Over the last 30 years we have seen the rise of preventative health. Some recent studies shine a spotlight on this and raise good questions. A US study questions the cost effectiveness of certain health programs. In Germany it has been suggested that many “preventative” health programs may do more for doctor’s wallets than patients.
A UK study has shown that simple lifestyle changes would reduce rates of bowel cancer far more than screening programs (testing blood in the stool. Mass skin cancer screening in Australia has seen the ratio of spots removed per cancerous spot go from one in four in 1980 to one in thirty today.
The issue with most public health and preventative health campaigns is that are focused on trying to detect or prevent specific diseases. There is rarely an emphasis on keeping people healthy overall.
Now, lets be clear, it is better to find disease early than late. However this is not the same as not getting disease and certainly not the same as focusing on being healthy. If being healthy becomes an obstacle course, then in avoiding one obstacle we may run straight into the next.
There are unintended consequences of this “disease specific” approach For example; skin cancer campaigns that urge people to stay out of the sun may be partly responsible for a staggering increase in vitamin D deficiencies. This may be causing more cancers (bowel and breast for example) than it is preventing. Vitamin D deficiency is also possibly linked to diabetes
Since the late 1970’s, there has been a big push to reduce fat intake. This has come about because of concern that cholesterol in the blood stream leads to heart disease. Interestingly, the original study (Framingham), which sparked this whole reduced fat movement, never actually concluded that circulating cholesterol levels were the problem. It was always to do with the build up of cholesterol plaque in certain artery walls and even more to the point, the rupture of this plaque. The reasons why this occurs in certain individuals and not others, has always remained a mystery.
Indeed, there are populations around the world who have very high levels of cholesterol and very low levels of heart disease and vice versa and up to 40% of people with heart disease have none of the “common risk factors”.
Nevertheless, the “fat is bad” mantra gained traction.
The proverbial baby has been thrown out with the bathwater, as many people may not get enough good fats. Omega 3 and omega 6 are called essential fatty acids because the body can’t make them and needs them. Also in a push to lower fat intake, consumers sought out low fat foods. What people didn’t think about was these foods were very high in carbohydrates (sugars) in general and refined carbohydrates in particular. Not only those, but also these foods do not provide much nourishment and often leave you with the munchies two hours later.
If the body gets excess calories it will store them. It can’t store them as sugars, it stores them as fat, so regardless of how many low fat foods a person eats, the excess calories are converted to fat. The gradual result of this over 25 years has been an increase in the rates of obesity. People have been eating less fat but guess what happened? They have been getting fatter.
The next knock-on effect has been an increase in the rate of diabetes. Obesity has skyrocketed since the mid 1980’s - all this under the watchful eye of the public health and preventative disease authorities. By focusing on trying to prevent one illness, a whole range of other effects was overlooked. The messages are not bad or negatively intended in any way, but too narrow in trying to stop one particular disease.
The solution of course is to focus on being healthy rather than trying to prevent specific diseases, especially when trying to prevent one disease can lead to getting another. This is the essence of Do It Yourself Health
The best way not to get sick is to be healthy.
Wednesday, March 31, 2010
Friday, March 26, 2010
Fitness Is Important Regardless of Your Day Job
Politicians can be criticized for many things. Being fit and healthy is not usually one of them. The general view of the lifestyle of the average politician would be one of too many meals out perhaps accompanied by a bit too much alcohol. Regular exercise is not often associated with politicians. Now, this is of course a generalization. There will be those who are watchful of what they eat and some maintain a fitness regime.
Australian Federal opposition leader Tony Abbott is a rare breed amongst politicians in that he is a fitness fanatic. He competes in iron man events and triathlons. He is in extremely good physical shape for his age and is getting known for photos in his Speedos. This is a rare look for any politician.
Now I am fairly fit and a couple of years younger than Mr. Abbott and have no desire to emulate his efforts. It is not necessary to do as much exercise as he does to be in good health.
It is interesting to see some of the reaction to this. Obviously political opponents want to score points so it can be argued that making jokes about media pictures of Mr. Abbott in his “budgie smugglers” as his bathers are colloquially known is fair game. Equally is the jibe that the public may be tiring of seeing photos of him in bathers on the beach.
There has been another criticism which is a bit stranger particularly sitting against the backdrop of ongoing discussion over health care reform. He has been criticized for spending too much time keeping fit rather than being at work. Now I do not know exactly how many hours per week he spends on his exercise regime or doing his day job. The Federal Treasurer was quoted as saying” I do not know where he finds the time …”.
Jokes aside, there are serious issues that emerge from this. Firstly no matter what your day job is, looking after your health is vital and keeping fit is a key part of this. We all have 24 hours in the day. Some of us prioritize exercise and others do not. Some of us are efficient in our tasks, others less so. Some people, not just politicians, wear the hours they work as some sort of honor badge- it is no such thing.
Excessive hours at work are not good for health as it makes your life unbalanced. In addition to this, the longer one works without break the less productive one becomes. On top of this exercise helps mental clarity and helps you sleep better. Hence a fit person will often get more done in less time that someone who is not fit. Of course exercise helps you maintain a healthy weight and reduces your risks of disease such as heart disease and stroke to name but two.
So with all the arguments over “health “ reform and ways to pay for more disease services, which are required because many people do not exercise, it is in some ways refreshing to have a political leader who is leading by example when it comes to health. A politician who is showing that health is not about hospital beds but about looking after yourself.
