JERRY WOLKOFF BLOG-IN LOVING MEMORY OF MY SON STEVEN NATHANIEL WOLKOFF, MY FATHER SAMUEL WOLKOFF, AND ALL THE OTHER VICTIMS OF INJUSTICE, EVIL IN THIS WORLD.THEY DIMINISH YOUR RIGHTS,THEN THEY DIMINISH YOUR EXISTENCE, THEN THEY LIE ABOUT IT, SAY YOU NEVER EXISTED, AND THE PROBLEM IS PEOPLE FORGET THE SUFFERING THAT LASTS FOREVER, NEVER KNOWING THE TRUTH BY WHOSE HANDS, OR HOW YOU WERE KILLED.
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.
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.
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.
