Getting more for less in health care (National Post, 06 Oct 2009)

Esmail assumes that producing “health care” is analogous to producing widgets; the law of supply and demand applies to both. Not so. Demand for “health care”, really disease care, is infinite. Deluded inhabitants of developed societies believe that any money spent on doctors and hospitals will prolong their lives. But, there is no correlation between per capita expenditure on doctors and hospitals and any measure of health. The cost of disease care will continue to rise as long as demand is fueled by absurd expectations of a necessarily finite system, driven by the latest, doctor-self-aggrandizing story on some “life-saving” technology. The cost of disease care can only be contained if doctors are put on salaries and practice according to the Hippocratic Oath and the best evidence for effectiveness and safety of treatments. Only then will doctors have an incentive to do less. Unlike the present perverted fee-for-service system, there would be no incentive to administer profitable but superficially attractive and potentially lethal procedures or drugs for non-life threatening disease. Also, unlike the present system, there would be a primordial incentive, less work for the same money, to prevent the diseases of lifestyle that account for most of the cost of the disease care system and most of the premature deaths in our society.

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Getting more for less in health care
NADEEM ESMAIL
National Post
06 Oct 2009

Thanks to poor fiscal management, the government of Ontario finds itself in a difficult fiscal situation. It must find a way to eliminate the significant deficits that are expected until at least 2015/16. Given that tax increases are certain to damage…read more…

Tech Tags: National Post newspaper ISSUES & IDEAS

WHAT YOU EAT MAKES YOU FAT

Great article, Joe. We appreciate there are those that are confused. But there are also large numbers who know what is healthy to eat, but easily blind themselves to reality; they are junk food addicts. That “food” they are piling on their plates is specifically formulated to appeal to addictions to sugar, salt and the mouth feel of fat. Extensive advertising of these high calorie density, low nutrient density foods, “junk food,” reinforces this desire, and gives legitimacy to guiltlessly indulge the addiction. That “food”  that the cruise passengers are piling on their plates is specifically formulated to appeal to addictions to sugar, salt and the mouth feel of fat. Unfortunately, treating junk food addiction is just as hard as treating addictions to tobacco, cocaine or heroin. Doctors are not trained to and not paid to treat addictions. They are paid to “treat” the symptoms of junk food addiction, like hypertension, Type 2 diabetes and “cholesterol” and do futile gastric bypasses. “Treatment” of these symptoms deceives the addict into believing that s/he can avoid the consequences of the addiction and makes the addiction worse. Americans are inundated with direct-to-consumer (DTC) drug advertising, claimed to be a First Amendment right by corporations with $billion ad budgets, promoting this deception and doctors are paid to prescribe those drugs.  Canada is catching up fast. Obesity rates are rising and there is pressure from the media to allow DTC in Canada, presumably guaranteed by the Bill of Rights.

The solution? Each individual has to balance the transient pleasure of addiction against the long term disastrous consequences of the addiction. In our society this is the hardest thing most people have to do 24/7/52 for a lifetime and doctors must avoid aggravating addictive behaviour.

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WHAT YOU EAT MAKES YOU FAT
JOE SCHWARCZ
The Gazette
13 Sep 2009

Occasionally, I like to spy on people. Only for the sake of science, of course. And what better opportunity to do that than on a cruise ship? I like cruising. Besides outstanding entertainment, impeccable service, interesting ports, activities galore…read more…

Tech Tags: The Gazette newspaper Insight

Once-a-day trap

Not mentioned is the moral hazard effect of taking any pill that one thinks will obviate the need for constant vigilance in lifestyle choices. The deceptive hype behind multivitamins and “cholesterol” pills has been largely responsible for the pandemic of obesity and Type 2 diabetes.

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Once-a-day trap
BY JULIE BEUN-CHOWN Canwest News Service
National Post
30 Mar 2009

Joe Schwarcz is known for his blunt, take-noprisoners style when he gets fired up. For the past 25 minutes, the erudite director of McGill University’s Office for Science and Society and outspoken star of the Dr. Joe Show on Toronto’s CFRB radio has…read more…

Tech Tags: National Post newspaper Body & Health

Escaping the dungeon of our own desire

Why do we need to keep having to prove for ourselves that Seven Deadly Sins, codified 1500 years ago are still valid? Every few generations we forget the power of the addictions to which the human brain is prey and become convinced that some form of technology will save us from the consequences of self-destructive lifestyles. One hopes we and our descendants have learned the lesson that constant vigilance is lifestyle choices is and will always be essential, regardless of the technological sophistication of a society.

