Monthly Archives: May 2014

health market quality, healthcare, policy

Specialists gaming medicare

silly, pathetic behaviour…

http://www.abc.net.au/news/2014-05-13/annual-specialist-referrals-wasting-millions-say-gps/5447822

PDF: 223489955-The-response-From-Medicare

Specialists forcing patients back to GP for fresh referrals to charge higher fees: health industry

Specialist doctors could be raking in millions of dollars from Medicare by forcing chronically ill patients back to their GP for a fresh referral each year so they can then charge twice the fee.

An ABC investigation has found evidence of widespread concern in the health industry about the billing practices of some specialists, particularly dermatologists, ophthalmologists and cardiologists.

The Royal Australasian College of Physicians, which represents most specialists in Australia, declined to comment and said the issue of referrals was a matter for Medicare.

The Federal Government would not comment on whether specialist doctors are breaching regulations but there is a general concern in the health industry that the practice of routinely seeking a new referral every 12 months is a waste of money.

Some GPs have spoken out about the issue because they believe it is a misuse of patients’ time and appointments.

Central to their concerns is the practice of specialists refusing to accept ongoing or “indefinite” referrals. Some specialists only accept “standard” referrals, which expire after 12 months.

How it works

Initial attendance (Item 104):
Minimum charge by specialist: $85.55
You get back from Medicare*: $72.75

Subsequent attendance (Item 105):
Minimum charge by specialist: $43.00
You get back from Medicare*: $36.55
* Out of hospital

Initial attendance (surgery or hospital)
Minimum charge: $150.90
You get back from Medicare: $128.30

Subsequent attendance
Minimum charge: $75.50
You get back from Medicare: $64.20

Initial attendance (review and management plan)
Minimum charge: $263.90
You get back from Medicare: $224.35

Subsequent attendance
Minimum charge: $132.10
You get back from Medicare: $112.30

It means when a patient returns after 12 months with a new referral, the specialist can bill for another initial consultation, which is double the price of a subsequent consultation.

Ultimately, the taxpayer is billed three times: the double consultation and the visit back to the GP for the new referral.

In 2012-13, specialists charged Medicare almost $600 million for initial and subsequent visits, so specialists could potentially be reaping millions.

Medicare paid $347 million in initial consultations and $241 million on subsequent visits for the 2012-13 period.

GPs say the specialists are only supposed to ask for fresh referrals when a condition changes.

It has angered them at a time when the Government is considering slugging patients a co-payment to see the GP.

The ABC understands it has been a contentious issue between GPs and specialists for many years since guidelines changed to allow the writing of indefinite referrals.

Doctors speak out

Melbourne GP Owen Harris is part of a busy practice in St Kilda. He gets annoyed when he has written a patient an ongoing referral only to see them back at his desk 12 months later requesting a fresh one.

He says it wastes an appointment other patients could use.

“I think some specialists are being a bit greedy here and billing Medicare rather than following the requirements,” he said.

“It’s a waste of patients’ time, the GP’s time, and certainly Medicare’s money.”

Dr Harris emphasised it was not all specialists but said the practice was widespread, and particularly prevalent at busy city clinics where doctor turnover is high.

“Medicare is a difficult and complex system,” he said.

“Patients can’t possibly understand all the complexities. If they’re told by the clinic you must bring a new referral then they’re simply following that advice without knowing whether or not that’s true.”

Patients can’t possibly understand all the complexities … if they’re told by the clinic you must bring a new referral then they’re simply following that advice without knowing whether or not that’s true.

GP Dr Owen Harris

His concerns have been backed by the Royal Australian College of General Practitioners, who said they were aware of the issue and it was one that needed to be examined.

President Dr Liz Marles says it is common for a melanoma patient to return each year for a referral to a dermatologist for a skin check.

“This is an area that could certainly be explored in terms of increasing efficiency for the patient, the GP and the specialist to make sure we’re getting value for money,” she said.

Dr Marles says some GPs favour 12-month referrals so they can keep track of patients and hear back from specialists.

However she says specialists should be keeping GPs in the loop regardless of referrals.

The Australian Healthcare and Hospitals Association is also concerned given discussions about co-payments.

Chief executive Alison Verhoeven says it is one of the many anomalies in the health system costing money.

“This is an issue of governance,” she said. “It would be helpful if there were better guidelines.”

Patients critical of referral process

Auditor wrong on doctor visits


Fact Check examines Tony Shepherd’s claim that “Australians, on average, go to the doctor now 11 times per year”.

