Tag: Health

The Crisis in American Medicine: Limited and Costly


This morning my wife shared a letter just received from her former health care provider in Santa Fe, New Mexico. She writes that she’ll no longer bill insurance, with the exception of Medicare. To continue with her, she asks that you join her health community at $4100 annually. Medicare recipients must also join.

I ran into this same thing two years ago when I saw a specialist for a leg ailment. In the future, her clients would need to pay a $3700 annual retainer fee. That was two years ago. I’m reasonably sure with inflation her fee has increased.

I want to warn you that American medicine, formerly the finest in the world, is likely to become more expensive, limited and inequitable. Increasingly with the rise of corporate medicine, the emphasis is on quantity rather than quality. On average, you may need to wait several months before accessing your primary care physician, and even more to see a specialist, and when you do, it’s a physician’s assistant.

Concurrently, private insurance coverage is becoming more discriminating in what it pays for and how much. Medicare payout to physicians suffered a 4% cut this year, with an additional 4.5 anticipated cut for next year unless Congress intervenes before its adjournment next month.

Cuts like these result in reduced treatment, hiring of staff, and implementation of new technologies.

In response, doctors are increasingly resorting to concierge medicine, i.e., retainer fee medicine, now averaging $4000 annually per individual. Obviously, this will accelerate the already large number of Americans foregoing or delaying medical treatment, resulting in tardy diagnosis of mortality threatening illnesses.

As for hospitals, Mayo Clinic, accepts Medicare, but will bill you for the difference between original billing and Medicare payout. I fear this may become a growing trend.

—rj

Business as Usual: Lockdown Unenforced

Protestors in Texas

As experts have warned and a rogue president, prioritizing reelection, has ignored, recharging the economy when Covid-19 continues to ravage has exacted a surge in the pandemic’s victims, with a new wave anticipated this fall.

But Americans are its lead cause, a spoiled populace ignoring the laws governing exit from the crisis, wearing a mask in public, practicing social distancing, limiting unnecessary activity. Fifty states, each with its own governance, unequal to enforcing these mandates of public safety, subservient to economic interests, fuel our crisis. Shamefully, we lead the world in the pandemic’s victims.

Meanwhile, climate change exacts its continuing world toll. We tied the record in May for the highest monthly average on record; investment in renewable energy has plummeted; in the next five years, five-hundred species will disappear as humanity continues its assault on Nature, despoiling fauna and flora in a greedy rush for profit. Worse is the meat industry, a virus hotspot, progenitor of the pandemic, not just now, but historically in its previously related strains.

As I write, the Amazon forest continues to burn to make room for cattle ranches, environmentalists have been killed or discredited, indigenous tribes decimated. In Croatia, yesterday, 50 million bees died, suspected victims of pesticides. You think it only happens abroad? It’s happening here. Last year in Texas, someone deliberately set fire to beehives, killing 500,000 bees. Almonds, a prime contributor to California’s agricultural sector, may soon devolve into memory.

Where do we go from here? For the sake of the present we are ravaging our children’s future. I think anew of poet Robinson Jeffers’ credo of “inhumanism,” a summons to abandon a plethora of mass murder and commodification, to simplify our lives, to embrace with stoic discipline those values that both uplift and secure our children’s destiny.

—rjoly

The war on cancer: New treatments lock-out most of us

trialsDeath has many doorways, none of them particularly pleasant, but some downright gruesome, cancer for instance.

My father died from lung cancer at age 79. That’s a generous portion of life, when you consider the mean is several years less. Nonetheless, I remember his final hours at the Veterans’ hospital in Chelsea, MA, strapped to his narrow bed, and the moaning that even massive morphine couldn’t assuage.

And then there was my brother, Donald, so full of life, with robust talent and zeal to harness success. I had been doing a seminar at Claremont Graduate School in California that summer in 1979. Weekends I’d spend with him and his lovely wife, Barbe. Six months later, the devastating news of brain cancer, immediate surgery that made him no longer Donald, and death seven months after–cruelly, on his birthday. He had turned 47.

