HealthyConcerns.com

The continuing saga of Vitamin D deficiency

When you blog, your friends send you links. Links to stories similar to what you've been writing about. Sometimes stories they simply think you should be writing about.

Today my friend Maria NIles contributes to my ongoing series of posts about Vitamin D, or Vitamin D deficiency to be more specific.

The post: Why Black People Need More Vitamin D from TheRoot.com.

This I already knew, but the article goes into some detail about why.

Bottom line: The melanin in the skin of people of color does something great: It protects them from harmful UV rays. but it also does something not-so-great: It blocks Vitamin D production.

And since the medical community has evolved from thinking Vitamin D only impacts bone health, but also may lower the risk of diabetes, hypertension and other very common illnesses and conditions, they are thinking that epidemic Vitamin D deficiency is really not a great thing!

The article's bottom line is that it is very very difficult to get enough Vitamin D naturally from either our diet or from foods. They recommend supplements all the way.

Kind of a bummer, but there it is...

Surviving the system, courtesy of the ACS

The American Cancer Society has a lobbying arm called the Cancer Action Network [Read about it here.] The ACS CAN recently launched a big initiative for cancer patients called "Surviving the System". They launched it with a Lobby Day which took place on the 20th.

The idea was to get regular people sharing their stories...and reachng out to their elected officials to ask for health care reform, for cancer patients and in general.

While cancer isn't the number one killer in America, it does claim over half a million lives a year. And getting cancer can be devastating to families for more reasons than just the fear and anxiety over our lvoed ones' health. According to a study released to coincide with ACS CAN's Lobby Day:

•  Nearly one in three people diagnosed with cancer under the age of 65 has been uninsured since their cancer diagnosis.  Scientific research shows that being uninsured can adversely impact your chance of survival.
• One in five families affected by cancer have used up all or most of their savings because of health care costs and more than 40 percent have had difficulty affording their health care costs in the last two years. 
• More than two-thirds of Americans under age 65 who tried to find insurance outside their employer couldn’t afford a plan. 

Our family just went through a cancer scare or two ourselves, but luckily we are all covered, well-covered. Imagining the stress of having no or insufficient coverage, on top of the stress cancer brings on its own...well, I wouldn't want to experience that. 

And once again, it begs a fundamental question: Insufficient or non-existent coverage can impact someone's chance of survival. Is it OK that people live or die in this country based not on whether what they have is treatable or curable or not, but rather on their income level or class or employment status? All of which seems highly volatile in this economy. And what if we're talking about children, who surely aren't responsible for their parent's socio-economic status? 

California is experiencing record unemployment, and I'm guessing a lot of people are losing their coverage. Or being forced to choose between paying exorbitant COBRA payments vs. paying for other necessities, like food, shelter etc.

Those people may be very employable, may have new jobs with coverage waiting around the corner. Is it OK that they have to hope that nothing catastrophic happens to them...whether one-time, like a car accident, or chronic, like a cancer diagnosis...while they're toughing out this economy like we all are?

I continue to think it's not. You can read more about the ACS's perspective and their efforts for health care reform on their site and their blog.

Universal Health Care, examined

Joe Paduda from Managed Care Matters caught my eye with his Top 10 Reasons Universal Health Care is Bad. The thing is that he listed the ten reasons without commentary, although some were willing to go at it over whether these were valid or invalid reasons in his comments.

Friday he followed up with a post examinig Item #1 on his list: "Universal Healthcare Will Lead to Rationing".

I hope he follows up every single item from the Top 10 list in this fashion!

Here's some interesting data to get you hot and bothered to read the whole post:

Here's what a bit of specific data show (excerpted from the Commonwealth Fund report).

• The percentage of U.S. patients who waited six days or more for a doctor appointment when sick was not significantly different from the rate in Canada (23% v. 36%), the worst-performing country
• Only 47 percent of U.S. patients were able to see a doctor on the same or next day when sick, versus 61 percent to 81 percent of patients in the four better-performing nations
• U.S. patients were less likely than patients in Canada (12% v. 24%) but more likely than patients in Germany (4%) to wait four hours or more to be seen in the emergency department
• U.S. patients were less likely than patients in four countries (except Germany) to wait four weeks or longer to see a specialist (23% v. 40%–60%) or to wait four months or longer for elective surgery (8% v. 19%–41%) (Schoen et al. 2005)

"It is worthwhile to have 10 lives disrupted by overtreatment than even one life lost from a lack of early detection"

Kevin MD points us to a NY Times article questioning the efficacy of mammograms. Or rather, questioning whether the benefits of administering mammograms routinely as a preventative measure vs. the impact of false positives such routine mammograms create.

Kevin MD pulls out one key stat from a survey cited in the NY Times articles:

"for every 2,000 women age 50 to 70 who are screened for 10 years, one woman will be saved from dying of breast cancer, while 10 will have their lives disrupted unnecessarily by overtreatment."

One of his commenters opines:

"I would still argue it is worthwhile to have 10 lives disrupted by overtreatment than even one life lost from a lack of early detection."

