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Lifestyle and habits

Addressing the Obesity/Cancer Link: What Will We Learn From China?

It has long been known that excess weight is a major health risk, but until recently cancer hadn’t been a major part of the obesity/health discussion. A recent British study of 5.24 million people, however, looked at the occurrence of 22 different cancers and their association with body mass index (BMI), a measure of weight/body size and type.

The study concluded that when adjusted for factors like age and smoking, a higher BMI was associated with a large increase in risk of cancers of the uterus, kidney, gallbladder, and liver, and smaller risk increases for at least six other types of cancer.

What’s Your Fitness Age?

It’s not news that longevity is tied in part of how fit we are. What is new is a study from researchers at the Norwegian University of Science and Technology which examined data from more than 55,000 Norwegian adults who had completed extensive health questionnaires beginning in the 1980s. The scientists used the volunteers’ answers to estimate each person’s VO2max and “fitness age.”

According to the study’s authors, the results suggest that fitness age may predict a person’s risk of early death better than some traditional risk factors like being overweight, having high cholesterol levels or blood pressure, and smoking. There’s also a link directly to a short test to find your own fitness age, with exercise suggestions.

Thankfully, fitness age can be altered, said Ulrik Wisloff, professor at the K.G. Jebsen Center for Exercise in Medicine at The Norwegian University of Science and Technology, who led the study. His advice if your fitness age exceeds your chronological years or is not as low as you would like? “Just exercise.”

Medicine still requires the vignette

In an era of systematic clinical research, medicine still requires the vignette, as explored in this opinion piece. The multiple comments are interesting as well, many with strong opinions which provide illumination into why patient stories are (still) so important and how they fit with a sound scientific approach to better treatment:

In addition to reminding us of the real and human part of practicing medicine, stories are great hypothesis generators. Evidence-based medicine is important, but no real evidence can be generated until a testable hypothesis is created. This is where vignettes play an important role. When we see an outcome, especially if it’s unexpected, it forces us to ask questions, which in turn lead to hypotheses.

Your Brain’s Silent Killers?

by Laura McFarland, Communications Director

Turns out my mother might not be so unusual after all. Or at least in one particular way: she’s gluten intolerant, but not celiac. For years she ate crackers to settle her stomach; then she learned that it was the crackers that were upsetting her stomach.

She is joined by nearly 20 million other Americans who regularly experience distress after eating products that contain gluten. About 1% of the population has celiac disease (an autoimmune disorder that can occur in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine). Currently, however, according to this fascinating article in The New Yorker, about a third of American adults, a number well beyond even this 20 million,  say that they are trying to eliminate gluten from their diets.

Given that humans have been eating wheat for about ten thousand years, what’s going on that would suddenly make the numbers of those who experience intolerance increase? The article explores multiple possibilities — a change in wheat’s genetic composition, the modern diet, changes in the bacteria which help us digest food, intolerance of a specific group of carbohydrates (FODMAPs), too much vital wheat gluten — and provides examples of studies.

Multiple opinions are noted, from David Perlmutter, a neurologist and the author of one of the gluten-free movement’s foundational texts, “Grain Brain: The Surprising Truth About Wheat, Carbs, and Sugar — Your Brain’s Silent Killers,” writes “Gluten sensitivity represents one of the greatest and most under-recognized health threats to humanity.’’ Given that 20% of the world’s calories, not to mention the basis for multiple economies, come from wheat, that’s a fairly daunting concept to grapple with.

Then there’s research by Joseph A. Murray, a professor of medicine at the Mayo Clinic and the president of the North American Society for the Study of Celiac Disease. Said Murray, “Everyone is trying to figure out what is going on, but nobody in medicine, at least not in my field, thinks this adds up to anything like the number of people who say they feel better when they take gluten out of their diet. It’s hard to put a number on these things, but I would have to say that at least seventy per cent of it is hype and desire. There is just nothing obviously related to gluten that is wrong with most of these people.’’

So which is the more accurate perception? Perhaps understanding what’s really being removed from one’s diet when they try to give up gluten. As author Michael Specter suggests, “The initial appeal, and potential success, of a gluten-free diet is not hard to understand, particularly for people with genuine stomach ailments. Cutting back on foods that contain gluten often helps people reduce their consumption of refined carbohydrates, bread, beer, and other highly caloric foods. When followed carefully, those restrictions help people lose weight, particularly if they substitute foods like quinoa and lentils for the starches they had been eating. But eliminating gluten is complicated, inconvenient, and costly, and data suggest that most people don’t do it for long. The diet can also be unhealthy.”

