The United States Health Care System

This article is focused on describing what is wrong with the United States Health Care system and how it can best be reformed.  The current system is described as being inefficient and expensive, with poor outcomes and many people who are denied access.  The authors advocate a health trust system that would provide core medical benefits to every American, while improving efficiency and reducing redundancy.  In this country we have the most technologically intensive medical practice in the world, yet our country also spends more money than any other nation on medical care, with outcomes inferior to those in other developed nations.  Lack of access to health care leads to major disparities in health.  A fragmented delivery system also leads to cost shifting, which is the practice of insurer's transferring costs to other payers, administrative waste, and an imbalance between spending on medical care and spending on population health initiatives.  Most proposals for reforming the health care system call for universal coverage independent of employment status, disability status, or age.  Also essential to integrate is personal prevention programs and therapeutic care with public health.  A reformed system should also be organized and funded to take advantage of new knowledge about medical and nonmedical determinants of health.  This new health trust system, would assess the cost of health care insurance equitably, promote efficiency by reducing fragmentation and relying on competitive markets, allow coordination of spending on population health and personal medical care, accommodate heterogenous preferences, and build on existing American health insurance and provider institutions, informed by international experience.  The current financing structure and organization of care in the U.S. provide strong incentives to treat illness after it occurs rather than focus on preventative care.  This is extremely troublesome because it would be a great way to reduce costs by preventing illnesses before they happen. But since our system is more concerned about treating visible illnesses, physicians and other health care professionals may be likely to just let a disease come about so they can make money by treating the disease or condition.  According the authors of the article, a reformed health care system would also foster coordination of public, population, and private health care at the local level, impose financial discipline and encourage choice for and responsiveness to, clients.  The first level would be the national health trust, which would use risk-adjusted capitations to allocate funding to regional health trusts, which would direct funding to the appropriate areas in their regions.  Doing this would ensure that funding for health services would be responsive to the needs of the different populations in different locations.  Also needed to be taken into account is the costs of delivering medical care in various areas throughout the country, through mechanisms similar to Centers for Medicare and Medicaid services developed for Medicare inpatient and outpatient services.  Another responsibility of the NHT is developing uniform national policies to promote information technology, define criteria for high-quality care for particular diseases, conduct comparative effectiveness analyses, and forecast future health manpower needs.  The Regional Health Trusts would be responsible for the organizing, managing, and overseeing the delivery of the core benefits: personal care combined with population health interventions.  Something important to remember is that RHT's would not directly provide care, they would contract for services either directly with providers or indirectly through integrated plans and would also finance population and public health initiatives.  RHT's would employ quality standards developed by the NHT to evaluate the quality of care and make this information available to consumers to facilitate the selection of providers or care plans.  They could also monitor quality of care at the patient level, tracking patients by their unique insurance identifier.
        This plan sounds good on paper,  but I am questioning its practicality, even though I believe that a change in the health care system has been long overdue.  I am of the opinion that perhaps this method could be proposed to Congress, and perhaps they would be able to make a working model of the plan that would be better suited to dealing with the problems that we face in this country.  One problem I have with this article is that it seems to be biased towards those who favor health care reform.  I feel that the authors of this paper may not have looked carefully enough at the other side of the debate before they wrote their article.  Even so, they still have some very good points that I feel warrant a closer look at by the National government as they attempt to determine the best way to go about reforming the health care system, because it is inevitable that change will happen, what will be variable in the equation is how much change do we want?  That's that most important question that we all have to ask ourselves before we form our own opinions about what should be done.