Being fit is not grounds for bring elected.Like all politicians he needs to be judged ultimately on policies and how well he does his day job. Criticisms of his exercise regime particularly in an environment where governments are concerned about the spiraling costs of the consequences of not exercising are ridiculous.
Australian Federal opposition leader Tony Abbott is a rare breed amongst politicians in that he is a fitness fanatic. He competes in iron man events and triathlons. He is in extremely good physical shape for his age and is getting known for photos in his Speedos. This is a rare look for any politician.
Now I am fairly fit and a couple of years younger than Mr. Abbott and have no desire to emulate his efforts. It is not necessary to do as much exercise as he does to be in good health.
It is interesting to see some of the reaction to this. Obviously political opponents want to score points so it can be argued that making jokes about media pictures of Mr. Abbott in his “budgie smugglers” as his bathers are colloquially known is fair game. Equally is the jibe that the public may be tiring of seeing photos of him in bathers on the beach.
There has been another criticism which is a bit stranger particularly sitting against the backdrop of ongoing discussion over health care reform. He has been criticized for spending too much time keeping fit rather than being at work. Now I do not know exactly how many hours per week he spends on his exercise regime or doing his day job. The Federal Treasurer was quoted as saying” I do not know where he finds the time …”.
Jokes aside, there are serious issues that emerge from this. Firstly no matter what your day job is, looking after your health is vital and keeping fit is a key part of this. We all have 24 hours in the day. Some of us prioritize exercise and others do not. Some of us are efficient in our tasks, others less so. Some people, not just politicians, wear the hours they work as some sort of honor badge- it is no such thing.
Excessive hours at work are not good for health as it makes your life unbalanced. In addition to this, the longer one works without break the less productive one becomes. On top of this exercise helps mental clarity and helps you sleep better. Hence a fit person will often get more done in less time that someone who is not fit. Of course exercise helps you maintain a healthy weight and reduces your risks of disease such as heart disease and stroke to name but two.
So with all the arguments over “health “ reform and ways to pay for more disease services, which are required because many people do not exercise, it is in some ways refreshing to have a political leader who is leading by example when it comes to health. A politician who is showing that health is not about hospital beds but about looking after yourself.
Being fit is not grounds for bring elected.Like all politicians he needs to be judged ultimately on policies and how well he does his day job. Criticisms of his exercise regime particularly in an environment where governments are concerned about the spiraling costs of the consequences of not exercising are ridiculous.
Tuesday, March 23, 2010
Weight Loss Does Not Come From A Pill
The weight loss drug Sibutramine, better known as Reductil had its license suspended by the European Medicines Agency (EMA). The agency recommended that the drug should neither be prescribed by doctors nor dispensed by pharmacists. The reason for this was that a trial of 10,000 people followed for six years showed an increased rate of heart attacks and strokes in the group taking Reductil compared to a control group. The EMA has concluded that these risks outweigh the benefits.
Whilst the drug remains licensed in other countries at this stage, the end cannot be far off. Even if other government agencies do not follow suite, the manufacturer may well pull the drug off the shelves on potential liability grounds. This trial result would make a liability action difficult to defend.
This drug will not, in my opinion, be missed for the simple reason that it does not do much. Those taking it lose only marginally more weight than those taking a placebo and the effect is not long lasting.
This drug now joins a list of other weight loss drugs, which have been taken off the market because the risks were greater than the benefits. At the same time the race to find a new pharmaceutical agent for the “obesity” crisis goes on. There is a cash prize on offer. It is estimated that Americans spend $59 billion each year on weight reduction products and services. Only a small part of this is spent on pharmaceuticals.
There are currently three new drugs lining up at the FDA for regulatory approval. Apparently they have shown “promising” results in one-year trials.
Whilst that is fine, a one-year trial will not show risks, which might appear after three to five years. The trial, which has led to the decision on Reductil, was done over six years.
Here is something to think about. If it was not a pill that caused you to become overweight, why would you expect the solution to be in a pill? The basic fact is that we put on weight when our energy intake (calories) exceeds our energy expenditure. Now, I know the calories in, calories out idea are not popular in some quarters. It is true that some people have different metabolic types and do better with some foods than others. It is also true that to reduce weight, combinations of foods, times when you eat, and your emotions play a part.
The bottom, line though is that whilst there are a vast number of roads to travel, the final common pathway has to be an alteration in the energy equation. This is not medicine; this is a basic law of physics and cannot be gotten around.
Therefore lets be honest about weight. The problem is not your bones, your genes, your family, the take away shop down the road, your job or any one of a thousand other excuses. The problem is the energy equation of energy taken in compared to energy used up. When you bring it back to basics the solution is simple. It is to change your eating patterns. It is about putting the fuels into your body that it actually needs. It is about reducing processed foods and eating more real foods.
What you have created, you have the power to change-if you want to.
Whilst the drug remains licensed in other countries at this stage, the end cannot be far off. Even if other government agencies do not follow suite, the manufacturer may well pull the drug off the shelves on potential liability grounds. This trial result would make a liability action difficult to defend.
This drug will not, in my opinion, be missed for the simple reason that it does not do much. Those taking it lose only marginally more weight than those taking a placebo and the effect is not long lasting.
