Just days after I wrote “Lose Weight, Get Healthier, Not So Easy!” the CDC (www.cdc.gov)announced that about 10 percent of medical costs in this country are linked to obesity. Expenditures of $147 billion per year or 9% of all medical dollars spent treat problems related to weight. One out of three Americans is carrying an average of 23 extra pounds. The CDC study points out that obese individuals’ health costs are approximately $1500 (@41%) more than individuals who do not have weight issues. Most of that money goes to pay for prescription drugs to control diseases such as Type II diabetes and heart conditions. These same individuals also have a higher incidence of disability and early death.
Twenty three pounds, you say, look around you! Who does not have 20 or more pounds to lose? It is easy to justify carrying extra pounds when everyone has the same problem. It is extremely difficult to follow a regiment to shed those pounds by modifying your diet. Everywhere you turn, you are tempted by high fat, high sugar, high calorie foods some of which are touted as “healthy”. Even when you think you are healthy because you exercising several times a week, if you do not shed pounds you need to pay attention.
The CDC (www.cdc.gov) looks at the bigger issues – the health of the nation and how to implement changes that impact everyone including: regulating how foods are marketed and presented to the American public; taxing those foods that offer no nutritional value and educating Americans on healthy eating habits. I suggest they also look at regulating the multi-million dollar diet industry and those diet promoters who push fad diets and quick weight loss programs, many of which encourage you to continue to eat the same foods (albeit in smaller portions) that got you to where you are. The record shows that as soon as you go off those diets, you gain back all the weight you have lost and more.
The key to reducing the overweight population is to change people’s eating habits. For starters people need to eliminate all juices and sodas and products that contain white sugars, corn starch, and white flour. There are healthy eating programs and healthy foods are on the grocery shelves alongside the bad foods.
The USDA has a website (www.finc.usda.gov) where individuals can go to learn about the recommended healthy foods, register and enter their name, age, weight. They can record and track their daily food intake and exercise program and the USDA site creates an individualized set of recommendations. It is an eye opener. The calories you think you have eaten are generally higher the exercise program you think you have completed to counter-act your intake of food is lower than required.
None of us are ready to give up the piece of apple pie with ice cream, chips, hot dogs, and glass of wine or beer completely. However, if we begin to understand what we are eating and how that fits in the overall nutritional scheme, it will be a start toward to a healthier nation.
Monday, August 3, 2009
Sunday, July 26, 2009
Lose Weight; Get Healthier, Not So Easy!
In my last blog ("Should we be Paying Individuals for Good Health Habits") I advocated that healthcare insurance companies reward their customers for practicing good health habits including: exercising, losing weight and quitting smoking, by reducing insurance premiums thus putting money back into their customer’s pockets. In the long term this alone will lower the number of people who suffer from chronic disease and save millions in healthcare costs.
Many applaud this idea which is embedded in the healthcare reform legislation that is currently being discussed. Several health plans now pay a percentage of a person’s health club or weight loss program fee. However, in spite of exercise and a million different diet programs, when it comes to losing weight and keeping it off, most people simply cannot win this battle. Who cannot say that they have lost 10 pounds only to gain back 15 pounds a year later? We live in a society where richer, fattier food in large portions is marketed to the American public as a way to experience the good life.
In a recent Boston Globe column: “Putting Obesity out of business” (www.boston.com/bostonglobe/editorial_opinionoped/articles),Ellen Goodman points out that overweight people are not where they are just because they do not have the will power to resist food but because we live in a country that makes it cheaper to buy fast food than fresh food; where portions served are bigger and where the food industry works very hard and spends a lot of money to make it attractive for us to eat more.
Accolades should be given to the Starbucks coffee shops in New York City where they are posting the outrageous number of calories in the drinks and pastries they sell, which for many are standard breakfast fare every day, (caramel macchiato grande whole milk 319 calories; white chocolate mocha venti, with skim milk 628 calories, classic blueberry muffin 422, mixed fruit scone, 335 etc.). Every Starbucks should adopt that policy.
If it became a law that every food company from MacDonald’s with its Big Mac – 540 calories, large fries – 539 calories, to the local ice cream parlor posted the calories of the foods that they sell; perhaps we would see a reduction in the pounds that people are carrying with them.
Hopefully, with more education, less marketing hype from the big food companies and posted calories people would begin to understand the real story behind what they are ingesting.
There are over 130 million Americans who suffer from chronic conditions, many caused by abusing their bodies with drinking and eating bad calories and introducing smoke and inappropriate drugs into their bodies. Millions more are on the brink of Type II diabetes, asthma, heart disease caused by over-indulging in bad eating and drinking. In discussions on healthcare reform, shaking up the food companies could go a long way toward a healthier nation.
