Category Archives: policy

healthy habits, meaning, musings, nutrition, policy, politics

Katz on attitudes to wealth vs health

Lots of quotable quotes…

https://www.linkedin.com/today/post/article/20140330140626-23027997-health-wealth-and-wisdom-be-serious

Health, Wealth, and Wisdom? Be Serious!

March 30, 2014(Note: some content adapted for use in this column originally appeared on the Huffington Post on 3/9/12.)

As my newly published review article, “Can We Say What Diet is Best for Health?” makes the media rounds, some questions arise more commonly than others- and some are just more interesting than others. One that stands out in both categories is: what’s the problem? Why, if we really do (and yes, we really do!) have knowledge of the basic theme of eating that could do so much to promote health- adding years to life, and life to years– don’t we embrace it and put it to that excellent use for ourselves and those we love?

There are a number of answers, and different ones received particular emphasis in different interviews. But several of the most important start along distinct trajectories only to wind up at exactly the same place: money.

One such trajectory has to do with those entities – Big Food, Big Publishing, Big Pharma, Madison Avenue, Big Weight Loss industry- that profit enormously from the status quo. Many in this space would be well within the bounds of reason, if not propriety, to wish fervently for our dietary pseudo-confusion and related health travails to last forever. Maybe they do- but I won’t presume to say. I will say: it’s much about the money being made.

But it’s about our hard-earned, carefully tended money as well, and that’s the more interesting part of the story. Because if most of us in our culture treated our money and wealth in any manner vaguely comparable to how we treat our health we would be, in a word, morons. Or, at best, suckers. That’s the problem, right there. Fix this, and a world of opportunity would open up before us.

What’s the case?

Over nearly 25 years of patient care, I have seen — far too many times, painful to recall — people reach retirement age with nicely gilded nest eggs, and disastrously scrambled health. I have never met anyone seriously willing to trade their capacity to get out of bed for a large bundle of cash. I have known many people who would gladly give up large fortunes for the chance to get out of bed one more time, or get out of a wheelchair or be free of weekly dialysis.

But now we enter the Twilight Zone, where what’s real and important, and how we behave, part company. We value money (i.e., wealth) before we have it, while we have it and if ever we had it. We want it if we can’t get it. It’s a crime when someone takes it from us. We fight to keep it.

Health is more important, but most of us — and our society at large — value it only after it’s lost.

Consider that one of the more significant trends in health promotion is providing some financial incentive for people to get healthy. This strategy is populating more and more programs in both real space and cyberspace, and is incorporated into many worksite wellness initiatives.

I have no real problem with it — whatever gets us to the prize is okay with me. But it is… bizarre. We have to be paid to care about getting healthy.

Consider if it were the other way around. You could do a job, and you would get money for doing the job, but then you demanded an “incentive.” Money is not an incentive? No! We insist on being provided “health” to incentivize us to work for the sake of wealth. Unless you, my employer, can guarantee that working for you will help make me healthy, you can take this job and paycheck and…

Ludicrous, right? It doesn’t even sound rational to insist on getting paid in health to accept benefits in wealth. And yet, we all accept that it’s perfectly rational to require payment in wealth to accept benefits in health. We all accept it, that is, until health is gone, we realize what really mattered all along, and we say: What the %#^$ was I thinking? Too late.

I have a real problem with this, not because I want to be in charge of anyone else’s life, but because I know that people want to be in charge of their own lives. Once health is gone, so is control. Your life is governed by medications, procedures, doctor visits and emergencies. You are the very opposite of in charge.

Our society makes it quite clear that responsible adults take care of their money. They don’t spend it as they earn it — they put some into savings. They anticipate the needs of their children, and their own needs in retirement. Wealth — or at least solvency — is cultivated. If you neglect to take care of your budget and your savings, you are, in the judgment of our culture, irresponsible.

But our culture renders no such guidance for those who routinely neglect their health. Those who don’t have time today to eat well, but will have time tomorrow for cardiac bypass. Those who don’t have time today to exercise, but will have time tomorrow to visit the endocrinologist. Those who get, and apply, mutually exclusive recommendations dosed almost daily by daytime television. Prevailing neglect of health costs us dearly, individually and collectively, and it costs us both health and wealth. Being sick is very expensive — in every currency that matters: time, effort, opportunity cost, legacy and yes, dollars.

What if health were more like wealth?

  • If health were like wealth, we would value it while gaining it — not just after we’d lost it.
  • If health were like wealth, we would make getting to it a priority.
  • If health were like wealth, we would invest in it to secure a better future.
  • If health were like wealth, we would work hard to make sure we could pass it on to our children.
  • If health were like wealth, we would accept that it may take extra time and effort today, but that’s worth it because of the return on that investment tomorrow.
  • If health were like wealth, society would respect those who are experts at it- and not substitute the guidance from those who are not.
  • If health were like wealth, young people would aspire to it.
  • If health were like wealth, we would be serious about it.

But health is not like wealth. We venerate wealth, and all too often, denigrate health. People are routinely willing to lose weight fast on some cockamamie diet to look good for a special event. It’s not healthy, but what the heck? Well, it would be like cashing out your 401(k) to show up at the special event in a flashy car you can’t really afford. It would feel good for a day, and bad for the rest of your life. We know this, and responsible people don’t treat wealth this way. But we mortgage health to the point of foreclosure as a matter of routine.

Health is not like wealth. It is vastly MORE important. Just ask anyone who has one but not the other.

We are raised to aspire to wealth, while health is often left to languish in that space where stuff just happens. Wealth is its own prize; we need an incentive in another currency to recognize health as such. We watch sitcoms to laugh at get-rich-quick gullibility, then apply that very delusion ourselves to promises of get-thin-quick, get-healthy-quick, or stay-young-forever. We look to genuine experts for advice in almost any field, and certainly when it comes to managing our money- but if some Hollywood celebrity tells the world “I lost weight by eating only pencil erasers while being thrashed about the elbows with wilted artichoke leaves”- we get in line and reach for our credit cards.

To the extent we own wisdom or at least common sense, we are encouraged at every turn to apply them to our careers, and our bank accounts. But they lapse into a coma with every weight loss infomercial.