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Escaping the dungeon of our own desire
MICHAEL GERSON Washington Post Writers Group
National Post
27 Feb 2009

There is now a minor but raging academic debate taking place over the effect of an economic downturn on your health. In the traditional view, unemployment can cause a kind of recession flu — a funk that leads to stress-smoking, unhealthy comfort foods…read more…

Tech Tags: National Post newspaper Issues & Ideas

‘The Heart Truth’ for both men and women

Unilever, the maker of Becel margarine, would like us to believe that Becel is a health food; the more you eat the better. To that end Unilever contributes $millions to various cardiovascular and dietetic organization who reciprocate by putting the Becel logo on their literature and web sites.

There is no such thing as a healthy refined fat. Both margarine and butter are junk food, naked calories. Besides, pure fat is tasteless. The taste in butter and margarine comes only from their salt content. Obesity is the major nutritional problem and refined fats (butter, margarine or oil)are the most concentrated form of calories and should have no place in a healthy diet.

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The Heart Truth’ for both men and women
Margaret McKellar, brand manager, Becel.
National Post
26 Feb 2009

Re: Barbara Kay, Apparently Men No Longer Have Heart Disease Or Strokes: That’s The Message From Becel Margarine And The Heart And Stroke Foundation, Feb. 16. I have had personal experience in dealing with loss due to heart disease and stroke. My…read more…

 

 

Tech Tags: National Post newspaper Letters

The Atherogenic Football Diet

Who are the coaches and “nutritionists” that advise football players to eat atherogenic, obesogenic , diabetogenic, hypertensogenic diets just so they can trample the opposing team? They should be banned from the game.

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By Madison Park
CNN

(CNN) – Football players guzzle protein shakes, down steaks and lift weights. They train and gain weight, hoping to build mass under the careful eye of the team’s coaches, nutritionists and gurus.

“It was a scripted lifestyle where they tell you how to eat, how to take care of yourself, how much body fat you should have,” said Chuck Smith, a former defensive end for the Atlanta Falcons and the Carolina Panthers.

But once their glory days are over, they have the same problem as millions of other Americans: They’re fat.

Football Team

“When I trained, they told us to eat all you can eat,” said Smith, who played in Super Bowl XXXIII with the Falcons. “Drink beer, eat peanut butter to gain weight. All those eating habits were great for football. But when I got done, no question I had to make adjustments.”

Without scheduled practices, meals, and games on Sunday, it became tougher to keep in shape.

When players were younger, they had the opposite problem.

Many tried to gain weight, believing that bigger is better. But as they age and retire from football, many are seeing that “big” is causing problems.

Smith, who weighed 274 pounds during his professional days, often had four plates of food in one sitting “to keep my weight up.” After retirement, Smith had to unlearn those habits.

“I had to retrain my thinking,” he said. “I don’t need to be full. I don’t have to stuff myself to feel comfortable. That took a long time. You stuff yourself to gain weight, then you get out of shape.”

Smith learned he had high cholesterol (he had to take Lipitor), and his blood pressure was climbing, too.

“I had to take the bon-bons out of my mouth,” said Smith, 39. “I had to empower myself. Strength coaches, nutritionists aren’t going to take care of me. Guys have to empower themselves to take care of themselves.”

Smith is now a fitness trainer at Defensive Line Incorporated, where he works with football players. Through healthy foods and workouts, he trimmed his body fat, lowered his cholesterol and shed 50 pounds.

Some players understand the risks, said Dr. Archie Roberts, a former National Football League quarterback and retired cardiac surgeon.

“They understand that if they stay 250, 300, 350 pounds as they age, that’s going to shorten their life span and cause them more health problems,” he said. “Others don’t get it and they’re unable — for whatever reason — to lose the weight, and they will suffer the consequences, just like anybody else in the general population carrying too much weight.”

Diabetes, hypertension and high cholesterol are all cardiovascular risks associated with obesity.

Roberts heads the Living Heart Foundation, a nonprofit promoting health for former football players. For five years, he has conducted research to determine whether former football players are at added risk for heart problems (they’re not).

After left tackle Bob Whitfield retired from the New York Giants in 2007, he gained 20 pounds. The 37-year-old Pro-Bowler is trying to lose 40 pounds, which would bring him to 290 pounds, the lowest he has weighed since ninth grade.

