quite gross.
Anyway, I was shipped back to Canada for a complex ACL repair procedure by the Olympic Ski Team’s surgeon (I was NOT Olympic material in case any of you had the slightest doubt – I was just in the right hospital at the right time). What followed my fine surgery was a not so fine follow up – in fact I didn’t get any physical therapy whatsoever, and had no idea about how to make my knee functional again. All I knew is that it hurt like heck and I didn’t want to move it. And I pretty much didn’t. Not for a month or so.
Now the healthcare professionals in the audience just winced at that. Not moving a limb for a month is highly inadvisable. My knee became contracted so that I couldn’t straighten it at all. I could barely bear weight on it and I relied almost solely on crutches. I didn’t know how long knees were supposed to take to heal so I figured everyone went through this crutch phase for months.
I returned to Scotland for my spring semester, and I can tell you that traveling alone with one functional leg, a pair of crutches, winter gear and two suitcases is no piece of cake. But the most memorable part of this whole debacle was when I received my new dorm room assignment: the room was on the 5th floor – no elevators. I pleaded with the dorm warden (a humorless, underweight Scottish man with extraordinarily greasy hair and snaggle teeth) to have pity on me and reassign me to a room on the first floor or maybe the second. He handed me the 5th floor room keys unflinchingly.
So it took me about an hour to drag myself and all my stuff up to the 5th floor. I was really in a lot of pain, and totally exhausted from the multi-stop flight overseas – hadn’t slept in about 36 hours. Of course the room was the last one at the end of the hall and no other students had checked in yet – the whole place was deserted because I’d come back early to see if I could get a more conveniently located room (thinking ahead).
When I got to my room I was nearly overwhelmed by the smell of vomit. Apparently the winter session kids had been using my dorm room for drunken partying and had puked on the mattress. I was so tired all I wanted to do was go to sleep but the options were the cement floor or the pukey mattress so I called down to the front desk. The warden picked up – I really couldn’t understand much of what he said in his thick brogue. I explained to him that I’d made it to my room but that the mattress was covered in vomit and I wondered if (now) I might be eligible for a different room. He said he’d come up to check on the mattress.
It took him about 40 minutes to show up. He made no eye contact with me as I limped after him into the room to show him the vomit. He looked at the mattress, smiled wryly, dragged it to the edge of the bed frame and flipped it over. Then he walked out of the room and went back down the stairs to retake his post at the front desk at the entrance to the building.
Now that’s cold.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 13th, 2008 by Dr. Val Jones in Patient Interviews
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Therese Borchard is a vibrant author, editor, and mother of two. She writes a critically aclaimed blog called “Beyond Blue” at beliefnet.com, which is devoted to supporting people who are living with bipolar disorder. Therese’s writing is engaging and humorous, as she normalizes the experience of mental illness through her own lens of motherhood. Revolution Health salutes Therese for her compassion, and I hope you enjoy getting to know her through this interview:
*Listen to Podcast*
Dr. Val: Tell me about the circumstances surrounding your diagnosis of bipolar disorder. What was it like when you received the diagnosis for the first time?
Therese: I’ve struggled with depression most of my life, though college was when I first started taking medication and came to terms with the diagnosis of major depression. However, I had a much harder time when I realized that what I had was actually bipolar disorder. This was really difficult for me because my aunt was the only person I knew with bipolar and she took her own life when I was 16. So I had a lot of resistance to that diagnosis.
In fact, I ended up seeing 7 different psychiatrists, went through 2 hospital stays, and tried a total of 23 different medications.
Dr. Val: What’s the story behind the 7 psychiatrists? Were you not connecting with them?
Therese: I strongly advise people with bipolar or anyone struggling with depression to find the right doctor. For me it was going to Johns Hopkins, an academic center that has the best research and an outstanding team of doctors. My bipolar symptoms were not clear cut or “textbook” so it took a team of specialists to really help me find the best treatment path.
Dr. Val: What have you found to be most helpful (therapeutically) to keep you feeling balanced and in control?
Therese: My three staples are diet, exercise, and sleep, because I think that with any illness you just have to make those a priority. Obviously, finding the right doctor and the right medication is important too. Another key component to my recovery was connecting with a greater mission – I see that as my blog. Reaching out to others gives back to me every day. When I read a biography of Abraham Lincoln (he struggled with major depression, but didn’t have meds back then) I was struck by the fact that he focused on the emancipation of slaves as a positive way to get through his depression.
Obviously, a good therapeutic relationship with your doctor is important, as well as finding the right medications for you when/if needed.