The result is an endless appetite for an unending parade of “my diet can beat your diet” contestants, rather than a sensible devotion to applying the fundamentals of healthful eating. It’s exactly analogous to frittering away all of our money on a comparable parade of get-rich-quick schemes, while ignoring the readily available, reliable information about sound investing. Or, if you prefer: it’s shopping for fiddles while Rome burns.

Wise is wonderful, but probably sets the bar too high. We could be both healthy and wealthy- or at least exercise comparable control over both- if we were just comparably sensible about both. We don’t even need to be wise to be healthy- we just need to be serious about it, rather than silly. What’s the problem? When it comes to eating well and being healthy, we are not serious people. Silly prevails.

-fin

Dr. David L. Katz has authored three editions of a nutrition textbook for health care professionals. He is editor-in-chief of the peer-reviewed journal, Childhood Obesity, and President of the American College of Lifestyle Medicine. He was commissioned by Annual Review in Public Health to write the review article, Can We Say What Diet is Best for Health? He is the author, most recently, of Disease Proof.

www.davidkatzmd.com
www.turnthetidefoundation.org

http://www.facebook.com/pages/Dr-David-L-Katz/114690721876253
http://twitter.com/DrDavidKatz
http://www.linkedin.com/pub/david-l-katz-md-mph/7/866/479/

Photo: Stefan Holm/Shutterstock.com

facts & data points, healthy habits, nutrition, policy

Katz on Butter

 

http://www.linkedin.com/today/post/article/20140327141338-23027997-bittman-butter-and-better-than-back-to-the-future

Bittman, Butter, and Better than Back to the Future

March 27, 2014

I generally appreciate the work and writing of Mark Bittman. But on one prior occasion, I was obligated to highlight his erroneous interpretation of an epidemiologic study about sugar, obesity, and diabetes. Mr. Bittman responded cordially and graciously when I pointed out his error, and more generally, his want of training or qualifications to offer up seemingly expert opinion to the public on research studies. I was pleased and gratified by the exchange that ensued between us, including a phone conversation and plans to meet for lunch, which alas, never came to fruition.

But old habits, it seems, die hard- and in this week’s New York Times, Mr. Bittman is indulging again in intellectual mission creep, with predictable consequences. While not trained as a chef, Mr. Bittman has established himself among the foodie elite, and is thus qualified to opine expertly on the culinary merits of butter. Or, at least, I am not qualified to say he is unqualified to do that- I defer to Jacques Pepin.

But Mr. Bittman is absolutely not qualified to assert the health effects of butter based on arecent meta-analysis I rather doubt he read in its somewhat excruciating detail. (In fact, he doesn’t even seem inclined to pretend he read it; he references the work several times, but in each case, the links he provides lead to someone else’s blog about the study, each reaching a conclusion- surprise- aligned with his own.) He should restrain himself from such inclinations to impersonate an expert, and the New York Times should set the bar higher. Experts should earn the rarefied real estate of New York Times pages only for their domain of actual expertise; the public probably expects, and certainly deserves, no less.

Mr. Bittman’s writing is, as ever, engaging and stylish. Overall, his column entitled “Butter is Back,” which turns out to be much about other things, such as limiting our overall intake of meat for ecological and humane reasons, is balanced, and thoughtful, and reaches generally reasonable conclusions about a diet of real foods, mostly plants – for the benefit of human health, our fellow species, and the planet alike. This is a topic near and dear to my heart, and one to which I have devoted considerable, recent effort.

But speaking of hearts, his conclusion that butter has now been exonerated of all harms formerly alleged is, in a word, wrong.

Since the study Mr. Bittman cites was about fatty acids, not foods, and only headlines in pop culture said anything about butter or cheese, we might begin with: what, exactly, are the saturated fatty acids in butter, and how did they fare specifically in the meta-analysis in question? I am betting you don’t know or care-but my point is, I bet the same of Mr. Bittman.

We could, perhaps productively, wade into just such weeds of the meta-analysis, but I’ve done that already, and see no value in redundancy here. My prior column is accessible to you. Note, as well, that colleagues have identified potentially quite important flaws in the actual analysis, the investigators themselves have conceded those flaws, and an outright retraction of the paper is at least being discussed.

But we can leave all of that alone and grind better grist altogether. Consider that the meta-analysis, even if sound, showed only that Western diets with lower and higher levels of saturated fat still produced roughly comparable levels of heart disease. It actually showed slightly less heart disease with lower saturated fat intake, but statistically speaking, that’s picking a nit, so we can let it go. Let’s accept that without addressing at all what replaces the saturated fat, a fairly typical Western diet produces about the same amount of heart disease whether higher or lower in saturated fat content. Substituting in Mr. Bittman’s leap of faith, this might mean that typical Western diets with higher or lower amounts of butter produce about the same amount of heart disease.

On this basis, Mr. Bittman says: bring back the butter.

Before you do, consider these points, in no particular order:

1) All ‘Western’ diets produce very high levels of heart disease, at least 80% of which has been shown to be outright preventable by a litany of studies spanning decades.

2) The new meta-analysis did NOT consider what was replacing the saturated fat in the diets of those who ate less, but others have told us that: mostly refined starch and sugar. Importantly, then, despite Mr. Bittman’s assertions that these are the ‘real’ culprits in our diets- diets lower in saturated fat did NOT show higher levels of heart disease, as we might expect if we were replacing a false culprit with the real ones (i.e., cutting saturated fat, adding sugar). So, the new study might just as well be interpreted to show that ‘adding sugar and starch to the diet in the place of saturated fat’ does not increase heart disease rates. So on what basis does this study indicate these are the ‘real’ culprits? Mr. Bittman just brought his preconceived notions along for the ride. (My view? Excesses of saturated fat, sugar, and refined starch are in on it together, and all still wanted for further questioning.)

3) The new study did show lower rates of heart disease with higher intake of omega-3 fat. There was a favorable trend with polyunsaturated fats in general, but this was not significant.

4) Overall, then, the study showed that some dietary fats can be beneficial to health, butsaturated fats as a class were not among them. The best the study said of saturated fats is:they don’t seem to make things worse than the prevailing status quo.

5) But to rephrase point 1: the status quo stinks!

6) Other studies have blown the status quo away. In his famous study years ago, Dean Ornish showed a relative 70% reduction in the rate of heart attack with a plant-based, low-fat diet that certainly did not feature butter.