The NY Times article is interesting and full of various, often conflicting, opinions.

Unfortunately the article closes with a truly stupid statement. One I must believe must have been taken out of a much larger context:

"There’s no question on one count: if you get screened, it’s more likely you’ll have a diagnosis of breast cancer."

Um, dare I say no sh*t Sherlock?

Almost 10 years ago now I had a "baseline" mammogram. When I went back at age 40 to have my first annual mammogram, there was a shadow in the film that wasn't there when I was 35. After an ultrasound that found nothing I was told that it could just be some denser tissue, but to be safe I should get re-mammogrammed every six months for a while. I did that for two years. Each time the shadow remained the same, so we moved me back to an annual mammogram, which I've been doing for three years.

The shadow remains, and frankly, I am happy to have this checked regularly and to have an eye kept on it.

I do not feel put out at all, nor did I feel put out by those two years of extra mammograms. It is definitely worth my small effort for that peace of mind...and never did I feel like my doctors, either when I was on Blue Cross nor on Kaiser, were anxious to over-react. An ultrasound was the only additional procedure they prescribed.

That's my story.

What's yours?

Wow, Americans have a slow-death wish

Hat tip to Daily Green for pointing me to Food Politics, if for no other reason than learning about how the most famous cookbook in America (The Joy of Cooking, natch) has adjusted its portion sizes over the year.

One example cited:

That recipe calls for about 4 pounds of ingredients to make only 18 cookies, each of which runs 500 calories — one quarter of the amount needed by most people for an entire day. I’d call one of those cookies lunch or share it with three friends. By the way, a similar recipe in the 1975 “Joy of Cooking” made 45 cookies with just half the ingredients. These would be just under 100 calories each.

Wow, right?

I, too, would like to know how the editors justified this ballooning of portion sizes over the years. Certainly, as people with free will, we could always choose to serve more than the recipe calls a portion if we protested against their original small portion size, but when recipes (and restaurants) put portions of immense size in front of us, it does sort of re-set our expectations of how much we should eat.

Seems like this is just another way that our culture is killing us slowly and insidiously.

Am I being over-dramatic?

Health Care vs. Health Insurance...words matter

InsureBlog has a short but to-the-point post on why "health care" is not synonymous with "health insurance" and why it matters.

Their basic point is that trying to fix the rising cost of health insurance without dealing with the underlying problem of the rising cost of health care will lead to moving the problem around, but not solving it. I'm sure they're right.

But I more often hear people actually confuse "health coverage" with "health insurance". And I'd love to see a post addressing how those two terms differ and why it's important.

I recently watched Michael Moore's documentary Sicko, and he focused primarily on people who did indeed have health insurance...but discovered that they weren't really covered for very much or very well.

I think a big takeaway from that movie is that yes, it's terrible that 1 in 6 Americans doesn't have health insurance at all, but our health care system is a real clusterf$%^ because the 5 in 6 who do have health insurance often don't have sufficient coverage. At least that was my takeaway.

And for all those naysayers who say the problem with that lies with irresponsible people and foolish government mandates I would simply ask why health insurers are ever more profitable? not ever more revenue-generating...ever more profitable.

They certainly seem to be doing OK in this era of rising health care costs.

Today is World Vegetarian Day...and a vegan diet turns out to be good for Type 2 Diabetes

Today happened to be World Vegetarian Day. Which, as you may know, is something I basically celebrate every day as a practicing vegan! In fact all of October is Vegetarian Awareness Month (according to the North American Vegetarian Society).

Now, i could encourage you all to give veganism a try by pointing you also to VeganMoFo, spearheaded by noted vegan chef, cookbook writer and cupcake aficianado Isa Moskowitz. That's short for the Vegan Month of Food, and is a project where scores of bloggers commit to blog as much wonderful stuff about food...recipes, reviews etc...as they can for the entire month of October.

But this is a health blog, so I will point you to the latest medical study indicating a vegan diet is effective for staving off, in this case, cardiovascular disease, particularly in patients with Type 2 diabetes. Honestly, I thought we already knew that, but i think the differentiator about this study was that it was specifically looking at Type 2 diabetes patients because heart attacks or strokes kill two-thirds of those patients! Which is pretty shocking.

So take advantage of VeganMoFo and Vegetarian Awareness month and give peace (and peas) a chance in October. Let me know how it goes, m'kay?

Should I be surprised?

Apparently a very small study published by the The Lancet Oncology showed that "comprehensive lifestyle changes", including a vegan diet, daily exercise and meditation, "increase the body’s ability to fight premature aging, cancer, heart disease, and other chronic diseases."

Honestly, who can be surprised that a vegan diet, daily exercise and meditation would have that kind of positive effect? What I'm really curious about, though, is whether they will be able to allocate the responsibility for the positive results to these various lifestyle changes. I doubt this small study did it, but I'd love to see a study where different groups did various combinations of these lifestyle changes, and see how the results differ. Oh, and can we take into account their starting genetic factors and starting vital stats too?

