See The Article: Why? What can we do about it?

[ventana]

thread has me depressed

 

so much is wrong with tangential arguements about food supply, sugar, and all the other crap

 

But we all experience a selection bias - we only see the the people that come in for care

we never see those that are working hard, and not getting care due to expense (which is a lot of people)

 

Yes it would be great to eliminate junk food (but what do you do with all the jobs and lives the would be shattered when you stop making junk food?) or othe issues.  But that is not our issue

 

our issue is meeting the patient where they are at and being able to provide atleast a basic level of care

 

Lets take DM

I propose the follow should be allowed to every single American free of charge

1) annual hg11c

2) if DM annual meeting with DM educator

3) the following meds for free (paid by gov't)  insulin long and short acting, metformin, glyburide/glipizide, losartan, atorvastatin

4) quarterly visits with a PCP to help manage their DM

With just these 4 things I could likely get most people < 8 and many less then 7 (I do it every day in my practice with far more barriers)

 

Did you know PCP has a pretty huge drop off in business in Jan and Feb?  Why?  People avoiding care due to deductibles.

 

 

Unhealthy citizens do not need their soda and chips taken away, they need their providers to manage their pathology with medicines.....

 

 

I am not a politician and will never be so.  I am here to help patients and if society wants to poison them with drugs and foods then I am left to pick up the pieces, but every American should be able to at least get basic care (not the million dollar work ups and MRI for simple back pain but good basic care.)

[FiremedicMike]

2 minutes ago, ventana said:

Unhealthy citizens do not need their soda and chips taken away, they need their providers to manage their pathology with medicines.....

 

This is truly the first statement I've ever read on this forum that I vehemently disagree with.  Unhealthy citizens need to take some responsibility to make themselves healthy. 

Obviously some can't help it due to physiologic deficiencies beyond their control, but the overwhelming majority those living an unhealthy lifestyle are doing so due to poor health management and conscious choices.

Tossing pills at everyone for everything was not the answer when we were growing up and should never be the goal.

I need to lose about 25 pounds.  On the way home from the ED today I decided to stop and get some wings and beer.  It's not my PCP's responsibility to toss a pill at me so that I can keep eating like an idiot and lose weight anyway, it's my responsibility to stop eating like an idiot and lose weight naturally.

[ventana]

21 minutes ago, FiremedicMike said:

This is truly the first statement I've ever read on this forum that I vehemently disagree with.  Unhealthy citizens need to take some responsibility to make themselves healthy. 

Obviously some can't help it due to physiologic deficiencies beyond their control, but the overwhelming majority those living an unhealthy lifestyle are doing so due to poor health management and conscious choices.

Tossing pills at everyone for everything was not the answer when we were growing up and should never be the goal.

I need to lose about 25 pounds.  On the way home from the ED today I decided to stop and get some wings and beer.  It's not my PCP's responsibility to toss a pill at me so that I can keep eating like an idiot and lose weight anyway, it's my responsibility to stop eating like an idiot and lose weight naturally.

wow, just wow

 

so you advocate for taking away patient autonomy? 

Sorry but this sounds just like "she was asking for it, she had a sexy dress on"

 

nope no way, no how

 

We meet the patients where they are at - we are not the judge and jury

 

now do I 'wish' the gov't would clean up the food supply - heck yes - but I do not have paternalistic thoughts of mandating life changes in others - that is to close to a form of government that would never fly.....

[SedRate]

30 minutes ago, ventana said:

thread has me depressed

 

so much is wrong with tangential arguements about food supply, sugar, and all the other crap

 

But we all experience a selection bias - we only see the the people that come in for care

we never see those that are working hard, and not getting care due to expense (which is a lot of people)

 

Yes it would be great to eliminate junk food (but what do you do with all the jobs and lives the would be shattered when you stop making junk food?) or othe issues.  But that is not our issue

 

our issue is meeting the patient where they are at and being able to provide atleast a basic level of care

 

Lets take DM

I propose the follow should be allowed to every single American free of charge

1) annual hg11c

2) if DM annual meeting with DM educator

3) the following meds for free (paid by gov't)  insulin long and short acting, metformin, glyburide/glipizide, losartan, atorvastatin

4) quarterly visits with a PCP to help manage their DM

With just these 4 things I could likely get most people < 8 and many less then 7 (I do it every day in my practice with far more barriers)

 

Did you know PCP has a pretty huge drop off in business in Jan and Feb?  Why?  People avoiding care due to deductibles.

 

 

Unhealthy citizens do not need their soda and chips taken away, they need their providers to manage their pathology with medicines.....

 

 

I am not a politician and will never be so.  I am here to help patients and if society wants to poison them with drugs and foods then I am left to pick up the pieces, but every American should be able to at least get basic care (not the million dollar work ups and MRI for simple back pain but good basic care.)

