What Dr. Oz Learned From His Cancer Scare - Honest and Unplugged. What Doctors Can Learn.

Dr. Mehmet Oz recently had a piece in Time titled "What I Learned from My Cancer Scare" in which he became the the more humbled Mr. Mehmet Oz.  As noted previously here, Dr. Oz last summer had a colonoscopy at age 50 and much to everyone's surprise had a precancerous colon polyp.  He was advised to follow-up again for a repeat test in 3 months.

As the Time magazine piece noted, he didn't return for 9 months despite repeated reminders from his doctor.

From this experience, he essentially stumbled upon what has been challenging American medicine and primary care.  How do we enable patients to do the right thing and get the screening tests done and treatments necessary to avoid premature death and maintain a high quality of life?  As a highly trained professional, Dr. Oz knows the risks and benefits of not doing a preventive screening test.  As a doctor, he knows all of the secret protocols and codespeak we use when calling patients or asking them to see us in the office for important matters.  As a doctor, he also understood the importance of a repeat colonoscopy to ensure no more colon growths.

Yet he didn't return for 9 months.  Why?

None of us want to deal with our mortality.  Having a screening test means there is a possibility that the test may be abnormal and now we must confront it face to face. Skipping the test means to be blissfully ignorant, even if it is the wrong thing to do.

Also, as Dr. Oz noted, many individuals, particularly those who are otherwise healthy with no family history, feel that many of these tests or interventions don't apply to them.  Trust me, I know.  As a practicing primary care doctor, do you know how hard it is to convince someone to get screened for colon cancer?  Get vaccinated for pertussis, influenza, or pneumonia?

Dr. Oz, however, did discover what will compel people to do the right thing.  It isn't about statistics.  It isn't about knowledge.  (And though he never discussed it, it certainly won't be consumer driven health care where the theory is that forcing people to have more financial "skin in the game" will enable the right behavior).  It's about getting to our emotions.

Most important, my colonoscopy wasn't entirely about me. It was about my wife and our children. It's about our someday grandchildren. It's about my childhood friends whose lives remain closely intertwined with mine. It's about my colleagues and patients at the hospital who teach me as I learn from them. I need to be there for all these people I know and care about. I need to show up in my own life. And you need to show up in yours. Sometimes that requires courage — the courage to undergo a colonoscopy or Pap smear or mammogram or chest X-ray. It's not easy, but it could save your life. And if it helps even a little, remember that I will be rooting for you.

Reminding our patients that their inaction isn't just affecting their own livelihood but their network of family and friends.  It's the reason why certain topics in the media, like the concerns about vaccine safety and autism, gain far more momentum than the scientifically researched and proven life saving interventions and treatments do.

They focus on the emotional aspect of us that make us uniquely human.

Until we, as doctors, employ those same tools, too many Americans will not learn from Dr. Oz's cancer scare or those from a variety of public figures.  The same problems will simply repeat themselves, just different people become spokespersons (note Katie Couric from a decade earlier regarding colon cancer screening).

Though highly unlikely Dr. Oz will ever read this article, one thing he must do is to highlight the need for a robust primary care workforce and inspire a generation of doctors in training to become the front-line of prevention.  Despite his work as a public figure, the intimate and personal conversations needed about preventive tests and treatments happen one on one at a primary care doctor's office.  And we certainly need a lot more of us to get the job done.

How to Pick Good Health Insurance - Your Life Depends on It.

Unless your doctor is a policy expert, in healthcare administration, a researcher, an author or blogger, I seriously doubt he will be reviewing an important report card that helps you pick the best health insurance plan that keeps you healthy.  Published annually by the National Committee for Quality Assurance (NCQA), this year's report card ranks 227 health plans across the country on their ability to keep you healthy and well, treat you quickly, and how patients feel about their insurance coverage.

Because unlike banking or airlines where there is not much difference in ATM machines or planes, there is a big difference in whether a health insurance plan helps in keeping its enrollees healthy.  Do children get their vaccinations?  Do healthy mothers get screened for breast cancer or cervical cancer with mammograms and pap smears respectively?  Do kids only get antibiotics appropriately for strep throat and not overtreated and unnecessarily when they have a viral illness or cold?  Are adults over 50 screened for colon cancer (something Dr. Oz can relate to).

You are incredibly busy living life.  Your health plan should proactively works with you and remind you to do the right thing?  It also helps doctors do the right thing.   

The NCQA report has been part of the US News and World Report best health plans over the past few years and will now be incorporated as part of Consumer Reports.

Be smart.  Be wise this year.  Trying to pick a health insurance plan seems easy.  They are all the same, right?  Simply look at the price.

No.

This is different.

This isn't auto insurance.  This is your health.  You want the best.  Choose wisely because your life and those of your family depend on it.

The Dr. Oz Show - Just What the Doctor Ordered. Not a Moment Too Soon!

Dr. Mehmet Oz, cardiothoracic surgeon at Columbia, noted author of multiple best-selling books, as well as guest on the Oprah, who dubbed him "America's Doctor" has his own television show.

And not a moment too soon.