Melbourne man Peter Barton has an eye condition that requires timely treatment when it recurs intermittently.

His specialist has asked that he return to the practice each time it recurs.

“I just don’t understand that at a time when I need to see the specialist, where they want me to see them I’ve got to do this side trip to the GP first,” he said.

“It would be an hour-and-a-half round trip to the GP, on top of the time away at the actual specialist, it almost doubles the time for me to get my eye sorted. It’s frustrating.”

Debate over whether approach breaks the rules

Dr Harris says the Medicare rules are clear and that specialists are breaking them.

“There’s no reason for that to be happening and it isn’t something that should continue,” he said.

But a senior health industry source has told the ABC the laws and guidelines around the referral billing practices are actually quite vague.

“It all depends on the specific interpretation of very general rules,” they said.

“The spirit of the thing is a single course of treatment.”

A spokeswoman for the Department of Human Services did not comment on whether specialists were in breach of rules by refusing to accept indefinite referrals but said they monitor doctors over Medicare billing rates.

“A single course of treatment involves an initial attendance by a specialist and the continuing management [of that condition] until the patient is referred back to the referring practitioner,” she said.

“The issuing of a new referral does not necessarily mean a new course of treatment.”

complex adaptive systems, cool

How we forget – dentate gyrus neurogenesis is the key!

 

http://theconversation.com/neuron-study-helps-explain-why-we-forget-26367

Neuron study helps explain why we forget

Childhood memories seem few and far between – if they still exist at all. So why can’t we dig them up as adults? Rob./Flickr, CC BY-NC

Memories from early childhood are notoriously elusive but why can’t we recall our most formative experiences? New research suggests it could be a case of the old making way for the new – neurons, that is.

A study, published today in Science, has found that neurogenesis – the generation of new neurons – regulates forgetting in adulthood and infancy and could significantly contribute to the phenomenon of “infantile amnesia”.

Throughout life, new neurons are continually generated in the dentate gyrus, part of the brain’s hippocampus. This is one of only two areas in the mammalian brain that consistently generates neurons after infancy, aiding the formation of new memories of places and events.

These new neurons compete for established neuronal connections, altering pre-existing ones. By squeezing their way into these networks, new neurons disrupt old memories, leading to their degradation and thus contributing to forgetting.

Neurogenesis is particularly rampant in humans during infancy but declines dramatically with age. So researchers hypothesised that this increased disruption to hippocampal memories during childhood renders them inaccessible in adulthood.

Rodent recollections

To investigate the correlation between neurogenesis and forgetting, a team from the University of Toronto conducted a series of tests on mice, guinea pigs and a type of small rodent called degus.

First, a group of infant and adult mice were trained to fear a certain environment through the use of mild electric foot shocks.

Some of the adult mice were then provided access to running wheels, an activity that has been shown to boost neurogenesis. When returned to the initial environment, the adult mice who used the running wheels had largely forgotten their fear of the electric shocks, while those without the wheels maintained an association between the space and fear.

From the group of infant mice a number were given drugs to slow the rate of neurogenesis to see if decreasing the generation of new neurons mitigated the forgetting normally observed in infant mice. In accordance with the researchers’ hypothesis, the ability of these animals to retain memories improved in comparison to their untreated counterparts.

The study was then moved to rodents whose infancy period distinctly differs from mice – and humans – guinea pigs and degus. These rodents have a shorter postnatal hippocampal neurogenesis because they are more neurologically mature at birth. That means they have extended memory retention as infants so those animals were given drugs to artificially increase neurogenesis – which resulted in forgetting.

Psychologist Dr Amy Reichelt, from the University of New South Wales, said it was good the study used infant guinea pigs and degus.

“These animals are born in a ‘precocious’ way – they are basically miniature adults – able to run about independently, as opposed to mice, rats and humans who are vulnerable and dependent at birth,” she said.

“In young animals where neurogenesis is at a high level, memory circuits are constantly changing, so this supports that certain memories are ‘pruned’ out and thus forgotten – supporting the notion of infantile amnesia.”

How could you forget?

Previous studies have examined the relationship between hippocampal neurogenesis and memory, with a focus on its importance in the consolidation of memories in adult animals. But they have not considered how neurogenesis can also jeopardise memory retention.

Behavioural psychologist Dr Jee Hyun Kim, Head of the Developmental Psychobiology Lab at Melbourne’s Florey Institute of Neuroscience and Mental Health, said: “It has long been speculated that the ‘immaturity’ of the hippocampus may be responsible for infantile amnesia. Back in the days ‘immaturity’ was interpreted as dysfunctional, or low in function.