“You don’t want to be the person at the buffet and people look at you crazy,” Whitfield said. “Overall, you want to have a healthier lifestyle. It doesn’t mean you want to be muscled up. … I don’t want to be the biggest man in the room anymore.”

Looking back at his career, Whitfield doesn’t think his size made him a better player.

“When that mass gets too heavy, you decline, you can’t accelerate, you don’t have as much force,” he said. “I never felt that being bigger gives you a competitive advantage. I put it on flexibility, the explosive nature of your movements.”

Several decades ago, 300-pound players were a rarity; now, the league has more than 500, Roberts said.

Decades ago, the Washington Redskins’ offensive line was known for its size and dominance.

“They had the largest line in the NFL, called the Hogs, 20 years ago,” said Dr. Ben Levine, director of the Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital in Dallas, and professor of medicine. “If you go back and look at their size, they’re about the size of the running backs today. The impression was these guys were massive, huge. They couldn’t play in the NFL today. They’re too small.”

Smith said he wasn’t forced to gain weight, but perceptions exist on how a player should look based on his position. That “needs to change in the NFL,” he said.

Being faster, stronger and more aggressive is more important than size, Smith said. He drew an analogy to airline stewardesses: “We want her to be tall and slim so she can walk down the aisles. Now is there really a difference between a 135-pound woman and a 150? Well, maybe a little bit different in the hips, but the same effectiveness happens when she does her job.”

He added, “I’m a classic example that size doesn’t matter.”

But that’s not what young, aspiring players think.

Jackie Buell, director of sports nutrition at Ohio State University, said she encounters players who seek to gain as much as 30 pounds by next season and seldom care whether it’s fat or muscle.

Buell’s research examined 70 college linemen and found that nearly half have metabolic syndrome, meaning that the players have at least three of the five risk factors of developing diabetes and heart disease. Her next project is to explore whether junior high and high school football players are developing metabolic syndrome.

“My fear is, these young men have this metabolic profile, what happens when they stop working out intensively?” Buell said. 

Every disease is “genetic”. So what?

Every disease is caused by some combination of nature and nurture, genetic susceptibility and the environment, especially nutrition. Fortunately, most of the common fatal diseases and those costing the most to the disease care system are mostly environmentally caused. Attempts to find a simple genetic cause for atherosclerosis, hypertension, obesity and Type 2 diabetes were and are unscientific fishing expeditions driven by the analogy that we could immunize the population against these chronic diseases of lifestyle, as we can immunize against acute infectious diseases like polio or smallpox. As this paper makes clear the four-billion year old genetic code is a highly refined, self-referential system that is unlikely ever to be completely understood.

Unfortunately, changing the environment, aka lifestyle, necessitates conquering legal addictions to junk food, tobacco and alcohol. We would much rather spend $many billions on a futile attempt to find a magic genetic bullet to obviate the destructive consequences of addiction than face the painful necessity of eliminating them. 

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Genetic diseases may be tougher to crack, new research suggests 

Last Updated: Friday, December 26, 2008 | 4:07 PM ET 

CBC News

Finding a cure for many genetic diseases — including some cancers and neurodegenerative ailments — may be much more complicated than previously thought, new research indicates.

An international team’s work on alternative splicing, the process that produces 75,000 of the proteins in human cells, found that small changes in the environment near an alternative splice could produce a large change in the proteins produced.

That’s important, because mutations in DNA sequences in alternative splicing cause more than half of all genetic diseases.

If the materials used in splicing are seen as forming a long sentence, then the individual parts can be considered words, said Tim Nilsen, director of the Case Western Reserve University School of Medicine’s Center for RNA Molecular Biology in Cleveland.

“Adding or deleting one word,” he said “can radically change the meaning of the sentence.”

Biologists believe that rules hidden in the DNA code control alternative splicing, so once the code is broken, cures can be found for genetic diseases.

But the finding by Nilsen’s team on the importance of the environment means the code is much more complicated than thought. That will likely delay that progress of scientists who hope to amend the code to cure genetic diseases, said Joseph Nadeau, chair of the medical school’s genetics department.

“It’s context, not [genetic] code, that’s important,” he said.

The study, Dynamic regulation of alternative splicing by silencers that modulate 5′ splice site competition, was published in the Dec. 24 issue of Cell.

Nilsen led a team from three U.S. institutions — Case Western, Columbia University and the Memorial Sloan-Kettering Cancer Institute — and the Max Planck Institute for Biophysical Chemistry in Germany.