7) Perhaps of more general interest: the Lyon Diet Heart Study showed exactly the same, impressive, relative 70% reduction in heart attack rates. But in this case, the intervention diet had no ascetic overtones; it was a Mediterranean Diet. The control diet, which resulted in standard –and thus appallingly high- rates of heart attack was a typical Western diet. But the Lyon Diet Heart Study, as the name suggests, was centered in Lyon, France- and conducted in European countries. The ‘typical’ diet was not American junk- it was the real-food diet of Northern Europe, dripping in, among other things, butter. Other Mediterranean Diet studies have shown much the same.

8) Combining point 7 with the new study could be said to show this: saturated fat (and therefore, maybe, butter) may not be bad for hearts and health compared to other things that are bad for hearts and health. But there is no evidence they are good for hearts and health. That hardly seems cause to start shmearing.

9) In contrast, a balanced portfolio of monounsaturated and polyunsaturated fats-characteristic of all of the world’s most healthful diets; particularly associated with the Mediterranean diet; and derived from foods such as olives, avocadoes, nuts, seeds, with or without fish and seafood- is decisively associated with lower rates of all chronic disease, dramatic reduction in the rate of heart attack, and reduction in the rate of premature death overall. And that’s without buttering it up.

10) Well, I guess I’m done. Just reread 1-9, and there you go.

I don’t think butter is poison. Go ahead and have some if so inclined. But do it for pleasure, not health. The new study was not about butter, but had it been, it could have concluded that there are things we can eat instead that are just as good, or just as bad. Either way, there was no hint that adding butter to our diets would improve our health. Since other studies do show us how to do just that, why would we settle for a lateral move, and stay mired in a place where coronary disease is practically a middle-aged rite of passage? There are places around the world that get the healthy living formula right where heart disease is all but unknown.

I have opinions about cuisine-but they are just opinions. I cannot, and do not, claim culinary expertise. Mr. Bittman, by popular affirmation, can-and I, like many of you, am happy to listen and learn when he does so. But he is no scientist, and when he forgets that, he becomes a potential danger to public heath, misdirecting his considerable influence, and exploiting the faith of his followers. When it comes to clear messaging about nutrition and health, we all should be a bit more careful about which side of the bread is being buttered, and who wields the knife.

If you don’t mind living in a world where everyone you know over age 50 is on multiple medications to fix what lifestyle as medicine could fix far better, by all means add back the butter. If you think it’s normal that most adults of a certain age have had their chests opened up or their coronaries ballooned open, butter away.

But we certainly know how to do far better than such variations on the theme of eating badly. Even in the home of the famous French paradox, replacing butter with olive oil –among other things- slashed rates of heart disease. In my unprofessional opinion, cold-pressed, extra virgin kalamata olive oil on fresh, whole grain bread is sublime. In my professional opinion, it’s good for me. I’m sticking with it for both reasons.

Butter is not, and never was, a singular nemesis– any more than sugar is, or wheat is. But butter never did our health any favors either- however it may treat our taste buds. Advice to add it back takes us back, not forward, to our nutritional future. We know how to do far better.

-fin

Dr. David L. Katz has authored three editions of a nutrition textbook for health care professionals. He is editor-in-chief of the peer-reviewed journal, Childhood Obesity, and President of the American College of Lifestyle Medicine. He was commissioned by Annual Review in Public Health to write the review article, Can We Say What Diet is Best for Health? He is the author, most recently, ofDisease Proof. He likes olive oil.

data saving lives, health market quality, policy, politics, rapid learning health systems

US Physician Payment Data

Great opener in this article:

The days of building electronic medical record software are over. Oh sure, EHRs will continue to get built, improved, “skinned,” perhaps even reimagined. But with the EHR incentive program beyond its peak, attention is shifting to other important aspects of the healthcare technology spectrum.

Really belies where these guys are coming from…

http://www.healthleadersmedia.com/content/TEC-303683/Physician-Payment-Data-is-Where-the-Action-Is

Physician Payment Data is Where the Action Is

Scott Mace, for HealthLeaders Media , April 22, 2014

 Look beyond the EHR incentive program. A national effort to turn CMS’s recent release of Medicare physician payment data into useful, actionable data visualizations is the hottest HIT challenge right now.

The days of building electronic medical record software are over.

Oh sure, EHRs will continue to get built, improved, “skinned,” perhaps even reimagined.

But with the EHR incentive program beyond its peak, attention is shifting to other important aspects of the healthcare technology spectrum.

Last week in this space, I described how entire communities are engaging in friendly competition to leverage the many digital breadcrumbs that make up today’s total population health picture.

The Way to Wellville effort is a five-year marathon. Health Datapalooza’s Code-a-Palooza is an opportunity for a variety of stakeholders, healthcare systems included, to step forward and compete in a national one-month sprint to turn CMS’s recent burst of Medicare physician payment data into useful, actionable information for patients and payers alike.

While this data gives patients the opportunity to compare and contrast physician-level data on charges, it is a lot of information to sift through.

That is the challenge for Code-a-Palooza entrants. A collaboration among Health Data Consortium, the ONC and CMS, developers are invited to use the newly released data to create a data visualization that improves consumer decision-making when it comes to selecting a physician or procedure, in turn helping to potentially reduce costs and increase value to the patient.

Health Data Consortium will award $35,000 to three top teams at Health Datapalooza on June 3.

To learn more, I spoke with Health Data Consortium CEO Dwayne Spradlin. Last year, Spradlin reminded me, an earlier competition used a specially prepared CMS data set that had not been made public. This year, for the first time, the competition is based on public data. That should drive lots of discussion, and no small amount of controversy.

Last year, the competition winner was a team of doctors who had coding chops. You never know where in healthcare such tech talent may be waiting.

“I would be floored, in fact, if we don’t have quite the diversity of individuals and teams registered,” Spradlin said.

I responded that there is this conventional wisdom that healthcare is so far behind the technology curve that mere doctors cannot be expected to be the leading technology innovators, but instead must be rescued by the rocket scientists, Wall Street quants and otherBrainiacs who populate so many venture-backed healthcare startups, parachuting in as if their ignorance of the healthcare system is some sort of advantage.

