FOR all the debate lately, one basic fact about America’s health care crisis is rarely mentioned. Namely, the one thing that could really reform health care is you, collectively speaking: People living healthier lives.
The statistical evidence has been clear for years, but it bears repeating. Studies show that 50 percent to 70 percent of the nation’s health care costs are preventable. Much of that expense goes to treat a few chronic conditions that are closely linked to behavior, including cardiovascular disease, diabetes, obesity and cancer. Bad genes and bad luck matter, of course. But behavior — exercise and choice of diet — matters most.
Your chair is your enemy.
It doesn’t matter if you go running every morning, or you’re a regular at the gym. If you spend most of the rest of the day sitting — in your car, your office chair, on your sofa at home — you are putting yourself at increased risk of obesity, diabetes, heart disease, a variety of cancers and an early death. In other words, irrespective of whether you exercise vigorously, sitting for long periods is bad for you.
For many people, weight gain is a matter of slow creep — two pounds this year, three pounds next year. You can gain this much if, each day, you eat just 30 calories more than you burn. Thirty calories is hardly anything — it’s a couple of mouthfuls of banana, or a few potato chips. Thus, a little more time on your feet today and tomorrow can easily make the difference between remaining lean and getting fat.
A team of Canadian medical researchers have inadvertently provided a very clear picture of the current state of the security risks posed by P2P networks. The authors intended to determine whether P2P clients were exposing personal health information, but their approach—downloading all files from a set of common document formats—provided them a clear picture of just what’s being made available on Gnutella and eDonkey: personal identification, health, and medical information, and a healthy collection of trojans.
The motivation for the work is pretty simple. With the increasing digitization of health records, individual users are more likely to exchange e-mails and files with their doctors, insurers, and other health care officials. An obvious consequence is that personal health information (PHI) will end up on the users’ hard drives, which creates a potential security hole. In the past, the research team has found that they could scrounge PHI from roughly 10 percent of the used hard drives available through second-hand computing vendors.
All of this is possible because Mr. Danstrup lives in Denmark, a country that began embracing electronic health records and other health care information technology a decade ago. Today, virtually all primary care physicians and nearly half of the hospitals use electronic records, and officials are trying to encourage more “telemedicine” projects like the one started at Frederiksberg by Dr. Klaus Phanareth, a physician there.
Several studies, including one to be published later this month by the Commonwealth Fund, conclude that the Danish information system is the most efficient in the world, saving doctors an average of 50 minutes a day in administrative work. And a 2008 report from the Healthcare Information and Management Systems Society estimated that electronic record keeping saved Denmark’s health system as much as $120 million a year.
Now policy makers in the United States are studying Denmark’s system to see whether its successes can be replicated as part of the overhaul of the health system making its way through Congress. Dr. David Blumenthal, a professor of health care policy at Harvard Medical School who was named by President Obama as national coordinator of health information technology, has said the United States is “well behind” Denmark and its Scandinavian neighbors, Sweden and Norway, in the use of electronic health records.
Denmark’s success has much to do with the its small size, its homogeneous population and its regulated health care system — on all counts, very different from the United States. As in much of Europe, health care in Denmark is financed by taxes, and most services are free.
The public option is dead, killed by a handful of senators from small states who are mostly bought off by Big Insurance and Big Pharma or intimidated by these industries’ deep pockets and power to run political ads against them. Some might say it’s no great loss at this point because the Senate bill Harry Reid came up with contained a public option available only to 4 million people, which would have been far too small to exert any competitive pressure on private insurers anyway.
But we still end up with a system that’s based on private insurers that have no incentive whatsoever to control their costs or the costs of pharmaceutical companies and medical providers. If you think the federal employee benefit plan is an answer to this, think again. Its premiums increased nearly 9 percent this year. And if you think an expanded Medicare is the answer, you’re smoking medical marijuana. The Senate bill allows an independent commission to hold back Medicare costs only if Medicare spending is rising faster than total health spending. So if health spending is soaring because private insurers have no incentive to control it, we’re all out of luck. Medicare explodes as well.
Democratic leaders delayed a vote, in part, because they feared that the proposal would be approved, potentially blowing apart a deal negotiated by the White House and the pharmaceutical industry.
The industry, represented by the Pharmaceutical Research and Manufacturers of America, or PhRMA, adamantly opposes legalizing additional imports and says the government could not guarantee the safety of imported medicines.
As members of Congress before last year’s election,President Obama and his chief of staff, Rahm Emanuel, supported efforts to allow drug imports. But now the Obama administration, like pharmaceutical companies and the Bush administration, is raising safety concerns.
Business as usual…
“Most components (strength, power, speed) of athletic performance are worst in the early hours of the morning,” he wrote in an e-mail message. “Ratings of perceived exertion during exercise have generally been found to be highest in the early morning.”
If you exercise later in the day, your muscles are more flexible and stronger and your heart and lungs are more efficient, said Michael H. Smolensky, an expert in chronobiology, the study of the body clock.
Exercise physiologists say you should be able to perform at the same level with a heart rate of 140 in the morning as in the afternoon or early evening. But chronobiologists say your capacity to generate and tolerate a higher heart rate is better later in the day.
In fact, Dr. Smolensky added, people at risk for a heart attack should plan their workouts for late afternoon or early evening.
But if you are used to regular exercise, is it better to train in the early evening?
“I really don’t know the answer,” Dr. Smolensky said.
“My personal approach is to train when your biological efficiency is greatest, which means late afternoon or early evening for most people,” he said. “Others say if you train when your biological efficiency is least you will get a harder workout.”
Of course, it’s controversial whether we should be taking vitamins at all. Recent studies have indicated that taking a multivitamin won’t protect you from heart disease or cancer. And experts maintain that if you eat well, you don’t need vitamin supplements.
“The evidence shows that a healthy diet and exercise are the best way to ward off disease; a vitamin cannot replace those benefits,” says Eric Rimm, associate professor of epidemiology and nutrition at the Harvard School of Public Health.
But what if you don’t eat well or are chronically stressed out? Then, Professor Rimm says, there may be some benefit from taking a multivitamin. “Certain subgroups, including women of child-bearing age attempting to get pregnant, may need specific supplements, like folic acid and omega-3,” he added.
|