This drug now joins a list of other weight loss drugs, which have been taken off the market because the risks were greater than the benefits. At the same time the race to find a new pharmaceutical agent for the “obesity” crisis goes on. There is a cash prize on offer. It is estimated that Americans spend $59 billion each year on weight reduction products and services. Only a small part of this is spent on pharmaceuticals.
There are currently three new drugs lining up at the FDA for regulatory approval. Apparently they have shown “promising” results in one-year trials.
Whilst that is fine, a one-year trial will not show risks, which might appear after three to five years. The trial, which has led to the decision on Reductil, was done over six years.
Here is something to think about. If it was not a pill that caused you to become overweight, why would you expect the solution to be in a pill? The basic fact is that we put on weight when our energy intake (calories) exceeds our energy expenditure. Now, I know the calories in, calories out idea are not popular in some quarters. It is true that some people have different metabolic types and do better with some foods than others. It is also true that to reduce weight, combinations of foods, times when you eat, and your emotions play a part.
The bottom, line though is that whilst there are a vast number of roads to travel, the final common pathway has to be an alteration in the energy equation. This is not medicine; this is a basic law of physics and cannot be gotten around.
Therefore lets be honest about weight. The problem is not your bones, your genes, your family, the take away shop down the road, your job or any one of a thousand other excuses. The problem is the energy equation of energy taken in compared to energy used up. When you bring it back to basics the solution is simple. It is to change your eating patterns. It is about putting the fuels into your body that it actually needs. It is about reducing processed foods and eating more real foods.
What you have created, you have the power to change-if you want to.
Friday, March 19, 2010
Immunization Debates Generate More Heat Than Light - We Need Facts on Vaccinations
Unless you have been on mars for most of the last twelve months you would have heard about the H1N1 virus also known as swine flu. In response to the perceived “killer” virus, governments around the world ordered mass dosages of a vaccine against the virus in a bid to save the populace from the terror of flu.
As things turned out there was no threat and many governments in the northern hemisphere have scaled back their orders considerably. In fact latest figures from the USA show that this flu season has been particularly mild with far less cases than usual. The Australian government was not able to cut back its order and hence has a lot of vaccine in storage. It is looking to get rid of this by another scare campaign about second waves (which is tricky when there was no first wave).
Through all this though there has not been any questioning of the basic assumption that giving people a flu vaccine protects them from flu and that in turn they and society benefit. Many countries have annual flu vaccination programs for those over 65. Some of these have been going for many years.
It was with some interest then that it emerged recently that there is not actually any evidence to show that this does any good! The well-respected Cochrane collaboration released a report, which looked at 75 studies over a 40-year period. The conclusion was that “The available evidence is of poor quality and provides no guidance regarding the safety, efficacy or effectiveness of influenza vaccines in people aged 65 years or older”.
In simple terms after 40 years we do not know if giving people over 65 a flu vaccine does any good or any harm. Now to be fair there is nothing at all to suggest that there is any harm done even though the safety of its use has not been proved. Also it could be that nobody was able to find the evidence of benefit even though it may be there.
However after 40 years and 75 studies on a commonplace medical procedure you would expect evidence of benefit to be apparent. The assumption that because it involves vaccination it must be good is not a scientific position but one of faith. Interestingly it is exactly the type of criticism that is leveled at those opposed to vaccines by health authorities and doctors. Unfortunately “debates” over vaccination generate heat and no light as positions are entrenched and facts are of little interest.
Some drugs are more useful than others. Those, which are shown to be not useful, go out of use. Medical procedures too, become superseded. There is no reason the same logic should not apply to vaccination. Those, which are shown to be useful, should be continued. Those where there is not shown to be benefit should not.
Last year serious questions were raised over the papiloma virus vaccine (marketed as the Cervical Cancer vaccine) as how long it lasts in the system is unclear and by giving it to 13 year old it may have worn off by the time they need protection. Also there is the lingering question about whether the body will in most cases clear the virus anyway.
An Australian report showed that after the introduction of the Chicken Pox vaccine there was an increase in the rate of hospitalization of the elderly with Shingles, which is caused by the same virus. This led a call for another vaccine program. Whilst there was a reduction in cases of chicken pox, in children this is hardly a massive achievement as it is essentially a minor childhood illness (yes there can be complications but this is rare).
The bottom line is that this matters. Governments spend large sums of money on vaccine programs. There is in many instances some compulsion about being vaccinated and penalties for not doing so. This does not occur with any other area of medicine. Assessments made on the basis of facts, not pre conceived notions, faith in vaccines, or opposition to vaccines, is what is needed. Those, which are shown to have benefits outweighing risks, are worth doing. Those where this is not the case, are not worth continuing.
Vaccination is a medical and public health issue. It is not a sacred cow. Programs need to be assessed, criticized and changed or stopped if not found to be of benefit. Justification on the basis that vaccination, of itself, is good is no better an argument than vaccination, of itself, is bad.
As things turned out there was no threat and many governments in the northern hemisphere have scaled back their orders considerably. In fact latest figures from the USA show that this flu season has been particularly mild with far less cases than usual. The Australian government was not able to cut back its order and hence has a lot of vaccine in storage. It is looking to get rid of this by another scare campaign about second waves (which is tricky when there was no first wave).
Through all this though there has not been any questioning of the basic assumption that giving people a flu vaccine protects them from flu and that in turn they and society benefit. Many countries have annual flu vaccination programs for those over 65. Some of these have been going for many years.