Then there’s my niece, Denise. She passed away several months ago from myeloma dysplasia (considered a blood cancer malady). I had spoken with her on the phone several months earlier. She’d been eagerly looking forward to her upcoming bone marrow transplant from brother, Richard. Initially, it went well, then relapse. She was 57.

Two of my siblings survived cancer. Ruth was experiencing intestinal distress suggestive of colon cancer, but doctors at the local hospital failed to find anything wrong after administering a CT. Thanks to my niece’s insistence on a second opinion, doctors at Massachusetts General, doing their own CT, found a baseball size tumor, diagnosed as Stage 3 cancer. They seem to have got it all in the surgery the very next day.

My brother David received chemotherapy and radiation for his colon cancer, following surgery. Proving the cure can be as devastating as the disease, radiation destroyed his digestive capacity, subjecting him to a hugely diminished quality of life.

I realize this is painful reading, but cancer insidiously invades our life premises in one way or another despite our efforts to wall it out. We get nowhere “crossing the street” to ignore it.

One thing about cancer is it is impartiality. It respects neither age, wealth, nor origin; the pious or the amoral.

One of its monstrous cruelties is when it ravages children. It’s what the Jimmy Fund is all about.

I remember how, in 1971, President Nixon, meaning well, declared war on cancer. Now, forty-five years later, it continues to assault many millions. Recently President Obama renewed that war in this year’s State of the Union address, pledging $1 billion for new research.

Each year, more than 500,000 Americans succumb to cancer.

That surpasses by more than 100 million the toll of American deaths in all of WWII!

In this year, 2016, an estimated 595,690 deaths will occur.

Even more ghastly, 14 million Americans have the disease right now!

But there’s good news to be had as well: a 21 percent drop in cancer mortality from 1991 to the present.

This may result from a more knowledgeable public, making lifestyle changes that include giving-up smoking, exercising more, eating healthier foods, undergoing yearly physicals, and taking advantage of screening venues that include colonoscopies and mammograms.

What’s more, there’s a plethora of new drugs along with innovative trial therapies that utilize one’s immune system, potentially bypassing radiation and chemotherapy protocols with their often serious side effects. In early phase 1 trials, we’ve seen B-cell leukemias and lymphomas disappear.

The problem is that these trials are often highly specialized, focusing on rare, sub-category cancers.

Additionally, there are all too few trials available even for those who qualify.

Frequently, doctors contribute to the dilemma, refusing to recommend patients for inclusion in a trial or committing to a new approach until the traditional cancer options of chemotherapy, radiation, and surgery have proven ineffectual. In short, it’s imperative we advocate for ourselves, keeping aware of new methodologies and of doctors and cancer centers on the cutting edge.

Former president Jimmy Carter, however, lucked-out. On August 20, 2015, he made public that he had melanoma induced cancer that had metastasized to his brain. With a 3-5 pound tumor, experts gave him only several months to live.

Along with radiation, his treatment protocol included infusion of pembrolizumab (keytruda), one of several of the new immunotherapy drugs employing the immune system and endorsed by the FDA for those having exhausted other therapies.

On December 6, 2015, Carter shared the good news that his recent brain scans were negative for cancer.

This would seem to bode well for the rest of us that the day may be coming when we’ll see the scourge of cancer pushed back, sparing ourselves and our loved ones.

But keytruda doesn’t come cheap at $150,000 for a year of treatment. For seniors, the most prone to cancer, Medicare, which won’t even pay for your glasses, hearing aids, etc., isn’t likely to cough up money for your treatment any time soon. Same story with private or employee insurance.

Fame and fortune access, as always, the best medical care. The poor and minorities needn’t apply.

But let me add another caveat to all of this: immunotherapy, while promising, is hardly around the corner as a standard protocol any time soon. Was Carter actually cured, or is this simply cancer’s quirky finesse to tease with remission rather than resolution?

Beware media hype! In the trials for keytruda, 76% of 173 patients receiving the drug didn’t see their tumors shrink.

In the follow-up on those who did experience tumor shrinkage, the time element was a paltry 8.5 months. Normally, we’d like to view things in a five-year context.

As I see it, however, it’s the prohibitive cost factor that largely hinders the delivery of effective cancer treatment, delaying the finding of a cure.