His focus has been educating the public in preventive health and wellness. With Dr. Michael Roizen, Chief Wellness Officer of the Cleveland Clinic, founder of Real Age, as well as co-author with Dr. Oz, they have made getting healthy a mission. In a country where obesity is unfortunately becoming the norm rather than the exception and where everyone seems to expect solutions for illness and stress to come from the outside through medical interventions and medications rather than from within, Dr. Oz's insight via his guest appearances on Oprah, his radio show on XM, as well as the many articles he pens, provides a major breath of fresh air.

The boring and unsexy stuff of exercising, eating well, maintaining a healthy weight, as well as focus on mental wellness really works. In a frantic world with 24/7 news cycles and instant gratification, this perspective is sorely needed particularly in our country where we are the unhappiest and certainly one of the unhealthiest among industrialized countries.

Dr. Oz is frankly brilliant. Not only did he graduate from the University of Pennsylvania School of Medicine as well as the Wharton School of Business, (of which yours truly is an alumnus), but also Dr. Oz holds a number of patents, practices and preaches the power of complementary medicine, and makes any medical topic understandable, entertaining, and memorable to the general public. As a practicing primary care doctor, I'm amazed how effortlessly he makes the complex simple. It's a sign of a true mastery of the variety of subjects he comments one and a skill that only the best teachers and professors possess.

His stage presence will make the show ultimately successful as he tackles what a potentially ho-hum topic, preventive health. Our society that favors 30 second soundbites and sensationalism and rewards media for providing this. Yet, we know in medicine that prevention works. Unfortunately no one in this country pays for this kind of intervention or advice. Medical students are flocking to specialties like dermatology, ophthalmology, anethesiology, and radiology for these reasons and shunning primary care specialties like internal medicine and family medicine. Our healthcare system reimburses for fixing problems not for preventing them. His zen-like calm, candor, and thoughfulness, as well as his ability to not be shy or embarrassed about even the most sensitive topics will make his show a mainstay of many households.

Despite this traits, however, Dr. Oz, still a significant uphill battle in making Americans healthier and better stewards for their well-being. The food industry has make what we eat more tasty, convenient, and less healthful than the foods generations ago once had. Households are stressed more than ever with higher expectations and perceived needs to keep up with the Jones as well as a fear that the American dream is being lost to other countries and foreigners who seem to work even harder for less. Children seem to stripped of childhood sooner and regimented into programs early in life so they can get ahead. Can Dr. Oz make his message heard?

A sign of a good doctor and one aspect I particularly like about him is that he will call people out. Honest, but tough. In one show, he admonished someone for not purchasing health insurance. Sure it is increasingly unaffordable and the nation must reform the healthcare system, but Dr. Oz's point was that the individual chose to spend money on plenty of other things that were not essential. Health is important and something too many of us take for granted until something happens. Dr. Oz has and continues to demonstrate that there are many things we can do to maximize our chances to stay healthy or even improve health.

Although I think he's great, I don't always agree with what Dr. Oz has to say. It's probably because he is so smart that what he touts won't been known for decades to come and that individuals like myself can't see that far ahead. (I truly believe that to be a good possibility). For example, on a previous Oprah show he had recommended that people get a testing for biochemical markers to help them determine their health. Cost? About two thousand dollars! Scientific evidence? None that I know of. Yet, Dr. Oz felt that this was important for people to have it done and Oprah recommended it as well. As a result, I suspect quite a few people spent some serious money for blood work. (A nice treadmill and a couple pair of sneakers could probably have a better health benefit for the same price). He may know more than the rest of us, so give him the benefit of the doubt, but with a little skepticism at times. I hope as he gets people to work on being healthier he balances that with the reality of increasing financial hardship. If people need to spend a lot of money to get healthier, then many will be left out.

Nevertheless, the nation needs a doctor who will speak up, make preventive health fun, entertaining, and memorable. As he noted in an article with the Associated Press:

"I found myself going to work and taking care of people who wanted to get better who believed that their only path to salvation was through my scalpel," he said. "I can heal with steel. I know how to do that. But it's very disenfranchising when you realize the true solutions are outside the operating room."

Yes, the solutions to America's healthcare system crisis is in preventive health and should be in the hands of individuals and families. Can Dr. Oz alter the perception in this country that more is better? Can he show that answer to good health isn't more imaging tests, blood work, medications, and surgeries, but the unsexy stuff that not enough of us do like eat healthy foods and stay physically and mentally active? Perhaps Dr. Oz can inspire a generation of Americans to take care of their health and a generation of medical students to commit to the primary care specialties. With a healthcare system in crisis and the current generation of children expected to be the first not to live as long as the generation before, what this country needs is a hero and a leader who boldly and wisely can get the message out that preventive health is important, cool, and most importantly accessible to all who wish to try.

I for one hopes he succeeds and suspect he will do so as he has proven time and time again brillantly.

Real Simple Magazine - Time Saving Healthcare Tips

The August issue of Real Simple has many time saving tips when dealing with healthcare.

Many are from yours truly! It's focuses on preventive health, pharmacy, and the area I'm most often referenced is how to get the most out of a doctor's visit!

Enjoy and stay healthy!