It's unfortunate that as a healthcare provider and therefore an authority in health, you're actually not interested in discussing the solutions to fixing the problems that might be causing the diseases you treat in the first place. Why aren't you open to better understanding the possible Whys of our declining health and increasingly sedentary and inactive society? 

[FiremedicMike]

7 minutes ago, ventana said:

wow, just wow

 

so you advocate for taking away patient autonomy? 

Sorry but this sounds just like "she was asking for it, she had a sexy dress on"

 

This is a giant overreach and you know it.

[SedRate]

36 minutes ago, FiremedicMike said:

I need to lose about 25 pounds.  On the way home from the ED today I decided to stop and get some wings and beer.  It's not my PCP's responsibility to toss a pill at me so that I can keep eating like an idiot and lose weight anyway, it's my responsibility to stop eating like an idiot and lose weight naturally.

Yeah, but if you're too responsible and healthy, who will keep for-profit medicine churning and those local pubs in business? 

[iconic]

We don’t need to take anything from anyone also clearly tossing more pills has clearly not worked. We need healthier food options that are inexistent/inaccessible/unaffordable to many. No excuse why kids in schools should be served burgers, fries and pizza 

[Boatswain2PA]

13 hours ago, ventana said:

so you advocate for taking away patient autonomy? 

Sorry but this sounds just like "she was asking for it, she had a sexy dress on"

so you equate someone eating too much and never getting off the couch to a woman getting raped.

Shall we continue with the idiotic extrapolations?  Or can we just knock that off now??

 

13 hours ago, FiremedicMike said:

This is a giant overreach and you know it.

Huge overreach, not sure about knowing about it.
 

 

10 hours ago, iconic said:

No excuse why kids in schools should be served burgers, fries and pizza 

What's wrong with burgers, fries and pizza?    What would you propose?  Michelle Obama's lunch requirements of salad, carrot sticks and vegetable burgers?  (where most of it was thrown in the trash)

 

[iconic]

29 minutes ago, Boatswain2PA said:

 

What's wrong with burgers, fries and pizza?    What would you propose?  Michelle Obama's lunch requirements of salad, carrot sticks and vegetable burgers?  (where most of it was thrown in the trash)

 

Is this a joke? I grew up in Europe an we were never served garbage fast food in schools. We had soups, meatballs, potatoes, etc. And certainly no sodas 

https://www.madeformums.com/news/which-country-has-the-best-school-lunches/

There was maybe one obese kid in school at the time. You had to go out of your way to get fast food, which was still a lot of healthier than what we have here. 

I also did not grow up worrying about being gunned down by a maniac with AR 15 in school. But that's for a different discussion altogether. And yes, I see kids in child psych who worry about those things AND who have been victims of shootings 

Edited February 3, 2023 by iconic

[rev ronin]

Shall we all avoid invective, false equivalencies, and false dichotomies, please?

- Diet is only one part, and probably a small part, of the problem. We don't do routine activity anymore.  I'm not talking about structured exercise, I'm talking things like walking around.

- Food preparation and food consumption are part of the problem, too.  Eat in front of the TV or computer, or in the car? Stop that! Eat with human beings, face to face, put down the phone, and talk to your loved ones. The act of preparing food from raw-er ingredients is itself healthful, vs. ordering what someone else made or what you slapped into the microwave.

- Medicine is a great way to solve things that cannot be solved by lifestyle.

- As a society, we are wusses who have no patience and no tolerance for suffering. Go to a 2/3rds world country and see what they get for postop analgesia. We spend so much time ending suffering that we forget that 1) not all suffering is bad, and 2) not all suffering is avoidable.

That's a start.  There's more, but the fact is that human beings of the 21st century don't live like human beings have, and we're maladapted to our lives of excess and idleness, hence health impacts.

[CAAdmission]

6 hours ago, iconic said:

Is this a joke? I grew up in Europe an we were never served garbage fast food in schools. We had soups, meatballs, potatoes, etc. And certainly no sodas 

Is there really a substantive difference between meatballs and hamburgers?

[rev ronin]

23 minutes ago, CAAdmission said:

Is there really a substantive difference between meatballs and hamburgers?

I've never heard of Swedish hamburgers?

[Boatswain2PA]

6 hours ago, iconic said:

Is this a joke? I grew up in Europe an we were never served garbage fast food in schools. We had soups, meatballs, potatoes, etc. And certainly no sodas 

No, not a joke.

What is wrong with a hamburger?  Meat, cheese, veggies, bread...

And pizza?  Bread, veggies, meat, cheese....

Meatballs ain't much different than hamburgers.  