There may be some truth in such thinking. “There’s an adage in the field of open innovation, which is some problems are too big to leave to the experts,” Spradlin said. “Very often, if the expert in a particular field could solve a problem, they would have already.” So, will there be contenders from outside of healthcare? You bet.

And yet, Code-a-Palooza may continue to put the lie to this stereotype.

“You do need the people who are the subject masters to really come in and say take this data set from CMS and make it do things that really matter to healthcare,” Spradlin said.

But as Spradlin reminded me, last year’s winners “did not represent your father’s healthcare system. They were fearless, unafraid. They had been brought up in the develop arena as well. They saw a need to do some things differently.”

But just to set expectations, remember that the recently released CMS data is all about cost, not quality. The full matching set of quality data is locked up still somewhere in CMS, and since I understand the agency operates at least four separate data warehouses, it could be some time before we see a truly complete coding competition.

That will invite in the controversy, because just looking at cost without the associated quality measures is bound to be taken out of context by someone somewhere. To some extent, because the newly released data hasn’t been poured into apps as easy to use as Yelp, some of that controversy hasn’t erupted yet. And there’s always the possibility that a Yelp-style app won’t capture the nuance or the inherent value of a medical encounter. The ensuing outcry could simply be added to all the other perceived outrages of our public healthcare debate.

Still, Spradlin pointed out that in the initial flush of reportage after April 9, reporters and healthcare critics were able to go after apparently inflated costs.

“It took all of about a day for them to start finding which providers had the highest billing numbers,” Spradlin said. “But it certainly won’t be the last word.” Geographic variations, socioeconomic variables and other deep population analysis “may be the most interesting of all. Some of that could come out of this competition. People will be analyzing this data for months and months. I think the least interesting thing is actually what got published on April 10.”

Every time more of this data gets released, a network effect will kick in, with new opportunities to correlate previously-released data with the new.

In a world where consumers can spend five hours picking out their latest smartphone, and less than 20 minutes picking a physician, this kind of information will fundamentally change healthcare, Spradlin said.

“The AMA is right, in that there is a lot of context that’s important to understand,” Spradlin said. “As we get a little bit smarter, and the consumer population gets a little bit smarter about understanding and parsing a lot of this, we’ll get better at correlating the quality measures in these cases.

“I also think we could see some unexpected attempts at driving some that, even here. When you look at claims data, you can’t help but look at readmission rates. Are readmission rates potentially a strong signal of quality? I think for certain procedures, probably.”

Code-a-Palooza visualization proposals are due on April 25. (Don’t worry, the coding doesn’t all have to be done by then.) As competitors and other healthcare luminaries assemble in Washington June 1–3 and I’ll be there again to cover it—then the real fun begins.

Scott Mace is senior technology editor at HealthLeaders Media. 

facts & data points, healthcare, policy

Obesity Society of Australia

good obesity and diabetes stats, otherwise fluff…

http://www.medicalobserver.com.au/news/govts-should-weigh-in-on-obesity

Govts should weigh in on obesity

22nd Apr 2014

THE release in 1997 of the National Health and Medical Research Council’s report, Acting on Australia’s Weight: a Strategic Plan for the Prevention of Overweight and Obesity, was supposed to be a watershed.

Associate Professor Tim Gill

Executive Officer, Australian and New Zealand Obesity Society

This was the first time a national agency anywhere in the world had produced a national action plan that recognised the seriousness of the growing obesity problem and set out a strategy to deal with it.

Great anticipation surrounded the level and vigour of action on treatment and obesity prevention it would stimulate.

Alas, after several years of procrastination, several government taskforces and innumerable additional reports (with mostly the same recommendations) the original report has been re-branded from Acting on Australia’s Weight to ‘Waiting on Australia to Act’ by health advocates frustrated by continued unwillingness by successive Australian governments to take up the tougher recommendations required.

All governments now acknowledge the seriousness of the public health problem of obesity and the financial and social burden of obesity-related conditions.

However, they proffer a confusing range of reasons for their unwillingness to act upon recommendations from their own expert committees.

Among the most perplexing rationales for inaction include: obesity is not a disease; we cannot act without certainty that this intervention will be effective; obesity is a lifestyle problem that requires personal rather than government action; and we do not want to create a nanny state.

In isolation, some of these justifications appear valid, especially when espousing a need for evidence-based policy and a desire to avoid causing unintended harm.

However, few stand up to critical analysis within the context of type of response required to make headway.

Since the release of Acting on Australia’s Weight, the prevalence on obesity has risen from 18.7% to 28.3% and now almost two-thirds of Australian adults are overweight or obese.

The predicted avalanche of weight-related chronic disease is beginning to emerge. The level of type 2 diabetes has more than doubled since 1995 and now affects 4.2% of the adult population.

Every day 280 Australians develop diabetes, and the Baker IDI Institute estimates there will be 2.5—3 million people with diabetes by 2025 and about 3.5 million by 2033. These sorts of figures should see governments eager to identify and support any action. Instead we have reached a point where the range of strategies acceptable to governments is narrowing. Potentially effective interventions have been ruled off the table as a consequence of a combination of political, philosophical and technical considerations.

It is true there are no easy or quick solutions to the problem of Australia’s expanding weight. It is also true that governments alone cannot solve this problem; it will take a concerted effort from individuals, communities, professionals, industry and all sectors of society.

Governments must provide leadership, however. This necessitates tough decisions in the face of corporate resistance and public self-interest that demonstrate commitment in tackling obesity and perceptions around this issue.

Telling people battling with genetic and physiological liabilities overlaid with an environment that promotes sedentary behaviour and overconsumption of food that they must take personal responsibility is not leadership.

But preparedness to embrace a range of structural, regulatory or fiscal reforms that have the potential to push the environment in a direction that supports appropriate behaviour change provides a clear indication of the government’s stance.

This display of leadership is likely to achieve more in terms of modelling and endorsement of additional action than the direct impact of the intervention itself. And that is the role of government.

healthy habits, nutrition, policy

Leeder on ageing – UN: “Good health adds life to years”

 

“Good health adds life to years”

In old age, as the WHO theme suggests, it is the disease burden rather than age itself that is the biggest problem.