It was with some interest then that it emerged recently that there is not actually any evidence to show that this does any good! The well-respected Cochrane collaboration released a report, which looked at 75 studies over a 40-year period. The conclusion was that “The available evidence is of poor quality and provides no guidance regarding the safety, efficacy or effectiveness of influenza vaccines in people aged 65 years or older”.
In simple terms after 40 years we do not know if giving people over 65 a flu vaccine does any good or any harm. Now to be fair there is nothing at all to suggest that there is any harm done even though the safety of its use has not been proved. Also it could be that nobody was able to find the evidence of benefit even though it may be there.
However after 40 years and 75 studies on a commonplace medical procedure you would expect evidence of benefit to be apparent. The assumption that because it involves vaccination it must be good is not a scientific position but one of faith. Interestingly it is exactly the type of criticism that is leveled at those opposed to vaccines by health authorities and doctors. Unfortunately “debates” over vaccination generate heat and no light as positions are entrenched and facts are of little interest.
Some drugs are more useful than others. Those, which are shown to be not useful, go out of use. Medical procedures too, become superseded. There is no reason the same logic should not apply to vaccination. Those, which are shown to be useful, should be continued. Those where there is not shown to be benefit should not.
Last year serious questions were raised over the papiloma virus vaccine (marketed as the Cervical Cancer vaccine) as how long it lasts in the system is unclear and by giving it to 13 year old it may have worn off by the time they need protection. Also there is the lingering question about whether the body will in most cases clear the virus anyway.
An Australian report showed that after the introduction of the Chicken Pox vaccine there was an increase in the rate of hospitalization of the elderly with Shingles, which is caused by the same virus. This led a call for another vaccine program. Whilst there was a reduction in cases of chicken pox, in children this is hardly a massive achievement as it is essentially a minor childhood illness (yes there can be complications but this is rare).
The bottom line is that this matters. Governments spend large sums of money on vaccine programs. There is in many instances some compulsion about being vaccinated and penalties for not doing so. This does not occur with any other area of medicine. Assessments made on the basis of facts, not pre conceived notions, faith in vaccines, or opposition to vaccines, is what is needed. Those, which are shown to have benefits outweighing risks, are worth doing. Those where this is not the case, are not worth continuing.
Vaccination is a medical and public health issue. It is not a sacred cow. Programs need to be assessed, criticized and changed or stopped if not found to be of benefit. Justification on the basis that vaccination, of itself, is good is no better an argument than vaccination, of itself, is bad.
Tuesday, March 16, 2010
Parenting Is About Using Judgement Not Protocols
One of the important contributors to a child’s health, both physical and mental is a reasonably stable environment. This for various reasons is not always possible and humans are fairly resilient. When one looks at the requirements people have to go through to be approved as adoptive parents and applied this to parents in general there would be very few children born.
Departments of child services or child protection are there to step in and protect children if they are deemed to be in danger for some reason and that it is deemed unsuitable or unsafe for the child to remain with their natural parents. These children are then placed in foster care. Again there are certain criteria that people have to satisfy to be selected as foster parents.
A row has broken out in my home of Perth this week about a prospective foster family who has been told they cannot fulfill such a role. This family has 11 children of their own and told The West Australian newspaper that they saw fostering as part of their Christian duty and an opportunity to put back into the community. There are reportedly 3238 children on the emergency waitlist for foster placement.
The reason this family was told that they are not suitable is because during the interview they admitted that occasionally smacked their own children. They indicated that they would not smack a foster child in their care.
Now I will put three things on the table. I do not think smacking is the best way to discipline children and I have on very rare occasions smacked my children. I have never met the family in question.
In some countries smacking is against the law .It is not against the law in Australia. According to the Department of Child Protection, if one of the children in the house were to be smacked then this would traumatize the foster child.
What are we to make of this? If there are over 3000 children awaiting emergency placement then clearly there are more children that prospective foster families. Being a foster parent is possibly the hardest gig. They are not your own children and you have not adopted them as your own. You are charged with raising them for an unspecified period of time under the watch of a government department. These children necessarily have issues otherwise they would not be in foster care.
This does not mean that there should not be a vetting process and that any family that puts their hand up gets selected. It does mean that commonsense rather than political correctness needs to rule the day. If a parent is honest enough to say they occasionally smack their child, does this automatically make them a bad parent? Is this worse then sending a child to their room for two hours or grounding them?
And here is the key thing. Being a parent requires the use of judgment. You need to judge situations and respond at the time in the way that seems best. In doing so there is a chance with hindsight that your judgment call may not have been the best one. This is thing that government departments and the people who inhabit them cannot abide. And why is this?
It is because when you make a judgment call you are taking personal ownership and responsibility for what you do and the consequences. You are not hiding behind a committee decision or guidelines or protocols, which are supposed to be able to second guess, in advance every nuance of every situation. You are making a decision and in so doing must take responsibility for that decision.
The same thinking is behind equating an occasional smack with child abuse. By making everything the same, there is no need to make judgment calls on individual situations with the inherent need for personal responsibility and the possibility of being wrong. Of course such an approach diminishes the severity of real abuse but can be easily placed in protocols.
A family with 11 children is fairly easy to assess for parenting skills. Look at how the children are turning out. Talk to their school, the local community maybe employers of the older children. The proverbial proof of the pudding is in the eating. If these parents are capable you will see it in their children.