“However, recent studies speculated that immaturity can also occur in the form of hyper functionality. This study shows that the extreme plastic nature of our brains early in life can be the reason why we forget quickly episodic memories happening early in life.”

Infantile amnesia is not restricted to hippocampus-dependent memories in humans and animals. Dr Kim said it was likely that neurogenesis formed only a part of the story.

“I wouldn’t be surprised if we find undiscovered neurogenesis in other parts of the brain,” she said.

A spotless mind

But does this research hint at ways of improving memory retention in the future?

“It would not be feasible to discourage neurogenesis and reduce forgetting of existing memories,” Dr Kim said, “as adult neurogenesis has a well-established link to depression (low neurogenesis means high depression)”.

Surprisingly, it’s the other side of the coin that promises more potential opportunities. Harnessing neurogenesis to destabilise pre-existent memories could have its own benefits. Dr Kim said depressed or anxious people may want to forget and focus on creating better memories and/or thought patterns.

This can be especially constructive for children who experience trauma in early life, Dr Reichelt said.

“Increasing neurogenesis could be a useful therapy to treat or prevent the onset of post-traumatic stress disorder,” she said.

healthy habits, nutrition, quantified self, rapid learning health systems

PACT – tool to motivate exercise

Larger fines fund smaller rewards. Perfect!

http://www.medicalobserver.com.au/news/money-a-motivator-in-exercise-app

Money a motivator in exercise app

6th May 2014

Dr Rosemary Atkinson   all articles by this author

PACT is a good tool to recommend to the techno-savvy patient needing motivation to get out and moving.

Created by a pair of Harvard students, it purports to help 92% of users live a healthier life by using money as a motivator.

Pact requires users to set the number of exercise sessions they will complete in the coming week. They then agree to a fine ($5–50) for every session they miss. Those who meet their goals are rewarded by receiving money paid by those who fail (25–60 cents per workout).

In order to verify that the exercise is being done, visits are logged at a gym via GPS check through the app, or for physical activity outside of a gym by measuring activity with a ‘motion tracker’, or in conjunction with partner apps such as Run-Keeper, Fitbit, Jawbone Up, MapMyRun or MyFitnessPal.

Users can access the number of workouts completed and money earned via the profile page. The settings screen allows you to set and modify your workouts for the next week, withdraw rewards and schedule a break.

Pact uses a carrot and stick approach to promote positive behaviour change and although the monetary reward is small, it may be enough to provide motivation for at least a proportion of patients.

App: Pact

Cost: Free 

Compatibility: iPhone, iPod touch, iPad

Requirements: iOS 6.0 or later

Registration required: Yes 

The verdict: 3 stars

1=optional 2=useful 3=recommended 4=must have

iTunes: https://itunes.apple.com/au/app/pact-earn-cash-for-living/id456068701?mt=8

facts & data points, health market quality, healthcare, policy, politics, rapid learning health systems

Anne-marie lays down the case in The Conversation

 

 

http://theconversation.com/the-state-of-australia-health-25920

The state of Australia: health

We’re unlikely to solve persistent challenges to the health system, such as ensuring equitable access to well-coordinated care, with quick fixes. AAP Image/Quentin Jones

In the lead-up to the budget, the story of crisis has been hammered home, but there’s more to a country than its structural deficit. So how is Australia doing overall? In this special series, ten writers take a broader look at the State of Australia; our health, wealth, education, culture, environment, well-being and international standing.

In the lead up to this year’s federal budget, the government has been telling us short-term budget pain is needed to secure our long-term economic future.

The release of the National Commission of Audit report last week reinforced the government’s message that we need to do something more than tinker around the edges to get our economy back into shape.

But is Australia’s health system so bad it needs some kind of shock therapy to ensure it meets our future needs?

How are we doing now?

In 2011-12, Australia spent 9.5% of GDP on health, just higher than the OECD average of 9.3%. Twenty years ago, Australia spent 7.1% of GDP on health, which was about the OECD average. These figures somewhat undermine the argument that we have a crisis in health spending.

When you take a look at the headline indicator for health status, life expectancy, Australians are doing fairly well by global standards. In 2011, the average life expectancy for all Australians was 82 years, making us the seventh longest-living people among OECD nations.

There are some concerns, however, that we might not be living such long lives in the future. In 2011, Australians drank a little more alcohol than the OECD average (ten versus 9.3 litres per person per year). And we’re also a lot fatter: 21% of the population report being obese, compared with an OECD average of 15%.