In my last blog ("Should we be Paying Individuals for Good Health Habits") I advocated that healthcare insurance companies reward their customers for practicing good health habits including: exercising, losing weight and quitting smoking, by reducing insurance premiums thus putting money back into their customer’s pockets. In the long term this alone will lower the number of people who suffer from chronic disease and save millions in healthcare costs.
Many applaud this idea which is embedded in the healthcare reform legislation that is currently being discussed. Several health plans now pay a percentage of a person’s health club or weight loss program fee. However, in spite of exercise and a million different diet programs, when it comes to losing weight and keeping it off, most people simply cannot win this battle. Who cannot say that they have lost 10 pounds only to gain back 15 pounds a year later? We live in a society where richer, fattier food in large portions is marketed to the American public as a way to experience the good life.
In a recent Boston Globe column: “Putting Obesity out of business” (www.boston.com/bostonglobe/editorial_opinionoped/articles),Ellen Goodman points out that overweight people are not where they are just because they do not have the will power to resist food but because we live in a country that makes it cheaper to buy fast food than fresh food; where portions served are bigger and where the food industry works very hard and spends a lot of money to make it attractive for us to eat more.
Accolades should be given to the Starbucks coffee shops in New York City where they are posting the outrageous number of calories in the drinks and pastries they sell, which for many are standard breakfast fare every day, (caramel macchiato grande whole milk 319 calories; white chocolate mocha venti, with skim milk 628 calories, classic blueberry muffin 422, mixed fruit scone, 335 etc.). Every Starbucks should adopt that policy.
If it became a law that every food company from MacDonald’s with its Big Mac – 540 calories, large fries – 539 calories, to the local ice cream parlor posted the calories of the foods that they sell; perhaps we would see a reduction in the pounds that people are carrying with them.
Hopefully, with more education, less marketing hype from the big food companies and posted calories people would begin to understand the real story behind what they are ingesting.
There are over 130 million Americans who suffer from chronic conditions, many caused by abusing their bodies with drinking and eating bad calories and introducing smoke and inappropriate drugs into their bodies. Millions more are on the brink of Type II diabetes, asthma, heart disease caused by over-indulging in bad eating and drinking. In discussions on healthcare reform, shaking up the food companies could go a long way toward a healthier nation.
Monday, July 20, 2009
Should We Pay Individuals for Good Health Habits, You Bet!
We have all heard about pay for performance for physicians. Now there are proposals that would, in effect, pay individuals for good performance for controlling their bad health habits by quitting smoking, changing their eating habits and losing weight.
In my book, Digital Communication in Medical Practice published by Springer for a physician audience, I propose that individuals should be compensated for recognizing the importance of good health habits and following through on programs that encourage them to make changes in the way they live.
A provision in the healthcare overhaul bill that is before the U.S. Senate right now proposes to reduce health insurance premiums by as much as half for those members who change their habits through exercise, weight loss and no smoking. This proposal has the potential to save employers thousands of dollars per year with a healthier workforce that has fewer lost days of work, more energy to perform at peak and less chronic diseases like Type 2 diabetes and hypertension.
In a recent Boston Globe article, writer Michael Kranish reported that some companies such as Safeway and EMC Corporation have already adopted such programs and provide positive feedback on their success. EMC offers its employees a 12 percent reduction in their insurance payments – approximately $300 savings annually on a family plan – for employees who take a health risk assessment and engage in sessions with a “life style coach” that the company offers. According to Delia Vetter who is in charge of the EMC project, about 90 percent of the company’s US workers participate in this program.
The Safeway grocery chain also provides reduced health insurance to its nonunion employees who demonstrate that they can meet certain health measures or take definitive steps to make themselves healthier, including quitting smoking and weight loss. About 74 percent of their workers participate and their savings can be as much as $1,560 per year for workers who have a family plan.
Politics as usual is rearing its ugly head in these discussions as some Congressmen and Senators try to ban provisions in legislation that would pay individuals to get healthier. We can only hope that enough members of Congress have the foresight to take the long view and understand that giving employers a model that encourages employees to work at becoming healthier will lower healthcare costs and elevate the quality of health for all of this nation’s citizens.
In my book, Digital Communication in Medical Practice published by Springer for a physician audience, I propose that individuals should be compensated for recognizing the importance of good health habits and following through on programs that encourage them to make changes in the way they live.
A provision in the healthcare overhaul bill that is before the U.S. Senate right now proposes to reduce health insurance premiums by as much as half for those members who change their habits through exercise, weight loss and no smoking. This proposal has the potential to save employers thousands of dollars per year with a healthier workforce that has fewer lost days of work, more energy to perform at peak and less chronic diseases like Type 2 diabetes and hypertension.
