According to the ADA, the diagnosed cost of diabetes in the United States is estimated to be $412.9 billion in 2022, including both direct medical costs and indirect costs like lost productivity. As the prevalence of diabetes continues to rise, costs will climb higher and higher, placing an unsustainable and unnecessary burden on our health system and economy. It points to a stark, uncomfortable realization that the biggest cost burden on the American taxpayer isn’t drugs (11 percent of the total national health spend); it is the cost of manageable disease run amuck.

While the White House and Congress rightly tout their success in lowering the cost of insulin for Americans in need, the policy victory speaks to the persistent problem—akin to closing the barn door after the horse has escaped—that more and more people are being diagnosed with or unaware of their diabetes risks. The bigger “hairy audacious goal” is to reduce the number of people with diabetes in the first place.

A Tale of Two Americas

The Type 2 diabetes epidemic is not an equal opportunity offender. It disproportionately affects racial and ethnic minorities, as well as those with lower educational attainment and socioeconomic status. This is not a coincidence; it results from systemic inequalities plaguing our health-delivery system. It speaks to the long overdue need to use PK-12 education to inform young people about healthy diets.

Black Americans, Hispanic/Latino Americans, and Native Americans bear a heavier burden of this disease because of deeply rooted social determinants of health. Access to quality healthcare, education, and economic opportunities are crucial in determining who develops Type 2 diabetes and who doesn’t.

According to the ADA: “The poorer you are in America, the less likely you are to have a grocery store within walking distance of your home. Diabetes rates are inversely related to income level, and nutrition is critical to diabetes prevention and management. Every American with diabetes and prediabetes must have access to affordable, culturally relevant food and the information they require to eat healthfully.”

At the heart of this crisis lies a fundamental issue raised for years: our relationship with food and education. The lack of basic nutritional literacy in many communities is not just unfortunate; it’s a tipping point for heart disease and diabetes. Many Americans, particularly in underserved communities, make food choices that harm their health because of strained household economics or lack of information. The food label on packaged goods is helpful to those who can translate the percentages listed into actionable decisions. Still, desperation often makes those decisions for people regardless of what the label says.

In urban and rural areas with limited access to fresh, nutritious food, food deserts are not just inconveniences but public health hazards. When the only food options available are processed, high-calorie, or convenient and tasty fast foods, we set up communities for a lifetime of health struggles.

Innovation and Public Policy: Islands of Hope

Traditional approaches are proving inadequate in the face of this growing threat. The health system needs to embrace innovative, policy- and technology-driven solutions that can reach people where they are and provide personalized support.

More than 41 million people participate in the Supplemental Nutrition Assistance Program (SNAP) and receive an average monthly benefit of $191 per person, or a little over $2 per meal. ​Roughly four out of 10 SNAP participants (42%) are children under age 18; 16% are people 60 and older, and about 12% are people with disabilities. The results are dramatic!

Children receiving SNAP benefits have better health status than youngsters who are not SNAP participants, and their households are less likely to sacrifice health care to pay for other necessary expenses. Older SNAP participants are less likely to be admitted to a nursing home or hospital than their counterparts who do not participate. It seems like common sense. Caring for the chronically ill costs taxpayers more.

Telemedicine and remote monitoring technologies offer potential avenues for diabetes management. These tools can provide real-time data to healthcare providers, allowing for more timely interventions and personalized care plans. AI-powered nutritional guidance apps have the potential to democratize access to customized meal plans, accounting for an individual’s health status, cultural preferences, and economic constraints. These tech tools can only be used as preventive and interventional extensions of the doctor’s office if third-party payers – private and public – ensure it is in the health providers’ interests. 

On the pharmaceutical side of innovation are the GLP-1 receptors – that can help millions of people struggling with obesity – among the key catalysts for the surge in pre- and Type 2 diabetes. GLP-1 receptor agonists mimic the hormone’s action, crucial in regulating blood sugar levels. But here’s the kicker: these drugs don’t just lower blood glucose; they’re a Swiss Army knife of metabolic health. However, private payers often place obstacles in the path of access. Obesity is a complex – tipping point – disease leading to diabetes, mental health challenges, heart disease, and more. Payers often will not authorize GLP-1 use for people who are overweight and have prediabetes – waiting till people (their beneficiaries) graduate to Type 2, citing cost.

The Obesity Society spokesperson Katherine H. Saunders, MD, of Weill Cornell Medicine, New York City, in an interview with Medscape, comments: “What is more expensive than Wegovy (a GLP-1 class drug)? A day in the hospital. This is a particularly important finding for health plans, employers, and any group covering the total cost of care — many of whom are concerned about the cost of Wegovy. Hopefully, this data will encourage more decision makers to recognize not only the significant health benefits associated with Wegovy but also potential cost savings.” Dr. Saunders is among the nation’s top thinkers in the field of obesity and associated conditions, and as an entrepreneur, co-founded FlyteHealth, a community of health providers who specialize in helping people manage their weight.

Health- or Sick-Care – We Must Choose a Path

The economic impact of Type 2 diabetes is staggering. The time for half-measures and incremental change is long past. We need a coordinated, multisectoral response—the health sector, industry, government, and private philanthropy—working together to address the epidemic’s foundational causes.

Five suggestions include:

1. Investing in education at the primary school level and ensuring children understand healthy food choices and have access to in-school meals.
2. Addressing social determinants of health through Federal and state policies that promote economic equity and access to quality health and education
3. Leveraging well-proven approaches in remote patient monitoring to improve diabetes intervention, detection, and management
4. Strengthening the use of Federal and state programs such as SNAP and the Child and Adult Care Food Program (CACFP)
5. Fostering collaboration between health providers, community organizations, national professional health organizations and tech companies to deploy proven solutions.

The Future We Must Embrace

Current efforts to address Type 2 and prediabetes prevention are insufficient. By acknowledging the complex relationship among social, educational, economic, and environmental factors contributing to this chronic illness epidemic, the United States private and public health system must examine drug costs; however, it can develop more effective policies and campaigns for diabetes intervention and management. 