I’ve found Dr. David Burns’ book, “Ten Days To Self Esteem” to be really helpful. It’s a work book that you can use as a journal. He asks you to list all your distorted thoughts, how they’re distorted and then how you can think differently. For example, we sometimes engage in mind-guessing, like “Oh he hates what I just said…” when the person isn’t thinking that at all. This book is really good for people with mood disorders.
I also regularly engage in prayer, and as a Catholic it’s really important to me and my healing.
Dr. Val: What advice do you have for people living with bipolar disorder?
Therese: You have to surround yourself with people who understand your illness because it’s so easy to be hard on yourself and adopt an attitude of “I should be able to get over this problem” and then feel deflated when it doesn’t magically disappear. It is so much easier when you have friends around to remind you that bipolar disorder is an illness like arthritis or diabetes – that it can be disabling and it’s not your fault.
Bottom line: Work as hard as you can on your diet and exercise, use light therapy as needed to help elevate your mood, and educate yourself as best you can about your illness.
Dr. Val: You mention diet as an important factor. Do you follow a special diet or do you just mean ‘healthy eating’ in general?
Therese: Mostly I’m talking about a healthy diet with lots of fiber, fruits and veggies, lean protein and whole grains. Caffeine and sugar are dangerous and alcohol can really mess up psych meds. Everything nowadays seems to have high fructose corn syrup in it. I try to stay away from highly processed foods and white flour.
Dr. Val: Do you believe that there is a stigma associated with bipolar disorder? How can that be reduced/removed?
Therese: The stigma does exist. I read a recent article about celebrities basically saying that antidepressants sap your personality, creativity, and sex drive. They make it sound as if people with bipolar disorder are doomed to live a dull and mediocre life. Other articles, like those about Britney Spears, are so negative. They make you think, “Oh God, this woman is never going to be normal.” The media really does bipolar disorder a disservice. Why not say that 70-80% of people with bipolar recover completely and do beautifully? They live very fruitful and productive lives. I have a hard time with how the media presents mental illness in general.
I also find that when I tell people that I have a therapist appointment their eyes sort of bug out. But it shouldn’t be shameful, it’s no different than going to a doctor’s appointment. We have to continue to work on tolerance and acceptance for mental illness.
Dr. Val: What role can online communities play in the management of daily life with bipolar?
Therese: Online groups have proven to be beneficial to those suffering from depression. Sharing your story is therapeutic in itself. Also the anonymity offered by online groups can make sharing stories and struggles more comfortable. For people who live in remote areas or who don’t have access to transportation, online groups offer the best way to connect with others.
Dr. Val: How do your coping mechanisms change when you’re struggling with mania versus depression?
Therese: Some of them are the same, like getting good sleep, eating healthy foods and exercising. I have two little kids so I watch the movie Cars a lot with them. And I like what one of the characters says in response to a question about steering around curves. He says, “in order to go left, you need to turn right, and in order to go right, you need to turn left.” I always remember this when I’m manic or depressed because it’s counter-intuitive.
When you’re depressed, the last thing you want to do is to get yourself involved in life, and get up and get moving – but that’s exactly what you need to do. When you’re manic it’s so easy to say, “This is so great, I’m on a roll, let’s go all night!” It’s hard to shut down your computer and say, “No, I’ve worked enough, now it’s time for bed.” But that’s what you need to do.
Dr. Val: Is there any bipolar-related information or service that you’ve always wished you could get from the Internet but doesn’t exist yet?
Therese: I wish there were an Amazon.com type directory online where you could find therapists, doctors, partial stay hospital programs, and support groups in your zip code, and read reviews from others about them. A one stop resource center would be great!
Dr. Val: You work at Belief Net – tell me a little bit about what the spiritual side of the bipolar journey. How has spirituality played a role in your healing?
Therese: I grew up as a very religious kid and my “OCD” made itself manifest at a young age. I remember that when I was in fourth grade I wrote a book for my mom and her prayer group friends about how to get to heaven. I look back and laugh at that now because it probably listed things like looking at the sacred heart and praying the rosary 15 times.
But on a more serious note, when I was deeply depressed and feeling suicidal the thing that kept me from taking my life was the thread of hope that God was there. If I didn’t have that I don’t think I’d be here. I often asked God for signs of His presence during that horrible times, and believe it or not, I always received them.
*Full Interview Available Via Audio Podcast*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 12th, 2008 by Dr. Val Jones in Celebrity Interviews
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I had the chance to interview diabetes spokesperson and Hollywood A-lister, Maria Menounos, at a recent diabetes conference. Prior to the interview I was given her Entertainment Industry Foundation biography for my review. Most of the biographies that I see belong to physicians and health policy experts – so it was an interesting change to read an entertainer’s biography.