This of course requires judgment and individual responsibility, something that is anathema to government departments who whilst charged with protecting children, have 3238 awaiting care but bask in the glow of protocols, which “protect” children.
Departments of child services or child protection are there to step in and protect children if they are deemed to be in danger for some reason and that it is deemed unsuitable or unsafe for the child to remain with their natural parents. These children are then placed in foster care. Again there are certain criteria that people have to satisfy to be selected as foster parents.
A row has broken out in my home of Perth this week about a prospective foster family who has been told they cannot fulfill such a role. This family has 11 children of their own and told The West Australian newspaper that they saw fostering as part of their Christian duty and an opportunity to put back into the community. There are reportedly 3238 children on the emergency waitlist for foster placement.
The reason this family was told that they are not suitable is because during the interview they admitted that occasionally smacked their own children. They indicated that they would not smack a foster child in their care.
Now I will put three things on the table. I do not think smacking is the best way to discipline children and I have on very rare occasions smacked my children. I have never met the family in question.
In some countries smacking is against the law .It is not against the law in Australia. According to the Department of Child Protection, if one of the children in the house were to be smacked then this would traumatize the foster child.
What are we to make of this? If there are over 3000 children awaiting emergency placement then clearly there are more children that prospective foster families. Being a foster parent is possibly the hardest gig. They are not your own children and you have not adopted them as your own. You are charged with raising them for an unspecified period of time under the watch of a government department. These children necessarily have issues otherwise they would not be in foster care.
This does not mean that there should not be a vetting process and that any family that puts their hand up gets selected. It does mean that commonsense rather than political correctness needs to rule the day. If a parent is honest enough to say they occasionally smack their child, does this automatically make them a bad parent? Is this worse then sending a child to their room for two hours or grounding them?
And here is the key thing. Being a parent requires the use of judgment. You need to judge situations and respond at the time in the way that seems best. In doing so there is a chance with hindsight that your judgment call may not have been the best one. This is thing that government departments and the people who inhabit them cannot abide. And why is this?
It is because when you make a judgment call you are taking personal ownership and responsibility for what you do and the consequences. You are not hiding behind a committee decision or guidelines or protocols, which are supposed to be able to second guess, in advance every nuance of every situation. You are making a decision and in so doing must take responsibility for that decision.
The same thinking is behind equating an occasional smack with child abuse. By making everything the same, there is no need to make judgment calls on individual situations with the inherent need for personal responsibility and the possibility of being wrong. Of course such an approach diminishes the severity of real abuse but can be easily placed in protocols.
A family with 11 children is fairly easy to assess for parenting skills. Look at how the children are turning out. Talk to their school, the local community maybe employers of the older children. The proverbial proof of the pudding is in the eating. If these parents are capable you will see it in their children.
This of course requires judgment and individual responsibility, something that is anathema to government departments who whilst charged with protecting children, have 3238 awaiting care but bask in the glow of protocols, which “protect” children.
Saturday, March 13, 2010
Health Reform Is Not More Services - It Is People Being Healthy
Health reform is on the front page in Australia, again. Prime Minister Kevin Rudd revealed a plan for the Commonwealth Government to take over the funding of public hospitals from state governments. Prior to being elected in 2007 Mr Rudd promised to fix the health system and stop the “blame game”.
Funding of the health (read “disease” system in Australia is split between the two levels of government. In simplest terms the Commonwealth raises tax dollars. It then gives the states a pot of money under the Australian Medicare agreement, to run the public hospitals. This allows Canberra (the capital) to blame the states for not wisely spending the money they have and allows the states to blame Canberra for not providing them enough money to do the task.
Strange anomalies occur. For example, if you get a prescription from a doctor in a private practice and get it dispensed at a pharmacy, the Commonwealth will in part pay it for. If you get a prescription at an emergency department and it is filled out there, it is paid for by the state. See a specialist in their consulting room and it costs the Commonwealth. See the same specialist in a clinic and he will be paid by the state. This has also led to attempts by both levels of government to try to push costs on to one another. For example hospitals now send people home with little or no medication whereas previously they got two weeks worth. This “pushes “ the cost of tablets onto the Commonwealth.
These discussions about funding cause the eyes of the average person to glaze over. The dollars involved are astronomical. The Treasury’s Intergenerational report suggested that spending on “health” would rise from 15% of Commonwealth outlays to 26% by 2050. Type 2 Diabetes is estimated to increase six fold by 2033. It is already estimated that obesity costs Australia $56 billion a year.
As usual all these arguments centre on how to pay for an inexorable increase in demand for services. The issue is the same in the USA and all western countries. Australian Health Minister Nicola Roxon told Fairfax radio taxes might need to rise, as “ …we have to be able to fund delivery of services into the future”.
Has it ever occurred to any of these bozo politicians that the solution may not be in trying to fund more and more services? Has it occurred to them that the solution may be in finding ways to lower the need to provide services? Are they aware that 75% of spending on services is already for preventable lifestyle related conditions, which are preventable, or reversible with simple changes to how people live their lives?
Or is it better to promise to fix people and hence make themselves look important. Oppositions always promise to fix health. When in government they find that they cannot do this. I doubt it comes as a surprise.