It’s time for a mindset shift in approaching this preventable condition. We must recognize that we have, to date, given lip service and window dressing to address disparities and support the needs of children growing up without sufficient knowledge about food choices or, in the case of cash-strapped families, access to a healthy meal that reinforces what they are learning in school. Half measures were never good enough and are no longer acceptable.

Every step toward managing Type 2 diabetes – or better yet, preventing it entirely – is a step toward a healthier, more equitable society. The challenge is immense, but the ability to make a difference is possible.  There are proven delivery methods for insulin, vastly improved ways to monitor blood glucose and policies that could be tweaked to meet people’s needs.  Together, we can turn the tide on this epidemic and create a future where Type 2 diabetes is no longer a looming threat but a manageable condition.

Pay now or pay later. It’s a decision payers and policymakers must make.

The post The Diabetes Epidemic: A Pressing Public Health Catastrophe appeared first on Medika Life.

Lifestyle changes are the goal of population-wide interventions. For example, exercise affects blood pressure and has many other health benefits. But for these solutions to work, people must commit to them for a long time, and not following through is still a big problem. Because most patients will not stick to this lifestyle change, it is important to consider how much exercise interventions cost and how much time they take. Isometrics can provide the answer patients and healthcare providers have been seeking. A large analysis of 270 clinical trials found that isometric movement training is the best way to lower systolic and diastolic blood pressure.

Isometric training aims to tighten or contract a muscle or group of muscles. The muscles being worked on do not get longer or shorter, and the joints involved do not move. You stay in one place during the exercise, and your body weight helps keep you strong and stabilize your core and joints.

Isometric exercise can help people with pain or injuries get stronger and more stable. It does not involve the full range of motion or movement and only works on certain muscles.

The key to isometrics is that they can be done without equipment and throughout the day if you wish. If you’re sitting in an office or working to prepare meals in your home, you can still exercise while doing anything else. It’s an all-inclusive exercise program you can do whenever you have a few minutes or while doing something else. Always discuss this with your healthcare professional before starting any exercise regimen. Here are a few to try:

Press Your Hands Together
With your elbows bent, clasp your hands together or press your palms together in front of your chest. Use the same amount of force in both arms. Hold down each button for 10 seconds, then let go. Do this five or six times. These moves will make your biceps, chest, and triceps stronger. You could do them while reading texts. So, it’s perfect for students, researchers, or writers.

A-Hold
Keep your back straight and your shoulders back. Take deep breaths and tighten your abs like you are getting ready to punch someone. Hold for five seconds. Then, let out a breath and “crunch” your abs as if doing a sit-up. Take a few deep breaths, then exhale all the way. Since this is a quiet exercise, no one will know you are working out your abs hard while taking notes. It can be especially helpful during dull meetings.

Glute Squeeze
Sometimes, sitting in a chair all day can hurt your back. Having strong glutes can help. As an easy isometric exercise, squeeze your glutes and hold the contraction for 10 seconds. Then, relax.

Press on the Wall
Put your hands against a wall about three feet away and space them out shoulder-width apart to move your shoulders and work your core. For 10 seconds, press hard against the wall and then let go. You can also lower your body toward the wall and press back up to turn this into a push-up.

Isometrics may be something to consider for your daily routine. As we already know from research, they can reduce BP, but exercise also has mental health benefits and maintains mobility, which then maintains independence and strength. Some studies have shown that it can reduce depression and anxiety and is a very effective means of combating stress, whether on the job or in life. It may even work where pills fail.

The post Whatever Happened to Isometrics as a Promising Muscle-Management Method? appeared first on Medika Life.

The goal of this post is to share some tips and ideas that could be useful as you manage your health and mental health. You don’t need to try all of these at once — see what feels like a good fit to you and start there.

1. Pace yourself

Before you were diagnosed with your chronic illness or disability, you may have been used to doing things a certain way — perhaps with greater speed, energy, and motivation. You may feel like you have to compete with your former self or prove to yourself that you can do it just like you did before.

Give yourself permission to not do everything exactly the way you used to. Recognize that you are still the same person — abilities and challenges in all — and go at a pace that suits you best based on your current situation.

2. Focus on energy conservation

Similarly, you may even need to figure out when to hold yourself back in times when you need to rest before a day of medical appointments, travel, work or volunteer work (modified or not), or a social engagement. Perhaps you are a morning bird or a late night owl — or maybe this all changed after your diagnosis and you are adapting to a new internal shift.

Learning what makes you feel energized or drained is a good first step. This will help you determine when you need to put on the brakes and when you can push yourself. Monitor how your energy ebbs and flows depending on the time of day or type of activity and try to use that as a guiding principle for how you structure your day, including fitting in time for rest.

3. Be a good self-advocate

Educating yourself about your new needs, asking questions, and speaking up when something concerns or worries you are important skills to learn as you adjust to your new chronic illness or disability.

If you feel nervous at the thought of using your voice, perhaps it may help to give yourself a pep talk or an encouraging internal monologue before a medical appointment or difficult conversation. Or bring a trusted loved one to an appointment if you feel you need moral support or a little prompt every so often to share your point of view. Knowing that someone is there who has your back can mean the world in a hard scenario.

4. Speak kindly to yourself

You can learn to be your best friend. How do you do that? Well, you can start by speaking to yourself in a positive, supportive way. Let go of the self-critical statements and instead choose to use words that reflect you just as worthy, loveable, deserving, and important as anyone else.

Remember: your chronic illness or disability doesn’t make you any less of a person. You are still you. Your health issues don’t define you. You do.

5. Do what makes you happy

It can be hard to turn your attention to positive things when you are feeling sad, lonely, frustrated, or demoralized. But that’s when you might need to the most. Bring to the forefront of your mind what makes you happy, fulfilled, motivated, and energized.

Is it spending time with loved ones? Being with your pet? Being in nature? Creating art? Listening to music? What else? Tune into yourself and find ways of bringing these things back into your life even if it is incorporated a little differently now compared to your pre-illness or pre-disability life. Adding these things back in can make a difference in boosting your daily mood and outlook on life.

6. Pursue activities that align with your skills and abilities

If there are activities you used to do that you now can’t as it presents a significant risk to your health — or if you cannot do it anymore from a physical/mental/emotional standpoint — then maybe you can explore these activities in a modified or adapted way or possibly find a related activity that is more feasible and that you feel will still be enjoyable. Choose something that is not as demanding of your energy or endurance or perhaps fits more with your current abilities. Take some time to think about what fits best with you at this present time and start there.