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Childhood Obesity

In the United States, childhood obesity is a problem that has continued to increase in prevalence over the past thirty years.  Obesity contributes to a long list of health concerns and diseases, including hypertension, dyslipidemia, chronic inflammation, asthma, endothelial dsyfunction, hyperinsulinemia, diabetes, cardiovascular disease, certain cancers,w and premature death.  While there has been an increase in the amount of fast food consumed, and growing trends toward eating away from home, two-thirds of the foods children consume are in the home.  Childhood obesity is a problem that stems for several sources, and in order to deal with the problem, several areas need to be examined for what can be done to create a better lifestyle for children.  The authors of this article propose a model that divides the home food environment into three different domains, each one with macro and micro level implications.  Micro refers to areas closer to the child's home life, whereas macro refers to existing in the greater community.  The three domains include political and economic environments, socio-cultural environments, and built and natural environments.
           Political and economic environments are composed  of financial resources, policies, and laws.  The macro level includes food prices, which determine the likelihood of what kinds of foods families will purchase, and government and business policies.  Businesses will make use of inexpensive commodities by processing and adding value to create and market profitable, palatable, energy rich food.  The availability of federal and community food programs such as food stamps for the poor and the WIC ( women, infants, and children) program are designed to improve the eating habits of the disadvantaged or vulnerable.  The last macro influence is the link between economic conditions and healthy eating.  The less money people have, the less willing they will be to spending more money to eat healthier foods.  On the micro level, lower family socio-economic status has a wide variety of effects on families, including: eating fewer family meals, having parents with less authoritative feeding practices, eat less fruits and vegetables, are more likely to skip breakfast, watch more television, are more likely to be overweight, and are more likely to eat fast food, just to name a few.  Another micro level effect is family food insecurity, which is defined as the limited or uncertain availability of nutritionally adequate foods, and has strong links to poverty and financial insecurity.  In the United States, more than fourteen million children under the age of 18 live in a home where they sometimes do not get enough to eat.  Therefore these children are less likely to eat fruits and vegetables and more likely to eat energy dense foods when they are available.  The third and final micro level structure is the lack of use of federal assistance programs by those who qualify for them.  The reasons that less than seventy-five percent of those eligible sign up for a food program includes the fear of stigma for being poor, the lack of funds to afford the food, or being ignorant of what programs are available.
             In terms of socio-cultural environments, there are several macro and micro influences on eating behaviors.  On the macro level, race, ethnicity, and cultural identity all have an influence on children becoming obese.  Children from ethnically diverse groups are at an increased risk of obesity.  In a study of adolescent meal patterns, blacks were four times as likely as whites to eat less that two meals a day, skip meals, or snack frequently.  Similarly, Mexican American children may be help to culturally specific standards where there parents expect them to have hearty appetites.  Advertisers will also target their ads toward specific ethnic groups.  Another macro level change is in the consumption trends changing to favor greater consumption of soda and snacks.  In the micro level, it has been shown that cultural inheritance accounted for thirty to forty percent of the dietary intake variance for children.  Also, changes in family structure have led to less meals eaten together as a family, which has the risk of having children live on convenience diets, which are not healthy.  Other influences include family eating habits, parental eating habits, and educational and nutritional knowledge of the parents.
        Lastly, the built and natural environments have an impact on children's eating habits.  On the macro level, the food landscape, which refers to the production of food and its availability and accessibility.  Studies show that lower income neighborhoods are less likely to have grocery stores, whereas wealthier areas are more likely to have more supermarkets.  Television has a major impact on eating habits, especially in permissive environments.  It leads to sedentary behavior, which leads to low energy expenditure, which leads to obesity.  People are also more likely to eat while watching the television, which leads to mindless eating, a high energy intake, and then obesity.  Children see adversing through the television, which leads to either the child or the parent making food purchases that are not nutritionally beneficial.    In conclusion, all three of these domains need to be examined in order to find a way to reduce the levels of childhood obesity in this country.
