In summing up, though life and death are inextricably bound together, we prefer avoiding any discussion of death and do our best to masquerade its occurrence.   On the other hand, when we confront our mortality we enter into the larger, more important question as to how then ought we to live?

We may not have an an answer to the riddle of cancer in our lifetime, but we can defy it with courage and living out our destiny with human sympathy and loving kindness,   indulging  in each new day as unique in its capacity to enthrall with the cornocupia  of life.

–rj

 

 

 

 

 

 

Why I Relish Going to the Gym

gty_crowded_gym_kb_141229_12x5_1600

For many of us, throwing off the blankets and crawling out of bed on cold winter mornings to go to the gym seems pretty dumb.

I felt that way too until my pre-diabetic diagnosis several years ago which meant that if I didn’t do something about it, I might well succumb to full-blown diabetes with its many lethal complications that include heart disease, kidney failure, blindness and even limb amputation.

Still, I didn’t do anything about it until a chiropractor friend had me do a full blood workup that showed I had moved even closer to diabetes with an A1c of 5.9 and ominous glucose average of 123.   If you get to 125, you’ve got the disease, for which there’s no cure, only management.

Now, fifteen month later, I’ve gotten the A1c down to 5.2. The A1c tests your blood for glucose management over the previous two to three months. The pre-diabetic range is 5.7-6.4. In short, I’m no longer pre-diabetic.

How did I do it? Quite plainly, by cutting carbs and exercising regularly.

Exercise is good for you no matter what ails you or–if you’re an outlier–from nothing at all, promoting good health, better sleep, stress reduction, more energy, and self-esteem.   What’s nicer than people commenting on how good you look?

But let me add to these verities several other reasons exercise has become a mainstay of my daily regimen.

Personally, I can wax euphoric at the gym like this morning walking my fourteen laps (2 miles), with Herbie Hancock’s pulsating jazz rhythms funneling into my ears via my wireless headset, making me pump my arms still more vigorously.

I like, too, the camaraderie going to the gym gives me, a sense of being part of a group. I see many of these people regularly, of both sexes and of all ages and body types. On occasion, we say our hellos or share smiles and sometimes conversation. Call it tribalism. I like the feeling.

I admire many I see at the gym for the obviously hard work they put into their workouts, whether pumping weights, walking raised treadmills or elliptical machines, or doing stair-steppers, etc. I see the payoffs in their lithe bodies with muscular arms, wide shoulders, and developed pecs. I know it didn’t come easily. Many of them exercise before going to work.   No wonder they inspire me.

But I also get a sense of personal satisfaction, or of time well spent. Call it a relish in self-discipline: I haven’t surrendered to the couch or big screen TV. I take pride in that, knowing my former tendency to both procrastinate and be downright lazy.

Every session becomes a moral lesson, and I remember what my high school track coach told me: “We all get stiches in our side. The good runner, win or lose, ignores the stich, holding out for the second wind that propels him to the finish line.” Today, I resisted cutting my four sets of curls to three. I like to think such lessons learned at the gym can help me better cope with life at large.

And then there’s that sense of jubilation in sharing my good news with my dear wife that today I did 70 sit-ups. Just a few months ago, I could barely do 25!

The Chinese have this wonderful saying that “the longest journey begins with the first step.” In going to the gym, I’ve taken more than one step now and I’m eager to do infinitely more in the climb to good health and the contentment it confers.

–rj

 

 

 

 

 

 

 

 

Being Mortal

gawandeI’ve just finished reading Being Mortal: What Matters in the End by Dr. Atul Gawande.

I had read his previous Complications about life as a surgeon several years ago, greatly impressed.

Both books have been highly praised, with the present book listed by the New York Times as among must reads of 2014.

As a surgeon at Massachusetts General Hospital, Gawande knows what he’s writing about.

And he writes well, often movingly, in layman’s language, of death scenarios with their accompanying challenges that need to be individualized, since we’re all different.

I suspect many readers will opt to avoid a seemingly morbid subject, but that’s a mistake, for   mortality knows no exceptions and our best approach is one that, through knowledge, provides us with options.

