Friday, February 28, 2014

HOMEWARD BOUND

                                                  HOMEWARD BOUND

I used to dream about escaping my ordinary life, but my life was never ordinary. I had simply failed to notice how extraordinary it was. Likewise, I never imagined that home might be something I would miss.

Homeward Bound is the thing that enables you to see how all the dots in your life are connected, how one decision leads you to another, how one twist of fate, good or bad, brings you to a door that later takes you to another door, which aided by several detours, long hallways and unforeseen events, eventually puts you in the place you are now.

Homeward bound is in the mind, we can never go back as much as we would like to, life goes on. Draw from that experience, the good things to make this life for ourselves and that of our children's better.

We yearn to travel, go to other amazing, magical places, smell the greener pastures of far away lands.

But homeward bound is also a source of comfort when we have been away too long. 

Tuesday, February 18, 2014

I WAS FEELING SO BAD-SO I ASKED THE FAMILY DOCTOR JUST WHAT I HAD

                                           GOOD LOVING-THE RASCALS
                                           
As the Young Rascals song goes :  
I was feelin' so bad
I asked my family doctor just what I had
I said, "Doctor, Mr. M.D."
"Now can you tell me what's ailin' me
He said, "Yeah, yeah, yeah, yeah, yeah"
(Yeah, yeah, yeah, yeah, yeah)
Yes, indeed
All I, I really need
Is Good loving'

The report card on US health is not so good.  Good loving won't help us. We aren’t heading in the right direction, and everyone involved knows that it’s because of a failure to accept the truth.


A mega-group of health researchers (who call themselves the US Burden of Disease Collaborators) published an exhaustive report detailing the health of this nation. (The actual study is available (free) at JAMA. Ron Winslow from the WSJ has this excellent summary.)

The bad news is really bad.

We fell to 35th place, down from 20th in1990. Imagine: the United States of America, with all the fury of its health care on demand, the stents, the ICDs, the chemo, the brand-name medicines, the fish oil, the vitamins, and all that, grabs 35th place.

List by the World Health Organization (2013)