Prevention Won't Save on Health Costs

The Wall Street Journal recently reported that the belief that a focus on preventive health won't save on healthcare costs. In the article, "Prevention Efforts Provide No Panacea on Health Costs" noted that

• The Congressional Budget Office, in a December report, concluded that greater use of preventive care would at best generate modest reductions in costs over 10 years, and might even result in increases.

Saying that prevention will save money is the wrong goal. What prevention does is free up dollars that would have been spent on other treatments and interventions that would have occurred without being proactive and allow them to be spent on improving coverage. As Federal Chairman Ben Bernanke noted in 2008 when addressing the Senate Finance Committee on Healthcare Reform, "that improving access and quality may increase rather than reduce total costs" and the better question may be, "whatever we spend, [are] we are getting our money's worth?"

Without improving prevention, both the insured and uninsured aren't getting their money's worth.

Save Money on Health Screenings - President of American Academy of Family Physicians Wrong

The NY Times published a new section titled Patient and Money, which is particularly timely as individuals and families facing reduction in income or in some cases losing jobs are having the difficult choices between basic necessities and health care. Their piece titled "Health Care You Can't Afford Not to Afford" unfortunately was wrong. Particularly the perspective of Dr. Ted Epperly, the president of the American Academy of Family Physicians.

As a practicing board certified family doctor, I strongly disagree that screening tests can be safely skipped for months which is what Dr. Epperly was quoted as saying. The reason they are called screening tests because we do them when we feel completely fine and have no symptoms. Research has consistently shown that these do save lives. Whether the American Cancer Society gave him some criticism for his comments (he acknowledges that “The American Cancer Society wouldn’t like me saying so,” Dr. Epperly said, “but you can stretch out those tests when you need to.”).

Yet, in the same article he highly recommends that people get an "annual physical" done which research also consistently shows isn't worthwhile! From the article "If you’re due for your annual physical, for instance, and you feel fine, you can wait a few months before forking over that hefty co-payment. Even children, once they are past vaccination age, can skip a check-up or two, as long as they are healthy and at a normal weight." Indeed, having an annual physical done randomly is no better than taking your car for a check-up when it is running perfectly well. What do you think your mechanic will say? Everything is fine. Randomly dropping by your auto dealer is different than taking your car in for a scheduled maintenance.

Knowing when you must get checked is far better than just dropping in on an annual physical. If Dr. Epperly means an annual physical is the only way you can figure out if you are obese, need to be screened for high blood pressure, or diabetes, then that's different. (Those on prescription medication for conditions like high blood pressure, high cholesterol, heart disease, diabetes should be checked annually). But for the most part, most of us who are healthy and aren't on medications can figure that out ourselves. The trouble is in our busy lives how do we remember to take a time out and assess our health? Do it at New Years or every year on your birthday.

When should you go in and what tests should you ask for (if your doctor forgets to remind you or is squemish about screening for colon cancer - only those readers 50 years and older, possibly younger in people with family history of colon cancer) can be found in Do the Right Thing Regularly and Repeatedly - Preventive Screening Tests and Interventions for Adults. Helpful websites to keep you healthy and well in addition to figuring out when to see your doctor are right here.

For decreasing drug costs, I would add that Walmart and Target's $4 /$10 medication option is a great one as many high quality medications are available. I would also add that Consumer Reports has a free website called CRBESTBUYDRUGS.ORG which lists the best medications for
the money.

For your symptoms, understanding when to see the doctor and when you don't need to is as simple as going to the American Academy of Family Physicians website - www.familydoctor.org and clicking on the symptoms check link - Search by Symptoms.

Also realize that giving doctors a good medical history about your symptoms prevents us from ordering too many tests / imaging studies which cost money and time. Unfortunately, if you simply tell us that your back hurts and are unable to say what makes it better or worse, what the pain feels like, how long it lasts, if you've had other symptoms with it, among other important information, doctors meaning to help will prescribe medications and do tests which may not help you get better, but hurt your wallet more. This is particularly challenging as doctor visits are getting shorter and doctors, research shows, cut patients off in 23 seconds.

Full Disclosure - Calorie Counts

The New York City Health Department had a press release announcing their campaign in making the public aware of the number of calories individuals should have daily to maintain a healthy weight. Dubbed "Read ’em before you eat ’em" and with ads in NYC subways, the health department is trying to make aware how portion sizes have increased.

Recently California Governor Arnold Schwarzeneggar signed into law a proposal which requires restaurants operating more than 20 sites to have calorie counts posted on the menus by 2011, becoming the first state in the union to do so.

Will calories displayed prominently help consumers make wise decisions about their eating habits and decrease the numbers of individuals who are now overweight or obese? While both the NYC and California proposals are excellent (and note that the restaurant industry is fighting the NYC plan and yet seems on board with the California one), perhaps they could take it a step further and indicate how much activity it takes to burn off calories. After all, calories are simply numbers. To make people fully appreciate their caloric intake, illustrate how much time and what type of exercise would be needed to burn off a muffin or hamburger.

Since few of us have free time, if these groups showed us that we needed to exercise for four hours to maintain our weight, I'm sure most of us would be much more careful about how much we eat. After all, who has four hours to exercise everyday?