If your job used to be very physically involved and this is not possible anymore, maybe there are other tasks in your job that you can perform that is more desk-based. You may of course also decide to take a completely different direction in your career and that is ok as well. Listen to what you need and honour it.

You may also want to join new in-person or online communities where you can meet people who are going through similar challenges as you. The peer support they provide can be extremely valuable to you, especially if you are adjusting to a new health problem.

7. Move towards acceptance

Adjusting to a new disability or chronic illness can be a very difficult process. You are going to understandably grieve all the things you could do before your diagnosis. Perhaps you are also grieving major changes you will need to make regarding your living environment and your career, or you may now depend on health professionals or family to do some of your basic personal care tasks.

Ever so slowly, you will eventually reach a place in your mind and your heart where you come to terms with what has happened to you. You don’t have to like it. You don’t have to be happy about it. But recognizing how it affects you and what you need to do to live the best quality of life you can will help you navigate these difficult times that much more easily.

8. Enjoy the little moments

Nestled between moments of pain and sadness will be little moments of joy: hearing a good result at a medical appointment; being able to complete a physical exercise successfully; having a good day in terms of minimal pain or fatigue; doing something you previously couldn’t do; enjoying quality time with a loved one.

Hold on to these moments as they are important for keeping your eyes focused ahead and on your future rather than turning to look backward at your past.

9. Remember your wins

Just as you will want to enjoy the little positive moments, you will also want to remember your wins as well — both big and small. Recalling your strengths, what you do well, what you are capable of, and what you are looking forward to are all important factors in building you up and helping you maintain your momentum.

Consider these wins as signs that you have so much to give and so much to gain as you move forward. Keep going one step at a time. Wishing you the best on your mental health journey.

The post 9 Tips for How to Cope with a Chronic Illness or Disability appeared first on Medika Life.

Henry was fortunate to find a primary care doctor who would devote the time needed to fully understand his many problems, including his social/psychological issues. With an attentive PCP, he had much less need for various specialists, but as the need arose, the PCP was there to coordinate his care.

Unfortunately, most primary care physicians do not have enough time for careful listening and contemplation nor for delving into anxiety and family issues that may precipitate an exacerbation of heart failure. For example, concern about a sick adult child might be underlying the heart failure flare. Some physician recommended changes in medications will help but what is really needed is attention to his deepest concerns.

Adequate time between patient and doctor, especially the patient with one or more chronic diseases and the primary care physician (PCP), is essential. Developing a population that values healthy lifestyles and government actions designed to assist in prevention is equally crucial. Unfortunately, we have none of these three in today. PCPs are too busy; we don’t take care of our health and wellness; and government is AWOL.

Since most chronic illnesses are preventable with simple lifestyle modifications (I know, easier said than done), we need aggressive attention to preventive approaches and maintaining and augmenting wellness. Physicians (and other members of the healthcare team) and patients working together can make significant inroads here. This would reduce the burden of disease over time and greatly reduce the rising cost of care.

But that is not enough. Government, in its many forms, needs to assist. Addressing lifestyle needs as done over the past few decades with tobacco is critically important. But, unfortunately, the American government places far too few resources into wellness and preventive care, whether regarding school lunches, employer wellness programs, insurance rebates for healthy living, or many other possibilities. And as the pandemic clearly demonstrated, there has been decades of inadequate public health funding, from the Centers for Disease Control (CDC) to state and local health departments.

Individuals all too often and for many reasons do not follow basic approaches to general wellness, including the top five: sound diet, adequate exercise, stress management, enhanced sleep, and no tobacco/ moderate alcohol.

Living in “food deserts,” unsafe neighborhoods that prohibit effective exercise and augment stress while tempting illicit drug use all conspire toward less wellness and poor health with later chronic illnesses. Marketing tobacco products in these same neighborhoods has often left islands of continued smoking.

All of us are bombarded daily with marketing that touts ultra-processed foods high in fats, refined white flour, salt, and sugar. Think of most sodas with their high levels of sugar; fruit yogurts that always add sugar; those packaged snacks loaded with all the wrong ingredients plus others you never heard of; those buns in the mall that smell so good from their cinnamon and butter but are mostly sugar and white flour.

Think also of most breakfast cereals. Even the ones you might assume are healthy often have substantial sugar added, and most only use refined white flour, which is almost equivalent to eating sugar. Unfortunately, government, unlike tobacco, puts little or no restraints on such marketing of blatantly unhealthy foods.

We all love French fries, hot dogs, fried chicken, and high-fat content hamburgers. Fast food outlets know what we like and do their best to not only attract us but seduce us to buy more. “Get a double for only half price.” One of my favorite stories relates to iced tea. We stopped at a fast-food place to take a break from traveling and get a drink. My wife got a black coffee; I ordered an iced tea. “Large or small?” I said small but she looked at me skeptically and said that the large was only a few cents more. I didn’t want to tell her that a large would run right through and we would have to stop again sooner than planned, so I just reiterated “small.”

“Sweetened or unsweetened?” “Unsweetened, please.” “You should get the sweetened; it is $1, and the unsweetened is $2.” I insisted on unsweetened, and she looked at me as though I was the stupidest customer she had ever encountered. She gave me a small cup, and I went over to the other counter where you could take from the sweetened or the unsweetened containers. I could have said “Sweetened,” paid less, and taken the unsweetened. Later, in the car, I looked at the receipt. She charged $1 me for a “sweetened iced tea.” So kindly toward this foolish old man.

But why should sweetened cost less than unsweetened. Because once the sweet taste is in your mouth, you will want more – either at this stop or the next. The company knows it and so lures you back with a “reduced” price. It is a “nudge” but in the wrong direction. Another example of good marketing but lousy policy.

Assuring medical insurance for all Americans is an important goal, but it is far from sufficient to ensure we all get the best or even adequate care. For example, what good is an insurance card in your pocket if you cannot access a PCP in your neighborhood, one that has the time needed to give you the care you need. So instead, you go to the local emergency room, which, although well intended, is no substitute for a personal physician or nurse practitioner.