It is also among older people that attention should be lavished on the modifiable factors that multiply absolute risk of death and disability. Treating blood pressure, for instance, is more, not less, important in the individual older patient than it is in a younger person in the prevention of stroke and heart disease, as the Lancet implies.

 

http://steve-leeder-better-health.blogspot.com.au/2012/05/age-old-debate.html

Saturday, May 12, 2012

An age-old debate*

World Health Day is celebrated on 7 April to mark the anniversary of the founding of WHO in 1948.  It is not a day that stops the nation – no sweeps and no light switched off, especially this year.

 

What is it?  The WHO web site states that: ‘World Health Day is a global campaign, inviting everyone – from global leaders to the public in all countries – to start collective action to protect people’s health and well-being.’

 

This year the topic was Ageing and health with the theme “Good health adds life to years”. Noting the theme of World Health Day this year, a recent Lancet editorialhttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2960518-2/fulltext points out that while the biggest causes of years of life lost among people aged 60+ years are ischaemic heart disease and stroke, only between 4-14% of older people in less- and least-developed settings are receiving antihypertensive treatment.

 

April 7 received zero media coverage.  Old age is boring.  It is not news.

 

Shortly after World Health Day, in Australia, $3.7 billion of reforms to aged care over five years were announced by the federal government. http://www.theaustralian.com.au/national-affairs/at-a-glance-aged-care-reforms/story-fn59niix-1226334312515

 

  • $1.2 billion to strengthen the aged-care workforce.
  • $268.4 million for dementia.
  • $54.8 million to support carers.

These proposals are linked to existing aged care support and include $880.1 million over next five years to expand home care with 80,000 new home-care packages by 2012.  The ageing of the world’s population is a special challenge for nations still undergoing economic growth such as China and India. The population aged 65+ years in those countries will, according to UN projections, double between 2000 and 2020 and quadruple — to 900 million people — by 2040. The number of older citizens in more-developed countries by 2040 will be only one-third that of those in the less-developed countries. The economically-advanced world thus holds no monopoly on old age.

 

In China where a one-child-per-family has operated since 1978 and applies to 40% of families, family for older parents will be very challenging, especially if the one child lives in a city and the parents live rurally.  Whereas now there are 10 million people in China aged 80 or over, by 2050 there will be, according to current estimates, 100 million.

 

In old age, as the WHO theme suggests, it is the disease burden rather than age itself that is the biggest problem.

 

It is also among older people that attention should be lavished on the modifiable factors that multiply absolute risk of death and disability. Treating blood pressure, for instance, is more, not less, important in the individual older patient than it is in a younger person in the prevention of stroke and heart disease, as the Lancet implies.

 

The policy challenges for an ageing world, especially one that seeks to sustain health in old age, concern the context, content and cost of services.

 

The context is not a straightforward policy component because social attitudes towards older people vary widely. Oriental concepts of filial duty will confront the practicalities of distance, time, and new lifestyles.  In some cultures, the wisdom of the elders is prized while in others it is ignored. In multicultural Australia, sensitivity to cultural variations is critical to the effective provision of support for older people. Different cultural attitudes to institutional, home and respite care all need to be respected.

 

The content of care includes the technicalities and includes decisions about how resources for aged care will be used to best effect.  That is true at the macro level but closer to the people we are aiming to help, end-of-life discussions are a valuable part of a patient-centred aged care policy.

 

When it comes to cost, we must ask if the welfare model of health service provision that we follow at present is sustainable in the light of population ageing, and if it needs modification. How will this be achieved without doing violence to notions of equity and bankrupting the nation? Questions such as these have been addressed partially in the financial arrangements in the new federal aged care proposals.

 

As grey demand increases, the attitude of younger taxpayers cannot be assumed to one of selfless generosity towards meeting the costs of care and support of ever more older people. This makes the development and protection of superannuation and personal savings a huge political priority right now.

 

Ageing is not like HIV or bird flu — it is entirely predictable and susceptible to rational examination, prediction and policy formation. The Productivity Commissionhttp://www.pc.gov.au/projects/inquiry/aged-care/report and groups such as Alzheimer’s Australiahttp://www.fightdementia.org.au/dementia-an-economic-and-fiscal-disaster-waiting-to-happen.aspx are urging us to think, discuss and debate seriously the major policy elements within ageing.

 

*Published in MJA Insight Magazine

healthcare, management and leadership, policy, politics, quotes & aphorisms

LNL: Wilful Blindness

touches on medical establishment and effect of medical school hidden curriculum on medical students leading to very poor patient care.

Also references Steven Bolsin and his impact on the NHS…

Face value isn’t very valuable.

How do things affect the least powerful people in a system.

The story of Cassandra.

http://www.abc.net.au/radionational/programs/latenightlive/wilful-blindness/2926516

Wilful Blindness

Monday 25 July 2011 10:40PM
Eye of the storm: Rupert Murdoch in LondonIMAGE: EYE OF THE STORM: RUPERT MURDOCH IN LONDON (REUTERS: LUKE MACGREGOR)

Were the Murdochs ‘wilfully blind’ to the practice of phone hacking at the News of the World?

 

Guests

Margaret Heffernan
Visiting professor and entrepreneur-in-residence, University of Bath. Columnist with the Huffington Post.

Publications

Title
Wilful Blindness: Why We Ignore the Obvious At Our Peril
Author
Margaret Heffernan
Publisher
Simon and Schuster

Credits

Researcher
Stephen Crittenden

Comments (7)

Add your comment


  • Peter Houston :

    26 Jul 2011 5:51:02pm

    Good segment on ‘wilful blindness’ – it reminded me of Barbara Tuchman’s ‘cognitive dissonance’. How about a follow-up on the psychological profile/dimensions of wilful blindness and related phenomena? What makes it tick?

    Reply Alert moderator


    • Mulga Mumblebrain :

      27 Jul 2011 4:21:06pm

      ‘Willful blindness’ seems to me to be a mealy-mouthed euphemism for rank untruthfulness, a sort of ‘innocent on the grounds of insanity’ defence.

      Alert moderator


  • marsha :

    26 Jul 2011 8:42:39pm

    And you must remember that Allan Bond had Alzheimers. I wish he’d share his cure with rest of us.