Fountain of Youth - Exercise

Fascinating article from Men's Health, not talking about the fountain of youth per se, but about the feeling among researchers that people were born to run. Titled, "Yes, You Were Born to Run" it speaks about the evolutionary adaptations that people have that provides proof we were meant to be running - a strong nuchal ligament to keep our head straight and focused when hunting prey (evidently pigs can't do that), a large number of long leg tendons which provide bounce so we can run (chimpanzees have short and few leg tendons which are fine for climbing trees), and the ability to perspire when running continuously (which provides the advantage of hunting speedy prey like a kudu which although faster than a human is unable to sweat and therefore needs to stop and therefore can be run down). More from the article:

• According to a controversial body of research, is that our passion for running is natural. A small group of biologists, doctors, and anthropologists say our bodies look and function as they do because our survival once depended on endurance running, whether for long-distance hunts like the one Liebenberg witnessed or for racing the competition across the African savanna to scavenge a kill.
• In his book Why We Run, the biologist and runner Bernd Heinrich, Ph.D., argues that something exists in all of us that still needs to be out chasing antelopes, or at least dreaming of antelopes. Without that instinct, "we become what a lapdog is to a wolf. And we are inherently more like wolves than lapdogs, because the communal chase is part of our biological makeup."
• Anyone who has put in some miles knows how good running can feel, once it stops feeling bad. But beyond the way it feels, medical evidence also suggests that humans are built for endurance exercise. In response to a good training program, for instance, the left ventricular chamber of the heart can increase as much as 20 percent in volume. The chamber walls thicken, too. So the heart fills up faster and pumps more blood to the rest of the body. The coronary arteries also change, dilating more rapidly to meet the body's demand for oxygen. Endurance exercise won't make anyone live forever. But it seems to make the cardiovascular system function the way the owner's manual intended.
• In the skeletal muscles, increased blood pressure causes new capillaries to emerge. The mitochondrial engines of the cells ramp up to consume energy more efficiently, helped along by an increase in the production of various antioxidants. These changes in the heart and extremities together typically boost the maximum amount of oxygen the body can consume each minute by 10 to 20 percent. For men who used to become short of breath slouching to the fridge for a beer, VO2 max can increase even more. Lapdogs start to function like wolves.
• More surprisingly, the brain responds as if it was built for endurance exercise, too. researchers have discovered lately that exercise affects the function of 33 different genes in the hippocampus, which plays a key role in mood, memory, and learning. By stimulating growth factors, exercise also produces new brain cells, new and enhanced connections between existing cells, new blood vessels for energy supply, and increased production of enzymes for putting glucose and other nutrients to work.
• People who exercise regularly perform better on some cognitive tests: Run more, think better, hunt smarter, eat better. Exercise also seems to buffer the brain against neurological damage, reducing the effects of stress and delaying the onset of Alzheimer's and other diseases. Most significant, exercise helps prevent and alleviate depression, which afflicts one in six Americans and costs $83 billion a year.

Not advocating everyone start running, you might need to check with your doctor first before doing any vigorous exercise, but what is clear is that people were built to move. In our American 21st century society where everything is built on convenience and relatively little work -- cars allow us to travel distances without walking / running, grocery stores and restaurants provide us food without us actually laboring in the fields to grow, harvest, and then prepare food, entertainment is becoming more sedentary with internet, video games, television, movies, instead of us actually participating in activity, and finally that for many of us work isn't as laborious as the past -- perhaps it isn't surprising as a nation we are getting fatter and less healthy than a generation before even though we understand more about health and illness.

It appears we were born to run or be active. Our society makes our bodies more like lapdogs rather than the wolves that our anecestors evolved to be to survive. The fountain of youth is very much staying active whether dancing, swimming, walking, running, biking, or whatever. It affects our bodies and our minds. Unlike any machine that exists, our body is dynamic and adapts to the challenges ahead, regardless of your age or whatever happened (or didn't happen) in the past. So even lapdogs have the potential to slowly become wolves again with increased activity. So start getting active!

Wishing For Natural Therapies Can Kill or Injure

A couple of news reports reminds us about how as a society we have very short memories - one involves measles and the other involves raw cow milk.

The CDC reported a large increase in the number of measles cases. An outbreak in Illinois occurred in home-schooled children and none were vaccinated. Already in 2008, 131 cases were reported, which is three times that of 2007.

• "Before the measles vaccine in this country, there were 400 deaths of U.S. children each year caused by measles," says Dr. William Schaffner, department of preventive medicine chairman at the Vanderbilt University School of Medicine. "Measles carries serious complications, including pneumonia and encephalitis, which is a life-threatening inflammation of the brain tissue that can be caused by viral infections such as measles. Measles is a serious illness. To be cavalier and not vaccinate shocks someone like me, who has seen the devastating effects of this disease."

• So far this year, 15 patients have been hospitalized as a result of measles. They suffered symptoms such as high fever, dehydration and pneumonia. Four of those who were hospitalized for measles were infants.

