As a reader of this newsletter you are likely to be swimming against the current. A recent New England J. of Medicine article addressed our dysfunctional health care system and how it may be fixed by swimming with you-and this newsletter.[1]
“[Since as much] as one third of U.S. health care spending is wasteful. health care organizations are now embracing explicit consideration of value and turning their attention to overuse. Reducing overuse could theoretically improve quality while slowing spending growth. [The] American Board of Internal Medicine Foundation’s Choosing Wisely program, the U.S. Preventive Services Task Force, and the National Quality Forum have advanced the dialogue about low-value care by identifying services that deserve that label.”
“Demand-side interventions – targeting patients – principally include financial incentives and education. Increasing patient cost sharing.”
‘Supply side: caregivers incentivized is best—risk sharing, in which providers accept financial responsibility for total costs of care. In a national survey, 92% of physicians said they felt responsible for ensuring that patients avoid unnecessary tests and procedures, and 58% believed that physicians were best positioned to do so.”
“[We need to] transitioning to a population-health focus. To address overuse, we now need to work against the current of culture and payment models that still largely reward volume over value.”
If you harbor hopes that the ACA or Obamacare will achieve these lofty goals, think again. The Journal of the American Medical Association recently devoted an entire issue on the economics of health care. The editorial on page 1639, “Who benefits from health system change?” concluded that most certainly it is not patients.[2]
The best way to reduce cost is prevention, which must be nutrition based. We must reign in “Big Food” and their toxic, deceptive advertisement, especially where children are concerned.[3] They, and older people, are also being lied about milk: it increases the risk of fractures![4] Perhaps we need a “political prescription”[5] to deal with misinformation, such as taxes; I prefer NOT taxing veggies as opposed to taxing processed foods.
We must also cut back on tests that are often shown to be unproductive. Canada recently gave up on PSA testing for the prostate,[6] and Switzerland abandoned mammography.[7] I doubt we will do the same thing any time soon in the USA given how economically entrenched those practices are.
We must encourage more activity in patients. If you sit for 30 minutes try to walk for 100 seconds. If you sit for 9 hours see if you can exercise for 30 minutes.[8] We must also cut back on unnecessary surgeries. Physical Therapy on most knees and shoulders results in outcomes as good as surgery.[9] We must encourage patients to stop smoking-it contributes to obesity and insulin resistance.[10] And, rather than embark on expensive interventions such as InVitro Fertilization, let’s first look at simple issues that may be lurking behind the problem, like insulin resistance due to bad diets[11] and toxins in the environment.[12] BTW.
Cell phones and brain cancer
Studies on the risk of brain cancer from cordless and cell phones have been ignored by the media and by industry for years. The makers of these phones claim that any unfavorable study is flawed for one reason or another. They trot out their own studies proving that there is no such association. Will the latest study incriminating their gadgets be dismissed as well? Probably.
“Mobile phone and cordless phone use and the risk for glioma – Analysis of pooled case-control studies in Sweden, 1997-2003 and 2007-2009.”[13] This study showed the highest incidence is after 25 year of use and in those who first got them under 20 years of age. Pretty much you and I and our children. Let’s use our speaker phone more often.
As an Environmental doctor I have tracked this and similar issues through the years. The following quotation from Boston University’s Public Health Director David Ozonoff is worth reviewing. He was one of the first to blow the whistle on asbestos. Mr. Ozonoff paraphrases the makers of this now widely discredited toxin:
“Asbestos doesn’t hurt your health.
OK, it does hurt your health, but it doesn’t cause cancer.
OK, it can cause cancer, but not our kind of asbestos.
OK, our asbestos can cause cancer, but not the kind this person got.
OK, Our asbestos can cause cancer, but not at the dose this person was exposed.
OK, This person got a dose that can cause cancer, but he really got it from smoking.
OK, He got cancer from our asbestos, but we didn’t know about the danger when we exposed him.