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The Influence of the FDA

The FDA is an organization that the evidence-based review process for evaluating the evidence for health claims and qualified health claims.  A health claim is any claim that is made on a label, food, or dietary supplements.  All health claims and qualified health claims need to be reviewed and evaluated by the FDA.  Evidenced based reviews in the field of nutrition have become more common in evaluating the strength of the scientific evidence on a nutritional statement.  The FDA seeks to by objective by relying on verified evidence, being flexible in the levels of data needed to support the validity of the different substance/ disease relationships, and by being responsive to the need to re-evaluate the data as experimentation are refined.  Substances are defined as being a food such as tomatoes, or a food component like lycopene.  A disease is defined as damage to an organ, part, structure, or system of the body that has not been properly functioning.  There are several health claims that have been shown to meet the standards of significant scientific agreement.  In regards to cancer, dietary lipids, fiber-containing grain products,fruits and vegetables have been shown to have effects on the body.  In terms of coronary heart disease, dietary saturated fat and cholesterol, products containing soluble fiber, soy protein, and plant sterol.  Sodium is proven to have an effect in hypertension, folate is know to stop neural tube defects, dietary noncarciogenic carbohydrate sweeteners in dental carries, and calcium and vitamin D are shown to have benefits for osteoporosis.  Qualified health claims subject to enforcement discretion include the effect of tomatoes on prostate, ovarian, gastric, and pancreatic cancers, calcium in colon/rectal cancer, green tea in breast and prostate cancer, selenium in bladder, prostate and thyroid cancer, walnuts in coronary heart disease, and phosphatidylserine in insulin resistance and dementia.
Basically, the purpose of the FDA is to evaluate the health claims made in regard to food, medication, nutritional supplements, and basically any kind of things that may have an impact on one's health.  The FDA is shown to be an organization that works to make sure that people are not being taken advantage of by it's makers.  Of course, the every day person needs to be able to distinguish how the FDA is involved in establishing the rules that are enforced in the market places.  I am of the opinion that the FDA's influence is not that significant because the majority of the population is not as well informed about the way that the FDA determines what is safe to consume.
 

Osteoarthritis Treatment Options

Osteoarthritis, or degenerative joint disease, is a disorder that ultimately leads to pain in the affected joint, and functional degeneration of the affected joint.  Over 12 million people over the age of 65 are affected by this disease.  The most commonly affected joints are those of the knee, hip and hand.  OA is responsible for 400,000 hospital visits, and up to eight billion dollars for hip and knee replacements annually.  The most common risk factors include advanced age, obesity, past occupation, participation in certain sports, joint trauma, and family history.  Symptoms include joint stiffness in the morning, or after a period of inactivity of thirty minutes or less, limited or reduced range of motion, and joint deformity in later stages.
              The first place where treatment should start include preventive measures including weight loss, quitting smoking, and reducing joint damage by avoiding activities that involve high impact on joints and repetitive motion such as typing, writing, kneeling, squatting, or heavy lifting.  Patient education should be the first step in the treatment of OA.  Education should cover the progression of the disease, the patient prognosis, and appropriate treatment options.  Also, proper resources that the patient can consult for efficient self management information and programs.  The most important modifiable risk factor for the development of OA is obesity.  It is shown that a three to fourfold increase in the risk of joint replacement is associated with increased body weight.  This should be a major focus for individuals with OA in the knee and hip.  An eighteen month program of caloric restriction and exercise resulted in a twenty-four percent improvement in physical function and a thirty percent reduction in knee pain.  Physical and occupational therapy is shown to be beneficial for patients who do not benefit from home exercise programs or need further instruction in range of motion, joint protection, or muscle-strengthening principles.  Exercise programs focused on the quadriceps, adductor, and abductor muscles have be shown to improve knee and hip stabilization.  Surgery is recommended as a last resort effort tom manage OA symptoms in patients whose disease is refractory to less-invasive management methods.  Joint replacement should not be delayed in order to best preserve optimal restorative function.  In terms of pharmacologic treatment options, the first medication that should be used is acetaminophen, which is shown to be effective for mild-to-moderate pain relief.  Non-steroidal anti-inflammatory drugs are shown to be more effective that acetaminophen, but due to the large side effect list of NSAID's,  including nausea, abdominal pain, peptic ulcers, edema, increase in blood pressure, and renal insufficiency, acetaminophen is preferred as the first line of therapy.  If symptoms persist, NSAID's should be used, and the choice of NSAID's should be based on patient comorbidities, cost, and side-effect profile.  Topical analgesics are used for patients unable to tolerate systemic agents.  If symptoms persist, intra-articular glucocorticoid injections are used to bring relief to a localized area.  Then opioid analgesics are used, for a short time period only in order to avoid addiction.  If none of these things help, the last resort is surgery.
              This topic hits particularly close to home as my mom, my dad, and my grandmother are all affected by OA.  My mom has gone through many series of injections, and ultimately a recent surgery to reduce the arthritis in her thumb joint.  My dad will be forced to have a total hip replacement in both of his hips, and his knees are pretty bad.  My grandmother has been dealing with arthritis of the hand and wrist for quite some time now.  Since I have a rare bone disease myself, called fibrous dysplasia, I hope that I am not at a higher risk of developing OA later in my life.