Although there has been concern, but yet to be proven scientifically, a link between vaccinations and autism, it appears many parents refuse to have their kids immunized. Unlike Dr. Schaffner, who has evidently witnessed the complications of measles, since the vast majority of us have never seen it, we wrongly assume that it can't happen. One option parents can consider is delaying the measles vaccine until their child is older as the shot is given at 12 months of age. Since autism is picked up at about 18 to 24 months, one could ask the pediatrician if it would be ok to delay for a few months. For older children, vaccinating them will make it less likely they can carry it and give it to vulnerable infants.

The other story was about raw cow milk and how 15 people became ill and one woman became partially paralyzed! This frankly is unbelievable and sad. Louis Pasteur, the famous French scientist, who figured out that organisms invisible to the naked eye caused diseases, was also the one to understand and learn how to kill them and make things like milk safer for consumption. This is where the word- pasteurized - came from.

• The raw milk came from Alexandre Family EcoDairy Farms, which supplied the product to 115 customers.
• The county's Department of Public Health suspects at least 15 people were sickened by Campylobacter, a common bacteria found in domesticated animals. The department has confirmed three cases, and are awaiting test results for the other 12.
• Alexandre EcoDairy voluntary stopped its raw milk program June 15 after learning one of its customers was hospitalized. That woman later became partially paralyzed by a rare disorder often associated with Campylobacter infection.

In a high-tech world where many of us wish for simpler times, we must not forget that these more natural methods had major problems as well. The leading cause of death about a hundred years ago was due to infectious diseases. Like the example of measles, just because we don't witness illness or problems ourselves doesn't mean that the problems still don't exist. Many of the reasons we live longer than generations ago is because of high immunization rates and more sterile and hygenic food processing techniques. Are some of the foods perhaps less natural and less safe than the past because of pesticides and hormones? Hard to say, but in that case, purchase organically grown products. Don't ignore basic common sense.

Here's the other question. If people became ill because of an accident or food poisoning, then I don't think anyone would argue we should take care of them. However, what if a person out of ignorance gets ill from a very preventable infection, should we as a society pay of their healthcare? If the woman, who is partially paralyzed doesn't regain full use of her body and requires resources from the community, is that fair for the rest of us?

Could Tim Russert's Heart Attack Been Avoided?

Not a trivial or academic question. Time magazine identified the NBC's Meet the Press moderator and Washington bureau chief as one of the 100 most influential people in world in 2008. His loss at such a young age, 58, is tragic. His ability to make complex topics clear for the public and to ask the hard questions will be missed in this the most historic presidential races in American history.

But was his sudden passing and fatal heart attack an avoidable tragedy? His internist, Dr. Michael Newman, who is affiliated with George Washington Medical Center, noted that Mr. Russert died of a sudden coronary thrombosis, which can occur without warning. Mr. Russert had been diagnosed with asymptomatic heart disease which reportedly was well-controlled with medication and exercise. He passed a cardiac stress test in late April. It seems like he got the appropriate care.

Yet, our healthcare system only provides the right preventive care 55 percent of the time. What medical students know, lowering blood pressure, controlling cholesterol, and arranging age-appropriate cancer screenings, shown to save lives, are not done routinely in this country. The ability of doctors and insurance plans to provide this
basic fundamental care varies by about 20 percent. If one compared the safety performance of the top 10 percent of airlines with the national average, the quality gap was far less at less than 1 percent.

The National Committee for Quality Assurance (NCQA) estimates that had all doctors and insurance plans performed at the level of the nation's top 10 percent that 80,000 Americans, all who had health insurance, would have avoided premature death. That is twice the number of breast cancer deaths annually. A study of 20,000 patients in 12 US major cities found that only 68 percent of those with heart disease and only 65 percent of those with high blood pressure received the recommended care developed by expert committees.

Unfortunately, one can't assume that the best preventive care is done at university medical centers. A study in California found that the vertically integrated healthcare organization Kaiser Permanente outperformed both university medical centers and community hospitals in decreasing their patients' heart attack risk and death by 30 percent. The integrated VA healthcare system was also found to outperform community hospitals in caring for diabetics. It consistently ensured its patients got the right medications at the right dosages better that those in the communities around them.

It seems that as a country we take for granted the failings of the healthcare system which are occurring with alarming frequency. As we mourn the unexpected passing of a great journalist, we should instead ask ourselves whether there were systematic failures in the healthcare system that Mr. Russert relied on to keep him well? The goal wouldn't be to find negligence or to identify scapegoats, as like the aviation industry, the delivery of healthcare is too complex to simply isolate one person or entity that resulted in the mishap. It is very likely that General Electric, NBC's parent company, provided him with health insurance options that were accredited by NCQA as excellent in keeping people healthy.

Is it possible, however, that the recommended care wasn't delivered? As our nation struggles with how to make the healthcare system more affordable, accessible, and with higher quality, the debate boils down to who is best in determining the right care at the right time. Is the onus on patients? Does the responsibility rest on the healthcare industry? It is an important conversation our country must have and certainly would have gone better with a skilled moderator like Mr. Russert. He will be deeply missed.

What is Your Waist Score?

The NY Times reports that in Japan companies and local governments will need to measure waist sizes of their population. Those considered "metabo" or overweight will be educated on how to lose weight and then measured later. If they still aren't at healthy weight, the companies and governments will be charged more for healthcare costs. (Japan has a publicly financed healthcare system).