In a recent Boston Globe article, writer Michael Kranish reported that some companies such as Safeway and EMC Corporation have already adopted such programs and provide positive feedback on their success. EMC offers its employees a 12 percent reduction in their insurance payments – approximately $300 savings annually on a family plan – for employees who take a health risk assessment and engage in sessions with a “life style coach” that the company offers. According to Delia Vetter who is in charge of the EMC project, about 90 percent of the company’s US workers participate in this program.
The Safeway grocery chain also provides reduced health insurance to its nonunion employees who demonstrate that they can meet certain health measures or take definitive steps to make themselves healthier, including quitting smoking and weight loss. About 74 percent of their workers participate and their savings can be as much as $1,560 per year for workers who have a family plan.
Politics as usual is rearing its ugly head in these discussions as some Congressmen and Senators try to ban provisions in legislation that would pay individuals to get healthier. We can only hope that enough members of Congress have the foresight to take the long view and understand that giving employers a model that encourages employees to work at becoming healthier will lower healthcare costs and elevate the quality of health for all of this nation’s citizens.
Thursday, February 26, 2009
Digital Diagnosis: A New Dimension
A New York Times Magazine story “The Medical Detectives” by Robin Marantz Henig (Sunday, February 22, 2009) described the efforts of a unique medical team at the National Institutes of Health that takes on very sick patients with complex multiple problems and tries to figure out the mystery of what happened to these individuals. The unique approach of these doctors at NIH who are part of the Undiagnosed Diseases Program is to look at the entire litany of issues that the patient presents and not one problem at a time. Although their efforts may not cure the individual patients they are reviewing, they promise to provide new insights that could impact future generations.
This exciting work coupled with the research coming out of work on the human genome that has unveiled unimaginable insights about the functioning of the human body in relation to genetic mutations, has the potential to revolutionize the way that healthcare professionals approach disease. A key enabling technology to accomplish such intense data analysis and problem solving is the digitization of patient information, using an electronic health record. At the most basic level, the wide-spread use of the EHR for data analysis purposes enables healthcare professionals to aggregate baseline information on disease across populations. From this information they make assumptions that apply to a wide spectrum of health issues. Digital diagnosis is being used in little pockets throughout the medical world. The expansion of electronic health records throughout the population and the sophistication of these intelligent digital databases promise a new way of looking at health problems that astute diagnosticians such as the team at NIH will deploy to understand and ultimately cure many of the diseases that plague the citizens of the world.
This exciting work coupled with the research coming out of work on the human genome that has unveiled unimaginable insights about the functioning of the human body in relation to genetic mutations, has the potential to revolutionize the way that healthcare professionals approach disease. A key enabling technology to accomplish such intense data analysis and problem solving is the digitization of patient information, using an electronic health record. At the most basic level, the wide-spread use of the EHR for data analysis purposes enables healthcare professionals to aggregate baseline information on disease across populations. From this information they make assumptions that apply to a wide spectrum of health issues. Digital diagnosis is being used in little pockets throughout the medical world. The expansion of electronic health records throughout the population and the sophistication of these intelligent digital databases promise a new way of looking at health problems that astute diagnosticians such as the team at NIH will deploy to understand and ultimately cure many of the diseases that plague the citizens of the world.
Friday, January 16, 2009
Sick Economy, Sicker Patients
The Commonwealth of Massachusetts recently announced that its senior citizens are going to experience significant increases in their copayments for prescription drugs as a result of an $11 million cut in the state-funded Prescription Advantage program that was set up to defray pharmacy costs for eligible seniors. The cut is part of the $1 billion in funds slashed by the Governor Duval Patrick in October 2008 due to the economic recession.
Many other states facing similar huge deficits are also reducing services to the most vulnerable citizens. At least 19 states have proposed or implemented cuts that will affect low-income children’s or families’ eligibility for health insurance or reduce their access to health care services. For example, Rhode Island eliminated health coverage for 1,000 low-income parents; South Carolina is limiting coverage for many services, such as psychological counseling, physician's visits, and routine physicals; and California and Utah are reducing the types of services covered by their Medicaid programs.: At least 17 states plus the District of Columbia are cutting medical, rehabilitative, home care, or other services needed by low-income people who are elderly or have disabilities.
Almost 90 percent of individuals, age 65 and older, take an average of five or more prescription drugs daily. Many of these same individuals are retired and on a fixed income; 25% report that they do not fill one or more of the prescriptions their doctors write for them because of the cost. Others skip days or cut their dosage to make the prescriptions last longer.