And Gawande, a writer for the prestigious New Yorker as well as a physician, delivers–deftly, compassionately, and always with eloquence, on a difficult subject.

Moreover, his book preeminently addresses the medical community, often committed to treatment paradigms that work against the patient’s welfare.

Physicians are trained to see themselves as enhancers of health and survival. They are not taught how to handle lingering illness devoid of remedy:

…within a few years, when I came to experience surgical training and practice, I encountered patients forced to confront the realities of decline and mortality, and it did not take long to realize how unready I was to help them (3).

If your problem is fixable, we know just what to do.  But if it’s not? The fact that we have had no adequate answers to this question is troubling and has caused callousness, inhumanity, and extraordinary suffering (8).

What’s the point, anyway, of continuing chemotherapy, radiation, and surgery in terminal cases when such methodologies may involve great risk and, often, increase duress?

When, in short, should doctors, not just patients, let go?

Patients cling to hope and doctors knowingly feed into this, when frequently no regimen can procure that miracle of restoring health and dignity.

Or as Gawande vividly makes clear in his allusion to Tolstoy’s powerful tale, The Death of Ivan Ilyitch:

What tormented Ivan Ilyitch most was the deception, the lie, which for some reason they all accepted, that he was not dying but was simply ill, and he only need keep quiet and undergo a treatment and then something very good would result (2).

The ultimate challenge for physicians is to accept the restraints of biology and assist their patients to come to terms when that moment arrives

Otherwise, they can inflict considerable, even barbaric, suffering.

Doctors need to be patient-centered, addressing the patient’s best interests, and sometimes the greatest kindness entails being candid..

Ultimately, it’s about providing patients with options that preserve dignity, lessen suffering, and are in accord with the patient’s priorities.

We’ve made some progress in the now universal acceptance of Advanced Directives, though initially contested. But what about options for the terminal patient, still conscious, who lingers, often in great pain, and with perhaps even greater to come?

Gawande says that there are two dominating physician protocols: the one patronizing (this is what you should do); the other, informative (here are your scenarios).

Doctors do better when they ask the right questions of their patients in such contexts:

Whenever serious sickness or injury strikes and your body breaks down, the vital questions are the same: What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make or not willing to make? And what is the course of action that best serves this understanding? (259)

Palliative care, for example, may well be a better option to further surgery, chemotherapy and radiation when the outcome may make matters worse.

On the other hand, indulging patient fantasy may invoke “a prolonged and terrible death” (4).

Gawande carries out what he advocates. For me, his account of his father’s lingering passage into mortality is deeply moving, which I think many of us can identify with in our own wrestlings with the demise of those we love.

In addition to all of you, I wish every medical practitioner would read this book.

Death isn’t an enemy, but the natural order of things.

How much better it would be in our final moments to have someone like Gawande attending–a physician, with compassion, listening and helping us discern those best options that enhance our dignity and lessen our suffering.

–rj

 

 

 

 

A Court decision with deadly consequences

pigsWe should all be concerned about Thursday’s 2-1 decision by the U.S. Court of Appeals for the 2nd District that the FDA needn’t consider the banning of antibiotics in healthy food producing animals.

Given the growing menace of antibiotic resistant infections among humans and the inveterate use of antibiotics in the meat industry to promote weight gain or combat disease, we draw closer to a pandemic in which even a minor wound or infection could prove deadly.

As is, the Centers for Disease Control and Prevention (CDC) informs us that at least two million Americans are sickened with anti-resistant pathogens annually

I may have been one of them, having just recently recovered from an extended bout with a staph infection that ultimately required daily IV.

I naively had told my infectious disease physician that I didn’t really want to leave the hospital until I was over the infection. His rejoinder was that a hospital wasn’t the safest place to be, given the infection rate incurred among patients (one out of three).

The Centers for Disease Control and Prevention comments that “much of antibiotic use in animals is unnecessary and inappropriate and makes everyone less safe.”

More than 70% of all antibiotics are administered to animals, even when healthy.

To be fair, I can’t say what all the factors were in the court’s split decision, except that it imperils all of us.