Fries are made out of potatoes.

My kids school (here in 'Merica) serves pizza, hamburgers, AND soups, meatballs, and potatoes.

And there isn't a soda fountain in the school.

 

 

[iconic]

You could make healthyish burgers. Pizza is not healthy. The stuff they serve in schools around here is deep-fried, high trans-fat. Idk how it is in every state 

[SedRate]

6 hours ago, rev ronin said:

Shall we all avoid invective, false equivalencies, and false dichotomies, please?

- Diet is only one part, and probably a small part, of the problem. We don't do routine activity anymore.  I'm not talking about structured exercise, I'm talking things like walking around.

- Food preparation and food consumption are part of the problem, too.  Eat in front of the TV or computer, or in the car? Stop that! Eat with human beings, face to face, put down the phone, and talk to your loved ones. The act of preparing food from raw-er ingredients is itself healthful, vs. ordering what someone else made or what you slapped into the microwave.

- Medicine is a great way to solve things that cannot be solved by lifestyle.

- As a society, we are wusses who have no patience and no tolerance for suffering. Go to a 2/3rds world country and see what they get for postop analgesia. We spend so much time ending suffering that we forget that 1) not all suffering is bad, and 2) not all suffering is avoidable.

That's a start.  There's more, but the fact is that human beings of the 21st century don't live like human beings have, and we're maladapted to our lives of excess and idleness, hence health impacts.

Agree with just about all except for, "Diet is only one part, and probably a small part, of the problem."

I think what we eat is not a small part of the problem. Your sentiments about food preparation and food consumption are noted. 

[SedRate]

2 hours ago, Boatswain2PA said:

No, not a joke.

What is wrong with a hamburger?  Meat, cheese, veggies, bread...

And pizza?  Bread, veggies, meat, cheese....

Meatballs ain't much different than hamburgers.  

Fries are made out of potatoes.

My kids school (here in 'Merica) serves pizza, hamburgers, AND soups, meatballs, and potatoes.

And there isn't a soda fountain in the school.

 

 

A few slices of tomatoes and leaves of lettuce do not constitute a serving of vegetables, so saying a hamburger or slice of pizza has vegetables is a far stretch... Perhaps if you eat enough slices of pizza you'll get one full serving. Lol

Reminds me of a dinner at my friends who served a "side of vegetables." The "side of vegetables" was chopped iceberg lettuce and a few slices of celery. 

Edited February 4, 2023 by SedRate

[Boatswain2PA]

3 hours ago, iconic said:

You could make healthyish burgers. Pizza is not healthy. The stuff they serve in schools around here is deep-fried, high trans-fat. Idk how it is in every state 

Why isn't pizza healthy?  Bread, meat, cheese, veggies (and even veggie sauce!)

Guessing you live in a big city?

3 hours ago, SedRate said:

few slices of tomatoes and leaves of lettuce do not constitute a serving of vegetables, so saying a hamburger or slice of pizza has vegetables is a far stretch... Perhaps if you eat enough slices of pizza you'll get one full serving. Lol

Fortunately for me then that I usually eat the whole damn thing!  I LOVE pizza!!

[Boatswain2PA]

3 hours ago, SedRate said:

Reminds me of a dinner at my friends who served a "side of vegetables." The "side of vegetables" was chopped iceberg lettuce and a few slices of celery. 

You need better friends my friend.

Had some friends over to new house a little while ago - Venison Parmigian, green beans canned from our garden, roasted acorn squash from our garden....and a bunch of fermented grape juice!

 

[SedRate]

32 minutes ago, Boatswain2PA said:

You need better friends my friend.

Had some friends over to new house a little while ago - Venison Parmigian, green beans canned from our garden, roasted acorn squash from our garden....and a bunch of fermented grape juice!

 

He's a long-time friend who officiated our wedding so we can't get rid of em. Unless we get divorced... Lol. But yeah, to your point, we're working on it! 

[Boatswain2PA]

9 minutes ago, SedRate said:

He's a long-time friend who officiated our wedding so we can't get rid of em. Unless we get divorced... Lol. But yeah, to your point, we're working on it! 

Yeah, my best man is a "natty light" kinda guy.  

[jmj11]

There are some great ideas expressed here, but I'm pessimistic that the American government has any hopes of making things better. Now, it has become a war of power, red Vs blue and the only acts that matter are winning for that team. While there are good people in both parties, and bad, some days I would like to fire them all and hire smart independents who don't give a rat's ass about who is in power or who is winning, but real solutions to real problems. Sit and watch Fox News for an hour then turn and watch MSNBC for an hour and you feel the divide between two different cosmoses. My hope is my children's generation will find a better way to govern. We do deserve better than the circus our government has become.