In 2005, The New England Journal of Medicine reported that 33 - 69 percent of medication-related hospital admissions in the U.S. were due to poor medication adherence with a resultant cost to the American public of over $100 billion a year, because non-adherence results in more hospitalizations and more emergency room visits. This was part of the reason why Medicare instituted the drug benefit program, hoping Medicare Part D would make prescriptions more accessible and affordable.
In spite of the economic glitches that we face, as a society we have a responsibility to provide basic and essential health services to all individuals. What is going on with prescription drug co-payments and its impact on medication adherence should be concerning to payers, physicians and patients. When we accept short term solutions, such as cutting the budget for health reimbursement, we create longer term costly problems. When we force bands of citizens to seek care in emergency departments or end up as in-patients, the costs mound at a much steeper rate than if we foot the bills that keep co-payments at an affordable level. Doctors and patents need to work together to look at all possible options for addressing immediate and chronic health medication needs, including greater use of generics, and cooperative arrangements with pharma companies, associations and public agencies that might help fund some of the medical requirements of citizens who cannot afford to pay the full tab that is being asked of them. A sicker society is not an answer for anyone!!
Many other states facing similar huge deficits are also reducing services to the most vulnerable citizens. At least 19 states have proposed or implemented cuts that will affect low-income children’s or families’ eligibility for health insurance or reduce their access to health care services. For example, Rhode Island eliminated health coverage for 1,000 low-income parents; South Carolina is limiting coverage for many services, such as psychological counseling, physician's visits, and routine physicals; and California and Utah are reducing the types of services covered by their Medicaid programs.: At least 17 states plus the District of Columbia are cutting medical, rehabilitative, home care, or other services needed by low-income people who are elderly or have disabilities.
Almost 90 percent of individuals, age 65 and older, take an average of five or more prescription drugs daily. Many of these same individuals are retired and on a fixed income; 25% report that they do not fill one or more of the prescriptions their doctors write for them because of the cost. Others skip days or cut their dosage to make the prescriptions last longer.
In 2005, The New England Journal of Medicine reported that 33 - 69 percent of medication-related hospital admissions in the U.S. were due to poor medication adherence with a resultant cost to the American public of over $100 billion a year, because non-adherence results in more hospitalizations and more emergency room visits. This was part of the reason why Medicare instituted the drug benefit program, hoping Medicare Part D would make prescriptions more accessible and affordable.
In spite of the economic glitches that we face, as a society we have a responsibility to provide basic and essential health services to all individuals. What is going on with prescription drug co-payments and its impact on medication adherence should be concerning to payers, physicians and patients. When we accept short term solutions, such as cutting the budget for health reimbursement, we create longer term costly problems. When we force bands of citizens to seek care in emergency departments or end up as in-patients, the costs mound at a much steeper rate than if we foot the bills that keep co-payments at an affordable level. Doctors and patents need to work together to look at all possible options for addressing immediate and chronic health medication needs, including greater use of generics, and cooperative arrangements with pharma companies, associations and public agencies that might help fund some of the medical requirements of citizens who cannot afford to pay the full tab that is being asked of them. A sicker society is not an answer for anyone!!
Sunday, December 21, 2008
A Unique Patient Identifier could be Beneficial, But At What Price?
Linda was in constant pain so she went to the hospital emergency room where she was diagnosed with a severe stomach virus. After two weeks the pain got worse so she went to a clinic where she saw a gastroenterologist who ordered a CT scan which showed a large mass on her pancreas. Linda had a biopsy and was diagnosed with acute pancreatitis, given medication, and instructed to follow up in six months. The results of this incident were recorded in an electronic record. Six months later, Linda had changed jobs and relocated to another State. She tried to access her record, but discovered that the clinic had merged with a large hospital and they could not find the record. Her new doctors were unable to compare her current CT scan with the initial test, thus compromising their ability to give her the best follow-up care.
There is much talk about the benefits of electronic health records enabling doctors to have full information on a patient at the point of care. However, considering the mobility of the American population, there is a missing link, the absence of a unique patient identifier for every individual that enables the healthcare provider to look up data on that patient whenever and wherever they seek care. By their very nature, electronic records demand that individuals be uniquely identified if the processes of enrollment and authentication are done right.
Rand Research in 2008 conducted a study that concluded that a unique patient identification number system is necessary to reduce medical errors, protect privacy and simplify the use of electronic records. The idea is that associating data such as a sequence of numbers and letters with a particular human enables authentication of the individual and their health information that is resident in digital format. Current systems that match individuals with their information using attributes such as name, birth date, address, zip code, gender, medical record numbers, and all or part of the social security number are not as efficient since some of these factors such as name or address/zip code can change over time.