I do know that according to the World Health Organization (April 2014), antimicrobial bacteria resistance increasingly threatens public health worldwide, “a problem so serious that it threatens the achievements of modern medicine. A post-antibiotic era, in which common infections and minor injuries can kill, far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century.”

Consider that Carbapenem antibiotics used as a fallback in treating life-threatening infections from a common intestinal bacterium are now ineffective for nearly half of those treated in some countries. This bacterium is a major source of hospital acquired infections such as pneumonia, bloodstream infections and infections among newborns and intensive care patients.

Likewise, our best antibiotics for treating urinary tract infections caused by E. coli are now ineffective in more than half the cases.

Ten countries are now reporting that their last resort antibiotic for gonorrhea no longer works.

Unfortunately, while the FDA did ask pharmaceuticals, animal producers and vets to  exercise restraint in employing antibiotics that are also used for humans, the FDA appealed an earlier court ruling banning penicillin and two kinds of tetracyclides promoting growth, unless users can provide evidence it won’t produce drug resistant microbes. Thus, the Court’s decision in favor of the FDA’s appeal.

Overseas, the EU has banned the use of antibiotics in animal feed (2006) and now South Korea has done the same. In China, however, the use of antibiotics in animal production is widespread.

That animal and human health are linked was decisively demonstrated in outbreaks of multi resistant Salmonella in 2011, 2012 and 2013, traced back to ground beef and poultry sources (National Antimicrobial Resistance Monitoring System).

As physician David Angus admonishes in his best selling The End of Illness (2011),

Wealthy countries take for granted the triumph of science over bacteria, but increasingly doctors are battling infections that can only be quelled by the most powerful antibiotics known to medicine–or, at worst, by none of them at all. In the United States alone, antibiotic-resistant infections cause roughly 100,000 deaths a year. Imagine a world in which antibiotics produce toxic effects and unpredictable outcomes instead of the guaranteed cures we have come to expect–and you can understand what keeps epidemiologists awake at night (298-99).

 The Court’s decision brings that day much closer.

–rj

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Memory: Something to be Cherished

Do you ever get something tossing around in your head that seemingly you can’t get rid of no matter how you try?  I get that way when I listen to music, for example, the lyrics wearing down my synapses like “We had it all/ Just like Bogie and Becall/ Starring in our old late, late show/Sailing to Key Largo.”  But sometimes it’s a memory that pops up, crazy like, since there’s no triggering context, maybe reaching way back into early childhood’s opaque alleys.

Sometimes something sticks because we associate it with an event or person that brought us great happiness or, alas, considerable pain.   Maybe we never forget anything really, the mind simply archiving everything that makes us who we are. While time may soften the edges of past experience, its essence remains

Freud built his formidable psychological schema on memory, which he argued was always latent, and thus influential on what we do and say, want and fear.  His former protégée, Carl Jung, contended memory transcended time and individuals, ultimately taking on evolutionary status as archetype, or primordial pattern, shaping both our thinking and behavior.  According to Jung, the repository of memory is defined best in myth, which reenacts the human repertoire of experience.  Its roman a clef  lies in symbols compressing our individual and collective destinies.

On the literary front, some of our foremost fiction writers like Joyce, Proust and Faulkner have made a legacy of memory in works like Ulysses, Remembrance of Things Past, and The Sound and the Fury.  In poetry, the English poet Wordsworth famously defined poetry as “emotion recollected in tranquillity,” building his poetic artifice on reflecting past experiences.  Perhaps the bottom line modus operandi latent in literary creation is to keep memory, or human experience, alive.

Often memory over time embellishes or distorts as we add or subtract.  It’s a good reason to keep journals. Verbal photos I like to call them.  Poor recall is the nemesis in legal matters when witnesses can’t accurately recall what they saw or heard or when witnesses prove contradictory.

Too often we take our ability to remember for granted, when the truth is it begins to decline as we age and increasingly we can’t find those damned keys, or forget what we came to the store for, or that doctor’s appointment.  Nothing to be worried about, save when forgetfulness takes on habit such as:

1 .    We repeat the same questions.