America needs a new vision for healthcare delivery:

It must become a health care, not just a medical care system. It must recognize the importance of intensive preventive care to maintain wellness, and it must do so prospectively from the perspective of the population, not just an individual who appears in the doctor’s office. The keys are straightforward – good diet, adequate exercise, reduced chronic stress, enhanced sleep, no tobacco, moderate alcohol, good dental hygiene, and careful driving. Add to these – blood pressure control, cholesterol management, cancer screening, and combined, these will prevent most chronic illnesses.

For those who do develop chronic disease(s), the PCP needs the time to attend to the complexity of care and, when necessary, there needs to be excellent specialist coordination by the PCP. This will improve the quality of care and dramatically reduce the costs of care.

Because the PCP does not have enough time, the patient who already has a chronic illness is often sent for extra tests, imaging, or to see one or more specialists. As a result, the expenditures go up exponentially, yet the quality does not rise commensurately. Indeed, quality often falls. Again, Henry’s story is a good example.

Henry’s story points to another problem – clearly, America has a medical care system, not a health care system. American medical care focuses on a disease once it has occurred but focuses relatively little on maintaining health and wellness.

Healthcare must be redesigned so that the patient is the customer. Today the insurer controls. That makes no sense, including no financial sense, no quality of care sense, and certainly no patient or doctor satisfaction sense.

Very critically, America needs many more primary care physicians (and other primary care providers such as nurse practitioners) – the backbone of the healthcare system – who can offer outstanding preventive care, care for most illnesses, and care coordination for chronic illnesses when necessary. Unlike today’s insurance system, they need to be reimbursed for their efforts in a manner that allows for adequate time for each patient and their total healthcare needs. It must be satisfying to doctor and patient alike, with true healing in addition to expert medical care.

All of this requires a change in the conceptual approach to insurance coverage; to what PCPs believe their function is or could be, to your understanding of what excellent primary care can be, and to everyone’s understanding of the importance and effectiveness of preventive care to maintain health and wellness. These are major changes in how we think and act about healthcare. It will not come easily or quickly but desperately needs to begin the change process now.

It also requires government to change its approach to healthcare, to see it not just as an insurance problem but as an opportunity to improve the health and wellness of all citizens.

It is doable, but it means rethinking how we perceive health, wellness, healthcare, and how our delivery system is structured.

In the following articles, I will address the How’s to achieve real healthcare.

The post Preserving Health and Wellness and Preventing Chronic Diseases – America Does It Very Poorly appeared first on Medika Life.

To varying degrees, everyone experiences stressors in life. Yet many people seem to be able to tolerate life’s stressors without showing symptoms of stress — symptoms like anxiety, depression, heightened emotions and/or chronic pain.

So, if you’re someone who seems to be highly sensitized to stress, you might get the impression that there’s something “wrong” with you. (Spoiler alert: there’s not.)

We live in a culture that pathologizes emotional sensitivity and normalizes emotional numbness.

But the truth is, numbness and heightened sensitivity are both symptoms of emotional repression. On the surface, they look different. But they’re two sides of the same coin.

Repressed emotions are compressed energy. And compressed energy can take on multiple forms:⁠

• Compressed energy can stay contained for a while, like a pot of boiling water with the lid jammed on.⁠ But eventually it explodes.
• In some people, the lid stays jammed on most of the time. You might not even be able to tell that there’s boiling water under the surface, and they appear to be “doing just fine,” meaning: they’re conforming to the standards of our societal norms.⁠
• In some people, the pot of water looks like it’s always on the verge of bursting … and from time to time it does.⁠
• In other people, the pot seems to be constantly bubbling over, with the lid nowhere to be found.⁠

All of these are symptoms of a culture that encourages us to reject our own emotions. “Under-expressed” emotions are simply more convenient to patriarchy than “over-expressed” emotions, so blunted sensitivity is considered normal while heightened sensitivity is pathologized.

All this to say, it may seem like others are “doing just fine” while you seem to be “overly sensitive” — physically and/or emotionally. And you may be asking yourself “why me?”

But the truth is that we are all impacted by living in a culture of emotional repression — even if that impact looks different from person to person. And we would all benefit from a shift in culture toward allowing, accepting and honoring emotions. (If you’re reading this, I have a feeling you’re already taking part in this collective culture shift.)

Instead of seeing your sensitivities as something “wrong,” what if you were to view them as your superpowers? Your finely attuned antennae letting you know that there’s actually a kinder, more wholesome, respectful and nurturing way of being that we could all be moving toward? What if your emotions are the guiding stars pointing us all in the direction of a healthier and more loving human culture?

What if you aren’t broken at all, just reacting to a world that’s aching for positive change?

With love and warmth,

💖 Anna

The post Being Sensitive Doesn’t Mean You’re Broken appeared first on Medika Life.

The diseases that a physician sees today are markedly different than in years past. Decades ago, most illnesses were acute (or temporary, such as pneumonia and appendicitis) but today the vast majority are chronic (heart failure and chronic lung disease that stick with you for life).

Chronic disease is transforming health, medical costs and the delivery of care. Diseases such as diabetes, heart failure, emphysema, and cancer are chronic. Once developed, they usually last a lifetime, are difficult to manage and expensive to treat. Chronic illnesses, once rare, are becoming commonplace. They are responsible for the vast majority of health care costs but are, to a large degree, preventable.

Chronic illnesses have two primary antecedents — aging and adverse lifestyles. There has been a remarkable increase in average lifespans and an increasing percentage of those who live a longer time. With aging comes certain impairments, including impaired vision, hearing, mobility (osteoarthritis), bone strength (osteoporosis with fractures), dentition (and with it impaired nutrition) and cognition. Good diet and exercise will limit osteoporosis and joint damage, dental hygiene will limit loss of teeth, avoidance of excessive noise can lessen hearing loss, avoidance of excessive ultraviolet rays from the sun can limit the development of cataracts, and physical and mental exercise along with a good diet can stave off normal cognitive decline.  But as we age, many of these impairments, even with excellent self-care, will develop and progress over time.