    Reply Alert moderator


  • Mulga Mumblebrain :

    27 Jul 2011 4:19:29pm

    A relative who worked on the News Corpse switchboard in Surry Hills years ago well remembered Rupert’s habit of periodically ringing from New York to have that day’s edition of ‘The Fundament’ (known then as The Australian) read to him, from front to back. A real ‘hands-off’ proprietor! What we witnessed in the UK Parliament was, in my opinion, a tour de farce of deception, and an Oscar performance from Rupe as a demented old codger who didn’t know what was going on. Already parts of James’ testimony have been utterly refuted by former senior News Corpse functionaries. Rupe was more cagey, and possibly has set James up, along with Rebeckah and Hinton, as ‘patsies’.

    Reply Alert moderator


  • Simon Barlow :

    27 Jul 2011 4:43:30pm

    I thought the piece on ‘wilful blindness’ was a segue leading from the European right-wing terror story. Like Philip expressed, we all find the rising tide of xenaphobia, and anti-Muslim sentiment in Europe (and to some extend in Australia) worrying, but aren’t we kidding ourselves? The clash of cultures, so vastly different are bound to result in this reaction, and we are ‘wilfully blind’ and courting disaster if we ignore it.

    Reply Alert moderator


  • David from Leichhardt :

    28 Jul 2011 7:25:03am

    Regarding the story on “wilful blindness” I was interested in the notion that many of us refuse to listen to views that we do not agree with. You and your guest chastised us for “having our heads in the sand” about the panoply of of views surrounding an issue. I think that what is missing here is the role of “discernment”.

    I enjoy listening to LNL and consider myself much better informed for it. I will not listen to John Laws or Alan Jones. Should I be criticized for not giving them a fair go at informing me of their points of view? I think not.

    For that matter I must tell you that when Mr Abbott is being interviewed on the news I turn down the volume because I cannot bear listening to him. Does this make me “wilfully blind” to his point of view and policies? Can you be “wilfully blind” when there is, in truth, nothing there to see?

    Reply Alert moderator


  • Lyall St Kilda :

    28 Jul 2011 7:48:19pm

    Mr Adams listen back to your show where you interview the biographer Manning Clark. Perhaps the scales will fall from your eyes.

complex adaptive systems, policy, politics, rapid learning health systems

Geraldine and Piketty

Geraldine completes a tight interview with Piketty to pull out the main themes of his work… capital accrues wealth faster than the waged, so tax capital (vs income) and pay a lot more attention to inequality.

Implementation of the ideas hinge on a lot of international cooperation, peace, love and mungbeans, but it remains a compelling and disruptive concept…

Check this awesome Chomsky comment:

Ne Obliviscaris :

12 Apr 2014 8:14:59am

People read snippets of Adam Smith, the few phrases they teach in school. Everybody reads the first paragraph of The Wealth of Nations where he talks about how wonderful the division of labor is. But not many people get to the point hundreds of pages later, where he says that division of labor will destroy human beings and turn people into creatures as stupid and ignorant as it is possible for a human being to be. And therefore in any civilized society the government is going to have to take some measures to prevent division of labor from proceeding to its limits.

– Noam Chomsky on Adam Smith and the Wealth of Nations

http://www.abc.net.au/radionational/programs/saturdayextra/capital-in-the-21st-century/5362266

21st century capital

Saturday 12 April 2014 8:05AM
capital 21stIMAGE: THE RAGING BULL AT WALL STREET, NEW YORK CITY. (BEN HIDER GETTY IMAGES ENTERTAINMENT )

French economist Thomas Piketty has spent fifteen years collecting and analysing incomes reported on tax returns over the last 100 years to predict that the world is heading towards inequality rates not seen since the 19th century, unless there is global action to narrow the divide.

His book, Capital in the twenty first century, has been described by the former World Bank senior economist as “one of the watershed books in economic thinking” and The Economist magazine wrote it could change the way people think about the past two centuries of economic history.

Guests

Thomas Piketty
Professor at the Paris School of Economics

Publications

Title
Capital in the twenty-first century
Author
Thomas Piketty (translated by Arthur Goldhammer)
Publisher
Belknap Press of Harvard University Press

Credits

Presenter
Geraldine Doogue
Producer
Kate MacDonald

Comments (10)

Add your comment


  • Ne Obliviscaris :

    12 Apr 2014 8:14:59am

    People read snippets of Adam Smith, the few phrases they teach in school. Everybody reads the first paragraph of The Wealth of Nations where he talks about how wonderful the division of labor is. But not many people get to the point hundreds of pages later, where he says that division of labor will destroy human beings and turn people into creatures as stupid and ignorant as it is possible for a human being to be. And therefore in any civilized society the government is going to have to take some measures to prevent division of labor from proceeding to its limits.

    – Noam Chomsky on Adam Smith and the Wealth of Nations

    Reply Alert moderator


  • david hawcroft :

    12 Apr 2014 10:04:24am

    It took 20years of study to conclude that the rich get richer and the poor get poorer?

    In case there’s anyone doesn’t know it’s an axiom – amongst the poor, who know from bitter experience going back generations.

    Have you ever played Monopoly? The poor simply don’t exist, really. It’s a game between landowners, capitalists. And what happens? The capital finally concentrates in one player.

    Economics 101 : ‘the rational investor will always seek to maximise profit’. Whereas the rational human being seeks to maximise humanity and love of friends and family at the expense of profit.

    So in the end who gets most of which?

    Which calls into question the definition of ‘profit’ which is a concept that should not be confined to money.

    And calls into question the concept of ‘humanity’ which calls into question the concept of ‘civilisation’.

    Clearly our civilisation is being run as though it were a business with economic rationalism the guiding force and monetary profit the great light in the sky.

    All wrong. Needs rethinking. Needs philosophy. Political parties – as said somewhere I think this morning in this segment or somewhere – currently without any philosophy whatever.

    At bottom what’s been lost is humanity.

    You don’t run humanity as a business.

    You don’t measure what profits humans in dollar terms.

    We’re building a machine and populating it with robots – us. Daleks. We’re all becoming Daleks in a Dalek world.

    Are the rich the only ones who can escape this and live human lives free of the economic bondage and the madness of a robot world? No. They are the ones that lost and went under first.

