Consulo Indicium - 6/12/19

Information for your Consideration…

Support For Seeing Another Day – Are you getting a tad older?  Is the memory slipping just a bit too much – forgotten names, missed appointments, details lost, etc.?  Want to be healthier?  Do you need some data to encourage your patients to get off their duff?  A recent study reveals that moderate exercise such as simply walking or pedaling a stationary bicycle can make a huge difference in our long-term mental sharpness.  After only six months of moderate exercise, participants in the study had marked improvements in executive function which includes our ability to focus, to organize our activities, regulate our behavior and achieve our goals – all laudable capabilities that we all want to retain.  For more information on the study, go to WebMD for references and details.

Then, there is the physical side of the house.  A recent JAMA Open Network article reported a study of >300,000 AARP members. It showed that people who engage in “leisure-time physical activity (LTPA)” and who started in midlife (35% lower mortality) had comparable results to those who maintained such activity throughout their life (36% lower mortality) – compared to those who never engaged in physical activity.  That speaks volumes to the fact that it is never too late to start!  It does not have to be excessive exercise either.  For example, walking and moderate exercise will help to turn back the clock a bit for older adults and, it seems to help in increasing mental acuity.  In support of the “moderate exercise” theme, a separate piece in The New York Times reported that “dog owners are about four times more likely than other people to meet today’s physical activity guidelines, according to a large-scale new study of dogs and exercise.”  When Toto the Wonder Dog (my constant companion when I’m home) heard this news, his tail wagged even more than usual.  He’s incredibly excited about the “more walking” part.  He loves to walk and explore.  Now, about that travel side of my life… 

On A Healthy Note – Researchers at the Beth Israel Lahey Health – a Boston-based health care academic and care delivery system – reported a compound in Brussels sprouts, broccoli or other cruciferous vegetables can block an enzyme that drives the occurrence of human cancer. That’s consistent with the message my wife gives (pretty much every day) to “eat green vegetables”.  Another consideration includes eating more fruits and vegetables.  Put the two together and studies are showing a nine-year reduction in brain age, according to James Blumenthal, Ph.D. from Duke University.  In particular, the DASH diet has been called out as a successful strategy on the dietary side.  The diet includes not only fruits and vegetables but also whole grains, reduction in healthy unsaturated fats and a low sodium, sugar, and meat but high dairy diet. The result is that walking a dog every day and eating the right stuff keeps you younger and healthier longer. So, that means potatoes don’t count. What’s a German boy from North Dakota to do?  Argh! 

And, A Long-Term Health Note – It was very disturbing to learn that scientists are reporting the monthly peak amount of carbon dioxide in the Earth's atmosphere in 2019 jumped by a near-record amount to reach 414.8 parts per million (ppm) in May.  The level is the highest level on record and – what is even more disturbing – the highest level in the past 3 million years. And, oh by the way, the accumulation of carbon dioxide in the atmosphere is due to global warming.  So, what is the data that the naysayers are citing?  And, what are the health implications?  They range from the change of ecosystems to biomes to all manner of life on earth.  And, what are we doing about it?  Not as much as what is needed.  “Health” is a broad issue.  It’s not just human health but also “health” of the place where we live.

Kudos To The Derms – I recently received a copy of the American Academy of Dermatology position paper on “artificial intelligence” (AI) and was very pleased to see that they have adopted “augmented intelligence” (AuI) as the model for big data analytics in health care.  I’ve been arguing for some time that we need to be thinking of these tools as sources for “clinically augmented intelligence”.  But, in fact, the Derms are correct.  It goes beyond the “clinical” to include all the non-clinical elements in the lives of the people for whom we provide care.  It’s where they travel, it’s what they eat, it’s the social determinants of health, and more.  So, kudos to my Derm colleagues.

When Trade Wars Might Affect Healthcare – Unbeknownst to most of us, the pharmaceutical companies over the last couple of decades have moved most of their production overseas. In particular, the US makes almost none of its own antibiotics anymore – yes, I said “none”.  That’s an ominous declaration because it creates a health risk but also a national security risk.   And, the problem is not confined to unavailability.  It is also an increasing problem with generics that are made overseas that are not equivalent to the original drugs.  The result can be devastating.  Check it out in an article that appeared in the Boston Globe by Katherine Eban.  The details are chilling.  It’s an issue that deserves the greater attention of the medical community. 

Rural Inequities Continue – A new poll reported in U.S. News & World Report and conducted by the Harvard Chan School of Public Health, the Robert Wood Johnson Foundation and National Public Radio found that 1 in 3 rural Americans struggle to afford health care. If the health care component is combined with housing and food, the figure jumps to 4 of 10 “…rural adults have struggled to afford medical bills, housing or food in recent years.” Furthermore – and, not surprising – about a fourth of rural adults “have skipped health care at some point because they lacked either financial or physical access to care.” The rural inequity – which I’ve been blogging about for over a decade now, continues.  We seem to take a couple of steps forward and then fall backwards…

 But, It’s Not Just Rural Folks: Racial Inequities Continue As Well – In testimony before the US House Ways and Means Committee, Patrice Harris, MD, President of the AMA noted that racial disparities and social determinants of health represent a “maternal mortality crisis” for the nation.  She cited studies which show that contributors to the crisis include:

• Lack of insurance or inadequate coverage prior to, during, and after pregnancy,
• Increased closures of maternity units in rural and urban communities,
• Lack of inter-professional teams trained in best practices,
• Structural determinants of health, such as public policies, laws and racism that produce inequities in the social determinants of health, such as education, employment, housing and transportation,
• Stress exacerbated by discrimination that can result in hypertension, heart disease and gestational diabetes during pregnancy; and,
• Clinicians not listening to black women, resulting in missed warning signs and delayed diagnosis.

Dr. Harris noted in her testimony that, “At the provider and institutional levels, there is a growing body of evidence demonstrating that implicit and explicit biases exist that negatively impact the quality of health care equity and patient safety and drive these inequities.” In citing the issues, she called for a program to address maternal mortality and depression. The AMA also called for policy to encourage local and state health departments to develop material mortality surveillance programs along with support for research on best practices to reduce poor material mortality and morbidity in racial and ethnic minorities. 

Directing Care To Improve Care – In a major move to enhance the accuracy of diagnosis of employees, Walmart recently announced that it has selected 800 imaging centers which will be used by their employees in the future. In an internal study, the company found there was a high rate of error in the readings of CT scans and MRIs at certain centers providing imaging services. In an effort to curb misdiagnosis and improve care, they decided to direct the care to selected centers across the nation.  The trend towards directing care to those organizations that have better outcomes is not confined to imaging centers nor to Walmart. It’s happening across the board.  As transparency increases, the health care industry should anticipate that the trend will only accelerate.  And, I believe, it will be good for health care across the board.