Fewer Hospital Re-admissions = More Deaths

According to a study by Dr Ankur Gupta at Brigham and Women's Hospital in Boston, Medicare penalties for hospitals that readmit patients with heart failure have had their intended effect of reducing the frequency of readmission after discharge. Thirty-day readmission rates dropped from 20% before the penalties went into effect to 18.4% afterward. A whopping 1.6 point decline.

Unfortunately for the patients, this came at the cost of a 1.4 point increase in the 30-day mortality rate for heart failure patients - from 7.2% to 8.6%. Worse, the one year mortality rate rose from 31.3% to 35.3% - up 4 points - from before the program to after.

Medicare officials say that they are "monitoring" the readmission penalty program. Government healthcare at work.

Good Health is the Best Insurance

According to the 2017 Kaiser Family Foundation's annual Employer Health Benefits Survey, over the last 5 years, the number of employers offering health insurance as an employee benefit has declined from 61% to 53%. Why? Because of relentlessly rising costs. The average cost of the employer's share (not counting what the employee may contribute) of a family health insurance plan was $18,764. That's per employee.

Suppose that was your business? Could you as the owner afford to carry that sort of expense? And each year it goes up, with no sign of moderating increases. With more and more Americans chronically ill, there seems no end in sight.

The US Centers for Disease Control and Prevention estimates that 75% of all US healthcare spending goes to treating preventable chronic diseases, most of which are diet and lifestyle related. This should hardly come as a surprise.

In the US, 34% of us are obese. Not overweight, obese. Despite its many proven benefits, 79% of Americans do not meet the recommended level of physical exercise and 86% do not meet recommended dietary guidelines.

So when your employer announces increased employee contributions, benefit cutbacks or even the elimination of health insurance, reflect for a moment that the very best health insurance is living a wellness lifestyle. And that is really your responsibility. You haven't the time to live healthy? Then how will you afford to live sickly?

Deadly Drugs

Most Americans are aware that heart disease, cancers and strokes are the three leading causes of death in the United States today. They may not be aware of #4: the adverse effects of prescription medications. Every year, more Americans die from drug errors than from traffic accidents - forty people a day from prescription pain killers alone. And while nearly 40,000 of these deaths arise from behavior that might fairly be described as "drug abuse", nearly 750,000 perish is what can only charitably be called "mistakes".

To make matters worse, a recent study published in the Archives of Internal Medicine concluded that nearly 60% of the prescription medications taken by patients are not needed, and that 88% of patients reported feeling better when taking fewer or no drugs.

Let's take a look at just one type of prescription medication, the statins that are prescribed to lower cholesterol and which are the most prescribed, highest selling prescription drugs in the USA. One study published in the journal Pharmacotherapy found that 75% of people taking statins reported memory loss or other cognitive problems, and that fully 90% of them who stopped taking the medication showed rapid improvement. Other major side effects are well known and include muscle pain and weakness, neuropathy and an elevated risk of developing diabetes.

One of the less well known (among us non-experts anyway) measures of drug effectiveness is the so-called Number Needed to Treat (NNT). NNT is a measurement of how many people would need to take the drug in order for it to produce one beneficial outcome. Obviously the lower the number the better. For the popular statin drug Lipitor the NNT is 168. This means that 168 people would have to take Lipitor (for 4 years) to prevent one "cardiovascular event". Unfortunately, the risk for side effects can be as high as 1 in 10. That means 16 people will suffer the side effects so that 1 person may be helped. No doubt the fact that statin drugs produce an annual revenue of about $25 billion dollars in no way influences their popularity at the prescription pad. But to me these seem to be stunningly bad odds.

If you are taking two prescription medications a day, the odds of having a bad interaction between them is about 6%. If you are taking 5 per day, the odds skyrocket to about 50%.... 1 person in 2. With half (yes, half) of Americans taking at least one prescription drug (and nearly 1 in 5 taking 3 or more) this quickly produces large numbers of endangered people. We may be the most medicated nation on the planet.