While these indicators and global comparisons are useful high-level measures of our health system’s effectiveness, we need to get beyond averages to find the true picture.

 

More Australians are obese than the OECD average. Olivier Le Moal/Shutterstock

 

Most people know – whether from personal experience or just watching the news – that our health system does not serve us all equally well. Some people cannot get access to essential health care, such as pharmaceuticals, general practitioners or dentists, when they need it simply because of cost.

Other people, especially those living in rural and remote areas, struggle to get access to services close to home.

And with some types of elective surgery and cancer services now predominately done in private hospitals, people without private health insurance can find themselves waiting for an excessively long time for treatment.

If the care you get depends to some extent on where you live, what you earn or whether or not you have private insurance, we have a problem with equitable access to care. And it’s a serious one too because there is strong evidence showing the people in most need of health care are the ones least able to afford it.

Getting timely access to care is one thing, but the quality of it matters too. In aninternational survey by the Commonwealth Fund, Australia’s performance was patchy on a series of quality measures.

When compared with seven other developed countries (including the United States, United Kingdom and New Zealand), Australia ranked sixth overall on a series measures looking at medical errors.

We ranked fourth on how well care was coordinated between different health professionals and third on how well care was centred around patient’s needs and preferences.

How we got here – past reforms

Medicare is the foundation of the Australian health system. The scheme, now 30 years old, is funded partly through our progressive tax system, and this is one of the key reasons our health system is considered to be relatively equitable. While Medicare has served us well, the time is right to consider reforms.

Medicare was originally developed to help people get access to basic medical and hospital care; in the 1960s when the scheme was conceived, most people suffered from relatively straightforward acute health conditions (infections, for instance, and traumatic injuries). Treatment from GPs, medical specialists and public hospitals was often all people needed to be cured.

Now, with more than seven million Australians having at least one chronic disease, people’s health needs are more complex. For some, a basic level of care might mean being treated by a GP, physiotherapist, dietitian, occupational therapist and an array of medical specialists. Medicare now funds a limited range of non-medical services, but much of what people need still falls outside its scope.

 

Australia’s 30-year-old Medicare system needs reform. AAP Image/Dave Hunt MEDICARE

 

Medicare also works on an insurance model, with patients reimbursed for each visit to the doctor, and doctors paid largely on a fee-for-service basis. This model works reasonably well for one-off visits to the GP, but provides few incentives for health-care providers to work co-operatively and ensure patients receive coordinated care.

Over the last 20 years or so, federal and state governments have tried many different ways of improving the coordination of care. Some focused on reforms to financing health care, for example, the coordinated care trials of the 1990s.

Others have tried to improve coordination by making changes to the governance of the health system at the local level – the more recent establishment of Medicare Locals is an example.

In some areas, the long struggle to improve the coordination of care is starting to pay off, but these successes have yet to be replicated cross the country.

What’s next?

The National Commission of Audit report recommended some major changes to the structure and operation of our health system, and a 12-month period to review some of the proposals it outlined. But before the government looks at them in any detail, it’s important to recognise the limits of what Medicare, or any health system, can do to improve the length and quality of people’s lives.

It is well established that health services are just one of many factors that influence health outcomes. Other important determinants of health include the social, economic and physical environment, and people’s individual characteristics and behaviours. To improve the health of Australians, governments will also need to make gains in some of these other areas that determine health outcomes.

Health systems, however, do have an influence on health outcomes. A large study of 136 countries found that there was a correlation between rates of death and certain health system variables. Countries with more doctors, lower out-of-pocket costs, and higher total expenditure, for example, had lower premature death rates at the national level.

 

When you take a look at the headline indicator for health status, life expectancy, Australians are doing fairly well. Mercy Health/Flickr, CC BY-NC-ND

 

While this study includes many less wealthy countries than Australia, it shows that the design and operation of our health system does matter, even to headline indicators such as mortality.

The Australian health system clearly has some problems that need to be addressed, but they are long-standing ones, and ones shared by most other OECD countries.

We are unlikely to solve persistent challenges, such as ensuring equitable access to well-coordinated care, with quick fixes (we have tried most of them before). Nor are they likely to be solved by reforms naïvely borne out of economic theory, or imported holus bolus from other countries.

To improve Australia’s health system, we need to carefully consider a range of reforms and evaluate their potential to solve the most important problems we face (and this is not overall health expenditure).