But with aging also comes an increased frequency of chronic illnesses – cancer, heart disease, arthritis, diabetes, and Alzheimer’s. These diseases for the most part are mostly related to our lifestyles over a lifetime. Poor diet, lack of exercise, chronic stress, inadequate sleep, tobacco, etc. all conspire over the years to finally manifest as disease. And it is these diseases that most often cause death today.

Author’s Image from Fixing The Primary Care Crisis based on Jones, et al, “The Burden of Disease and the Changing Task of Medicine” in the New England Journal of Medicine. 

As reviewed in the prior article in this series, in 1900, the three most common causes of death in the U.S. were typhoid, tuberculosis and pneumonia – all infectious diseases. Now, the three most common causes of death in the U.S. are cardiovascular, cancer and lung disease – all chronic illnesses, mostly lifestyle-related and all largely preventable.

Not surprisingly, obesity and obesity-related diabetes have also emerged as major predisposing factors to chronic illness and are climbing the list of primary causes of death.

The most important underlying drivers of these chronic illnesses as of 2000, according to a Centers for Disease Control and Prevention (CDC)  report in the Journal of the American Medical Association, are tobacco use, poor dietary habits, lack of exercise and alcohol abuse – all modifiable behaviors. They commented, looking to the future, “These analyses show that smoking remains the leading cause of mortality [in 2000]. However, poor diet and physical inactivity may soon overtake tobacco as the leading cause of death. These findings, along with escalating health care costs and aging population, argue persuasively that the need to establish a more preventive orientation in the US health care and public health systems has become more urgent.”

In the ensuring twenty years, obesity has become epidemic and diabetes is rapidly following. They lead to more heart disease, kidney failure, strokes, and dementia.

The striking reduction of acute, infectious diseases is a testament to the successful collaboration of both science and society in its development and adoption of sanitation, safe water and food, hygiene, antibiotics and immunizations during the last 100 plus years. Safer work environments mean less environmental exposures, trauma and injury.

In addition, the presence of Alzheimer’s and suicide among the common primary causes of death today illustrates the complexity of how aging and mental health are impacting illness and survival. They further signal the reality that mental health has become an entirely new segment of concern in the ever-growing list of chronic diseases in our society. Although present for decades, the appearance of the Covid pandemic amplified the diseases of despair – alcoholism, opioid addiction and overdose deaths.

Older people have more chronic illnesses than younger individuals. But this is not necessarily due to the aging process itself. Yes, older individuals have various impairments, including vision, hearing, mobility and mental capabilities, but the important chronic illnesses such as heart disease, cancer, chronic lung and kidney disease and diabetes are related to long-term effects of lifestyle factors. For example, lung cancer occurs, on average, at age 72, but the steps leading to it began in someone’s teens and twenties when smoking began. Heart disease is more common among the elderly, but the process of creating atherosclerosis begins at a young age with the ingestion of the wrong foods, lack of exercise and good dose of chronic stress over a lifetime. Restated, it takes many years for coronary artery plaque to build up sufficient to cause a heart attack. Just because it occurs after age 65 does not imply that it was related to aging. Rather, it just says that the person has lived long enough for the progressive effects of poor and excessive diet, lack of exercise and related obesity, stress and smoking combined with genetic predispositions to finally have the effect of causing overt disease. Of course, the aging process diminishes the immune system and other body protective mechanisms so that acute and chronic diseases can more easily progress and manifest themselves.

This trend toward prolonged, chronic diseases now poses a new commensurate challenge for both science and society.

The magnitude of the task at hand was illustrated 2007 by the Milken Institute in An Unhealthy America: The Economic Burden of Chronic Disease. They evaluated cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions and mental disorders. The study noted that nearly one half of Americans had one or more chronic illnesses and that “each has been linked to behavioral and/or environmental risk factors that broad-based prevention programs could address.” 

Industry has also recognized that 75 percent of their healthcare costs go to the care of just a few diseases – each chronic and each largely preventable. Commercial insurers, primarily dealing with those under age 65, report that 70-85 percent of paid claims are for chronic illnesses. For Medicare, 85 percent of enrollees have at least one chronic illness, while more than 50 percent of enrollees have three or more chronic illnesses that require them to consume an average of 5 to 7 prescription medications per day.

In 2018 the Milken Institute put out a new comprehensive report entitled “The Costs of Chronic Diseases in the United States.”  Here are the summary conclusions: “Americans’ chronic health problems and diseases not only come at the expense of individuals well-being; they also constitute a massive burden on the U.S. economy. When including the costs of lost economic productivity, the total costs of the varying types of chronic disease in the U.S. is equivalent to almost one-fifth of the American economy. In 2016, the total costs in the U.S. for direct health care treatment for chronic health conditions totaled $1.1 trillion—equivalent to nearly six percent of the nation’s GDP.  The most expensive conditions in terms of direct health care costs are cardiovascular, diabetes, Alzheimer’s, and osteoarthritis.”

Milken emphasizes the importance of obesity on the development of chronic diseases. “Obesity is by far the greatest risk factor contributing to the burden of chronic diseases in the

U.S. The prevalence of obesity in the U.S. population has increased steadily since the 1960s.

In 2016, diseases caused by obesity and being overweight accounted for 47.1 percent of the total

cost of chronic diseases in the U.S. [italics mine]—responsible for $480.7 billion in direct health care costs, plus $1.24 trillion in indirect costs related to lost economic productivity. The total cost of chronic diseases due to obesity in 2016 was $1.72 trillion—equivalent to 9.3 percent of the U.S. GDP that year.”

Our medical care system has developed over centuries around the process of diagnosing and treating acute illnesses such as pneumonia, a gall bladder attack or appendicitis. The internist gives an antibiotic for the pneumonia and the patient gets better. The surgeon cuts out the gall bladder or the appendix and the patient is cured. One patient, one doctor.

But patients with chronic illnesses need a different approach to care. They need long-term comprehensive care, not episodic care. They need a physician with the time and expertise to give continuing attention to all aspects of their care. This physician, preferably a PCP, has the expertise to do most of the care required. But when specialists are needed, the PCP needs to serve as the orchestrator of a multi-disciplinary team with the PCP as quarterback to manage the myriad physician specialists and other health care providers, tests, and procedures to allow for a unified, coordinated care approach. Only when the PCP has the time to give most of the needed care related to chronic diseases and has the time for this type of coordinated approach, will care be maximized yet costs reduced.   

