Lifelong Health: Putting Primary Care First Is a Way To Fix Health Care

Recent research reports have shown that despite the enthusiasm around health care reform, every measure of our health is worsening. In the past few years, the prevalence of obesity has increased by 8 percent; the number of people who do the recommended amount of daily exercise has decreased by 10 percent; consumption of fruits and vegetables has decreased by 16 percent; smoking rates remain unchanged; and moderate alcohol intake has increased by 11 percent. The percentage of the population adhering to all "recommended lifestyle measures" has decreased by 15 percent. Particularly alarming is the observation that those who have had heart attacks, have high blood pressure or have diabetes are no more likely to commit to lifestyle changes than the general population is. We are in trouble. In those older than 20, 30 percent have high blood pressure; 30 percent are obese; 6.5 percent have diabetes; and more than 40 percent are totally sedentary. The problem is most severe in minorities, the poor and those without insurance. All of these statistics reveal people's complete lack of commitment to lead healthy lifestyles. It's no surprise that this lack of interest in health greatly increases risk factors for heart disease and stroke, which in turn account for the very high prevalence of preventable deaths. In 2002, more than 500,000 people died from coronary artery disease. Of those, 47 percent died before emergency services arrived or they were transported to hospitals. Had those people made it to hospitals, their risk of death would have been less than 10 percent. These alarming statistics are occurring despite vigorous efforts to make our population more aware of risk factors for disease and to encourage healthy lifestyles in our children, in ourselves and in the oldest of the old. Clearly, we are failing. Most alarmingly, it seems this is a uniquely American condition. Other developed countries around the world are making great progress in health outcomes despite spending much less on health care than the United States does. From my perspective, the difference is clear. Compared with other developed countries, the United States places a much lower priority on primary care and medically supervised prevention of disease. American physicians conduct more tests and more procedures in the evaluations of illnesses and tend to prescribe the most expensive medications. We are also more likely to deliver care that is of no proven benefit. Rather than a focus on primary care, our health care system is characterized by care that is delivered almost exclusively by specialists. The primary care physician is not valued, is reimbursed very little for his services, and must see so many patients a day that all he can do is triage and refer complex patients to specialists for further work-up and care. All of this greatly affects quality health outcomes and widens the gap between the U.S. health system and every other developed country's system. While some of the players in health care reform have voiced their commitment to primary care, I fear that the big business of medicine will overwhelm the real problems of American health care and lead to solutions that focus on more tangible areas of cost cutting. Most notably, a proposal already has been offered to cut physician reimbursement by 22 percent. Simply put, that would be a tragedy. Rather than fix the root problems of misallocated money and inappropriate focus on acute care, this sort of bottom-line policy would only result in more unnecessary tests and procedures while physicians struggle to make ends meet. Amid this gloom lies a glimmer of hope. Many leaders of the insurance industry have expressed a commitment to supporting "home physicians," who are primary care physicians who have the time and resources to comprehensively deliver quality care to patients. The home physician functions as a primary care specialist rather than as a triage physician, who refers any serious issue to a subspecialist. In concert with a team of nurses, physician assistants, dietitians, social workers and exercise physiologists, the home physician can either prevent illnesses or identify and treat them early. Hospitalizations would be reduced, and outcomes would improve. By allowing the home physician to provide individualized, hands-on education to his patients, the chances of significant lifestyle changes certainly would increase. In the fight for health care reform, remember the primary care physicians; they are the key to better health. ======== Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.DrDavidHealth.com.
Copyright 2009 Creators Syndicate Inc.