Overall
rank [4]
Country Overall life
expectancy
Male life
expectancy
Male
rank
Female life
expectancy
Female
rank
1  Monaco 86.5 83 - 90 -
2  Japan 84.6 82 - 87.2 -
3  Andorra 84.2 80.8 - 87.6 -
4  Singapore 84 82 - 87 -
5  Hong Kong 83.8 82 - 85.6 -
6  San Marino 83.5 82 - 85 -
7  Iceland 83.3 81.4 - 85.2 -
8  Italy 83.1 80.4 - 85.8 -
9  Australia 83 80.5 - 85.5 -
10  Sweden 83 81.4 - 84.6 -
11   Switzerland 82.8 80.4 - 85.4 -
12  Canada 82.5 80.4 - 84.6 -
13  France 82.3 79.4 - 85.2 -
14  Israel 82.1 80.2 - 84 -
15  Spain 82 79 - 85 -
16  Luxembourg 82 79.5 - 84.5 -
17  Norway 81.9 80.2 - 83.6 -
18  New Zealand 81.7 79.4 - 84 -
19  Austria 81.5 78.5 - 84.5 15
20  Netherlands 81.5 79.5 - 83.5 -
21  Ireland 81.4 79.2 - 83.6 -
22  Cyprus 81.2 79.1 - 84.3 -
23  Finland 81 78 - 84 -
24  Germany 81 78.5 - 83.5 26
25  Greece 81 78 - 84 21
26  South Korea 81 77.5 - 84.5 16
27  Malta 81 79.4 - 82.6 31
28  Belgium 81 78.5 - 83.5 27
29  United Kingdom 81 79.5 - 82.5 -
30  Liechtenstein 80.7 77.8 - 83.6 -
31  Taiwan 80.6 78 - 83.2 -
32  Portugal 80 77 - 83 -
33  Slovenia 80 77 - 83 -
34  Costa Rica 79.8 78.3 - 81.3 -
35  United States 79.8 77.4 - 82.2 -
36  Chile 79.5 76.5 - 82.5 -
37  Denmark 79.5 77 - 82 -
38  Cuba 79.4 77.4 - 81.4 -
40  United Arab Emirates 79.2 77.2 - 81.2 -
41  Brunei 79 77.5 - 80.5 -
42  Barbados 78.5 76.2 - 80.8 -
43  Kuwait 78.2 75.5 - 80.5 -
44  Czech Republic 78 75 - 81 -
45  Panama 77.8 74.6 - 81 -
46  Poland 77 72.5 - 81.5 -
47  Croatia 77.5 74.5 - 80.5 -
48  Dominica 77.5 75 - 80 -
49  Uruguay 77.3 74.2 - 80.4 -
50  Mexico 77.2 74.2 - 80.2 -
51  Maldives 77.2 76.2 - 78.2 -
52  Bahrain 77 75 - 79 -
53  Belize 76.9 74.4 - 79.4 -
54  Slovakia 76.8 73.4 - 80.2 -
55  Bahamas 76.5 73.5 - 79.5 -
56  Grenada 76.5 73 - 80 -
57  Brazil 76.2 72.6 - 79.8 -
58  Estonia 76.1 71 - 81.2 -
59  Ecuador 76 73 - 79 -
60  Argentina 76 73 - 79 -
61  Saint Vincent and the Grenadines 76 73 - 79 -
62  Oman 76 73 - 79 -
63  Bosnia and Herzegovina 76 74 - 78 -
64  Lithuania 75.9 70.8 - 81 -
65  Antigua and Barbuda 75.8 74.4 - 77.2 -
66  Malaysia 75.7 72.2 - 79.2 -
67  Saint Lucia 75.5 71.5 - 79.5 -
68  Qatar 75.5 73 - 78 -
69  Mauritius 75.2 71 - 79.4 -
70  Saint Kitts and Nevis 75.1 72.2 - 78 -
71  Vietnam 75 73 - 77 -
72  Hungary 75 71 - 79 -
73  Venezuela 75 71.5 - 78.5 -
74  Macedonia 75 73 - 77 -
75  Syria 75 72 - 78 -
76  Thailand 74.9 71.4 - 78.4 -
77  Trinidad and Tobago 70.8 66.5 - 75.8 -
78  Seychelles 74.7 71 - 78.4 -
79  Sri Lanka 74.7 71.4 - 78 -
80  Paraguay 74.7 71.6 - 77.8 -
80  Peru 74.7 71.6 - 77.8 -
81  El Salvador 74.6 70.8 - 78.4 -
82  Jordan 74.6 72.4 - 76.8 -
83  Colombia 74.6 72.4 - 76.8 -
84  Tonga 74.5 73 - 76 -
85  Cape Verde 74.5 70.6 - 78.4 -
86  Latvia 74.5 69.5 - 78.5 -
87  Nicaragua 74.5 71.5 - 77.5 -
88  Libya 74.5 71 - 78 -
89  Georgia 74.5 70.2 - 78.8 -
90  Tunisia 74.5 72.5 - 76.5 -
91  Montenegro 74.5 71.5 - 77.5 -
92  Bulgaria 74.5 71 - 78 -
93  Suriname 74.5 72 - 77 -
94  Turkey 74.4 72.4 - 76.4 -
95  Armenia 74.4 70.6 - 78.2 -
96  Saudi Arabia 74.3 72.4 - 76.2 -
97  China 74.2 72 - 76.4 -
98  Samoa 74 71 - 77 -
99  Lebanon 74 72.5 - 76.5 -
100  Palau 74 70 - 78 -
101  Romania 74 70 - 78 -
102  Honduras 74 72 - 76 -
103  Albania 74 72 - 76 -
104  Serbia 74 71 - 77 -
105  Jamaica 74.8 71.5 - 78.2 -
106  Iran 73.5 72 - 75 -
107  Marshall Islands 73.5 69 - 75 -
108  Algeria 73.3 71.8 - 74.8 -
109  Egypt 73.2 71.2 - 75.2 -
110  Dominican Republic 73.2 72 - 74.4 -
111  Fiji 73 70 - 76 -
112  Philippines 73 70 - 76 -
113  Solomon Islands 73 71 - 75 -
114  Nauru 73 70 - 76 -
115  Morocco 73 71 - 75 -
116  Belarus 72.5 68.5 - 77.5 -
117  Indonesia 72 68 - 76 -
118  Sao Tome and Principe 72 68 - 76 -
119  Vanuatu 72 71 - 74 -
120  Azerbaijan 71.5 69.5 - 74.5 -
121  Guatemala 71.5 68 - 75 -
122  Ukraine 71 65.5 - 76.5 -
123  Moldova 71 67 - 75 -
124  Russia 70 64 - 76 -
125  Bhutan 70.8 69.2 - 72.4 -
126  Guyana 70.5 67.5 - 73.5 -
127  Micronesia 70 68 - 72 -
128  India 70 67 - 73 -
129  Bangladesh 70 69.5 - 70.5 -
130  Kyrgyzstan 69 65 - 72 -
131  Iraq 69 65 - 72 -
132  North Korea 69 66 - 72 -
133    Nepal 69 68 - 70 -
134  Mongolia 69 65 - 73 -
135  Bolivia 69 67 - 71 -
136  Uzbekistan 68.5 66 - 71 -
137  Laos 68 66.5 - 69.5 -
138  Myanmar 68 66 - 70 -
139  Kazakhstan 68 63 - 73 -
140  Comoros 68 65 - 71 -
141  Kiribati 68 65 - 71 -
142  Tajikistan 68 67 - 69 -
143  Papua New Guinea 67.5 65 - 69 -
144  Namibia 67.2 66.2 - 68.2 -
145  Pakistan 67 66 - 68 -
146  Turkmenistan 66.5 63 - 70 -
147  Cambodia 66 64 - 68 -
148  Ghana 66 64 - 68 -
149  Madagascar 66 65 - 68 -
150  Botswana 66 64.5 - 67.5 -
151  Gabon 64 62 - 66 -
152  Yemen 64 63 - 66 -
153  Timor-Leste 64 63 - 65 -
154  Senegal 64 62 - 66 -
155  Haiti 63 62 - 64 -
156  Sudan 62 60 - 64 -
157  Eritrea 61.5 59 - 64 -
158  Cameroon 61.5 59 - 64 -
159  South Africa 61 59 - 63 -
160  Djibouti 61 59 - 64 -
161  Ethiopia 60.5 59 - 62 -
162  Kenya 60 59 - 61 -
163  Rwanda 60 59 - 61 -
164  Afghanistan 60 59 - 61 -
165  Mauritania 59.5 57 - 61 -
166  Liberia 59 58 - 60 -
167  Tanzania 59 58 - 61 -
168  Benin 59 58 - 60 -
169  Gambia 59 57.5 - 60.5 -
170  Malawi 58 57.5 - 58.5 -
171  Republic of the Congo 58 57 - 59 -
172  Togo 57 55.5 - 58.5 -
173  Burkina Faso 56.5 54 - 57 -
174  Côte d'Ivoire 56.5 55 - 58 -
175  Uganda 56 54.5 - 57.5 -
176  Niger 56 55 - 57 -
177  Zambia 55.5 54 - 56 -
178  Guinea 55 54 - 56 -
179  Equatorial Guinea 54 53 - 55 -
180  Zimbabwe 54 53 - 55 -
181  Burundi 53 52 - 54 -
182  Nigeria 53 52 - 54 -
183  Mozambique 52.5 52 - 53 -
184  Angola 52 51 - 53 -
185  Chad 51 50.5 - 53.5 -
186  Mali 51 50 - 53 -
187  Lesotho 51 50 - 52 -
188  Guinea Bissau 50 48 - 52 -
189  Swaziland 50 49 - 51 -
190  Somalia 50 48 - 52 -
191  Democratic Republic of the Congo 49.5 48 - 51 -
192  Central African Republic 48.5 47 - 50 -
193  Sierra Leone 47.5 47 - 48 -

