Please allow me to coin a new term:
Medical Homelessness – Not having access to a consistent familiar medical setting. Not having a care location where one is known or where the medical information is accurate.
I think medical homelessness is one of the main problems in our system.
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*This blog post was originally published at Musings of a Distractible Mind*
This week’s New England Journal of Medicine contained a very, very interesting proposal put forth by a few prominent physicians and researchers working on the obesity crisis in America.
They propose that beverages loaded with sugar should be considered a public health hazard (much like cigarettes) and should be taxes. The proposal calls for an excise tax of “a penny an ounce” for beverages like sugar sweetened soft drinks that have added sugars. They cite research that links obesity to heart disease, diabetes, cancers, and other health problems. They say sugar sweetened beverages should be taxed in order to curb consumption and help pay for the increasing health care costs of obesity.
They estimate that the tax would generate about $14.9 billion in the first year alone and would increase prices of soft drinks by about 15-20%. That is big money, but at what cost?
My personal opinion is that while the tax would generate a lot of money that could be put to good use on anti-obesity programs, it is singling out one industry when obesity has numerous contributing factors. Calories Americans are getting from beverages have actually gone down in the past decade, but obesity rates still climb. Soft drinks alone are not making us fatter.
Americans need to pay closer attention to portion sizes and overall calories coming into their bodies from all sources. We know that Americans also eat too much fried food, candy, ice cream, etc. Should we tax everything that is “bad” for us? Absolutely not! And these foods are not “bad” when consumed in reasonable quantities in reasonable frequency.
We also need to learn how to move our bodies more to burn off some of the sweet treats that we love to indulge in. Weight loss is a simple equation that I don’t get tired of explaining again and again: Move more and eat less.
Taxing soft drinks will not decrease heart disease risk…exercising more and losing body fat by consuming less calories definitely will!
This post, Will Taxing Soft Drinks Solve The Obesity Problem?, was originally published on Healthine.com by Brian Westphal.
As a primary care practitioner, I often am baffled by why Americans need insurance for primary, or day-to-day, care issues. When I’m talking about primary care, I mean those health problems that are considered routine, or day-to-day, problems including ear infections to poison ivy as well as many urgent care issues like sutures and draining infections. These account for a large portion of all health problems that occur in the U.S – and 80% of the things that typically up in the ER or urgent care.
My understanding is that the purpose of insurance is to protect our financial well-being and thus our financial nest egg. Investorpedia, which is part of Forbes Digital Media, offers the following definition: “Insurance allows individuals, businesses and other entities to protect themselves against significant potential losses and financial hardship at a reasonably affordable rate.”
This definition explains why we invest in insurance of all types: car insurance, home insurance and health insurance.
Then I wonder why our expectations and utilization of health insurance differs so significantly from home or car insurance. I pay a monthly premium for my car insurance, and it protects me against having to pay out large sums of money if I would be in a bad car accident. I don’t expect, however, my car insurance provider to pay for an oil change or new battery. Likewise, I pay a yearly premium for my home owner’s insurance, yet I do not expect the insurance company to foot the bill if I need a new screen door – but I certainly will turn to them if a tree crashes through my garage during a bad storm.
Then why should I expect my health insurance to pick up every small, day-to-day health issue that I have, particularly those that can cost less then $150, like a well-woman physical, help with pink eye, a tick bite or extricating a fish hook?
Don’t get me wrong; I feel that health insurance is a must to protecting anyone’s financial assets against a potentially catastrophic health event, like a tragic accident or illness. We all need to be ensured that we will not go broke if we are faced with such health issues.
I currently work for a primary care practice, DocTalker, is built to deliver affordable access to our medical team, round the clock, to ensure that our patients save cost and time. Our patients pay for a doctor’s fees when service is rendered. We base the fee structure on time and materials; our patients pay us for the amount of time they spend with the medical team. An office visit typically lasts for 15 minutes and costs $75. Believe it or not, roughly 75% of our patients pay less than $300 per year for their primary and urgent care health issues. I know of a lot of people who pay that in one office visit to the vet!
Our philosophy is that the faster we can talk to and treat our patients, the faster they will get better, thus saving them time and money from lost work, not to mention saving them in expenses from waiting to treat a condition that can worsen with time (like bronchitis). Once we’ve met with a patient face-to-face, we offer phone and email consultations, which typically cost $50.
The other thought is that if people pay, out-of-pocket, for their day-to-day care problems, then they will be more like to be aware of the cost and quality of the care they receive – much like they are with that vast majority of other purchases that they make, from a car to cell phone service to food. This will cause the consumer to demand a higher quality of care for a better price, and will lead to consumer choice and thus to consumer’s driving the market.
I don’t think that a price tag of $300 for the care of majority of primary and urgent care problems is really that much to ask; after all, many of us pay this much when we have a plumber come to the house to unplug a sink.
I think that my health is worth as much as an unplugged sink. I believe we do can it at a less expensive price. Don’t you?
Until next week, I remain yours in primary care,
Valerie Tinley, FNP-BC
If you just snapped a quick picture, you wouldn’t see it. Not unless you were looking for the small signs, like my insulin pump. Or my spotted fingertips.
Type 1 diabetes isn’t something you can see on me. It’s not an illness that, at this point in my life, comes with any constant external symptoms. I am fortunate enough to not use a wheelchair or need vision assistance devices. You can’t see my disease, even though it’s something I manage every day.
