While I don’t have any answers as to universal health care coverage, whether there should be one payer or many. However it’s nice to see something that shows a positive effect for having insurance.
This site is a reminder to take a lot of “advice”, or at least some headlines, with a grain of salt. In earlier posts I’ve gone over a bit as to where to get health information and things to think about when evaluating claims (Here are the posts: Where do you get your health information? and Evaluating Health Care Claims ). This link talks about some of the more common myths that still make rounds a lot on the internet.
For me this is an exiting and interesting story. As I have said in earlier posts, exercise is important. This just reinforces the notion that exercise, even if started later in life, does help health. I won’t wax poetic about how exercise is a “veritable fountain of youth” as I try to avoid being overly dramatic with health care claims.
Recently there was something in the news about roughly half of the information in the shows “The Doctors” and the Dr. Oz show was correct (actually it was 63% of the time in “the doctors: and correct about 49% on the Dr. Oz show). See an article reporting on this here. Often times people will have looked things up on the internet when they come into the office.
Now I’m not bringing this up to knock Dr. Oz or the doctors who appear on “The Doctors”, nor looking things up the internet. However it’s important to ask several questions when evaluating health claims.
1) Does the claim have any scientific basis?
2) Has the study (if a study is being quoted) been replicated with the same or similar results?
2a) Who funded the study? Was it reported in a reputable journal?
2b) If it is a product being touted, did the company making the product fund the studies of the product?
3) Does the person ‘reporting’ the results, or pushing the product have a connection with the company? If there is, what is the connection? Just because someone is employed or funded by a company doesn’t necessarily mean they’re biased, but it is something to take into account.Well you get the picture.
Looking up things on the internet may be just as hard, given that websites may not be what they seem. If a patient asked where to look for information I’d give the following advice:
Lean toward sites that end in .edu, .org (though it doesn’t totally eliminate the possibility of bias..) or .gov
Examples of places like this to start include:
WebMD does appear to be a commercial site with decent information
When on a site, look for a statement that indicates if they get funding from a source, and where that source is. Ask where is someone getting his/her data from (or if they’re willing to say).
Perhaps the best place to start is with your own physician.
Of note, I think when you click on the link above, you will have to download the PDF.
I remember reading this article abut the time it came out. Though I don’t think it necessarily has all of “The Answers”, it does bring up some interesting points. I’ve often why some health insurance plans won’t pay for some preventive care when it would benefit the patient. When I’ve asked colleagues this the answer I often get is “because the patient will be on different insurance [ie, medicare or a managed care product from a private insurance].”
However many private insurances also have a managed care product for seniors. people may not ‘graduate’ into a plan from insurance they have while working. However there are people that might go from Having Harvard Pilgrim Health Care to AARP’s program (through united health care). however, some might go fro United healthcare to HPHC’s product (or an equivalent insurance in a different part of the country). This might even things out a bit.
Anyhow, I sugges you read the article and make your own conclusions.
In this post I’ll be talking about Strokes (also known as Cerebral Vascular accidents). It is the fifth leading cause of death in the United States. It also is a major cause of disability and in terms of treatment, missed work, etc costs an estimated $34 billion dollars a year in the U.S. alone. Although the risk for stroke rises as we age, according to the CDC website 34% of strokes were in people younger than 65.
There are two kinds of stroke. One is hemorrhagic, meaning that is caused by bleeding. The other is ischemic, meaning that it is caused by a a blockage in a blood vessel. The symptoms, however are determined by the location and size of the stroke. Symptoms include: Facial Droop, double vision, confusion, garbled speech, limb weakness (especially if it occurs on one side of the body), numbness, and headaches.
It is important that if one suspects he or she is having a stroke that medical care be obtained quickly. There is a 3 hour window of opportunity from the start of symptoms that ischemic strokes can optimally be treated with clot dissolving medications. More than three hours after the start of symptom and the likely hood of poor outcomes increases – and the riskier it is to use medications to try and unblock arteries.