Western Medicine is great at acute care. If you break your leg, I do not believe that herbs or meditation will fix it. However Western medicine does chronic disease very badly. It offers expensive pills and technology when lifestyle changes are what are needed. This is why our disease systems are unable to cope with demand. They are not suited to the task. Hospitals are not the answer to diabetes obesity and other lifestyle related chronic diseases or the consequences thereof. Hence our systems are struggling. More of the same will not be the answer.
The answer lies in the hands of individuals who can choose to be healthy rather than wait for the system to “fix” their disease. In this scenario the disease systems will easily be able to cope with the demand for what they are good at, treating acute illness and injury.
Wednesday, March 10, 2010
Fitness of Nations - How is Government Money Best Spent?
It was interesting to see an editorial in the Vancouver Sun Newspaper questioning the spending of Canadian taxpayers money on Olympic sports. The Winter Olympics were a great success both in a logistical sense for Canada and in terms of medals. The Canadian Olympic Committee (COC) asked for an additional $11 million per year on top of the current $47 million.
The paper suggested that the COC had wanted to act quickly whilst the glow of success was still fresh in people’s minds. The same situation has occurred after summer Olympics in Australia and I suspect these issues come up in other countries too.
The paper noted that several medal winning athletes had said they could not have succeeded without funding. It then made the key point “…we have been buying medals. We know now that we can do it. But should we do it? Maybe the money should be spread around to give kids across the country more chances to ski, skate, hockey, curl and even bobsleigh.”
Last year an Australian Government report suggested funding for Olympic sports are reduced and monies directed more to sports with greater participation. It has been estimated that each Olympic gold at Beijing cost Australia about $15million.
Not surprisingly this call brought howls of protest from Olympic officials and athletes who not only do not want funding cut, they want more funding. One former medalist was quoted in the paper as saying how disappointed she would be if youngsters were not able to achieve their dreams because of lack of funds.
Now it is great for people to have dreams and go for them. However why should certain dreams be supported by taxpayers and others not be? If your dream is to be an Olympic athlete then significant money may be directed your way in terms of training and other support. What about if your dream is to be a musician or to be a scientist or anything other than an Olympic athlete, you have to manage on your own. Keep in mind also that Olympic medals are actually won by individuals not countries, even though medal counts are done by country.
More importantly is the issue of how government money should be spent. Given the demands on “health” dollars from lifestyle related conditions such as diabetes, obesity, heart disease and even forms of cancer, all of which are in part improved or reduced by exercise, is pouring millions into elite sports a good investment compared to putting money into facilities for more people to do sport and exercise. There is not a “trickle down” effect of fitness.
There is another aspect to this, which I saw at close quarters last year. The Australian Institute of Sport (AIS) is the training ground for Olympic athletes in Australia. On a Tuesday morning tour at around 10 am there were two six year olds doing gymnastics. I asked the guide why they were not in school? Apparently they have a compressed school day of four hours from 11 till 3 sandwiched between training for six hours per day. The families are moved to Canberra so that the children are not separated from parents. The children are “picked “ as young as three for their potential in the sport.
Exactly when do these children play and whom do they play with? What if their potential is not as great as the talent scouts thought? If certain Key Performance Indicators are not met then they will be ejected from the institute. The Australian community pays for this. I know some countries are much worse than this in their quest for gold but this does not make it any better.
Putting six year olds in an institute away from their friends and robbing them of a childhood is close to child abuse in my book. The carrot of a gold medal does not change this.
If individuals want to pursue dreams, be it sport or anything else that is great. If they are able to get external support, that is great too. Governments have a responsibility to the entire community. With 75% of the disease burden being lifestyle related conditions do we really want to buy gold medals for a handful of people or do we want to use money to build facilities and provide support in communities so more children (and adults) can be physically active and encouraged to be.
How many sports balls could be bought and how many community fitness trainers could be employed for a year, for the cost of a gold medal. Being active is vital for good health. Nations will get healthier if more people do a bit of sport or exercise than if a few do a lot.
The benefits of regular exercise are many and varied. You only get the benefit if you do it. Governments, which are supposedly interested in the health of the people they serve need to think long and hard about the best way to spend their dollars.
The paper suggested that the COC had wanted to act quickly whilst the glow of success was still fresh in people’s minds. The same situation has occurred after summer Olympics in Australia and I suspect these issues come up in other countries too.
The paper noted that several medal winning athletes had said they could not have succeeded without funding. It then made the key point “…we have been buying medals. We know now that we can do it. But should we do it? Maybe the money should be spread around to give kids across the country more chances to ski, skate, hockey, curl and even bobsleigh.”
Last year an Australian Government report suggested funding for Olympic sports are reduced and monies directed more to sports with greater participation. It has been estimated that each Olympic gold at Beijing cost Australia about $15million.
Not surprisingly this call brought howls of protest from Olympic officials and athletes who not only do not want funding cut, they want more funding. One former medalist was quoted in the paper as saying how disappointed she would be if youngsters were not able to achieve their dreams because of lack of funds.
Now it is great for people to have dreams and go for them. However why should certain dreams be supported by taxpayers and others not be? If your dream is to be an Olympic athlete then significant money may be directed your way in terms of training and other support. What about if your dream is to be a musician or to be a scientist or anything other than an Olympic athlete, you have to manage on your own. Keep in mind also that Olympic medals are actually won by individuals not countries, even though medal counts are done by country.