Vitamin D in fish makes it 'brain food'

WARSAW, England (UPI) -- Mothers used to call fish "brain food," but researchers in Britain say fish and sunshine really do help cerebral cognitive function. University of Manchester scientists, in collaboration with colleagues from other European facilities, compared the cognitive performance of more than 3,000 men ages 40-79 years at eight centers in Europe. Dr. David Lee of Manchester's School of Translational Medicine found that men with higher levels of vitamin D -- synthesized in the skin following sun exposure but also found in certain foods such as oily fish -- performed consistently better in a simple and sensitive neuropsychological test that assesses an individual's attention and speed of information processing. "Previous studies exploring the relationship between vitamin D and cognitive performance in adults have produced inconsistent findings but we observed a significant, independent association between a slower information processing speed and lower levels of vitamin D," Lee said in a statement. "The main strengths of our study are that it is based on a large population sample and took into account potential interfering factors, such as depression, season and levels of physical activity." The association between increased vitamin D and faster information processing was more significant in men age 60 and older although the biological reasons for this remain unclear, Lee said. The findings are published in the Journal of Neurology, Neurosurgery and Psychiatry.
Copyright 2009 by United Press International

Early Alzheimer's diagnosis reduces costs

MADISON, Wis. (UPI) -- The way to fight Alzheimer's disease is to intervene decades before someone demonstrates symptoms, U.S. researchers suggest. "The future of this disease is to intervene decades before someone becomes symptomatic. This analysis says you can save literally billions of dollars in long-term care costs if you can intervene at an earlier stage," study co-author David Weimer of the La Follette School of Public Affairs said in a statement. "What you don't know costs a lot of money when it comes to this disease." The researchers analyzed two types of interventions following diagnosis -- patient drug treatment and caregiver-support programs. The study, published in the Alzheimer's & Dementia: The Journal of the Alzheimer's Association, found each intervention provides positive net savings, with the greatest benefits achieved using a combination of both. Currently, Medicare does not support caregiver-intervention programs and even accounting for implementation costs, the analysis suggests it would result in net savings to governments by reducing the care burden on medical systems. The Wisconsin Medicaid program spends almost $500 million each year on nursing home care for 11,000 dementia patients -- a tiny fraction of the estimated 160,000 affected people in the state, but caregiver support is sparse, Mark Sager of the University of Wisconsin-Madison School of Medicine and Public Health said.
Copyright 2009 by United Press International

CANCER DRUG MAY BLOCK "HAPPY HOUR" GENE

SAN FRANCISCO (UPI) -- Rats given a cancer-fighting drug spontaneously consume less alcohol, U.S. researchers say. However, the rat's taste for another rewarding beverage -- sugar water -- is unaffected. The researchers say erlotinib -- a drug used to treat non-small cell lung cancer -- makes fruit flies and rats more sensitive to alcohol. "This is a very powerful example of how simple model organisms -- and the little fruit fly in particular -- can be used to move quickly from an unknown gene to a potential therapy for drug addiction," study leader Ulrike Heberlein of the University of California, San Francisco, says in a statement. She explains screening mutant flies for those less sensitive to ethanol led them to the gene they call happyhour. The gene affects Epidermal Growth Factor pathway being studied by cancer researchers. Heberlein and colleagues are trying to determine how alcohol influences the EGF pathway and if new gene candidates -- discovered in the fly screens -- may be tied to the pathway as well. "It's not yet clear how it all fits together," Heberlein said. "But the fact that we've come, in an unbiased way, to molecules in the same pathway is telling us this is really, really important." The findings are published in the journal Cell Press.

Copyright 2009 by United Press International

THREE ASPIRIN TYPES COMPARED FOR SPEED

SAN DIEGO (UPI) -- If you need aspirin to work fast, a U.S. researcher says chewable aspirin shows greater and more rapid absorption. Dr. Sean Nordt of the University of California in San Diego gave three types of aspirin to a group of volunteer research subjects: regular aspirin swallowed whole, regular aspirin chewed and swallowed and chewable aspirin chewed and swallowed. Nordt, the study leader, tested blood levels of aspirin to see which route led to the highest aspirin levels in the body. The chewable aspirin consistently showed greater and more rapid absorption than the regular aspirin -- whether swallowed whole or chewed. This seemingly quite simple finding could lead to improvements in the care of heart attack patients, Nordt says. Nordt presented the finding at the Society for Academic Emergency Medicine annual meeting in New Orleans.