This requires a new paradigm in management, incentives, responsibilities, and compensation for physicians and new responsibilities and incentives for patients as well. The key to this new paradigm is the primary care provider. He or she is well trained and experienced in chronic disease management. But to do this, the number of patients under care by each PCP must be reduced from about 2500-3000 to no more than 500-800. At this level, the provider can have the time needed to listen, prevent, diagnose, treat and think. This will reduce the excessive use of specialists, tests and procedures and the reflex to hand out a prescription when a lifestyle change would be both more appropriate and more effective. And when a specialist is needed, the PCP will have the time to personally call the specialist and explain exactly why he is referring the patient and ask for a prompt appointment. This approach has been proven, as explained in Fixing The Primary Care Crisis , to dramatically improve quality, reduce visits to specialists, ERs and hospitals, reduce the costs of care while improving patient satisfaction, and reducing doctor frustration and burnout.

But dramatically improving care for those with chronic diseases, valuable as that will be, is only part of the equation. Another critical, indeed most important, aspect is prevention which must start with maintaining health and wellness, something America does poorly — at best. A later article in this series will address wellness, health and prevention.

The post Follow The Money in Healthcare – It Will Lead You to Chronic Diseases appeared first on Medika Life.

Scott Wiener made a startling revelation at a spring legislative committee hearing: “I was in the hospital. I experienced the most intense abdominal pain that I could even imagine.”

The Democratic state senator recalled crawling up the stairs to his landlord’s apartment last July to get a ride to the hospital.

The San Francisco lawmaker also disclosed to his colleagues on the Senate Health Committee that he has Crohn’s disease, a chronic autoimmune condition that causes inflammation in the digestive tract. His body, he said, wasn’t responding to his medication, which led to abscesses in his abdomen and a weeklong stay in the hospital.

Wiener is a youthful, lean 52-year-old who is known around the Capitol as an energetic workaholic. It’s a reputation he has had since his early days as a San Francisco supervisor.

He is known for his progressive proposals on housing affordability, safe injection sites, mental health, and sentencing reform. Wiener is also an intensely private lawmaker, who, by his own admission, isn’t the type to “personalize these things.”

He opened up after some Republican lawmakers and health insurance lobbyists questioned the cost of one of his bills during a committee hearing in April. SB 853 would require state-regulated insurance companies to cover a denied prescription while the patient appeals the decision if a patient has previously taken the drug — even if it’s at a higher dose than the FDA has approved or in a different form than was previously prescribed.

The clause about drug dosage and form is especially important for patients who have an autoimmune disease, such as Crohn’s, because they sometimes need a higher dose of a medication than the FDA recommends. Or the medicine might work better for them in injectable form than as a pill.

Patients who are denied medicine often go without it while they appeal, a process that health plans say generally takes 30 days. Some patients, however, say it can take months.

Under his bill, if he ever had to contest his health plan’s decisions about his medications, Weiner told his colleagues, “I could get the proper dosage during the appeal so that I wouldn’t have to miss more health committee meetings.”

But Jedd Hampton, legislative affairs director for the California Association of Health Plans, said the bill would give patients “unfettered access to prescription drugs,” which could lead to abuse and addiction. “We are strongly concerned that stripping health plans of the ability to provide clinical oversight and access to certain drugs may cause potentially adverse reactions and real harm to our enrollees,” he said.

The Senate approved Wiener’s bill 39-0 last month. It is awaiting a hearing in the Assembly.

Wiener sat down with KHN senior correspondent Samantha Young to talk about what it’s like to live with Crohn’s disease, his hospital stay, and how that experience informs his work. The interview has been edited for length and clarity.

Q: How does Crohn’s disease affect your life?

I have had it for 33 years, and I’ve been lucky that, other than last year, I just deal with periodic pain. But last spring, I started getting more symptomatic, and I was hospitalized for one night at the end of June with pain. Then a month later, on a Tuesday night, getting into bed, all of a sudden, the only way to describe it, it was like an electrical storm in my abdomen. The most severe pain I have ever felt.

The hospital did a scan and found multiple abscesses in my abdomen. I was in the intensive care unit for three nights and in the hospital for a week. They had to drain abscesses, and I was on heavy antibiotics. I had a reoccurrence in September, and I had to go back to the hospital for four days. But now it got all cleared out, and I’ve been doing great since then. I feel lucky.

It’s never really affected my ability to be a workaholic, my ability to just live my life, travel, vacation. I feel very privileged. There are other people with other autoimmune diseases and Crohn’s who are much more impacted.

Q: How do you monitor your Crohn’s?

After I left the hospital, I began consulting with an infectious disease specialist. I know what to look for, so hopefully this will never happen again. I know I need to go to the hospital if I have an unexplained fever with some pain and I’m testing negative for covid-19. For a lot of people, if you have an unexplained fever for a few days and you just don’t feel well, you let it go. For me, I need to go to the hospital and have a scan done just to make sure I don’t have an infection.

Q: There are so many chronic health conditions that require specialty care and drugs, which can be very expensive. Have you ever had trouble getting coverage for them?

I was always on common generic medicines, but then the two times I had to go on specialty drugs, I’ve had two opposite experiences. The first time, my insurance company said I had to first try and fail the steroid prednisone. Well, anyone who knows anything about prednisone knows that it is a last resort. Prednisone has so many side effects, and long term, it can cause a lot of problems. It was just shocking to me and my doctor that the insurance company said you have to try and fail.

Then, when my doctor went to switch me to what I’m on now, it was approved within 24 hours. It was as easy as could be. So I’ve experienced amazing health plan response and also really challenging response.

Q: What does that tell you as a lawmaker about the way our health care system works?

Sometimes the system works really well, and sometimes it doesn’t. And if you are not the kind of person who can advocate for yourself or you don’t have your primary care physician able to advocate for you, you can really have a bad outcome.

Q: What have you and other lawmakers done to address that?

We do a lot of work around health plan accountability. I’m carrying another bill, SB 858, that would increase fines for health plan violations. During my entire experience last year, with various hospitalizations, my health plan was terrific. Everything was very prompt, and we always had a nurse follow up with me after I left the hospital. But people do fall through the cracks — sometimes mistakes are made in terms of denying coverage.