2.    We struggle for common words.

3.    We find it difficult to follow directions

4.    We lose our way in our neighborhood.

5.    We put things in odd places.

6.    We can’t recall something recently learned.

If I lost my sight or hearing, this would be debilitating and surely grievous, yet I think not equal to the loss of recall, condemned to an eternal present and essentially returning me to an infantile state as in dementia and its acute species, Alzheimer’s, that wipes away everything defining my humanity and lending  my life significance.

I don’t know, nor do any of us, what Fate holds, but in the meantime, I choose not to take this gift of memory for granted but to cherish it by nurturing it through learning new things, exercising regularly and vigorously, and eating nutritious foods.

Doctors who specialize in aging increasingly report that dementia may not necessarily happen if we keep our brains healthy by doing the right things.  Dr.  Majid Fotuhi, Chair of the Department of Neurology at Johns Hopkins, informs us that Alzheimer’s has only a limited genetic factor.  It can be delayed and even prevented with lifestyle changes undertaken in midlife.

I choose to run with that hope,

–rj

Unlearning our anger

English: Angry woman.
English: Angry woman. (Photo credit: Wikipedia)

I was angry with my friend:
I told my wrath, my wrath did end.
I was angry with my foe.  I told it not, my wrath did grow.

And I watered it in fears,
Night and morning with my tears;
And I sunned it with smiles,
And with soft deceitful wiles.
(from William Blake, “A Poison Tree”)

 I have known people who rise each morning to nourish their anger in resolve never to forget or forgive wrongs done to themselves.

Anger makes them feel alive, that they have significance and sovereignty over their lives.  The truth is that their anger masquerades their inability to set things right again.

The sources of anger are sometimes surprising.  Often we take up arms against family members, friends, and former loves.  As such, anger is many times symptomatic of love’s betrayal in the hands of those we’ve esteemed most through hurtful words, favoritism, or simply their not taking us seriously.

Anger may lead to sabotaging ourselves in acquiring a doomed dependency on others in the very likeness of ghosts that wronged us long ago, often in a childhood deficient in love.

The chronically angry are easily spotted in the sheer volume of their impassioned complaints against lovers and friends, the workplace, and government, surrogates for targets embedded in the past.

Hate stokes the past, unlike love which invests in the future.  Oddly, time may dull our memory of just what the hurt was or who did it, and yet we know we still feel the heat of rage.

To heal ourselves we may seek out love, only to reject it when it appears, fearful of its possibility for new hurt, or our becoming dependent on it, or its ultimate loss.

Anger can assume many shapes, among them a masochism of self-loathing; or a censuring of others; or a passive aggressiveness that denies one’s anger.

Anger has a way of becoming habit, or addiction to bookkeeping life’s liabilities; a kind of cowardice in a reluctance to confront one’s grievances, attempt their solution and, if unsuccessful, assume loss and invest one’s assets in the future.  As such, it’s self-defeating.  The late Merle Shain put it eloquently in her Hearts That We Broke Long Ago:

As long as you blame someone it makes the problem not yours but theirs, and allows you to keep it without taking responsibility for anything but pointing the finger.  Which means you give them responsibility for your life and paralyze yourself in a place you don’t want to be.

The positive side of anger is that it can help us assert ourselves against injustice; but when it entices us into a snare from which we cannot free ourselves, when we live our lives in the narrow confines of resentment, then it makes a wrong turn.  Quagmired in the past, we are unable to step into the future with its promise of new beginning

–rj

The Fountain of Youth: We are all Ponce de Leon

medical-symbol1As a 12-year old Florida school boy, I was introduced early to the 16th century Spanish explorer Ponce de Leon, whom legend says came to Florida in quest of the Fountain of Youth.  Drink or bathe in its waters and you could be young again.  A story-line like this isn’t unique, finding its replay in myth and legend throughout the world. 

Its insistence  doesn’t surprise us at all, since it mirrors our consummate dream to stay young, not for its own sake, but because we associate youth with beauty, vigor, and libido, or from another angle, the absence of chronic ills like coronary disease, cancer, arthritis, and God only knows what, that often define our later years.  All the parts are new and they work well and at 25 we may sometimes think ourselves immortal.  We dream not just ordinary dreams, but visionary ones that say I can and I will.