    It is our blindness and stupid belief that they are ‘rich’, ‘succesful’, ‘powerful’, ‘safe’ etc.. etc.. that leads us to wish to emulate them, follow them, be them…

    So we bend to our tasks and forsake our humanity and strive, strive, strive to become like those sorry creatures..

    bloody shame, eh?

    Reply Alert moderator


    • seyre :

      16 Apr 2014 1:59:42pm

      wonderful. YES! well said

      Alert moderator


    • Bob Elliston :

      18 Apr 2014 1:52:35am

      Thanks David.
      You are quite right.
      I’m reminded of Matthew 16:26:
      “For what is a man profited, if he shall gain the whole world, and lose his own soul? Or what shall a man give in exchange for his soul?”
      This dichotomy between the rich and the poor has troubled us for at LEAST two thousand years.
      Time for a new economic system, one that is centred on fairness, justice and sustainability.

      Alert moderator


  • Mike Ballard :

    12 Apr 2014 10:57:48am

    I see no political will on the part of those who appropriate the wealth which the bottom 90% produce to allow their gains to be redistributed through a tax on their accumulated wealth. Furthermore, history has demonstrated that as soon as politicians suggest such a tax change, they are hounded out of office through a flurry of public relations propaganda directed at workers anxious about their job security, just as Kevin Rudd was after he introduced the mining tax.

    Julia Gillard had Rudd’s tax renegotiated by a Labor right-winger, Martin Ferguson, and what was agreed to by the mining capitalists was the toothless tax we still have today; but which shall be axed after the new Tory dominated Senate convenes in July.

    Reply Alert moderator


  • Cedric Beidatsch :

    13 Apr 2014 10:14:59am

    I stress these comments come from the radio interview, not the book, which I have not yet read (or even seen in the stores!) Piketty shows that inequality increases under capitalism as the owners of capital accrue wealth at a greater rate than wage earners. This did not occur in the period 1945 – 1973 when high growth rates were experienced and inequality decreased. Piketty concludes that there is no “logical reason” why inequality should increase like it does and that what “we” need to do is find institutions on a global scale that can for example progressively tax capital to reduce this inequality gap. I have no argument with the statistics that illustrate the growth in inequality; but would suggest that rather than seeing this as a return to some mythical nineteenth century “hierarchical society” this phenomenon is in fact about 500 years old and is inherent in structure of capitalism itself. Piketty simply has had too short a time horizon for his research. If we view capital in a proper historical perspective the 25 years post WWII stand out as an anomaly not a normal to which we can easily return. The explanation for the post war social democratic consensus should then be sought in specific historical circumstances. I would suggest there are the following: 1) the massive destruction of capital in the period 1914 – 1945; 2) the strength and power of working class struggle from 1917 on that put capital on the defensive; 3) the absence of any real competitors to American capital after 1945 until European and Japanese capital rebuilt by ca. 1965; 4) the hyper exploitation of the Third World which does not even get a look in Piketty’s analysis (as far as I can determine anyway). What Piketty overlooks totally is the issue of class and the power of classes. Post 1945 the working class were strong and were able to wring a reformist economic agenda from a capital owning class and via the state, which could be granted because the specific global economic conditions were supportive of a high rate of profit that compensated or progressive taxation in the developed world. The moment that particular combination of historical circumstances came to an end, between 1965 and 1973, the capital owning class went on the offensive to restructure the game. The capitalist class are in the present conjuncture simply way more powerful than the working class and there is no neutral way to impose the kind of institutions that Piketty suggests. Politics is not the realm of dispassionate reason but of class conflict and winner takes all. Piketty’s research and stats will be useful; his proposed remedies a chimera. Without a really strong working class offensive, or the kind of destruction of capital produced by the Great Depression and 2 world wars, the rich just keep getting richer and the rest of us work to make them richer

    Reply Alert moderator


  • Pat :

    13 Apr 2014 4:12:53pm

    US ideologue economists are ‘revered’, unlike in France because they are serving to retail and legitimize cultivated triumphalist neoliberal economic rationalism (engendered via Hayek & in Friedman’s Chicago School lab) now become the only economics, the lingua franca under the global empire of conglomerated corporate capitalism. An elitist and rogue ideology, intentionally dissociated from and privileged above other social sciences. It is a purposefully designed system of exploitation for syphoning real wealth into fewer and fewer hands…..the cultivated “vampire squid” feeding the 1%. It is the functioning machine producing deliberate and massive inequality which runs the corporate empire (“the old industrial military complex”) and which occupies governments of the European “democratic” model via the paradigm of the revolving door between the various Wall Streets and Whitehouses. And globally via the architecture of the World Bank, IMF etc and a dysfunctional UN. The US CEO of this market empire has the NSA and the world’s biggest nuclear arsenal at his disposal. Why would this emperor supreme of crypto-fascism willingly, magnanimously (considering his late 20th century history of covert and overt operations, wars of aggression, assassinations/exercises of soft power etc) hand over this power and share his wealth without a fight after all the trouble he’s gone to in securing it? Koombyeya it won’t be.

    Reply Alert moderator


  • Bryan Kavanagh :

    14 Apr 2014 2:45:39pm

    Good on you, Thomas Piketty! Now we’re getting to the nub of things about how wealth disparities have risen! In your own way, you’re coming to the same conclusion the American philosopher and economist, Henry George, came to in his “Progress and Poverty” – that the returns to labour and capital will always be diminished if rentiers are permitted to steal our publicly-generated rents via untaxed rent-seeking.

    All we need in Australia is an all-in, single rate land tax, as suggested by the Henry Tax Review, because the wealthy own the more valuable land, and it can’t flee overseas. The first country to bring in a serious land tax will be the first country to reward workers and businesses with their fair due, and to redress the problem of economic rents flowing mainly to the 1%.

    Reply Alert moderator


  • Geoff Saunders :

    15 Apr 2014 7:45:17am

    “…precious few solutions, it must be said…”

    Gee. Let me think…oh, how about this one? Rich folks and corporations should pay a bit more tax back to the societies upon whose security, stability, infrastructure and amenity they base their wealth.

    Call me Trotsky…

    Reply Alert moderator


  • Groucho or Karl :

    18 Apr 2014 9:26:40pm

    Wonderful to have such a prominent (and modest) thinker on Aunty.

    Thanks Geraldine.