If we don’t, we will simply add to the growing pile of overly ambitious reform proposals that have fallen by the wayside and made no difference at all.

health market quality, healthcare, healthy habits, management and leadership, policy, politics, rapid learning health systems

Polypill Barriers

 

https://www.mja.com.au/insight/2014/16/polypill-barriers-remain

Polypill barriers remain

Nicole MacKee
Monday, 12 May, 2014
Polypill barriers remain

BARRIERS to the global availability of a polypill to prevent cardiovascular disease remain despite growing evidence of its clinical potential, according to former BMJ editor and long-term advocate of the polypill, Dr Richard Smith.

Dr Smith, who was in Melbourne last week to attend the Cardiovascular Combination Pharmacotherapy Global Summit, in conjunction with World Congress on Cardiology, said momentum was starting to gather with growing evidence of increased adherence and clinical benefit with the polypill — a fixed-dose combination of commonly used blood pressure and cholesterol-lowering medications, and aspirin.

“But in terms of actually getting it made available to lots of people, the progress is fairly slow because, although the big drug companies are the people who know how to get a drug on the market, they’re generally not interested”, Dr Smith told MJA InSight.

Dr Smith, director of the Ovations Chronic Disease Initiative, welcomed findings from the Single Pill to Avert Cardiovascular Events (SPACE) project that showed the polypill was associated with a 43% boost in patient adherence to medication at 12 months. (1) (2)

“That’s tremendously dramatic”, he said, of the research that was presented at the cardiology congress. “Generally, if you have people taking treatment for life … after a year [of starting therapy], you’ve only got about 50%̄60% of people [still] taking the treatment, so anything that can increase adherence is really important.”

The SPACE project, led by researchers from the George Institute for Global Health, analysed data from three clinical trials involving 3140 patients, including the Kanyini-GAP trial in Australia. (3)

Dr Ruth Webster, of the George Institute, said the polypill’s capacity to prevent cardiovascular events was “potentially massive”.

“In Australia, 50% of people who should be taking these combination medications don’t take them”, she said. “Globally at least 90% of people in lower income countries who would potentially benefit from these medications are not taking them.”

Dr Webster said the affordability of the polypill could ensure that its benefits were felt in low- as well as high-income nations.

“One of the key aims of the polypill has always been … to make it cheap so that patients can afford it”, said Dr Webster, adding that governments and health care organisations could use their buying power to ensure a cheap and effective pill was available globally.

Although a polypill is available in some Latin American and Asian countries, the UK, the US and Australia do not yet have one on the market.

Dr Webster said the George Institute was actively involved in efforts to have a polypill made available in Australia.

Dr Smith said that Iran was trialling providing the polypill to everyone over the age of 50 years who had at least one risk factor for cardiovascular disease. “The future is going to come not from Australia or Britain or the US, but from these kinds of countries, where … there’s much more to gain … as there are many people not being treated [at all]”, he said.

In addition to regulatory hurdles, cardiologists were also a barrier to polypill development, said Dr Smith, who recently wrote about the key barriers to polypill uptake in his BMJ blog. (4)

“[Cardiologists] think … that constantly titrating the drugs you give people, measuring their blood pressure regularly and their lipids … is a better way of doing things. But the problem is that we have this famous rule of halves — of all of the people at risk, half are not diagnosed; and of the half that are diagnosed, half are not treated; and the half that are treated, are not treated adequately”, he said. “So you end up with a very high proportion of people who are at risk who are not getting good treatment.

“The strongest argument for the polypill is how bad things are at the moment. Not just in low- and middle-income countries where, on the whole, they are terrible, but also in high-income countries because a lot of people are not getting adequate treatment.”

Dr Smith said the polypill had also faced opposition from public health experts concerned that giving people such a pill would discourage improvements in lifestyle and diet.

“But I think that’s a myth that’s been laid to rest because in three trials that have looked at lifestyle, people on the polypill don’t get fatter, they don’t smoke more, they don’t eat unhealthier diets”, he said.

1. Nature 2007; 450: 494-496
2. George Institute for Global Health: SPACE Project
3. BMC Public Health 2010; Online 5 August
4. BMJ Blogs 2014; Online 1 May

 

health market quality, healthcare, healthy habits, management and leadership, policy, politics, quotes & aphorisms, rapid learning health systems

Peter Baume on Money in Medicine

Former senator, doctor and colleague, Professor Peter Baume, used to say that:

“matters of principle usually turned out in politics to be matters of money, while matters of high principle usually turned out to be matters of lots of money.”