I seem “normal.” (Stop laughing. Let me use the word normal for the sake of this blog post, at the very least!) I seem like your average 30 year old professional woman (again, stop laughing), recently married, inspired to achieve, and happy.
And I am happy.
But my good health is not without great effort.
Type 1 diabetes is a chronic illness, and one that has required daily maintenance and effort from me, and from my caregivers, for the last 23 years. Every morning starts with my meter. Every meal I’ve eaten in the last two plus decades has been preceeded by a blood sugar check and an insulin dose. And every night has my finger pricked by a lancet before my head hits the pillow.
This isn’t a pity party. Not by a long shot. My life is healthy and I have a very fulfiling existance, even if days are bookended by diabetes and even if I’m now wearing medical devices 24 hours a day, every single day. And back when I was a fresh-faced litttle kiddo, people seemed to want to cure my disease because they didn’t like the idea of a small child dealing with this disease.
Kids are fun to cure. They’re cute. And their futures seem worth investing in.
What confuses me is how quickly people forget. Type 1 diabetes became a part of my life a long time ago, and I don’t remember even a snippet of “the before.” But even though I’ve lived very well with this disease and kept it from defining me in any way, it’s still here. And it’s still something I deal with every day, regardless of how well or poorly controlled. But just because I’m no longer a little kid with the bright, shining future, am I any less diabetic? Any less deserving of that cure? Just because you can’t see my disease, and because I seem to have it under physical and emotional control, does not mean it’s past the point of deserving a cure.
Here is a vlog post that I did back in February about vlogging during a low blood sugar and how “diabetes can look so normal yet feel so rotten.” It’s a video that shows how invisible diabetes can be, but how visible it feels from the perspective of those who live with it:
Children with diabetes grow up to be adults with diabetes. And all the while, we’re still ready for progress. And for hope. And for a cure.
This week, September 14 – 20th, is Invisible Illness Awareness Week. And today, I’m raising my voice for type 1 diabetes.
*This blog post was originally published at Six Until Me.*
This past month, I saw a couple of patients in the emergency department who suffered from gout. When I was a medical student at Duke in the early 1970s, we commonly encountered patients with this disease, because of epidemiological factors that clustered in the southeastern U.S. Today on the west coast, we don’t encounter it as commonly. However, for those persons who suffer from gout, it’s a big deal. An acute attack of gout, caused by uric acid crystal formation and the attendant inflammation and pain, can ruin a few days of activity, or even cause a trip to be terminated.
There are a few approaches to treating a person with an acute flare of gout. The current mainstays are administration of nonsteroidal antiinflammatory drugs (NSAIDs), such as naproxyn, or antiinflammatory drugs in the form of corticosteroids. Colchicine is less commonly used.
How does a person prevent gout? The basic tenet is to minimize uric acid production in the body, and/or to prevent its precipitation into crystals within the body’s tissues and fluids. There are risk factors associated with suffering from gout, so doing one’s best to mitigate these is the proper approach. Here are some of the commonly accepted risk factors:
1. Being obese or overweight
2. Eating purine-rich foods, although there is some controversy about this, since some researchers have identified certain purine-rich foods that, in their assessment, did not seem to be associated with an increased propensity to gout.
3. Drinking excessive quantities of alcohol. This has been recognized for centuries.
4. Elevated blood pressure
5. Lead poisoning. This is one of the reasons that we saw a certain form of gout, known as saturnine gout, when I was a medical student. Persons in the North Carolina region who manufactured moonshine whiskey using an apparatus (still) that included leaded radiators from cars suffered from gouty attacks.
6. Genetics – not much you can do about selecting your parents…
7. Kidney insufficiency or failure
8. Medication use that promotes increased uric acid in the bloodstream
9. Certain blood disorders, such as leukemia or lymphoma
10. Low thyroid function
There was recently a very interesting article that appeared in the Archives of Internal Medicine, entitled “Vitamin C Intake and the Risk of Gout in Men. A Prospective Study,” authored by Hyon K. Choi and colleagues (Arch Intern Med 2009;169(5):502-507). They sought to determine whether or not higher vitamin C intake significantly reduces serum uric acid levels, and therefore the risk of suffering from gout.
Adapted from the abstract to the article: We prospectively examined, from 1986 through 2006, the relation between vitamin C intake and risk of incidents of gout in 46,994 male participants with no history of gout at baseline. We used a supplementary questionnaire to ascertain the American College of Rheumatology criteria for gout. Vitamin C intake was assessed every 4 years through validated questionnaires. During the 20 years of follow-up, we documented 1317 confirmed incident cases of gout. Compared with men with vitamin C intake less than 250 milligrams per day (mg/d), the multivariate relative risk (RR) of gout was 0.83 for total vitamin C intake of 500 to 999 mg/d, 0.66 for 1000 to 1499 mg/d, and 0.55 for 1500 mg/d or greater.
The conclusion is that higher vitamin C intake is independently associated with a lower risk of gout. Supplemental vitamin C intake may be beneficial in the prevention of gout. This is, of course, only a single analysis, so warrants further investigation by others before the assumption can be completely made that this will bear out across a larger population. Vitamin C may not really do anything to prevent a “cold,” but perhaps it is useful to prevent gout.
This post, Gout Prevention And Vitamin C, was originally published on Healthine.com by Paul Auerbach, M.D..
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