Unique Patient Identification is not a new idea. In 1996 HIPAA legislation included a provision that asked that the Department of Health and Human Services issue unique patient ID numbers for all Americans’ medical information. The United States Congress reversed that provision after privacy advocates protested that such a system would violate the individual’s privacy protections and bring too much government interference into the health care system. With a massive database of over 300 million individuals with individual patient identifications, privacy issues loom large. Furthermore the Rand Study estimates that building that database could cost as much as $11 billion.
In the United Kingdom and in other European countries national identity smart cards have been tried with some level of success. It would be highly beneficial to individuals and the American healthcare system that an electronic record that includes an individual’s comprehensive health information could be accessed with a unique 9 or 10 digit ID. This is a task for Mr. Daschle’s Federal Health Board to consider as the new administration establishes its short and long term objectives.
Wednesday, December 3, 2008
Personalized Medicine, the Next Frontier
When an individual patient visits his or her doctor with a problem, traditional clinical diagnosis is made and treatment is administered based on the patient’s symptoms, medical and family history and results of lab tests.
In the e-health world of the 21st century, personalized medicine, a new approach to treatment and analysis of patients’ health issues, promises to revolutionize that process. Personalized medicine looks not only at an individual’s symptoms, labs and medical history but at the individual’s unique clinical genetic and genomic markers to determine a treatment program. Because these factors differ for each human being, the disease they carry and how they will respond to treatment will differ as well. Taking this to another level, personalized medicine enables doctors to make accurate predictions and assumptions not only about an existing condition but to make predictions about a person’s potential to develop a disease. This will enable clinicians to treat patients proactively rather than reactively resulting in a better outcome.
Personalized medicine is gathering momentum as evidenced by the significant attendance and enthusiastic involvement of the participants at the recent conference sponsored by Harvard Medical School and the Center for Genetics and Genomics at Partners Healthcare. Although there was general agreement that personalized medicine is now an accepted way to look at the patient, there are also enormous barriers to its widespread use, including:
1. Economic factors such as who will receive and who will pay for genetic testing.
2. Issues regarding who will be responsible for building the infrastructure needed to support widespread deployment,
3. Concerns about how we amass, use, and protect the vast knowledge base that results from genetic tests.
4. Legal questions regarding who owns the genetic test data - the patient, the physician, the institution - and whether or not that information can be used for additional research.
5. Unresolved issues regarding standards upon which to build a platform for using personalized medicine
6. Discussions about how to structure collaborations amongst all the stakeholders (patients, physicians and scientists) so that personalized medicine advances are translated ultimately into better patient care.
E-patients must be part of the conversation that determines where we are going with personalized medicine because personalized medicine uses genomics to focus not only on disease identification tied to a specific combination of genes in an individual, but also on disease prevention and wellness in which everyone has a high stake.
In the e-health world of the 21st century, personalized medicine, a new approach to treatment and analysis of patients’ health issues, promises to revolutionize that process. Personalized medicine looks not only at an individual’s symptoms, labs and medical history but at the individual’s unique clinical genetic and genomic markers to determine a treatment program. Because these factors differ for each human being, the disease they carry and how they will respond to treatment will differ as well. Taking this to another level, personalized medicine enables doctors to make accurate predictions and assumptions not only about an existing condition but to make predictions about a person’s potential to develop a disease. This will enable clinicians to treat patients proactively rather than reactively resulting in a better outcome.
Personalized medicine is gathering momentum as evidenced by the significant attendance and enthusiastic involvement of the participants at the recent conference sponsored by Harvard Medical School and the Center for Genetics and Genomics at Partners Healthcare. Although there was general agreement that personalized medicine is now an accepted way to look at the patient, there are also enormous barriers to its widespread use, including:
1. Economic factors such as who will receive and who will pay for genetic testing.
2. Issues regarding who will be responsible for building the infrastructure needed to support widespread deployment,
3. Concerns about how we amass, use, and protect the vast knowledge base that results from genetic tests.
4. Legal questions regarding who owns the genetic test data - the patient, the physician, the institution - and whether or not that information can be used for additional research.
5. Unresolved issues regarding standards upon which to build a platform for using personalized medicine
6. Discussions about how to structure collaborations amongst all the stakeholders (patients, physicians and scientists) so that personalized medicine advances are translated ultimately into better patient care.
E-patients must be part of the conversation that determines where we are going with personalized medicine because personalized medicine uses genomics to focus not only on disease identification tied to a specific combination of genes in an individual, but also on disease prevention and wellness in which everyone has a high stake.
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