An acronym used to keep in mind regarding stroke is the word FAST (Face – is the face symmetrical: is one side drooping? Arms – weakness in one arm. Speech – is it normal? Time – call 911 immediately if it seems someone’s having a stroke).
Ischemic strokes are the most common. Based on symptoms one can’t tell if a stroke is ischemic or hemorrhagic, so it’s better to get to a hospital quickly. At this point in time there may be fewer acute treatments to stop hemorrhagic strokes, but even then supportive treatment is available.
Sometimes symptoms resolve quickly (within a few minutes). This is called a Transient Ischemic Attack, or TIA. This should not be ignored because people who have had a TIA are at increased for having a major/bigger stroke.
Although there isn’t anything that can be done about some risk factors such as age, there are many things one can do to reduce the risk of having a stroke:
1) Control your blood pressure if you have high blood pressure.
2) Lower your cholesterol if you have high cholesterol.
3) Control your diabetes if you are diabetic.
4) If you smoke, stop. If you don’t smoke, don’t ever start.
5) if you have an irregular heart rate, talk to your doctor about whether you need to be on blood thinners as certain irregular heart rhythms increase your risk of ischemic strokes.
6) Exercise (this will help with numbers 1-3 above)
If there was a medication that you could take that would help reduce weight, reduce the chances of developing disorders such as diabetes, dementia, and osteoporosis, I think most people would take it. If the side effects of this medication (even in the absence of dementia, depression, fatigue, etc) were a better mood, a better ability to concentrate, less fatigue, even more people would probably clamor to take it.
There is such a medication: exercise. Some medical societies, such as the American College of Sports Medicine state that “exercise is medicine”. The current recommendations for the minimum amount of exercise is 150 minutes a week of moderate exercise. This comes out to 20 minutes 7 days a week or 30 minutes 5 days a week. Walking is an example of moderate exercise often used to give people an idea of what the effort level of moderate exercise is. One should be walking slowly enough that one could talk and not be out of breath, but fast enough that one couldn’t sing. When my patients state they can’t find the time to do 20 minutes a day, I encourage them to find 10 minute periods through the day to walk. Obviously for some forms of exercise (swimming, playing a game of basketball, etc), this would be impractical to do.
Some research indicates that exercise has an anti-inflammatory effect in the body. Other research seems to indicate increased sensitivity to insulin, increases in various other hormones (or decreases in others), it is likely the mechanism for the beneficial effect of exercise is due to more than one pathway. That is to say that rather than, say deceased inflammation is the cause for improved mood or a decreased risk of dementia, it is likely that improved insulin sensitivity, anti inflammatory effects, etc all act in concert to improve health in people who exercise regularly. When talking with my own patients I tend to avoid talking about why it works and prefer to talk about the kinds of exercising they could/should be doing.
Though I encourage people to do weight bearing exercises such as walking, jogging, basketball, etc, I also realize that there needs to be some accommodation. For someone who’s morbidly obese or has severe arthritis that limits, at least initially, how much they can walk I might suggest stationary bicycles, water aerobics or something like tai chi (which is a weight bearing exercise, but because one isn’t jumping around as much as with things like basketball) the stress on joints is lower. I also realize that if someone doesn’t like a particular form of exercise, that person’s less likely to do that than a form of exercise they enjoy doing. Prescribing exercise isn’t a “one size fits all” solution to promoting health.
For people who’ve read many of my earlier posts, have probably noticed that I’ve focused less on medication and more on lifestyle issues such as diet. This post is no different. Many of the most common diseases I see in the office are most commonly caused by, for lack of a better word, poor lifestyle choices.By this I mean having a poor (read “western”) diet and not exercising enough. Once one has hypertension, type two diabetes, obesity, etc, lifestyle changes might not be enough to totally reverse or cure a particular problem in a specific patient. However even if one needs an antihypertensive, diet and exercise don’t become less important.