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The Danger of Fad Diets

A fad is defined in the dictionary as "a practice or interest followed for a time with exaggerated zeal."  This can apply to a wide variety of things, such as Pokemon trading cards, toys, hairstyles, and so on.  The focus of this post is on fad diets, and how they turn practices that may have been intended to be beneficial into unhealthy choices.  The first major problem with fad diets is the fact that industries keep a close eye on the current trends and fads, and when they see a particular fad gaining popularity, you can bet that they will start extensive advertising campaigns for that fad.  For example, once it was discovered that people were severely lacking in omega 3 fatty acids, companies began to advertise that their product contained these omega 3's.  This was also heavily advertised through the use of the media, be it on a television show like The Doctors, or in health and fitness magazines.  Another example is the strategy of ketchup producers to place labels on their ketchup that lets people know that lycopene, an antioxidant found in tomatoes, is present in their product.  You just have to walk around a grocery store and you will see all different kinds of products that have advertising on them of why their product is a healthier choice than some other product of a similar nature.
                     The author of the article gives a good example of how a particular fad could come into being.  Take for example vitamin D.  It is a known fact that the sun can provide us with all of the vitamin D that we need.  When our ancestors lived, back in the age of cave dwelling, they were outside the majority of the day, and they got all the vitamin D that they needed from the sun.  Once we learned how to build houses and started to work in factories or offices, we didn't need to go outside as  much.  Eventually someone thought that we were not getting enough vitamin D, so dairy producers started adding vitamin D to milk.  But for whatever reason, this did not catch on with enough people, so the idea of a vitamin D supplement in the form of a capsule was born.  Since people had been getting insufficient amounts of vitamin D over the past decade, health guru's claim that vitamin D deficiency is the "root to a host of health evils."  So some people are going to start to take large amounts of vitamin D capsules, which is a fat soluble vitamin and excess intake can cause liver damage.  This continues in a vicious cycle of people realizing that they are deficient in some nutrient, and then the health industry comes up with an amazing supplement to try and solve our problem.
        The author gives six ways to determine if a particular strategy is a fad or simply a good, common sense idea.  Anything that claims to be capable of "burning away fat" or being a "superfood" is likely to be part of a fad.  In terms of weight loss, a rapid loss of weight is indicative of a fad diet, as what is likely being lost is either muscle mass or water weight, neither of which are particularly desirable effects of a diet.  Any diet that claims it can work without exercise is not only a fad, but is also completely untrue.  Someone could have the healthiest diet ever, and still not be physically fit because of a lack of exercise.  Low carbohydrate/high protein diets such as the Atkins diet are fad diets, because a diet is something that is supposed to be a well balanced amount of all of the essential nutrients that we need.  By eliminating carbohydrates, we remove one of the essential nutrients our bodies need to properly function.  This diet may have worked for our ancestors who relied primarily on hunting and gathering, but it is not suitable for our current lifestyle.
        I am of the opinion that in order to live a healthy life, one must do several things.  First, one has to have a well balanced, healthy diet.  This diet needs to be supplemented with appropriate levels of physical activity, ranging from aerobic fitness, resistance training, strength training, and flexibility training.  Also, proper levels of sleep are required to allow the brain to regenerate and grow.  These are just basic things that one should do, there is much more depth to living a healthy life that what I have said in this post.