Sooner or later, we are all Ponce de Leon, clutching to “the splendors in the grass” (Wordsworth).  Our ads promulgate our folly with promised effulgences of youth’s attributes, abolishing gray, dissolving winkles, restoring passion.

But even medicine itself increasingly wanders into the Ponce de Leon camp these days, some doctors proffering we may soon banish the ills of our human sojourn, advancing our life span dramatically into the 100 year range what with the promise of genetics making individualized therapies possible, perhaps a pill as it were targeting your specific ill, say cancer.

This is pretty much the message of Dr. David Agus’ fascinating The End of Illness, sort of what we do now at the car shop or electronics outlet, plugging into a computer that in seconds spits out solution.  He tells the story of 44-year old Bill Weir, host of ABC’s Nightline, who volunteered to go live, or cameras rolling in prime time, as the newest medical technology imputed his medical data at USC University Hospital.

It was the whole works, including not only blood tests and CT scans, but DNA analysis to assess his hereditary risk for illnesses such as heart disease, Alzheimer’s disease, colon cancer and about 32 other disease scenarios.  A CT uncovered substantial calcium build-up in Weir’s coronary arteries, narrowing his arteries and portending a possible heart attack in the next several years.  He had seemed a very healthy man until testing found him out.

The point is that we can increasingly predict and find impending diseases, and employing  intervention therapy, reduce if not eliminate, their threat.  Because of the high expense, sounds to me like you want to make sure you and your loved ones have the best possible medical coverage.  In the end, prevention may well be less costly than treating a patient with cancer, heart disease or diabetes.

Here I agree with those in Agus’ camp.  Take those prescribed pills, undergo the recommended testings, etc.  Consider pancreatic cancer, for example, a disease that takes no prisoners and recently killed actor Patrick Swayze, astronaut Sally Ride, and Apple’s Steve Jobs.  It’s an insidious illness that manifests its symptoms when it’s usually too late.  Still, you can undergo an annual complete abdominal ultrasound, MRI, or CT and gain a chance to nip the culprit in the bud.

But do I think medicine in the next 25 years will largely eliminate illness?  I will only say I think the jury’s still out on this one, though I’m doubtful. There is the expense; human inertia; new diseases in an increasingly global village appearing, impervious to our best antibiotics and the lengthy interval in developing new ones.  Even Agus contradicts his own optimism in predicting the inevitability of a pandemic:

The swine flu scare that occurred in 2009 will someday be dwarfed by a real epidemic that will spread rapidly through virgin immune systems and kill millions in its path (as happened, for example, in the flu epidemic of 1918, when an estimated 50 million to 100 million people died) (p. 277).

And I think the title of his book extravagant.  It may spawn sales, but little else, for fragile beings that we are, fraught with mortality, we share the fate of all living creatures, governed in the end by entropy.  We will never arrest illness completely, though we may at times lessen its impacting, and even its timing, by employing health enhancing strategies that will also lend quality to our lives.

At present, the American medical establishment is in breakdown mode.  While heart disease has shown a decrease, cancer continues to plague us.  Apart from disease, our doctors kill up to 200,000 patients yearly by way of medical mistakes; 50 million of us have no insurance; 25 million of us are underinsured.  Meanwhile, our unhealthy lifestyle continues to menace both our health and our wallets.  We have more diabetics than ever, for example.  Many of us are just plain fat.

I’d like to continue this subject in a later post and tell you things you can do specifically to help safeguard the health of yourself and loved ones, though I can’t promise you centenarian status.  Only 1 in 20,000 achieves that!

–rj

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Confessions of a reluctant vegan

Food for Life distributes food on an internati...

I never thought I’d give-up meat.   Up to my mid fifties, I ate meat at virtually every meal, starting out with bacon and eggs in the morning; baloney sandwiches or a Big Mac for lunch; chicken or hamburger paddy at night.  Once a week I’d treat myself to a bucket of KFC chicken.  A steak was the right choice for special nights out.