I’ve supported and co-authored numerous pieces of legislation to lower prescription drug costs. I’m very fortunate that I have excellent health insurance, but a lot of people don’t. I haven’t had copay problems, but there are people who had to pay huge amounts of money just to get medicine because coverage doesn’t kick in until they pay $5,000. It makes me very sensitive to those cost issues. And I was a proud champion and co-author of AB 1400, Assembly member Ash Kalra’s single-payer legislation.

Q: Does your personal life influence the bills you sponsor?

My personal experience certainly influences my perspective on life. My personal experience as a gay man, as a patient, and in the community in general. It’s true for any elected official, and that’s why it’s important to have officials with lots of life experience because I think it makes you a better representative.

Q: Your bill came under tough questioning from some Republican lawmakers, but that shifted after you shared your story. Do you think personal stories like yours carry weight with your colleagues and the public?

Yeah. I was really grateful that it got bipartisan support. And I think for some of these issues, there’s really no reason for it to be partisan.

As elected officials, sometimes we’re viewed as caricatures of human beings. We’re human beings who have the same challenges that other people do — challenges parenting or having a sick family member. We’ve had members who have had to deal with difficult family situations or health situations. I think it’s good for the public to know that.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

The post Lawmaker Takes on Insurance Companies and Gets Personal About His Health appeared first on Medika Life.

In the United States, a study funded by the National Multiple Sclerosis Society confirms that nearly one million people live with MS, more than twice the original estimate from a previous study.

Now comes news from Harvard researchers that points to the condition’s cause. Today, we look at multiple sclerosis, including epidemiology, risk factors, symptoms, and disease course.

We’ll end with the good news — researchers appear to have identified a viral cause of the disease. Spoiler alert: It’s the so-called kissing virus, or Epstein-Barr virus, the pathogen that causes mono.

What is multiple sclerosis?

Multiple sclerosis is a chronic disease that can affect your brain, spinal cord, and the optic nerves in your eyes. It can also be associated with other essential body functions such as muscle control and balance.

The symptoms associated with MS are variable. Some with the disease have mild symptoms and need no treatment. Others have challenges moving around and doing the typical tasks of daily living.

Multiple sclerosis results from the immune system attacking a fatty material (myelin) that envelopes nerve fibers to protect them. When the outer shell is lost, your nerves are more likely to become damaged, and scan tissue can form.

With nerve damage, your brain cannot correctly send signals through your body. The nerves don’t function as well as they should to help you move and feel. As a result, symptoms can include fatigue, trouble walking, muscle weakness or spasm, or numbness and tingling.

Some with multiple sclerosis have blurred or double vision, while others report sexual problems, poor bladder or bowel control, pain, depression, or troubling focusing.

Multiple sclerosis is common

Multiple sclerosis (MS) is the most common disabling neurological condition of young adults worldwide. You can develop MS at any age, but most with the condition receive diagnoses between 20 and 50.

The rates of multiple sclerosis go up as one moves away from the equator. In the southern states of the United States (below the 37th parallel), the incidence of multiple sclerosis is between 57 and 78 cases per 100,000 people. The rate is twice as high in northern states at approximately 110 to 140 cases per 100,000.

Canada, Denmark, Sweden, Hungary, Cyprus, and the United Kingdom have the highest risks worldwide.

Climate matters, too, with the risk of MS higher in regions with colder climates. Those of Northern European descent have the highest risk, irrespective of their geography. On the other hand, the lowest risk is among Native Americans, Africans, and Asians.

Women are more likely than men to suffer from multiple sclerosis. Far more women have MS — the National Multiple Sclerosis Society observes that multiple sclerosis is two to three times more common in women than men. Healthline.com offers other risk factors.

There may be a genetic predisposition to getting multiple sclerosis. For example, among identical twins, if one sibling has MS, the odds are about one in three that the other will have it, too. There appear to be both environmental and inherited components to multiple sclerosis.

Even though multiple sclerosis includes so-called relapsing, remitting, or progressive types, the course and rate of the condition are rarely predictable.

Multiple sclerosis and Epstein-Barr virus

Did you know that the Epstein-Barr virus (EBV) is a member of the herpes family? EBV is one of the most common viruses in the world. Common symptoms include fever, rash, body aches, swollen glands, and sore throat — problems associated with mononucleosis.

While there is no cure for multiple sclerosis, we may be much closer to understanding why MS occurs. According to a study led by Harvard T.H. Chan School of Public Health researchers,

The Epstein-Barr virus (which infects more than 90 percent of adults and causes the “kissing disease”) and multiple sclerosis are linked.

This study is the first “providing compelling evidence of causality,” according to the study’s senior author, Dr. Alberto Ascherio.

The researchers observed 955 active service members in the United States military who had a diagnosis of multiple sclerosis. The researchers discovered that those found with the Epstein-Barr virus were 32-times more likely to have developed MS. No other virus had a similar effect.

Observes Dr. Ascherio:

“This is a big step because it suggests stopping EBV infection could prevent MS; targeting EBV could lead to the discovery of a cure for MS.”

Thank you for joining me today in exploring this breakthrough in understanding multiple sclerosis.

The post A Virus May Cause Multiple Sclerosis appeared first on Medika Life.

Fortunately, age-adjusted death rates are falling globally. Death rates show a 17 percent decline from 1990 to 2016. Today we look at some advances in the management of advanced breast and melanoma cancers that have spread to distant sites of the body.

Breast cancer

Let’s be clear: When breast cancer has spread to distant organs (such as the bones, lung, liver, or brain), the disease is not currently curable. What has me excited this morning is a recent report about long-term survival for two subtypes of breast cancer. Let’s get right to the results:

Patients with two of the three major types of advanced breast cancer now have a median overall survival of at least 5 years, which is roughly a doubling of survival time over the past decade.

The two types of advanced breast cancer for which survival times have doubled over the past decade are HER2-positive (HER2+) breast cancer and ER-positive (ER+) breast cancer. HER2-positive means that the cancer cells have a particular protein sticking out like antennae.

