The Power of a Second Look
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This is an important article from the NY Times of April 18, that outlines the relationship between exercise and weight. In a nutshell, it cites research that suggests that dietary intake is the determining factor on weight and the exercise in the absence of intake reduction will have little long-term impact. Mechanisms exist that lead individuals to eat more following exercise, negating the caloric of the activity. Gender differences making loss harder for women is also described.
The New York Times Magazine of April 18 carried this article that addresses one of my pet peeves – the abuse of our beautiful language. Actually the article is too kind to the word, focusing on the first use and evolution of the term. What benefit is there to a word that has a perfectly fine equivalent called – health?
Wellness has become a buzzword and a marketing term to promote all sorts of expensive maneuvers and services, often in the workplace, to improve the health of individuals, often involving incentives, paid consultants and the like. I have yet to see a scholarly report that establishes the effectiveness of such programs and their cost benefit. I believe it most likely that those who wish to be healthy need no external incentive or program, and are already taking care of themselves, and those who can’t or won’t engage in healthy choices in their lives are unlikely to be significantly persuaded by a workplace program.
How many people are in the dark about what it takes to be healthy, especially adults in the workforce?
Physicians from time to time have issues impacting their ability to practice. Many of these issues are temporary, relating to health or substance abuse, skill deficiencies and other matters. Others may become permanent. At MCN in the course of credentialing consultants, we review cases where regulatory action has taken place. This Wall Street Journal article describes one program’s approach to assessment and remediation of physicians who have practice issues leading to regulatory action in California.
From the New York Times on Sunday March 14, this article states the obvious; that avoiding change in the health care system is not an option and that payers will exercise some decision-making and control over what is paid for and permitted. An inherent challenge in any system where the payers are not the consumers is that usual marketplace controls are not present. When we pay ourselves, we generally exercise restraint. In health care it is the rare service that is paid for by the patient. The patient has no particular motivation to not consume, or to shop for price, and the providers have motivation to treat and sell services to the degree that they can be medically justified. An interesting thought experiment would be to imagine a patient seeking or being advised to obtain a given treatment, and then instead of being given the treatment, they are given the money that the treatment would cost at the place they were considering, and told that they have a choice of getting the treatment, keeping the money and foregoing the treatment, shopping for the treatment at a lower cost and keeping the difference, or changing the type and extent of the treatment (for example switching from a brand name to generic drug). Obviously the complex nature of diagnosis and treatment would make decision-making a challenge for many. Furthermore, irresponsible behavior combined with the perverse incentive of keeping the cash would mean that many would take the money and not vaccinate their kids, and generally be more resistant to preventive care where they are not currently suffering or in pain. Health reform proposals as best we can tell, are not meaningfully addressing the excess utilization trends that occur regularly.
By Matthew Herper and Robert Langreth, From Forbes Magazine, Issue Date March 29, 2010
Instead of ignoring the placebo effect, doctors should try to enhance it, says a Harvard Medical School professor.
This interesting discussion on the placebo effect is worth a read. The presence of the placebo effect is well-known and generally accepted in medicine, though it may be frequently argued as to when it is taking place or not – especially when one’s own treatment is being questioned.
From a policy standpoint, a legitimate question is whether those treatments that have a significant placebo component are ethical to the degree there may be conscious deception on the part of the practitioner – on behalf of helping their patient. In addition, should third parties such as insurance or government be asked and expected to pay for placebo interventions?
