Friday, March 26, 2010
In persuading Congressional Democrats to pass the health care overhaul, President Obama addressed one of the most pressing issues facing the country: providing broader access to medicalinsurance for as many as 32 million Americans who do not now have it.
For many of the rest of us, the benefits could still be substantial once the law takes full effect in 2014. People with pre-existing medical conditions could no longer be denied insurance. All lifetime and annual limits on coverage would be eliminated. And new policies would be required to meet higher benefit standards.
But the new law does not tackle head-on the staggering cost of health care in the United States, which eats up $2.3 trillion a year, about 16.2 percent of our gross domestic product, according to the Department of Health and Human Services.
That raises the ultimate Patient Money question: How can the country reduce health care costs while not compromising quality?
During the health care debate, government officials, insurers, drug companies and medical associations all weighed in with their opinions. But what about the people who receive so much of our out-of-pocket health care payments: the doctors on the medical front lines? What do they think the country — in other words, you and me — should do to help moderate costs?
I turned to some of the doctors I've interviewed over the last year and asked them to prescribe remedies for high medical costs. Here is what they said. (The remarks have been edited and condensed.)
Tuesday, March 23, 2010
The Association for Medical Ethics consists of physicians from every specialty of medicine. The purpose of the Association is to promote patient care and evidence-based medicine and to provide increased public awareness of the detrimental and pervasive financial influence of industry on many health care providers and patients. The Association for Medical Ethics promotes the care of patients absent of any consideration of financial gain or loss based on choice of surgical equipment, implant, manufacturer, hospital or surgery center. AME members practice informed consent and believe patients have a right to know if their doctor is a paid consultant or distributor for any manufacturer or product. The purpose of this website is to provide consumers and doctors the opportunity to view the opinions of the Association for Medical Ethics members and the most current unbiased research on the latest medical advancements.
Monday, March 22, 2010
Schools have banned cupcakes, issued obesity report cards and cleared space in cafeterias for salad bars. Just last month, Michelle Obama's campaign to end childhood obesity promised to get young people moving more and revamp school lunch, and beverage makers said they had cut the sheer number of liquid calories shipped to schools by almost 90 percent in the past five years.
But new research suggests that interventions aimed at school-aged children may be, if not too little, too late.
More and more evidence points to pivotal events very early in life — during the toddler years, infancy and even before birth, in the womb — that can set young children on an obesity trajectory that is hard to alter by the time they're in kindergarten. The evidence is not ironclad, but it suggests that prevention efforts should start very early.
Among the findings are these:
The chubby cherub-like baby who is growing so nicely may be growing too much for his or her own good, research suggests.
Babies who sleep less than 12 hours are at increased risk for obesity later. If they don't sleep enough and also watch two hours or more of TV a day, they are at even greater risk.
Some early interventions are already widely practiced. Doctors recommend that overweight women lose weight before pregnancy rather than after, to cut the risk of obesity and diabetes in their children; breast-feeding is also recommended to lower the obesity risk.
Sunday, March 21, 2010
When I can't sleep, I think about what I'm missing. I glance over at my wife and watch her eyelids flutter. I listen to the steady rhythm of her breath. I wonder if she's dreaming and, if so, what story she's telling to herself to pass the time. (The mind is like a shark — it can't ever stop swimming in thought.) And then my eyes return to the ceiling and I wonder what I would be dreaming about, if only I could fall asleep.
Why do we dream? As a chronic insomniac, I like to pretend that our dreams are meaningless narratives, a series of bad B-movies invented by the mind. I find solace in the theory that all those inexplicable plot twists are just random noise from the brain stem, an arbitrary montage of images and characters and anxieties. This suggests that I'm not missing anything when I lie awake at night — there are no insights to be wrung from our R.E.M. reveries.
Unfortunately for me, there's increasing evidence that our dreams are not neural babble, but are instead layered with significance and substance. The narratives that seem so incomprehensible — why was I running through the airport in my underwear? — are actually careful distillations of experience, a regurgitation of all the new ideas and insights we encounter during the day.
Look, for instance, at the research of Matthew Wilson, a neuroscientist at the Picower Institute at M.I.T. In the early 1990's, Wilson was recording neuron activity in the brains of rats as they navigated a difficult maze. (The machines translated the firing of brain cells into loud, staccato pops.) One day, he left the rats connected to the recording equipment after they completed the task. (Wilson was preoccupied with some data analysis.) Not surprisingly, the tired animals soon started to doze off, slipping into a well-deserved nap. And that's when Wilson heard something extremely unexpected: although the rats were sound asleep, the sound produced by their brain activity was almost exactly the same as it was when they were running in the maze. The animals were dreaming of what they'd just done.