Individuals with HER2-positive disease represent about 25 percent of patients with metastatic breast cancer and now commonly live as long as ten years. Doctors can use drugs that target the HER2 pathway that drives cell growth and division. The best-known of these is trastuzumab (Herceptin).

For those of you who would like to hear more about Herceptin, try this book:

Her-2: The Making of Herceptin, a Revolutionary Treatment for Breast CancerAmazon.com: Her-2: The Making of Herceptin, a Revolutionary Treatment for Breast Cancer eBook: Bazell, Robert

To see a film representation of the passionate and inspiring story of Dr. Dennis Slamon, the UCLA (USA) doctor who helped develop the breast cancer drug, Herceptin, try this:

Living ProofTop-rated Lifetime movie! Dr. Dennis Slamon has reached a breakthrough in his career. He has helped to develop a new…

Melanoma

You may have heard about the revolutionary cancer management tool known as immunotherapy.

A group of investigators from around the world reported the results of using a combination of two immunotherapy drugs for advanced melanoma. Following treatment with nivolumab and ipilimumab drugs yielded a more prolonged progression-free survival and overall survival than with only one immunotherapy drug.

Striking to me are the long-term outcomes:

At a minimum follow-up of five years, the median overall survival was more than five years (median not yet reached) in the group that received two immunotherapy drugs in combination. Over half of patients with cancer spread to distant sites were still alive at the five-year mark.

Chronic disease survivors. Former United States President Jimmy Carter presented with advanced melanoma — his disease had spread to his brain. You know the rest of the story: First, doctors bombarded his cancer in the brain with a highly focused, high-dose radiation therapy known as radiosurgery.

The high-dose radiation therapy damaged the cancer cells in the brain. These dying cells then released substances into the bloodstream, attracting the attention of immune cells.

Carter then received immunotherapy; more specifically, he got a drug known as pembrolizumab (Keytruda). Three months after immunotherapy, the then-91-year old discovered that his tumors were gone. The drug supported his immune system’s response and appears to have completely eliminated any residual cancer.

More than five years later, President Carter has no evidence of cancer remaining. If you want to learn more about immunotherapy, please go here:

What is Immunotherapy?As of October 2021, the U.S.www.cancerresearch.org

You will not be surprised to learn that the 2018 Nobel Prize in Physiology or Medicine was awarded jointly to two cancer immunotherapy researchers, James P. Allison, Ph.D. of The University of Texas MD Anderson Cancer Center, and Dr. Tasuku Honjo of Kyoto University in Japan.

The Nobel Prize committee honored Allison and Honjo for their work on uncovering ways to activate the immune system to attack cancer.

Thank you for joining me today in exploring the promise of targeted therapy and immunotherapy in the management of advanced cancer.

The post Making Advanced Cancer a Chronic Disease appeared first on Medika Life.

There are myriad diseases that are currently linked to the impact of environmental toxins, but it doesn’t end there. There are more important long-term issues that will only grow progressively more challenging in the coming decades. These exist alongside the toxic climate we have created for our health. Issues like access to clean potable water, population density, plastics, and a host of other challenges.

Alongside these issues, racial disparities in health and society disproportionately shift the outcome of these pollutants and challenges onto the shoulders of racial minorities. Wealth acts as insulation, allowing access to superior levels of care, organic foods, and healthy lifestyle choices, including the ability to locate your family to areas where pollutants are less dense.

Poorer communities are however locked into a narrow band of choices, none of which are beneficial to their health.

These issues must be addressed. We can no longer afford to ignore them as chronic disease becomes our new normal. We believe that this is where the real challenge to our societal and global health will lie in the coming years. We also believe we’ve passed a tipping point and only desperate and immediate action will enable us to claw back a vestige of the damage we have inflicted, both to our home and ourselves.

If like us, you have concerns or would like to raise awareness, share a passionate and well-researched point of view on diseases and the environment, or other relevant environmental issues, then we would love to provide an audience for your thoughts. We’re also really big on solutions, which are in short supply, and FINN Partners is offering an added incentive to the best article we receive.

Our appreciation to frequent Medika Life contributor Gil Bashe, FINN Partners, Global Health Chair, and colleague Bob Martineau, JD, Senior Partner, Environmental and Sustainability, for their articles, commitment to EcoHealth, and support for this new editorial section.

A word from FINN Partners

For decades we have thought, written, and studied how environmental conditions and social determinants influence public health. Now as fires rage across the Pacific Northwest United States and floodwaters rise in Central Europe we see how environmental sustainability impacts human survival across developing and developed nations. 

Environmental health links directly to global public health. Medika Life has been serving as an editorial meeting ground for health professionals across the spectrum to explore how health is central to all human progress and continuity. 

Medika Life’s editors determined we will champion greater editorial discussion with a new section dedicated to EcoHealth. To encourage editorial submission, Medika Life and FINN Partners will honor an outstanding editorial contribution with a $500 donation made in the author’s honor to a global non-profit dedicated to environmental public health. 

Submissions

If you are active on Medium, please submit a draft of your work to Medika’s publication on Medium, BeingWell. If you’re not already a contributing author, please reach out to BeingWell’s EIC, Dr Jeff Livingston who will happily assist you in the process.

You can email Jeff at jefflivingmd@medika.life or reach out to our other editors, Dr. Hesham A. Hassaballa, Lisa Bradburn or Dr. Patricia Farrell.

If your article is one of those selected it will be published immediately on Medika Life and scheduled for subsequent publication on BeingWell. We will set up a dedicated author profile for you or your organization on the Medika site and you can submit additional material at your convenience.

Please note that as Medika caters to medical and health professionals, we will only consider materials from appropriately qualified authors and stakeholders. If you have questions or pitches you’d like to discuss, you can contact Medika’s EIC, Robert Turner, or reach out via email to robertturner@medika.life.

If you are not on Medium, you can submit articles directly to Robert on the email above. Please submit attachments in Word format or you are welcome to provide a link to a shared Google document.

The winning article will be selected by an editorial team from both Medika Life and Finn Partners and will be announced on the 31st of August, 2021. The relevant author will be notified by email and the article will be extensively advertised across social media. 

All rights are retained by authors on materials published to Medika Life.

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