It will be interesting to see how this program will do. Will people be healthier because the entire nation is focused on not being “metabo”, the preferred Japanese word for overweight? Will companies and local governments, who are responsible for measuring waist lines and ultimately financial penalties if their population, help change the lifestyle in Japan to be more healthful? For example, if your company produces food for the nation, do you promote smaller serving sizes? If you are a local government, do you greenlight more parks and neighborhoods that promote physical activity? Measuring waistlines gives us a starting point and a proxy of the health of a nation.

What will be fascinating to see is what they do with that data. It will be more, however, than simply re-educating people. We all should know that being overweight or obese, which is the status of 2/3 adult Americans, is not healthy, but the challenge is how do we make our increasingly hectic 24/7 lifestyle more supportive for staying active and eating well?

Presidental Fitness Test - How Good Are You?

Remember the Presidential Fitness Test we had to go through while in middle school? Get ready for the latest test, except it is for adults. The Presidental Fitness Test for Adults was unveiled in May and covers the following:

• The test involves three basic components: aerobic fitness, muscular strength and flexibility. The test is for people 18 and older who are in good health.
• The aerobic component of the tests consists of a one-mile walk or 1.5-mile run. The run is not recommended for those who don't run for at least 20 minutes, three times a week.
  Push-ups and half sit-ups make up the strength test. The push-ups are done until failure. The sit-ups are done for one minute.
• A stretching exercise called the "sit-and-reach" is used to measure flexibility.
  The scores from all four of the fitness tests can be entered online. Other information, such as age, gender, height and weight are also part of the equation.
• You won't get a presidential certificate, but the results will then show where you rank among people of the same age. For example, if someone scores in the 75th percentile for push-ups, that means 75 percent of the scores fall below your score.

How healthy do you think you are?

Health Savings Accounts - A New Way of Paying for Medical Care

The Wall Street Journal reported about a report from the General Accounting Office that found those individuals who purchased health savings accounts tended to be wealthier. Health savings accounts (HSAs), which must be coupled with a health insurance plan with a high-deductible, has been the cornerstone of the Republican plan to improve healthcare inflation. Certainly the premiums for a high-deductible plan are significantly cheaper than traditional plans by up to 50 percent and the rate of health care costs slowed to about 3.6 percent as compared to 7 percent for companies that adopted HSAs. The concern among some is that those with HSAs are getting less medical care and services.

Is this a bad thing? It depends. If individuals decreasing unnecessary care because now they are responsible for the deductible then less consumption of healthcare is a good thing. If, however, people are putting off or delaying important preventive care this could be more costly and detrimental in the future. Preventive care can often find problems before they become expensive debilitating problems.

For example, would you delay getting your car maintenance if you had a high deductible? It depends. If you could not afford to have your car breakdown at the most inopportune times, then you might get routine regular preventive care. You might even do it yourself and change the oil and rotate the tires if you knew how to and had the time. If, however, you didn't know what to do, then you might not do it or figure it is unnecessary and take your chances. The difference between our bodies and our cars is you can always buy a new car.

From the article:

• Some analysts say much of those employer savings come because many HSA participants tend to forgo care. "There is a lot of evidence that suggests that when patients pay a higher percentage of the cost of their care they get less of it," says Michael Thompson, a principal at PricewaterhouseCoopers, which advises employers on health plans.
• Self-employed attorney Jonathan Stein, 34, of Elk Grove, Calif., got an HSA in 2005. Because he is responsible for paying the entire bill, he didn't go to the doctor for a recent bout of flu and doesn't get annual physicals despite a family history of heart disease and cancer. "My doctor and I fight about that when I do see her because she wants me to come in every year," Mr. Stein says. "If it was covered by insurance I'd probably go."
• Watson Wyatt expects 54% of big companies next year to offer high-deductible health plans, many of which are HSA eligible, up from 39% in 2007. Since the plans were introduced in 2004, more than six million Americans have enrolled in HSA-eligible plans, although that represents a small percentage of the more than 200 million people with private health coverage.

HSAs make sense for individuals who know when to get care and when to safely skip care. Having less medical care isn't a bad thing as long as it makes sense and won't cause problems in the future. Who best to figure that out? Empowered and educated patients. If you don't feel like you have the knowledge or expertise to figure it out, then who next? A primary care doctor. After all, if you are like many people, you don't do the actual car maintenance yourself, you have a trusted mechanic tell you what needs to be done. The same applies to your health. The difference is that your health advisor is your doctor.

How Your Car Purchase Impacts Your Health

How to select a safe car is an important skill many people may not know. People often don’t realize how this simple decision can affect their health and future healthcare costs. Unintentional injuries are the leading cause of death among people age one to thirty-four and the third leading cause among forty-five to fifty-four-year-olds. The most common cause of unintentional injuries is motor vehicle accidents. In 2002, the death rate for motor vehicle accidents was triple the HIV death rate and 60 percent of the breast cancer death rate.