Gotten Your Flu Shot Yet?

Some good news on the vaccination front: the World Health Organization (WHO) welcomes the approval by Swissmedic, the Swiss regulatory authority for therapeutic products, for a trial with an experimental Ebola vaccine at the Lausanne University Hospital. This marks the latest step towards bringing safe and effective Ebola vaccines for testing and implementation as quickly as possible. The goal is to produce millions of doses of two experimental Ebola vaccines by the end of 2015.

That’s incredible news; as of last Friday the U.S. Center for Disease Control was reporting a total of 10,141 report cases worldwide, with 5,692 confirmed by testing and 4,922 deaths so far.

Closer to home, there are plenty of alarming health situations to worry about over which we have much more control. During the 2013-2014 flu season, for instance, only 46% of Americans received their flu shot, even though it kills about 3,000 people in this country in a good year, nearly 50,000 in a bad one. Flu shots don’t provide immunization against every strain of flu, but they greatly decrease the likelihood of contracting the flu and the severity of the flu should one become ill. So, as New York Times op ed piece asks:

Do me a favor. Turn away from the ceaseless media coverage of Ebola in Texas — the interviews with the Dallas nurse’s neighbors, the hand-wringing over her pooch, the instructions on protective medical gear — and answer this: Have you had your flu shot? Are you planning on one?

 

My Best Friend Siri

Occasionally we come across articles that contain useful information, or are news stories related to our industry or the more general world of health care and insurance and its ever-changing complexities. And there are those articles we want to share with our readers for the simple reason that we are human. We came across one of these recently, “To Siri With Love,” in The New York Times. We hope that people read this because it is beautiful and moving, and always worthwhile to remember that life is experienced by people in a myriad of ways.

The mother of a 13-year-old autistic boy discusses her son’s interaction with Siri. As she notes:

This is a love letter to a machine. It’s not quite the love Joaquin Phoenix felt in Her, last year’s Spike Jonze film about a lonely man’s romantic relationship with his intelligent operating system (played by the voice of Scarlett Johansson). But it’s close. In a world where the commonly held wisdom is that technology isolates us, it’s worth considering another side of the story.

Read more…

Deaf to Moore’s Law: The $6800 Hearing Aid Set, or the $475 One?

This Forbes article describes the applicability of Moore’s Law to health innovation and pricing. The author needed a hearing aid. He cited a teacher who had paid $6,800.00 for a pair of hearing aids. The writer had his own hearing loss and with some shopping, found an innovative source that sold him a hearing aid online for 7% the cost — $474.50 — delivered in 2 days via FedEx.

To be fair, the author notes that he does not know how his condition compared to that of the teacher.

We have seen similar disruptive changes in eyewear with Warby Parker and others selling prescription glasses for $100.00 or so, less than the cost of lenses alone in most outlets.

Must a set of hearing aids really cost thousands of dollars? Setting aside our lack of full information, we do know that they are a solid state electronic device, sold by the thousands and mass produced at some level. They would appear to filter and amplify sound, and be quite small.

Should a set of glasses cost hundreds of dollars? One has a piece of colored plastic in the form of a frame, and a piece of plastic bent to refract light. Both made by machines in bulk. There is a fashion aspect of the frames that to many buyers matters a great deal. Eyeglasses, unlike hearing aids, are worn by many billions of users world-wide, a number of whom own multiple pairs.

Compare a hearing aid to a smart phone. A top of the line Iphone without a carrier subsidy can be bought for $750.00. This device, like similar Android phones, is remarkable. Unlike the $5,000+ hearing aid, it is a full-fledged computer that computes, locates, calls, transmits, schedules, messages, photographs, shops, informs, and performs hundreds of other functions depending upon apps installed. One might reasonably assume that these devices are far more complex than a top of the line hearing aid. The price difference likely has more to do with scale, competition, buyer motivation, and other market factors.

Those who shop for eyeglasses and hearing aids are often paying out-of-pocket, and have a motivation to shop. Those selling such devices have a motivation to attract buyers with innovative delivery and pricing models. Can and should similar innovation be applied to high priced pharmaceuticals, medical devices, and medical procedures?