    Reply Alert moderator

healthy habits, policy, politics

Steve Leeder on the shutting down of ANPHA

 

http://steve-leeder-better-health.blogspot.com.au/2014/05/anpha-lost-in-earthquake.html

Monday, May 5, 2014

ANPHA: LOST IN AN EARTHQUAKE

So. The seismic monitor suggests that ANPHA, the Australian National Preventive Health Agency, established in 2011, is likely to slip into Hades through a crack in the ground as the tectonic plates of the Commission of Audit and the Hockey budget shift and grind.  What a pity.  ANPHA began in 2011. Let’s be clear why it was a good idea, so that when it’s gone (assuming it goes) we can mourn its passing properly.

The major afflictions of our community are conditions such as heart disease. stroke, cancer, depression, and problems of bones and joints.  None of these things are as preventable as whooping cough or polio, but the decline in heart disease in Australia in the past half century is deeply encouraging.  Through a combination of better treatment, less smoking and dietary change we’ve more than halved – considerably more in the case of the under 65s – death rates.  These disorders have a major preventive element in them.

The risks for heart disease are fully described.  They relate closely to what we eat, how much we drink, our physical activity and more.  Yes, these behaviours are ultimately matters of choice: we are, as GW Bush would say, are the deciders.

But we’re not really.  The shopping environment influences what we choose to buy.  The advertising environment powerfully influences our purchases of alcohol.  The economic environment determines where we can afford to live.  Get real. These are shapers, the causes behind the causes.  And we must attend to these things if prevention is to work.

Without legislation, kiss goodbye to tobacco control.  Other countries label foods so that people – not just robots – can work out which are the healthiest.  New York has eliminated trans fats – by legislation from all prepared food.  More broadly in the US, man-made trans fat consumption fell by 600 million tonnes between 2005 and 2012 as Dow and other vegetable oil producers acceded to the expectations and legislative urging of American citizens and govenrnments that they would produce stuff that was health promoting and not damaging.

Set yourself a preventive agenda that seeks to achieve these lifestyle opportunity-promoters and you need strength including at a national level.  Individuals struggle to win these battles.  Groups such as the National Heart Foundation, cancer societies and others have been zealous.  But the thought behind ANPHA was that it could become a counterweight to the big-time, burly avarice that drives health-destroying profiteering.  No wonder the alcohol industry will declare drinks all rounds in celebration when the bulldozers demolish ANPHA!  Bewdy mate, drink up!

The politics of prevention are what made ANPHA so important to our health future and so hated by those who, like the tobacco barons of yore, want free rein to push their wares no matter the health costs.  Get rid of food labelling, they beseech the government!  It infringes our liberty as manufacturers to sell whatever we want.  Think of our civil liberties!  Make health a matter of choice but diminish the capacity of the consumer to choose intelligently! Please, Mr Government, DO it!

Yes, ANPHA could support more research in prevention.  From the perspective of big business research is pretty innocent stuff and usually has little commercial impact.  It’s safe.  But when research is translated into advocacy, that’s when trouble starts. That’s when those driven fundamentally by profit start worrying, and when the political tectonic plates start grinding in response. And advocacy is what a national agency with muscle could do.

So. When ANPHA goes that is what goes with it – the ability for an agency, with clout, to argue for changes that will help ensure a future in which it would be easier to choose to be healthy.  Shame.

health market quality, healthcare, policy, politics, rapid learning health systems

Orthopods come clean on prostheses and care quality… sort of

 

 

Australian Orthopaedic Association research shows best artificial joints

  • SUE DUNLEVY NATIONAL HEALTH REPORTER
  • NEWS CORP AUSTRALIA NETWORK
  • OCTOBER 21, 2013 8:00PM

A model of knee bones and joint. Source: News Limited

HIP and knee replacement joints that are close to foolproof have been identified, in a breakthrough which will help tens of thousands of Australians fitted with dodgy devices.

Faulty joint replacements force 8000 Australians every year back on the operating table, butNational Joint Replacement Registry research has found four devices with lower rates of problems.

Even when novice surgeons implant these devices they have the same risk of needing revision as when an experienced surgeon uses them.

The National Joint Replacement Registry which has been tracking the performance of hip and knee replacements inserted since 1999 has for the first time reported on whether surgeon experience affects the outcome.

While it found surgeons with more than eight years experience had a lower rate of revision operations it found that with some devices surgeon experience did not matter.

The two most commonly used hip replacements – Exeter V40/Trident and Corail/Pinnacle combinations – show no difference in rates of revision regardless of the experience of the surgeon.

With knee replacements there was no difference in the revision rate when comparing surgeon experience for two commonly used LCS/MBT and Nexgen CR Flex/Nexgen combinations.

“We believe this is a very reassuring finding for the public,” Australian Orthopaedic AssociationPresident Peter Choong said.

While he said it was certain that there are many other prostheses that have similar results in the hands of inexperienced and low volume surgeons, the registry did not have sufficient numbers of procedures for these prostheses to undertake the analysis.

More than 800,000 Australians have a joint replacement and each year another 90,000 devices are inserted at a cost of around $1 billion.

But hundreds of thousands of patients have been fitted with dodgy devices that loosen, get infected, erode and have to be replaced, in a hidden medical scandal which has previously been revealed by News Corp.

The National Joint Replacement Registry’s annual report has identified more than 100 hip and knee replacements have higher than average rates of revision.

Of these eight hip and six knee prostheses have been reported for the first time.

Disturbingly 31 devices that have been identified more than once as having high revision rates are still being used by surgeons, the registry reports.

It was important to understand some devices were in the “still used” category because of a time delay in reporting, Dr Choong said.

The registry’s annual report found with hip replacements a head size of 32mm had the lowest rate of revision, while those with smaller head sizes had the highest rate of revision.

Using cement to fix hip replacements reduced revision rates in older age groups but cementless fixation worked better in those younger than age 75.

Having a device that was constructed from cross linked polyethylene also reduced the rate of revision.

With knee replacements the report found unicompartmental knee replacements had a higher rate of revision than primary total knee replacement.

Using a knee replacement constructed from cross-linked polyethylene may reduce rate revision, the report found.

The Australian Othopaedic Association says it is mindful that the better informed patients are – the better the outcome. The AOA has made attempts to make this information more accessible to patients, Dr Choong said.

 

###