Still, never anything wrong with continuing to bolster the argument for a healthy, cruelty-free and zen lifestyle :)

Source PCRM

How reimbursement policies drive treatment plans

Interesting guest post by Matthew Mintz on Kevin MD entitled As psychiatry goes, so will primary care. His basic point: That despite the fact that "psychotherapy has been found to be effective for many mental health disorders", it isn't reimbursed as highly as "diagnostic" or "medication management" visits. Therefore, you guessed it, the number of patients actually receiving therapy is going down.

Almost everyone I know who can afford it, including my own self and those close to me, have chosen to go privately for therapy and pay out of pocket when they've availed themselves of it. Why? Well, first of all the benefits on most insurance programs are so limited it hardly seems worth the hassle, but also, clearly, there is still a stigma associated with it. Going through your insurance increases the chance you might have something come up with the service and then have to check in with your company's benefits administrator.

People who have a choice tend to opt out of the whole loop. (Anecdotally speaking of course.)

So the post is interesting and worrisome, but this talk of heading towards a tiered system of care is a bit out of date...in real life, we're already there.

Life span, class, gender and race in America

Spurred on by a post on BlogHer by Health editor Catherine Morgan, I read with some dismay that while life expectancy has steadily risen in this country throughout the 20th century, that the trend is actually leveling off and even declining for some in the U.S., since 1983 actually.

If this trend has been happening for about 25 years why are we only hearing about it now? Well, the study was only published this past week. It's kind of disturbing considering the data stops at 1999, so it's not even taking into account what the policies and economic issues of the last eight years might have done to further exacerbate the problem!

Oh, and the problem? Most disturbing of all it seems to be all about class. Welcome to the Two Americas John Edwards was always talking about. if you didn't want to believe it was true, these studies may shake your faith.

Let's get to some excerpts from the two different NY Times stories i saw on the subject:

"Throughout the 20th century, it was an American birthright that each generation would live longer than the last. Year after year, almost without exception, the anticipated life span of the average American rose inexorably, to 78 years in 2005 from 61 years in 1933, when comprehensive data first became available.

But new research shows that those reassuring nationwide gains mask a darker and more complex reality. A pair of reports out this month affirm that the rising tide of American health is not lifting all boats, and that there are widening gaps in life expectancy based on the interwoven variables of income, race, sex, education and geography."

"The most startling evidence came last week in a government-sponsored study by Harvard researchers who found that life expectancy actually declined in a substantial number of counties from 1983 to 1999, particularly for women. Most of the counties with declines are in the Deep South, along the Mississippi River, and in Appalachia, as well as in the southern Plains and Texas."

"The first of the two reports, released two weeks ago by the Congressional Budget Office, declared that the life expectancy gap is growing between rich and poor and between those with the highest and lowest educational attainment, even as it is narrowing between men and women and between blacks and whites."

It's interesting that it's not as simple as to say those with lower income are less likely to have insurance, or to go to the doctor, or to get early diagnoses of ailments...all of which is true. There is also the fact that there are higher incidences of unhealthy behaviors in lower-income populations, such as smoking, alcohol abuse and poor management of chronic disease.

"Dr. Ezzati, of the Harvard School of Public Health, asked: “How much of this is pure material well being, the ability to purchase high-quality food, the ability to have a particular lifestyle? And how much of it is the impact of income on risk behaviors like alcohol and tobacco and stress mechanisms that are more psychosocial? There’s a series of debates around that that are unresolved.”

This may be the money excerpt form the entire series of articles:

"From 1961 to 1983, no county had a statistically significant decline in life expectancy, and reductions in cardiovascular disease led to a generally increasing length of life for both sexes. But after 1983, life expectancy declined an average of 1.3 years in 11 counties for men, and in 180 counties for women.

This lack of progress among the worst off was caused by a slowing or halt of reductions in cardiovascular disease, combined with increases in lung cancer and diabetes for women and in H.I.V. infection and homicide for men.

This rise in mortality for chronic diseases runs counter to trends in other developed countries, and the geographical differences are consistent with regional trends in smoking, high blood pressure and obesity. Dr. Ezzati speculates that data after 1999 will show more decreases in life span for the worst-off women. He expects to see a slight increase for men, with improved treatment for H.I.V. and AIDS.

“What’s driving the disparity is the worsening of the worst off,” Dr. Ezzati said. “In the U.S., there has always been a view, stated or unstated, that we can live with some inequality if everyone is getting better. This is the first sign that not everyone is getting better.”

So, is anyone else noticing that this decline started during the Reagan years? I consider that to be the starting point for the new Republican party values that eschewed (and continues to eschew) actual legislative or policy-driven solutions to our widening class gap...and in fact seems to celebrate it.l All while paying lip service to the concept of compassion...as long as it's someone else's problem.

Well, those chickens are coming home to roost, IMHO.

And here's something I found very odd: I scanned my usual suspects of medblogs looking for either concurring or opposing opinions, and found very little blogging about this.

What am I missing? Isn't this news disheartening? Does this not jive with how we think of ourselves here in the U.S.? Is this just old news to the medical community...are they so familiar with the problems that they're hardened to it? Where are the blog posts I'm missing? :(