More importantly is the issue of how government money should be spent. Given the demands on “health” dollars from lifestyle related conditions such as diabetes, obesity, heart disease and even forms of cancer, all of which are in part improved or reduced by exercise, is pouring millions into elite sports a good investment compared to putting money into facilities for more people to do sport and exercise. There is not a “trickle down” effect of fitness.
There is another aspect to this, which I saw at close quarters last year. The Australian Institute of Sport (AIS) is the training ground for Olympic athletes in Australia. On a Tuesday morning tour at around 10 am there were two six year olds doing gymnastics. I asked the guide why they were not in school? Apparently they have a compressed school day of four hours from 11 till 3 sandwiched between training for six hours per day. The families are moved to Canberra so that the children are not separated from parents. The children are “picked “ as young as three for their potential in the sport.
Exactly when do these children play and whom do they play with? What if their potential is not as great as the talent scouts thought? If certain Key Performance Indicators are not met then they will be ejected from the institute. The Australian community pays for this. I know some countries are much worse than this in their quest for gold but this does not make it any better.
Putting six year olds in an institute away from their friends and robbing them of a childhood is close to child abuse in my book. The carrot of a gold medal does not change this.
If individuals want to pursue dreams, be it sport or anything else that is great. If they are able to get external support, that is great too. Governments have a responsibility to the entire community. With 75% of the disease burden being lifestyle related conditions do we really want to buy gold medals for a handful of people or do we want to use money to build facilities and provide support in communities so more children (and adults) can be physically active and encouraged to be.
How many sports balls could be bought and how many community fitness trainers could be employed for a year, for the cost of a gold medal. Being active is vital for good health. Nations will get healthier if more people do a bit of sport or exercise than if a few do a lot.
The benefits of regular exercise are many and varied. You only get the benefit if you do it. Governments, which are supposedly interested in the health of the people they serve need to think long and hard about the best way to spend their dollars.
Saturday, March 6, 2010
Weight Watchers and McDonalds - An Unusual Pairing in Weight Loss
The famous golden arches have been in the news this week and as usual attracting a degree of criticism. Questions have been raised about McDonalds sponsorship of the Winter Olympics and also a deal struck with weight watchers.
It is worth getting something on the table straight up. McDonalds is in the business of selling fast food. They have a legal and legitimate right to do so and to promote and advertise their products. They are entitled to offer sponsorship dollars in return for publicity.
Each individual person has a choice as to whether or not they choose to go to a McDonalds outlet and if so what menu items they choose.
The issue surrounding the Olympics is the usual gripe about an “unhealthy” product being seen alongside sports, and healthy athletes. It is fairly unlikely that the competitors at the Olympics eat much fast food from any company so they can hardly claim that any medal won was a tribute to the foods advertised. In turn it is drawing a long bow to suggest that viewers will draw that inference. Essentially this is awareness advertising and creating “warm fuzzes” so consumers look more fondly on the company, whether they buy the products or not.
The real question that arises is whether the organizers of the Olympics should accept such sponsorship? In my view there is no reason why they would not. Being sponsored does not imply support of the sponsor-it is the other way around. People can argue that there is endorsement by association. That is possible but even if it is the case-so what?
The key issue is that like all fast food, the issue is not its existence but how people use it. If someone goes to McDonalds once a month or so then really that is not a problem. Whilst I would not recommend it, and I am not a customer, I have no issue with people who go from time to time. Health problems arise if people eat fast food frequently. The product per se is not the problem; it is how people use it. That is a function of the individual not the company. When asked if you want to supersize or would you like fries you are not obligated to say yes. You always have a choice.
The second story is more interesting. In New Zealand (and Australia later this year) three menu items will bear the weight watchers logo. No doubt there has been a fee paid by McDonalds for this. Previously the company paid the Heart Foundation over $300,000 to put the tick on seven meals.
The Weight Watchers website advises people to avoid fast food, including warnings about salt, fats and additives. At the same time Weight Watchers logos will be seen on mats and menu boards in McDonalds. The three meals, which have earned the logo, are a wrap, chicken nuggets and a fish dish. All have around 400 calories.
What are we to make of this? The meals have to meet certain criteria to have received weight watchers endorsement. McDonalds have responded to previous criticisms by broadening their offering. Equally it is a strange pairing to have people on a diet go for fast food with the support of a group like weight watchers.
A few questions arise. Will the dieters order the weight watchers approved meals? Will they take their children and what meal will they have? Will people be full after these meals or might they go back for more?
Smart companies spot market trends and look to cater to them. Generally businesses are much smarter than “non profit” organizations for the simple reason that they have to be to survive. If there is demand for healthier food then smart businesses will respond to this. By the same token, smart consumers will know when they are being “taken for a ride”.
In my opinion those who genuinely want to lose weight will not benefit by going to any fast food outlet even if there are lower calorie options available and regardless of whose “endorsement” it has. If you want to have the occasional Big Mac then by all means do so and enjoy it-just do not make it a regular occurrence.
It is worth getting something on the table straight up. McDonalds is in the business of selling fast food. They have a legal and legitimate right to do so and to promote and advertise their products. They are entitled to offer sponsorship dollars in return for publicity.
Each individual person has a choice as to whether or not they choose to go to a McDonalds outlet and if so what menu items they choose.