The chart above becomes even more troubling when one examines a report that the Institute of Health Metrics and Evaluation at the University of Washington released in July 2013. That study broke down life expectancy for men and women in different parts of the U.S., showing a strong correlation between income levels and longevity.

The report found that life expectancy is 81.6 for males and 84.5 for females in Fairfax County, Virginia (a very affluent area) and 81.4 for males and 85.0 for females in Marin County, California (another upscale area) compared to only 63.9 for males and 72.9 for females in McDowell County, West Virginia or 66.7 for males and 73.3 for females in Tunica County, Mississippi.

The fact that males in McDowell County are, on average, dying 18 years younger than males in Fairfax County or Marin County speaks volumes about inequality in the U.S.

That type of disparity is more typical of a developing country than a developed country. Yet when one compares life expectancy in McDowell County to life expectancy in Guatemala, one of Latin America’s poorest countries, Guatemalans come out slightly ahead. WHO has reported an overall life expectancy of 69 for Guatemala (66 for men, 73 for women).

So in other words, the poor in Guatemala are outliving the poor in McDowell County. In fact, McDowell County is only slightly ahead of Haiti, Ghana and Papua New Guinea when it comes to life expectancy for males: according to WHO, life expectancy for males is 62 in those three countries.

Although women, as a rule, are outliving men in many parts of the world, a report that was conducted by researchers David Kendig and Erika Cheng for the University of Wisconsin and released in March 2013 showed that life expectancy is decreasing among women in about 43% of the counties in the U.S. and many of those counties are in Southern states (Kendig and Cheng’s findings were published in the journal Health Affairs).

Then, in July 2013, a report from University of Wisconsin researcher Chris Murray found that between 1985-2010, female life expectancy had decreased or stagnated in 45% of U.S. counties.

And it gets worse.

On the upside, overall life expectancy in the US increased 4.8 years, from age 75 in 1990 to age 79.8 in 2013.