He could have been talking about matters of health policy.

Quoted by Steve Leeder

https://www.mja.com.au/insight/2014/16/stephen-leeder-policy-means-people

 

Stephen Leeder: Policy means people

Stephen Leeder
Monday, 12 May, 2014
Steve Leeder

SHOULD we pay more from our pockets for health care and less from the public purse?

What current institutions in health can we do without? Should prevention be a major concern of government or should it be left to the individual?

These questions should be addressed by a national government elected to oversee — among many things — the health of the nation.

Much health care in Australia is paid for from taxes. A long history explains why this is so, much of it expressing humane concern for people who are sick and assuring access to care for those who are not so well off financially.

Our politicians have choices — they can leave the health system as it is or they can try to change it by changing the underpinning policy. In seeking to make change they inevitably provoke the interest of those who stand to lose or gain as a result — doctors, nurses, patients, managers, insurers, pharmaceutical companies and many others.

So, whether they leave the system mostly in place and merely fiddle, or propose branch and root changes, politicians are engaging in policy decisions whether they recognise it or not (policy in this case being deciding how to apply resources available for health care).

These policy decisions affect people’s lives and are not trivial. For example, increasing theprivatisation of health care, as has been proposed in Queensland, carries costs for those least able to pay.

The more privatised the system, the less the needs of the poor and the marginal are met. This in turn means that society is changed and the values that it expresses — a fair go for all and concern for the weak — are hammered in the promotion of profit.

The results of a two-tiered health system are rapid access to quality care for the rich, who pay privately, and inferior care with long waiting times for the poor through a publicly funded safety net, a system well known in less developed countries.

Because it involves money, the health policy debate occurs in the context of other public policy discussions, most notably those that have to do with the Budget. Former senator, doctor and colleague, Professor Peter Baume, used to say that matters of principle usually turned out in politics to be matters of money, while matters of high principle usually turned out to be matters oflots of money. He could have been talking about matters of health policy.

As the word implies, policy has to do with the polis — the people. In a democracy the people expect their voices will be heard, alongside those of experts in health, the financial controllers and other interest groups. They also expect that changes to the system are canvassed with them before being announced and that they have a chance to have their say.

Optimally, a competitive, comprehensive statement of intent for health care would be provided by contestants for our vote at each election. This did not happen at the last federal election and we have not been canvassed about proposed changes.

Instead we have been bombarded in the past few weeks by government and the media about proposed cuts in tomorrow’s federal Budget, rumours of extinctions (eg, the Australian National Preventive Health Agency and Medicare Locals), increased costs to visit GPs and nothing much about our public hospital system.

It would be healthy if tomorrow’s Budget acknowledged the need for people-based health policy.

We should be presented with options that emanate from clear-headed policy thinking as well as a sound budget. The publication recently of the National Commission of Audit report is not reassuring. It focuses heavily on the supply side of the cost equation for health care but does not provide any insights into what can be done to achieve real efficiency through structural change. Instead, we just hear about rising charges through copayments and by forcing high-income earners out of Medicare and into private insurance schemes.

How to achieve more efficient (and generally more effective) care is left unconsidered. For example, in the Western Sydney Local Health District in the past 2 years, we have cut millions of dollars from our recurrent budget with an 8% increase in activity by attending to contracting, procurement and not using expensive part-time staffing from a budget of a mere $2.4 billion.

Let’s have less haste and hysteria, and more speed towards an efficient and humane health system, thank you.

 

Professor Stephen Leeder is the editor-in-chief of the MJA and professor of public health and community medicine at the University of Sydney. He chairs the Western Sydney Local Health District Board.

complex adaptive systems, cool, storytelling

LNL: The Reading Brain – Proust and the Squid

 

 

http://www.abc.net.au/radionational/programs/latenightlive/the-reading-brain/3276794

The reading brain

Wednesday 2 April 2008 10:40PM

The development of reading brought radical changes to the functioning of the human brain, as well as to the evolution of human society.

What does our move into a digital and visual culture mean for the brain and its capacity for transformation?

Guests

Maryanne Wolf
Professor of Child Development and Director of the Center for Reading and Language Development at Tufts University, Boston.

Publications

Title
Proust and the Squid: The Story and Science of the Reading Brain
Author
Maryann Wolf
Publisher
Harper Collins
Title
Proust and the Squid: The Story and Science of the Reading Brain
Author
Maryanne Wolf
Publisher
HarperCollins

Credits

Researcher
Sarah Kanowski
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

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