Clearly all vehicles are not created equal. I know this from personal experience having simply walked away from a serious accident. The car I was riding in was my soon to be father-in-law’s prized Mercedes-Benz. The car skidded on an oil patch on a very busy LA freeway, ran up a hillside, and flipped on its side. The car was a total loss. What was clear to me was that the engineering made a difference between my financee and I walking away, very shaken, but not injured, as opposed to being seriously injured or killed. The passenger compartment, while it gave slightly, stay intact protecting us. We’ve all see horrific pictures of motor vehicle accidents and often this compartment is obliterated. Was it because no amount of engineering could have overcome the tremendous forces involved in an accident or simply because safety wasn’t paramount to the design?

Although all vehicles seem strong with their metal frames, there are tangible engineering and design differences in motor vehicles. The outcome could be life or death. The result could be walking away from an accident or a life filled with disability.

Thinking critically about what you drive can impact your health. In fact, one study showed that the declining death rate in motor vehicle accidents over the past decade was not due to better drivers or improved roads, but to safer cars.

Where to look? Start with the Insurance Institute of Highway Safety. Be sure to check the model year of the vehicle you are interested in. Surprisingly, the safety of a particular make can vary annually.

Once you've found the vehicle that fits your criteria of safety, then you can move on and focus on how to improve the rest of your health by exercising, maintaining a healthy weight, not smoking, and only drinking alcohol is moderation.

Invest In Your Most Important Financial Asset - Your Health

The most important financial asset each of us owns is our ability to earn money. Specifically our earning power. But we can only work if we are of sound mind and body - i.e. we need to be healthy. Staying healthy and being able to work is a more powerful financial asset than our investment portfolio and our real estate holdings, particularly in today's market.

Yet most of us don't take the same level of care managing our health the same way we do our mutual funds. We spend more time evaluating the performance of the stock funds rather than how well our health insurance plan does to keep us healthy. Many of us sit down in front of our computers watching our bank account fluctuations rather than actively exercising and eating well to ensure we have the opportunity to make more money by staying healthy.

If we valued our health as much as we did our other financial assets, then we would take better care of it by quitting smoking, limiting alcohol intake, and getting adequate sleep. We would only seek out insurance plans that were best at promoting our health much the same way we would select mutual funds with a high rating by Morningstar and a solid ten year return. Instead of being distracted by the latest me too drug and newest medical malady, we would be focused on getting the boring hardly sexy preventive tests done like mammograms, colon cancer screenings, and cholesterol, much the same way we've been taught to save money early and often into financial investments we understand and are familiar with.

Too many of us treat our health the same way we do our retirement planning. We don't take the time and effort to do the little things that matter and then when we want to retire we find out we didn't do enough and can't. With health, many ignore the important preventive interventions only to develop a more complicated and expensive medical condition that should have been easily addressed had it been given priority. Instead of having a long productive and high quality of life, the individual now faces costly medical bills and often lost income because of the illness. People don't realize how fragile good health can be for if they did they would be much more careful with it.

A RAND study found that during a ten year period for individuals between the age 25 to 54, those in very good health who then described their health as excellent a decade later doubled their net worth. Those, however, that identified themselves as being in poor health saw their net worth shrink by half.

As your stocks and real estate holdings become less valuable, be sure to keep your most important financial asset in tip top shape. On average our healthcare system makes sure that you get the right preventive care only 55 percent of the time so like any of your other investments, take the time to educate yourself and then act on the information. Maintain a healthy weight, ask for the preventive tests shown to save lives, and partner with a primary care doctor, who is your advocate in keeping you well. Once you protect your most important financial asset, then any downturn in the market can be managed because as long as you are healthy, you can make more money. Having more money, however, doesn't necessarily mean one can acquire good health.

Knowing How To Reform Healthcare Is Easy. Doing Is Hard.

Like most things in life there is a big difference between knowing and doing. Most of us know what to do to stay healthy. Don't smoke or quit smoking. Exercise regularly. Eat a diet balanced with all of the different food groups in reasonable portion sizes. Maintain a healthy weight. Get screened for various medical problems early. One study suggested that doing these simple interventions extended life by 14 years!

Yet despite these seemingly boring yet simple lifestyle changes, there obviously there is gap between knowing and doing. About two-thirds of Americans are either overweight or obese. This trend is now affecting children. We all know what to do, but often it is we don't go about doing it.

The same applies to healthcare reform. A recent editorial in the NY Times noted that the cost of providing high quality medical care varied substantially among hospitals. The least costly were the famed Mayo Clinic and the Cleveland Clinic. The most expensive? UCLA, John Hopkins, and Mass General. The reason was that doctors at the most costly hospitals were paid fee for service. Do more and get paid more. On the other hand, doctors at the Mayo Clinic were on a salary. Health outcomes were the same. If all hospitals performed at the level of Mayo Clinic, then Medicare would save billions.

At the same time an article on the Wall Street Journal blog noted that a congressional advisory committee recommended that Medicare should pay primary care doctors more and less to specialists because of a shortage of primary care doctors, which if unresolved will result in increasing healthcare costs and worsening outcomes. In other words, pay primary care doctors more but have specialists be reimbursed less for each procedure. What will happen? Specialists will do more procedures to maintain their standard of living.