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Are Organic Foods Really Better than Commercially Grown Foods?

Organic food has quickly become a major part of the U.S. domestic food sales.  In 1990 sales were at 1 billion dollars.  By 2009 sales had increased to over twenty billion dollars.  The reason for this massive increase in sales is due to the fact that consumers believe that these foods are healthier to eat, and safer for the environment to grow.  In this article, the author examines organic food to determine the actual health benefits of eating organic foods.  Several other factors need to be taken into account, such as the differences in grower tendencies, the yearly weather patterns, and the length of time spent using organic methods to produce the food, as it takes ten years to organically grow tomatoes.  A three-year study done at the University of California found significant differences in the levels of phytochmeicals among different varieties, and from year-to-year.  Organically grown Burbank tomatoes were discovered to have higher levels of ascorbic acid (26%), quercetin (30%), and kaempferol (17%).  Organically grown  Ropreco tomatoes showed 20 % more kaempferol, but had a less robust showing overall in growth.  Over the span of ten years, UC conducted another study on the flavonoid content of conventionally grown tomatoes versus the organically grown variety.  They found that the organic tomatoes had 79% more quercetin and 97% more kaempferol than conventionally grown tomatoes.  Additionally, it was found that the flavonoid levels in the organic plots increased over the period of ten years, while the flavonoid levels in the conventional plots stayed constant.  With the increase in flavonoid levels, the levels of organic material in the soil also increased, making the soil better for continued use.  In regards to vitamin and mineral differences, it was discovered that organic foods have 21% more iron and 29% more magnesium, while on the vitamin side, ascorbic acid was found more frequently in organic fruits and vegetables.  Organic foods also were found to have higher levels of carotenoids, flavonoids, and many other polyphenols.  Flavonoids are known to be potent antioxidants, while carotenoids such as lycopene have been shown to reduce the risk of cancer.  Anthocyanin compounds in berries have been shown to improve neuronal and cognitive brain functions, ocular health, and genomic DNA integrity.  While it is true that organic farming methods prohibit the use of pesticides and herbicides, there is still the possibility of farming on land that is not yet free of insecticide residue, such as DDT.  A review conducted using data collected by the United States Department of Agriculture, and the California Department of Pesticide Regulation, showed that organically grown foods had one-third the amount of chemical residues found in conventionally grown foods.  Additionally, organically grown foods were shown to be far less like to have two or more residues.  Only 2.6% of organically grown foods had detectable multiple residues, compared to 26% of conventionally grown foods.  82% of conventionally grown fruits tested positive for insecticide residue, compared to only 23% of organic fruits.  65% of conventionally grown vegetables tested positive for insecticides, while only 23 of organic vegetables were shown to contain insecticides.  Organically grown vegetables were also shown to be better at suppressing the mutagenicity of several environmental toxins, including benzo (a)pyrene, the main carcinogen found in cigarette smoke and automobile exhaust.  Organic vegetables suppressed 30-57% of the mutagenic action, while conventionally grown vegetables only suppressed this activity by 5-30%.  Against the chemical 4-nitroquinoline oxide, organic vegetables suppressed 37-93% of mutagenic activity, while commercial vegetables suppressed this mutagenicity by 11-65%.  Also, organic strawberries block the proliferation of HT29 colon cancer cells and MCF-7 breast cancer cells.  From all of this information, it seems fairly obvious to me that while organic foods are not better in every single way, they still are far superior to commercially grown foods, and all agriculture companies should be focusing on changing their focus to organic production to make this a healthier nation.    















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