Tuesday, August 31, 2010

A Wonky Look at the Development of U.S. Obesity

We've all heard that obesity in our country is virtually pandemic. Indeed, 70% of the adult population is clinically overweight or frankly obese as defined by calculation of body mass index (BMI) which looks at your weight in relationship to your height.

This study looks at obesity since the mid-1800's and how it develops in the same people over time.

The conclusion is that the development of present levels of obesity did not just suddenly develop in the late 1980's, but rather has developed more slowly and steadily throughout the entire 20th century.

As this study points out,

The lifestyle changes of the 20th century affected the four groups under study somewhat differently. Identifying the deep causes of the long-run trends is outside of the scope of this study, but the “creeping” nature of the epidemic, as well as its persistence, does suggest that its roots are embedded deep in the social fabric and are nourished by a network of disparate slowly changing sources as the 20th-century US population responded to a vast array of irresistible and impersonal socio-economic and technological forces.

The most obviously persistent among these were:

  • the major labour-saving technological changes of the 20th century,
  • the industrial processing of food and with it the spread of fast-food eateries (To illustrate the spread of fast food culture, consider that White Castle, the first drive-in restaurant, was founded in 1921. McDonald started operation in the late 1940s, Kentucky Fried Chicken in 1952, Burger King in 1954, Pizza Hut in 1958, Taco Bell in 1962, and Subway in 1962.),
  • the associated culture of consumption,
  • the rise of an automobile-based way of life,
  • the introduction of radio and television broadcasting,
  • the increasing participation of women in the work force, and
  • the IT revolution.
These elements – taken together – virtually defined American society in the 20th century.

Monday, August 30, 2010

Health Care Reform Should Not Write Off Small Medical Practices

While I've generally been of an optimistic wait-and-see approach to the recently enacted health care reform legislation, I have been concerned to note that a fair amount of it seems optimized to large medical organizations.

For example, the billions to be spent to create incentives for doctors to use electronic medical records (EMR) does nothing to require uniform code standards so that various EMR products would still be able to communicate and share data with each other. I hesitate to spend up to $40,000 in start-up costs alone, only to find that my EMR system can't share data with other offices or hospitals.

Also, the use of medical practice data for statistics gathering is not useful in small office practices because of the smaller number of patients. This really presupposes medical groups with tens of thousands of patients like Kaiser or the VA.

This article reports on a meeting with two White House officials basically stating that doctors should get ready to enjoy a life in Big Medicine. Frankly, if I enjoyed working for Kaiser or the VA, I'd already be doing that.

I do find it unfortunate that the present administration's approach to stimulating businesses and propping up banks similarly seems to almost solely be directed to enterprise-scale businesses and large banks and not the small "mom and pop" businesses and local credit unions.

As far as I'm concerned, entrepreneurship is what makes America great!

Thursday, August 26, 2010

ALERT: Billing Issue with Marshall Lab

If you are a MediCare or MediCal patient, you have already noticed that Marshall Lab has been using computer software that can generate a paper for you to sign anytime you come in with a test ordered where MediCare has a possible restriction on how often they can be done. I posted on this on 11/30/09, as patients were becoming concerned about being billed for tests that were ordered by their doctor.

Evidently, a problem has arisen where you sign this paperwork even though MediCare should be covering the test. This should be OK, because all the form states is that you are aware that you MAY (not will or shall) be billed. However, MediCare seems to be taking this as blanket acceptance for them to refuse to pay on the tests.

This is not at all how this is supposed to work. We have been in touch with Chris, who is a woman who does billing for Marshall. She is advising patients not to pay in these situations, and is re-billing MediCare. She has given us permission to give out her name and also her phone number to use in case you are in this predicament.

Her number is 626-2770, ext. 2588#.

Tuesday, August 24, 2010

A Really Interesting Letter on the End of Life

Some of you may remember Marty Welsh; he was a family practice doc here, but retired a few years ago after he was diagnosed with ALS (otherwise known as Lou Gehrig's disease).

This was a real tragedy as this is known to be a slowly progressive, debilitating and ultimately fatal and untreatable illness, and also because Marty is a fantastic guy and a model doctor.

About a year ago, he wrote a letter to the opinion pages of the LA Times which is his hometown paper. This letter has been very widely read, posted and cited. It is a very clear and heartfelt letter written my a person dying of ALS, and also from the point of view of a doctor who is now a patient who knows what will happen to himself over the course of the illness.

Sorry it's taken a while to link to it, but better late than never. It's certainly a worthwhile reflection on the meaning of quality of life.