We spend annually almost 20% of our GDP (Gross Domestic Product) on health care and we get 4.8 years over a period of 23 years. That’s it.

These 4.8 extra years actually fell far behind the gains in overall life expectancy of numerous other Countries during the same period of 2013 compared to 1990.

The 4.8 added years of life are not always good ones. We may live longer, but the gap between healthy years and years with chronic disability changed little over the past two decade

How in the world did this happen?

The report tells us what we all know:

It begins with our dysfunctional medical system that refuses to make the necessary changes in the ways that medical care is dispensed.

It started with the big lie that we supposedly have the best medical system in the world because we spend (waste) the most money in maintaining this often dysfunctional network of health care.

It then morphed into the robot, android current managed care practice of modern medicine where an assembly line of patients get their 5 minutes of time to be assessed, undressed, dressed, and then literally pushed out the door.

 Sure there are those rare medical professionals still around to take the time to listen, allow you as the patient to share in your medical care decision making, and when everything else fails, they will honestly tell you that they "don't know what is wrong with you".  They are almost as rare as dinosaurs to find, so if you have one, hold onto them for dear life.

In addition, increasing alarming rates of chronic disability are on the rise.

The term for the gap between living well and living with disability is compression of morbidity. To compress morbidity means to shorten the time between onset of illness and death. The ideal is to live well into our ninth (or tenth) decade and then take a nap and not wake up. That’s complete compression of morbidity.

We aren’t accomplishing this at all. Despite all of our health care fury, or perhaps because of it, we are accumulating years without compressing the time of disability.

Death may come later, but disability comes earlier. Not a win, clearly.

If you care about health and helping people live better lives, this sort of data presents a real dilemma.

Most of what Doctors treat is acquired illness. People don’t have to have it. Take high blood pressure: we treat it with medicines, but the majority of patients could treat high blood pressure with relatively simple lifestyle and diet choices.

It’s the same with diabetes, sleep apnea and a host of other chronic diseases.

Perhaps an even more obvious example of preventable disability is the issue of skeletal disease.

The JAMA report documents bone and joint disease as a leading cause of disability. This lies at the core of the problem: our society’s richness, our automation, our technology, our damn inactivity, opposes our basic biology.

The human body needs to be fed well, used often and rested regularly.

Both society and health professionals need to balance sick care with health care. Right now, we aren’t even close.

Confession time: I am just as guilty in not practicing  above what I should be doing along with everyone else. So count me in with the rest of those who spend too much time not taking good care of our body and mind.

U.S. patients expect sick care, and U.S. doctors find it easy to deliver.

Patients are generally not proactive about their health care and are often passive. They place the medical community on a "god like" pedestal and expect a magic pill, easy answers for their medical issues.

Many in the health care field feed off this ego boosting sense that they possess the power of life and death, health and sickness, wave their magic wand and all will be well.

Of course from time to time most of us benefit from sick care, but we all know that comprehensive good health ultimately depends on consistently stringing together smart choices.

It’s not complicated but it is very, very hard to discipline ourselves to be consistent about the way we take care of ourselves. And only each of us can make these choices for ourselves.

Sadly this is a reality that even the leaders of Medicine don’t  even seem to grasp the problem. Here’s how Harvey Fineberg, MD and PhD and leader of the Institute of Medicine closed his JAMA editorial:
"Setting the United States on a healthier course will surely require leadership at all levels of government and across the public and private sectors and actively engaging the health professions and the public."
You see the problem? Setting the U.S. on a healthier course does NOT depend on leadership from government or health professions.

We have had plenty of that over the last decade. That got us to 27th place among other nations.

What is needed is the TRUTH:

The overall health of Americans isn't improving much, with about six in 10 people either overweight or obese and large numbers engaging in unhealthy behaviors like smoking, heavy drinking or not exercising, a new government report shows.

The U.S. Centers for Disease Control and Prevention report found Americans continuing to make many of the lifestyle choices that have led to soaring rates of heart disease, diabetes and other chronic illnesses, including the following:
  • About six of 10 adults drink, including an increase in those who reported episodic heavy drinking of five or more drinks in one day during the previous year.
  • Twenty percent of adults smoke, and less than one-half of smokers attempted to quit in the past year.
  • Only one in five adults met federal guidelines for both aerobic activity and muscle-strengthening exercise. One in three was completely inactive when it came to any leisure-time aerobic activity.
American history is replete with stories of strength. It’s sad and frustrating to see us so unhealthy and decrepit.

So yes, the truth sometimes hurts, but not as much as being lied to, and made to believe that  "we have the best medical system in the world, that spending a huge amount of our GDP on health care translates into a healthier population,or in the fantasy that a magical witch doctor medicine man will always have the correct answer for what ails you.