If Mayo Clinic can attract doctors and patients to their system. If doctors are salaried and patients do as well at less cost, then doesn't it make sense to have doctors paid to think instead of simply doing procedures?

Is Obesity a Lifestyle Choice?

A new book, "The Fattening of America", suggests that obesity is a lifestyle choice. From the article:

* "Obesity is a natural extension of an advancing economy. As you become a First World economy and you get all these labor-saving devices and low-cost, easily accessible foods, people are going to eat more and exercise less," health economist Eric Finkelstein told AFP.
* "When you have a first-rate medical system that can cure the diseases that obesity promotes, you no longer need to worry so much about being obese," he told AFP.
* "People make choices, and some people will choose a weight that the public health community might be unhappy about. Why should we try to make them thinner?" Finkelstein said.

I have a couple of problems with the above comments. While clearly more Americans are overweight and obese than previous generations. I doubt that it people are choosing an unhealthy weight. The issue is that the environment around them, specifically the food options are far larger in size and loaded in calories than in the past. Check how serving sizes have changed over the past two decades by taking the Portion Distortion quiz.

In my experience, many of my patients who are obese actually didn't have a weight problem as a young adult (i.e. high school graduate), but years later. The most common cause was inactivity and eating too much (i.e. supersizing everything). Many didn't see much of a problem until I calculated their body mass index.

A first-rate medical system does undoubtedly fix the problems caused by obesity. A first-rate healthcare system, however, should prevent the obesity problem to begin with. Unless we focus on keeping people healthy instead of treating the problems after they have occurred, the next generation of Americans will be the first not to live as long as their parents.

Why Don't Adults Get Vaccinated?

It's kind of depressing to keep reading about how our healthcare system fails to do the basic preventive tests and interventions that doctors and researchers know that can keep us healthy and lead productive lives. Here's another example in Time magazine's article Why Don't Adults Get Vaccinated?

A survey of 7000 adults found that most could only name the flu vaccine and that the hepatitis A, B, the shingles vaccine, the pneumococcal vaccine, the diphtheria, tetanus, and pertussis vaccine, weren't mentioned as easily.

Excerpts from the article:

• Just 2% of adults have had the new combo shot for tetanus, diphtheria and pertussis (better known as whooping cough), even though pertussis rates in adolescents and adults have soared in the last 20 years. The disease, a major child killer before the childhood vaccine was introduced, can cause coughing so forceful it breaks a patient's ribs or leaves him vomiting.
• Despite clamorous public debate and high-profile media coverage about the first cancer vaccine, which protects against the human papilloma virus, only about 10% of young women reported receiving at least one dose of the three-dose vaccine.
• Vaccines should be a cornerstone of preventive medicine. "They can prevent serious illness and death. They can save money and help keep us healthy, and at work and able to take care of our families, says Schuchat, who is also director for the CDC's National Center for Immunization and Respiratory Diseases. "We obviously have a lot of work to do and it involves literally rolling up our sleeves."

What perhaps is more disturbing is that many adults aren't vaccinating their children.

These reports only illustrate the increasing importance that you must take charge of your health and ask and even demand preventive tests and interventions you need to stay healthy and live longer as it is clear that our healthcare system won't do it for you.

Alzheimer's Disease - Searching for Preventive Treatments

The New York Times article Finding Alzheimer's Disease Before a Mind Fails illustrates the challenges facing doctors, researchers, patients, and families on finding preventive treatments, which do not currently exist, as well as challenges to help those afflicted with the illness. This is the last article in a six piece series which identified the six killers in America, heart disease, cancer, stroke, chronic obstructive pulmonary disease (emphysema), diabetes, and Alzheimer's.

The series was an excellent review of the challenges facing us and many of the shortcomings of our healthcare system in providing the right preventive care consistently and routinely to keep us healthy and living longer. It seems like we all take it for granted that our healthcare system is the worst among industrialized countries in keeping us healthy.

Personally, I see these problems as unacceptable and this shocking disparity gives me the motivation to educate everyone on what they must do to stay healthy and live longer.

Simple Lifestyle Changes Extend Lives

Perhaps hardly surprising but a study of 20,000 Britons found that four simple lifestyle habits potentially extended life by 14 years. The group that decreased their chance of death simply didn't smoke, had five servings of fruits and vegetables, exercised regularly, and drank alcohol in moderation.

• The study included healthy adults aged 45 to 79. Participants filled in a health questionnaire between 1993 and 1997 and nurses conducted a medical exam at a clinic. Participants scored a point each for not smoking, regular physical activity, eating five servings of fruits and vegetables a day and moderate alcohol intake.
• Until 2006, the researchers tracked deaths from all causes, including cardiovascular disease, cancer and respiratory diseases. People who scored four points were four times less likely to die than those who scored zero, the research showed.

Simple small changes made a big difference. If five servings of fruits and vegetables a day is too hard, start with more humble goals, perhaps two servings twice a week and build up to the goal of five servings everyday.

Why don't people adopt these practices? Maybe because the things that make the most sense often aren't particularly exciting or sexy, but require a little common sense, a little bit of work to make it happen, and then persistence to make it a healthy habit.