Copyright 2009 by United Press International

Vitamin D or sunshine may help treat MS
NEW ORLEANS (UPI) -- Giving multiple sclerosis sufferers vitamin D pills or encouraging them to spend more time in the sun might help treatment, U.S. researchers said. In a review for F1000 Medicine Reports, Bridget Bagert of Louisiana State University School of Medicine and Dennis Bourdette of the Oregon Health and Science University highlight recent advances in potential MS treatments. MS results from a failure of the body to recognize itself and the immune system attacks and destroys the sheath that protects nerve fibers, as if it were a foreign body or infection, the researchers said. Vitamin D, which is produced in the skin in response to natural sunlight, is an immune system regulator. This might explain why MS is less common in sunnier countries, the review said. Bagert and Bourdette said oral vitamin D therapy is now in phase II clinical trials, to see how well it works and how much would be needed. "The arrival of effective oral agents will give MS patients more therapeutic options and will be a major advance in the global effort to alter the natural history of this chronic disease," the researchers said in a statement.
Copyright 2009 by United Press International

PREGNANT WOMEN ARE STILL DRINKING ALCOHOL

CDC: 1 in 8 women drink while pregnant
ATLANTA (UPI) -- About 1 in 8 U.S. women drank some amount of alcohol during their pregnancy, federal health officials said. A 15-year-study by the Centers for Disease Control and Prevention found the number of women who drink alcohol while pregnant is not decreasing and that 1 out of 50 pregnant women engaged in binge drinking. Pregnant women drinking has persisted despite repeated warnings from surgeons general about the dangers of drinking alcohol while pregnant, the report said. "The surgeons general have told pregnant women, and women who may become pregnant to abstain from alcohol consumption in order to eliminate the chance of giving birth to a baby with alcohol-related birth defects," said the report, published in the CDC′s Morbidity and Mortality Weekly Report. The study found that pregnant women most likely to report any alcohol use were ages 35-44 -- 17.7 percent, college graduates --14.4 percent, employed -- 13.7 percent and unmarried 13.4 percent. Pregnant women who binge drink were more likely to be employed and unmarried, the study said. The researchers used data from 533,506 women age 18-44, of whom 22,027 reported being pregnant at the time of the interview.
Copyright 2009 by United Press International

VITAMIN D CAN BE CAUSE OF FEMALE INFECTION!!!

Study links female infection to vitamin D
PITTSBURGH (UPI) -- Researchers at the University of Pittsburgh say they have linked a common female infection, bacterial vaginosis, to vitamin D deficiency. The study found that black women are more likely to become infected because they are more likely to be deficient in vitamin D, the Pittsburgh Post-Gazette reported Saturday. Researchers tested 469 pregnant women for vitamin D levels. They found women with low levels of the vitamin were more likely to be infected. About one-third of women in their child-bearing years are infected with bacterial vaginosis, said Lisa Bodnar, an assistant professor of epidemiology, gynecology and obstetrics. The disease is associated with premature delivery. For many women, bacterial vaginosis is just a nuisance. But the infection can make women more susceptible to sexually transmitted diseases. Vitamin D deficiency is more common in blacks because they absorb less from sunlight and are more likely to be lactose intolerant.
Copyright 2009 by United Press International

BLACK WOMEN REFUSE CANCER THERAPY MORE FREQUENTLY THAN WHITE WOMEN

1 in 4 black women refuse cancer therapy
ATLANTA (UPI) -- Nearly 1 in 4 African-American women in the United States with late stage breast cancer refused chemotherapy and radiation therapy, researchers said. Study leader Dr. Monica Rizzo of the Emory University School of Medicine and Emory University's Avon Comprehensive Breast Cancer Center at Grady and colleagues reviewed stage III breast cancer data from 2000- 2006 from an inner city hospital in Atlanta that serves a large African-American population. The investigators identified 107 cases of stage III breast cancers diagnosed and/or treated at this hospital over the six years of study. Approximately 87 percent of these cases were in African-American women. Chemotherapy and radiation are recommended therapies for patients with stage III breast cancer; however, many women in this study decided to forgo these treatments. The study, published online ahead of print of the July 1 issue of the journal Cancer, found 20.5 percent of patients with stage III breast cancer refused chemotherapy and 26.3 percent who should have received chest radiation refused. The authors said the reasons why African-American women with advanced breast cancer often refuse necessary care are unclear.
Copyright 2009 by United Press International