Then it happened.  Karen shared an article she had just read in our local newspaper on the horrors of the turkey industry.  I’ll spare you the details, but it was pretty awful.

Both Karen and I then decided on switching to a veggie diet, though still including animal products such as eggs and cheese.  We made that decision the night before Thanksgiving Day, 1996, and we’ve been vegetarians now for close to 17-years and never looked back.

People choose vegetarianism for any of several reasons such as reducing weight, lowering heart risk, and promoting the environment.  We chose vegetarianism for ethical reasons, believing it wrong to inflict suffering on any sentient creature.  As the saying goes, always remember that the meat you eat once had a face.

The vegetarian diet, once you get past the meat cravings, is actually pretty good.  Sometimes it’s even too easy, what with all the veggie substitutes out there there for turkey, ham,  chicken and the like.  I can make a pasta dish complete with soy meatballs and fool people every time.  I can also fashion you a sumptuous veggie chili that tastes every bit like the original.  By the way, becoming a vegetarian doesn’t necessarily translate into a better diet than the ASD if you just gorge on junk foods like chips and sweets.

Transitioning to a vegan diet, however, has been a real challenge.  I chose to go this way about 15 months ago when a routine blood test showed my glucose at 108, meaning I was pre-diabetic.  It’s in this stage that you can make lifestyle changes that can prevent or delay the onset of diabetes.  I also found out I had high insulin resistance, meaning the insulin that the pancreas pumps out to handle blood sugar was having difficulty entering my cells, where it does its work.

I had to do two things in a hurry:  refine my diet even more by eliminating virtually all highly concentrated sugar foods such as soda, which I drank daily; candy, and baked goods.  I also needed to avoid refined, or processed, food products with their white flour, fructose, corn syrup and high sodium that are probably, along with meat and dairy, instigators of many of our health ills like obesity, coronary disease and, possibly, cancer.

I needed to eliminate foods having cholesterol content as well, which meant giving up cheese, one of my favorite foods.  Fatty foods clog the mitochondria, or cell gateways through which insulin accesses the cells, and obviously don’t do the arteries any good either.

Now I may surprise you when I say I don’t like going vegan–no more kitsch, or cheese, or morning fried eggs with buttered toast, or even pizza.  No more lovely potato salad.   No more sumptuous chocolate bars, cheese cake, apple pie.  Not even fruit juice.

It seems a diet made for hell, not heaven.  Frozen vegetables and mountains of lettuce just don’t cut it for me.  It’s like I’m turning into some kind of bunny.  It may have been ok for Gandhi, but hey, I’m not Gandhi.  Mexicans may love their beans, but day after day, it gets old for me.

What really makes things worse is that I’ve always been a slender guy not needing to lose weight.  On this diet over the past year, however, I’ve shed 15 pounds and have to cram nuts to steady my weight.  Weight loss may be great for most diabetics, who tend to be overweight, but not for yours truly.

At times I’m strongly tempted to compromise and resume the vegetarian diet, but then I remember it didn’t do anything for my insulin resistance, except maybe to encourage it.  Doing vegan, however, combined with aerobic exercise 5 times a week, I’ve cut my insulin resistance nearly in half, dropped my fasting glucose below 100, and have begun to transition from small LDL-p particles to the safer, large LDL-p particles.  Trigylcerides and bad cholesterol are way down;  HDL, the good cholesterol, is up sharply.  I think that’s where the second life style change kicks in.  You can’t just eat nutritionally dense foods.  You have to exercise vigorously 5 times a week for 30 minutes.  Even better, add resistance exercise 2 to 3 times a week.

But back to veganism.  Maybe it’s like being a baby again and Mama’s stand-by:  “Now eat up your veggies.  This bite’s for Mama.  This one for Papa.  This one for….

To put it frankly, I wish there were an easier, more appetizing route to good health.  But then again, all the studies that count show that diet matters and that a plant saturated diet does best for fostering good health.  The soundest dietary advice I ever got was put so simply by nutrition expert Michael Pollan in his fine book, In Defense of Food:  “Eat food. Not too much. Mostly plants.”  Though it isn’t easy, my own experience confirms its wisdom.

–rj

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