[SedRate]

28 minutes ago, jmj11 said:

There are some great ideas expressed here, but I'm pessimistic that the American government has any hopes of making things better. Now, it has become a war of power, red Vs blue and the only acts that matter are winning for that team. While there are good people in both parties, and bad, some days I would like to fire them all and hire smart independents who don't give a rat's ass about who is in power or who is winning, but real solutions to real problems. Sit and watch Fox News for an hour then turn and watch MSNBC for an hour and you feel the divide between two different cosmoses. My hope is my children's generation will find a better way to govern. We do deserve better than the circus our government has become.

Rather than focus on the powers that be, I think a great start is preventing some of the diseases in the first place. Less sickness and less disease roughly equals less costs and less burden on our healthcare system and society. Or am I missing something? Sadly, preventive medicine won't necessarily help those already afflicted or predisposed except for maybe curbing disease expression and progression. 

[rev ronin]

17 hours ago, SedRate said:

Agree with just about all except for, "Diet is only one part, and probably a small part, of the problem."

I think what we eat is not a small part of the problem. Your sentiments about food preparation and food consumption are noted. 

Fair point.  Let me amend that to "... and probably a smaller part than we've always assumed..."

[Reality Check 2]

For profit medical insurance is an oxymoron in the most moronic meaning of the word.

No one should profit from "health" except the patient. There should not be reward for NOT using healthcare.

We have degraded Public Health into a resume padding position on a town or county council by nonmedical people who want a hand in "politics".

Medicine and science are not political - they are science.

Until or unless the US as a whole chooses to accept science as a science and is willing to take care of themselves - nothing will change.

Insurance CEOs will continue with 7 figure "bonuses" and care will be rationed based on money not logic.

Pretty sure I was supposed to have been born Vulcan at this point. 

Tired of trying to convince people that I know what I am talking about medically and that I have their best interest at heart and there is NOT a pill for every damn thing.

As Scott says - people are making me tired. 

[SedRate]

23 minutes ago, Reality Check 2 said:

For profit medical insurance is an oxymoron in the most moronic meaning of the word.

No one should profit from "health" except the patient. There should not be reward for NOT using healthcare.

We have degraded Public Health into a resume padding position on a town or county council by nonmedical people who want a hand in "politics".

Medicine and science are not political - they are science.

Until or unless the US as a whole chooses to accept science as a science and is willing to take care of themselves - nothing will change.

Insurance CEOs will continue with 7 figure "bonuses" and care will be rationed based on money not logic.

Pretty sure I was supposed to have been born Vulcan at this point. 

Tired of trying to convince people that I know what I am talking about medically and that I have their best interest at heart and there is NOT a pill for every damn thing.

As Scott says - people are making me tired. 

I'm tired too. I'm tired of being the odd ball out and/or defending my healthy efforts to family, friends and peers. "Oh, c'mon, live a little. Just have a small one." Living in a society that encourages/promotes fast food, soda, alcohol, the newest diet or exercise trend, "things," etc, is getting old. Even worse now that cellphones and social media are a part of everyday life and inundated with marketing. You can also bet that AI is going to take over marketing and run with it. (Btw, if you're not aware, it's already started to.)

It's no wonder why human behavior is hard to change when one examines what we're all exposed, not only marketing, advertising, and sloppy, underfunded research that's rushed to publishing ("new research based on a small sample size suggests XYZ diet is good for us!"), but the habits of who we surround ourselves with and how we were raised. Awareness isn't the answer -- we're all well aware that we need to eat better, exercise more, etc. We need to change behavior. Easily said than done... 

The health system is for-profit just as insurance is. RVU bonuses, seeing more pts, doing more surgeries = more money. Healthcare providers are incentivized to treat more pts (although billing for time may help change this) and have a higher MDM, not prevent why people are unhealthy in the first place. We're paid to recommend behavioral change (aka lifestyle factors) AFTER the illness. (Who actually has healthy people regularly on their schedule for an annual wellness check? Lol.) And even in counseling pts on lifestyle changes, we're not necessarily experts (especially as it pertains to nutrition/exercise) and/or have the time to discuss thoroughly. "Patient, you need to eat healthier, exercise more, and reduce salt intake. Walk 10,000 steps a day and eat more vegetables. Ok, now go do that!" Once they leave, why would the average American be motivated to change when all they see is unhealthy foods and habits all around them by friends/family/media? 

Sadly, medicine and science have become political in terms of where NIH funding comes from (taxpayers) and who funds academia (local governments wanting to boost their own agenda or personal interests because a family member was sick). Academia also have less rigorous requirements than private research entities as well as more pressure to publish (to attain or retain tenure because the Dean promotes/incentivizes quantity over quality) which leads to bad science.