Of note, Maria is a featured reporter on The Today Show and Access Hollywood – she has directed and produced several films and was listed in People Magazine’s “50 Most Beautiful People.” She also landed in the top five of the askmen.com poll for “the girl men most want to marry” along with Angelina Jolie and Charlize Theron.
But don’t let her beauty fool you – Maria has struggled with poverty, a chronically ill father, and her own weight issues. I enjoyed getting to know her better, and to learn about why she is such a passionate advocate for diabetes awareness. Enjoy our chat!
Dr. Val: Tell me a little bit about your dad’s diabetes and how you’ve been helping him to manage it.
Maria: My dad has type 1 diabetes, and he’s quite unusual in that he is extremely compliant with medical advice and dietary restrictions. He NEVER cheats. Many years ago he was told to avoid carbohydrates and so even when he was having a low blood sugar attack he’d refuse to drink juice to bring up his levels. Unfortunately my dad’s English isn’t so good (his native language is Greek and he has quite a language barrier with doctors) and I think a lot was lost in translation when he was given advice about how to manage his disease.
As a result of growing up in a poor neighborhood and not having access to more advanced medical care (along with the language barrier), my dad’s doctors were not particularly effective at communicating what he should be doing. My mom did her very best to follow their instructions religiously – she became his personal chef and kept him from eating carbohydrates.
My dad was in and out of the hospital all the time for low blood sugar, and because of a lack of coordination of care my family never realized why this was happening or what we could do to prevent it. So we were trying harder and harder to be more strict with his diet, which was in fact making the problem worse. My dad did janitorial work and would nearly pass out on the job due to a low carbohydrate diet. But since the doctors told him not to eat sweets or bread or pasta, he believed that his sickness was due to his not being strict enough, so he’d just eat less and less until he ended up weighing 140 pounds at 6 feet tall. My family was living in constant fear of him passing out again and needing to go to the hospital. We knew every ambulance worker and every fireman in our neighborhood by name because they were always at our house.
Finally when I moved to Hollywood and had some career success I was able to get my dad to a world renowned endocrinologist, Dr. Anne Peters. Within three visits she straightened him out and explained how he did in fact need to eat some carbs. She got his blood sugars evened out and he never had to be hospitalized again.
What scares me the most is what’s happening to people who have diabetes and language barriers. They’re at incredible risk for misinformation, confusion, and poor care. Imagine how many people in this country are just like my dad – trying to follow advice they don’t fully understand? This is a real problem that we often overlook in diabetes education.
Dr. Val: As a Hollywood insider, how aware are your peers about diabetes and is there much talk amongst them about getting involved in campaigns to reduce type 2 diabetes?
Maria: I’m sure they are but I haven’t come across that many. It doesn’t come up that frequently. There haven’t been any breakthroughs in insulin therapy or any other huge scientific advances in diabetes care so the topic isn’t that newsworthy or “sexy.” It’s a real shame that it isn’t talked about more. Everyone seems to be aware that type 2 diabetes is preventable but no one seems to know how to do so. They don’t realize that you need to lose weight and exercise. But I learned about that when I had a weight problem.
Dr. Val: YOU had a weight problem?
Maria: As I said, I came from a diabetic home. We ate vegetables fresh from the garden every day and my mom was extremely careful about what we ate. We didn’t eat anything bad. My mom would buy ice cream and Doritos like, once a year when family was coming over. I didn’t even know what a bagel or a waffle was for most of my time growing up. Then I went to college and there was endless all-you-can-eat food. So over 3 or 4 years of eating pizza and I ended up gaining 40 pounds. One day I decided that I wanted to move to California and get into the business and I realized I needed to lose the weight.
I wrote down everything I ate in a week, and I realized that my problem was carbs. So I cut them back substantially and the weight just melted off. I lost about 20 pounds in several months, and then I added exercise to get the last 20 off. I’ve never looked back.
Dr. Val: How can we be more effective in getting Americans involved in their own health?
Maria: First of all, I think that we need to focus on educating children about healthy lifestyle choices. We have to get the message to them early. Kids enjoy knowing more than their parents and teaching them something new. So it’s really empowering for kids to learn about nutrition and then bring that knowledge home to their families and teach them a thing or two.
Obviously getting Americans to be more involved in their health is a very difficult challenge. Many people are struggling to get by and don’t have time to put their health first – they have to focus on work, paying their gas bill and putting food on the table. It will take a national, coordinated effort to really make a difference.
**Join Dr. Val’s Weight Loss Group**This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