Emergence of the Trauma Industry

This article from The New York Times focuses on a particular criminal ex-cop. But reference is made to many other defendants involved in this particular crime, of “feigning mental illness” and invoking the 9-11 attacks as a source of psychological scarring. These crimes did not take place in a vacuum. They occurred in a social context where the defendants, many sworn officers, believed they could get away with it, and likely saw themselves as damaged and entitled.

The experience of trauma and even the development of a diagnosis such as Post Traumatic Stress Disorder does not correlate with a person being damaged or disabled. Trauma is part of the human condition, and in most cases the victims adjust, move on, and support themselves and their families – at times with the help of some therapy. Men and women have gone to war, and returned to productive civilian lives. A bureaucracy of entitlement for compensation and pensions based upon ones experiences, rather than one’s actual impairment, did not exist.

Only in recent years have we observed an emergence of a trauma industry, where both individuals and clinicians all too frequently appear to correlate an unfortunate experience or experiences with damage. The ability to obtain compensation likely has driven this process and outcome.

Those who die in performing their jobs or who sustain serious injury warrant eternal respect and honor. What of those who ride on the coat-tails of dramatic news, and do their sometimes unpleasant and highly stressful jobs? Has the human condition and the nature of trauma and war changed fundamentally in the past couple decades to explain or justify the increased level of diagnoses and compensation for trauma-related experiences?

The article reflects some who were caught. In the culture of cynical entitlement that appears to be reflected in the article, what remains unrecognized? Does one really believe that this case and the Long Island Railroad abuses cover and resolve the core issues?

The Impact of Community Health Workers: Cutting Re-Admissions and Creating Healthier Communities

Community health workers can support, guide and encourage patients to manage their health over the long term. Many poor countries use CHWs on an enormous scale. This is a crucial role in a country where vast numbers of people are sick with chronic lifestyle-related diseases. Doctors can’t help patients change their behavior in the 15 minutes they spend with each patient. But community health workers can.

In the United States, in 2010, researchers from the University of Pennsylvania began interviewing patients who lived in high-poverty neighborhoods about what they saw as barriers that kept them from getting health care, and kept them sick. Those responses — from long interviews with 115 patients — became the basis of the Penn Center and IMPaCT, which stands for “individualized management for patient-centered targets.”

The Penn Center is one of several new models hospitals are trying to make CHW programs sustainable. Another is program is Grand-Aides. Unlike the Penn CHWs, Grand-Aides don’t help with social or logistical issues. They are nurse extenders who get hundreds of hours of medical training. Each patient visit is supervised in real time by phone by a nurse, who makes all the decisions. A pilot at two pediatric Medicaid sites in Texas showed that the program cut readmissions by at least two-thirds. Learn more…

Do Patients Feel Better in Redesigned Hospitals/Rooms?

Often ignored by front-rank architects, left to corporate specialists who churn out too many heartless buildings, hospitals are a critical frontier for design, for exterior design as shown in the photos included here, individual room layout, and overall hospital layout.

As an example of the impact of interior changes, after months of testing a new room layout at the University Medical Center of Princeton, patients in the model room rated food and nursing care higher than patients in the old rooms did, although the meals and care were the same.

Some innovations are logical and even seem obvious, and some do have their downside: patients in single rooms are likely to share more information with the medical staff more quickly than those in double rooms, so the Princeton plan opts solely for single rooms, though this increased the building’s overall size, thus forcing a larger separation between certain departments and thereby requiring new methods of internal communications. The new rooms include a sink positioned in plain sight, so nurses and doctors will be sure to wash their hands, and patients can watch them do so. A second sink is in the bathroom, which is next to the bed, a handrail linking bed and bathroom, so patients don’t have to travel far between them and will fall less often.

But the real eye-opener was this: Patients also asked for 30 percent less pain medication. Reduced pain has a cascade effect, hastening recovery and rehabilitation, leading to shorter stays and diminishing not just costs but also the chances for accidents and infections.

Health care is a trillion-dollar industry just discovering the medical and economic benefits of better design. “It’s a significant part of our G.D.P.,” noted Christopher Korsh, the principal architect on the Princeton project. “Patients now say they won’t come to a facility because they don’t like it, and if there’s a building that can save 2 percent on the cost of delivering health care, that’s huge. Plus good design really can make you better faster.” Read more…