I'll close with a personal story. About 10 years ago my mother, who was living in Florida and suffering from advancing Alzheimers disease, was no longer able to care for herself safely. As a result, she moved to California to be close to my brother. One of the first things he did was make an appointment with a neurologist, and on their first visit he took a list of the prescription medications that she was taking on a daily basis. She had prescriptions for diabetes, cholesterol, blood pressure, arthritis, degenerative heart disease and, of course, Altzheimers. Eight medications in all. When the doctor reviewed the list, she reacted with a combination of alarm and disbelief. Four of those medications were "mutually exclusive" - meaning that they had known interactions and were not prescribed together. Reducing my mothers medications to 3 per day produced an immediate, allbeit temporary, improvement in her mental and physical condition.

How could this happen? Because she was seeing four different "specialists", each of whom were prescribing medications without any idea what the others were doing. The doctors failed her, the pharmacist failed her, the insurance companies failed her, the healthcare system failed her and, to be fair, her family failed her.

The late Stephen Covey, in his book "First Things First", describes what he called "the rescue fantasy". "Most of us understand that a good percentage of the health problems we have are lifestyle-related. We live the way we want to live - little or no exercise, poor nutrition, burning the candle at both ends - and then when there is a problem we expect the medical profession to fix it. There's a pill for that."

There may be, but as more and more of us turn to medication to "fix" ourselves, we are starting to see that the cure may be more deadly than the problem.

The Diabetes Generation

An entire generation of America's children now face the prospect and dire consequences of a lifetime as diabetics, according to a report on today's NPR Morning Edition. In just 9 years, from 1999 to 2008, the incidence of "pre-diabetes" among Americans aged 12 to 19 has more than doubled (from 9% to 23%).

"That's a shockingly high figure that has dire implications to the health of this entire generation of children. This report really sounds the alarm," says David S. Ludwig, a childhood obesity expert at Children's Hospital in Boston. "It's one thing for an overweight or obese 55-year-old gaining an extra few pounds a year to develop diabetes at age 65 and then have a heart attack at age 70. It's a very different thing if the clock starts ticking at age 10. Children have so many more years to suffer from the consequences from these serious medical problems related to obesity. We're looking at the prospect of heart attack, stroke and kidney failure becoming common complications of young adulthood."

As we as a society struggle to find a way to provide affordable healthcare, "lifestyle diseases" such as diabetes will have to be addressed. To fight this trend, more and more children will face a lifetime of struggling to keep their blood sugar under control. "It requires a long period of medication use, strict diet, exercise and surveillance, all of which is quite expensive," says Vivian Fonseca at the American Diabetes Association. And that, she says, will be hard on them and society.

Listen to the full story here.

Wellness, Nutrition Cited as Key to Genuine Healthcare Reform

NPR's Weekend Edition Sunday host Liane Hansen speaks with Republican governor Jim Douglas of Vermont about that states experience with heathcare reform. He says Vermont's own state-initiated reforms could serve as a model for national changes in health care policy. Listen to the entire interview, then contact your Federal representatives and demand to know why nothing like this is even being discussed at that level.

Feel Better or your Money Back?

Not exactly. But if you are following Washington's "healthcare reform debate" at all you can be forgiven if the whole thing sounds more like "health insurance expansion". Proposals for, or even discussion of, actual changes to our broken healthcare delivery SYSTEM are more scarce than modesty at the Academy Awards. How about some innovation in the actual provision of medical services?

Here's an interesting idea from a PricewaterhouseCoopers study reported in the Colorado Springs Business Journal. What if instead of paying for how many different procedures a doctor ordered, we paid instead for the outcome? The RESULT of their treatment. Is it practical? Would it lower healthcare costs while maintaining or improving quality? I don't know, but it seems to me that simply adding more and more people to our unsupportably expensive system surely wont.