OK, We knew about the danger, but the statute of limitations has run out.
OK, It hasn’t run out, but if we are guilty, we will go out of business and everyone will be worse off.
OK, We agree to go out of business, but only if you limit our liability.”
“Chunky Liver”
No, that is not the name of a can of soup. It is what a lot of people’s liver looks like due to fat infiltrating it. Its technical name is Non-Alcoholic Fatty Liver Disease, NAFLD, an epidemic sweeping the country. This newsletter has been warning you about this problem for years. Fatty Liver is a sure sign that you may be struggling with Pre Diabetes or Diabetes. Despite good evidence Fatty Liver has been largely ignored and at best mentioned in passing when doing an Ultrasound looking for a reason to rip out your Gall Bladder.
Incidentally, Gall Bladder stones are a result of Fatty Liver since a liver so affected produces thicker bile; as such, bile is more likely to form stones. Taking out the Gall Bladder will not fix the underlying problem. Such surgery is sometimes necessary if you have ignored the root problem for too long. If picked up early most people can keep their Gall Bladder and thereby maintain proper digestion of food.
Fatty Liver, associated with Pre diabetes and Diabetes, is thus a sign of metabolic problems. This is why Fatty Liver is now also associated with plaque formation in the coronary arteries.[14]
By getting rid of processed foods and eating plant-based diets we may reverse all the above problems. Supplements like Alpha Lipoic Acid are helpful. ALA, an antioxidant from broccoli has been shown to help with both insulin resistance and Fatty Liver. Obesogens, or chemicals like BP that aggravate insulin resistance are then better eliminated in the liver.
Most people still think cholesterol is the problem. It turns out that cholesterol is modulated in the liver. If it is not in good shape cholesterol becomes inflammed and oxidized which makes it more likely to stick to arterial walls-already sticky themselves- resulting in plaque. Cholesterol is there to fix leaky arteries, if given a fighting change with good diets. I say don’t shoot the messenger.
[1] “Swimming against the Current – What Might Work to Reduce Low-Value Care?” N Engl J Med 2014; 371:1280
[2] JAMA October 22/29 2014 Cover issue: Price, cost, and competition in health care.”
[3] “Food marketing to youth: serious business,” JAMA 2014;312:1918
[4] “Milk intake and risk of mortality and fractures in women and men: cohort studies,” BMJ 2014;349:g6015
[5] “A political prescription is needed to treat obesity,” Epub JCMA Oct 27 2014
[6] CMAJ Epub October 27 2014
[7] “Abolishing Mammography Screening Programs? A View from the Swiss Medical Board,”
N Engl J Med 2014; 370:1965
[8] American J. of Clinical Nutrition 2013;98:538
[9] Bone Joint J. 2014;96-8:75 & NEJM 2013;368:1675
[10] Am J. Endo Met Epub November 4 2014. Reported in Salt Lake Tribune
[11] J. Clinical Endocrinology Metabolism 2014;99 (5) , pp. 1583-1585
[12] “High BPA levels in men reduce IVF rates,”
Am Soc for Reproductive Medicine Annual Mtg, Honololu Oct 2014. Abstract O-53
[13] Epub J. Pathophysiology Oct 28 2014.
[14] “High-Risk Coronary Plaque at Coronary CT Angiography Is Associated with Nonalcoholic Fatty Liver Disease, Independent of Coronary Plaque and Stenosis Burden: Results from the ROMICAT II Trial,” J. Radiology 2014, Ahead of Print, 10.1148/radiol.14140933.
“Association Between the Metabolic Syndrome, Its Individual Components, and Unprovoked Venous Thromboembolism: Results of a Patient-Level Meta-Analysis,” J. Arterioscler Thromb Vasc Biol. 2014;34:2478.
“Diabetes Mellitus, Prediabetes, and Incidence of Subclinical Myocardial Damage,” J. Circulation. 2014;130:1374