The issue surrounding the Olympics is the usual gripe about an “unhealthy” product being seen alongside sports, and healthy athletes. It is fairly unlikely that the competitors at the Olympics eat much fast food from any company so they can hardly claim that any medal won was a tribute to the foods advertised. In turn it is drawing a long bow to suggest that viewers will draw that inference. Essentially this is awareness advertising and creating “warm fuzzes” so consumers look more fondly on the company, whether they buy the products or not.
The real question that arises is whether the organizers of the Olympics should accept such sponsorship? In my view there is no reason why they would not. Being sponsored does not imply support of the sponsor-it is the other way around. People can argue that there is endorsement by association. That is possible but even if it is the case-so what?
The key issue is that like all fast food, the issue is not its existence but how people use it. If someone goes to McDonalds once a month or so then really that is not a problem. Whilst I would not recommend it, and I am not a customer, I have no issue with people who go from time to time. Health problems arise if people eat fast food frequently. The product per se is not the problem; it is how people use it. That is a function of the individual not the company. When asked if you want to supersize or would you like fries you are not obligated to say yes. You always have a choice.
The second story is more interesting. In New Zealand (and Australia later this year) three menu items will bear the weight watchers logo. No doubt there has been a fee paid by McDonalds for this. Previously the company paid the Heart Foundation over $300,000 to put the tick on seven meals.
The Weight Watchers website advises people to avoid fast food, including warnings about salt, fats and additives. At the same time Weight Watchers logos will be seen on mats and menu boards in McDonalds. The three meals, which have earned the logo, are a wrap, chicken nuggets and a fish dish. All have around 400 calories.
What are we to make of this? The meals have to meet certain criteria to have received weight watchers endorsement. McDonalds have responded to previous criticisms by broadening their offering. Equally it is a strange pairing to have people on a diet go for fast food with the support of a group like weight watchers.
A few questions arise. Will the dieters order the weight watchers approved meals? Will they take their children and what meal will they have? Will people be full after these meals or might they go back for more?
Smart companies spot market trends and look to cater to them. Generally businesses are much smarter than “non profit” organizations for the simple reason that they have to be to survive. If there is demand for healthier food then smart businesses will respond to this. By the same token, smart consumers will know when they are being “taken for a ride”.
In my opinion those who genuinely want to lose weight will not benefit by going to any fast food outlet even if there are lower calorie options available and regardless of whose “endorsement” it has. If you want to have the occasional Big Mac then by all means do so and enjoy it-just do not make it a regular occurrence.
Tuesday, March 2, 2010
Pills Are Not The Answer to Better Health
In what could almost be a man bites dog story, Australian researchers have criticized Australian doctors for not prescribing enough pills. The study released this week surveyed 322 General Practitioners (family physicians) looking at their management of patients over 55 with risk factors for cardiovascular (heart) disease. Each doctor filled out a survey on 15-20 consecutive patients. The total number of patients was 5293, of which 29% had established heart disease and 22% had risk factors.
The authors concluded there was “substantial under treatment of patients…” and that “ We recommend that GPs … ensure that high-risk patients receive evidence based pharmacotherapy”. It may not come as a surprise to find of the eight authors, five have been paid, in various ways by pharmaceutical companies and two are employed by a pharmaceutical company. Only one of the eight has no financial ties.
Now I have no issue with people earning a living and no issue with the pharmaceutical industry promoting their wares. However, I do have an issue when the only recommendation to reduce the chances of people getting heart disease is to use more pills.
Treatment of risk factors is a favorite in the pharmaceutical industry as it is lifelong therapy and a “no lose” situation as it is not the disease being treated, In other words treating risk factors means you get credit if the event does not occur and can claim to have done your best even if it does
Nowhere in this piece is a recommendation that there might be other ways to reduce the risk of disease. There is no recommendation that GP's advise patients about the importance of eating more fruits and vegetables. There is no recommendation that the doctors talk to their patients about weight reduction.
There is no recommendation that people be advised on the importance of Omega 3’s. There is no recommendation that exercise be considered. There is no recommendation that stress be looked at or managed. The fact that just following a Mediterranean diet results in a 10% drop in mortality from cardiovascular disease and cancer did not get a mention either.
In other words the whole solution is to put more people on more pills in the hope that if enough people take enough pills that all would be well with the world.Call me one of the “bad” doctors if you like, and I am sure our researcher friends would, but I do not buy this. Conditions like heart disease, strokes, diabetes, obesity and many others are not due to a shortage of circulating pharmaceuticals in the blood stream, they are a consequence of the choices we have made over an extended period of time. The solution then is to make the changes in our diets and daily life not just to pop more pills. After doing all this, there will still be a role for some pharmaceuticals in some people, but far less than is currently suggested be prescribed.
Meanwhile, just to show that not all research is a way to sell drugs, a study in the European Heart Journal has shown being happy can reduce heart disease by around 40%. The connections between the heart and happiness are legendary and like many things, which are part of human existence; there is a basis which science has not caught up with yet.
To get the benefit, people did not have to be happy all the time and it did not matter if they had down periods. What mattered is that they enjoyed life overall and had some fun. This could be as simple as listening to music for 15 minutes or walking in the park, anything which you enjoyed doing. This is Pillar 8 of DIY Health 101.
Advising people with their lifestyle choices and the importance of some fun in their lives is a much better role for doctors than dishing out pills even if that makes me a bad doctor in the eyes of certain researchers and their bosses.
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