Fit Cities

In the spirit of providing some positive news on the obesity front, here is an interactive map by the ACSM American Fitness Index of the fittest cities in the country (h/t Richard Florida).

On a related note, PSFK presents a strategy to make our more obese cities healthier: convert cityscapes into a connected system of jungle gyms.

Searching for Solutions

A very interesting article at from about the conundrum created by a policy tool meant to encourage pharmaceutical companies to research and develop “orphan drugs.”

The Orphan Drug Act grants orphan drug status to pharmaceutical companies and “is designed to encourage the development of drugs which are necessary but would be prohibitively expensive/un-profitable to develop under normal circumstances.”  Past developments have included drug treatments for such conditions as cystic fibrosis and multiple myeloma.

The result can be high-priced treatments for rare conditions. From the article:

Politicians say they are not opposed to drug companies earning strong returns on the costs of researching innovative drugs, and understand the high prices of many medications. But they are investigating whether some companies are price-gouging, concerned more about executive stock options than about running innovative companies.

But the sometimes prohibitive costs of orphan drug treatments is, as you may have guessed, too expensive—to the point where insurance companies may deny payment.  The article provides an example of an already-developed drug that jumped from a cost of $1,600 per vial to $23,000 per vial after it was granted orphan drug status.

There’s some perfunctory pharmaceutical company decisions resulting from the orphan drug status that you can read about in the article.

But here’s the interesting part.  The prohibitive cost of the orphan drug spurred a doctor to search for lower cost solutions.  And he found one with comparable efficacy.

Curiously, though, he found that the price hike “was one of the best things that could have happened.” Why? “Because we found something better and cheaper.” Far cheaper, it turns out. “We spent a few days going through all the medical literature, looking for what works, what doesn’t.”

The cost of the alternative treatment? $15.

Learning from Mistakes

As the hospital construction boom and health system consolidation trend continues in the United States, Moody’s Investor Services–a credit-rating organization–may be, in a few more words, telling the industry to slow down.

Moody’s is using the ten-year anniversary of the largest collapse of a non-profit health care system in U.S. history, Allegheny Health and Research Education Foundation, to issue a report that urges current industry leaders to learn from past mistakes.

The blog PhillyInc writes, “Moody’s calls the collapse ‘a cautionary tale for today as hospitals currently face a growing number of industry-wide pressures.'”

The report asks for discussions centering around “What have we learned?”

As they say, “Those who forget history are doomed to repeat it.”

Richard Simmons does good

Childhood obesity is a big problem.

Richard Simmons, he of Sweatin’ to the Oldies fame, is doing his part by testifying before Congress on ideas to combat childhood obesity on Thursday.

His personal contribution, from USA Today:

He says he is developing a reality TV show in which he’ll help children and families lose weight. “It’s going to show Americans that it’s possible to realistically lose weight, be happy and go on to other goals,” he says. “It won’t be an angry show with screaming and yelling. Just teamwork. No competition. It’s about saving lives.”

Are physicians risking their seat at the Medicare table?

Last week the United States Congress chose physicians over insurance companies in overriding a presidential veto of a bill that repealed Medicare fee cuts by 10.6 percent.  The measure, in large part, was a move to save health care accessibility for seniors.

From The New York Times:

The vote “renews the light of hope for those who need our help the most, senior citizens who depend on Medicare,” said Senator Harry Reid of Nevada, the majority leader.

It seems a light of hope was all it was for some seniors.  This from Anne Zieger at Fierce Healthcare:

With Medicare cuts looming, many physicians vowed that they’d stop accepting Medicare patients entirely if and when the cuts went through. The thing is, even though Medicare cuts have been held off, large numbers of physicians are dropping out anyway. One example of this comes in Tennessee, where doctors are increasingly dropping out of the program. Not only are many refusing new Medicare patients, some are thinking about dropping current Medicare patients too. That’s because in some cases, doctors aren’t even getting paid enough to cover their expenses, they say.

While the bill that prevented fee cuts does nudge reimbursements up just a bit, the problem of low reimbursements has been well documented, especially for primary care physicians.  In fact, we’re less than 18 months away from another fee cut, this one topping 20 percent.  Some think a completely new approach to Medicare is needed—such a measure is likely necessary to save the Medicare program.

Amidst promises by physicians to stop accepting Medicare patients should the cuts have remained, politicians prevented such a catastrophe from happening.  But some physicians have reversed course.

Are physicians risking their place at the table when new Medicare payment policy is formulated?

Too soon to tell.  Granted, physicians need to support themselves and adding minuscule incremental fee increases doesn’t fix already notoriously low reimbursement schedules.  But are doctors risking their credibility with politicians, who supported them by preventing this year’s version of the traditional Medicare fee cuts, by not accepting or dropping Medicare patients?

Unlikely since Medicare needs physicians in order to make the program work, but it’s worth a discussion.

In politics, leverage is everything.

Improving understanding through theater

Interactive theater “is a presentational style that breaks the “fourth wall” separating performer and audience both physically and verbally.”

It can be used, among other purposes, to invoke dialog, serve an educational purpose, and provide a therapeutic setting.

Several cancer survivors from the James Cancer Hospital are using interactive theater to better understand and become more comfortable with cancer experiences.

From The Columbus Dispatch:

Sharing such stories — and hearing the students react sensitively with laughter, groans or applause; or noting their silent appreciation — helped [a participant] become more comfortable with herself and “better define” her experience, she said.

The cancer survivors, along with collaborating theater students, will perform in front of a sold-out crowd this week.  Such a great idea. The power of this approach lies in the words of instructor Robin Post:

“We knew next to nothing about cancer, and they knew next to nothing about performance,” Post said. “Because everyone was very open to learning from each other, it became a powerful experience for both sides.”

Interaction aids understanding for all involved.

“Take two Matisses and call me in the morning”

Creativity is king.

From Dan Pink:

American medical schools, those bastions of left-brain muscle-flexing, continue their march toward whole-mindedness. Yesterday’s Boston Globe reports that Harvard Medical School has followed the lead of places like Mount Sinai Medical College and begun taking its students to art museums. The goal: To improve young physicians’ observation and diagnostic skills.

This isn’t about the artsy-fartsy or touchy-feely. It’s about dollars and cents — and sometimes life and death. As The Globe notes:

A study in the Journal of General Internal Medicine show[ed] that after completing the class, [the Harvard] students’ ability to make accurate observations increased 38 percent. When shown artwork and photos of patients, students were more likely to notice features such as a patient’s eyes being asymmetrical or a tiny, healed sore on an index finger. Observations by a control group of students who did not take the class did not change.”

For more insight into the power of right-brain thinking, pick up a copy of A Whole New Mind.

Ignorance is Bliss

System ignorance.  It is incredibly blinding.  It is incredibly powerful.  And it is incredibly pervasive.

But it’s bliss.

It’s also the reason we find health care in its current state.

Some blame doctors for ordering too many tests.  Some blame administrators for focusing on the bottom line.  Some blame insurance companies for their profit taking.  Some blame the government for participating too much.  Some blame the government for not participating enough.  Some blame patients for being uninsured or for not participating in care decisions.

Some + Some + Some + Some + Some + Some = Big Problems

As the problems in health care have mounted over time, it turns out the easiest and most plausible solution to such problems is to retreat and protect vested interests.  It becomes a turf war instead of a collaborative to find fixes.  System ignorance.  Local focus.

While all stakeholders are partly to blame (granted, some more than others) for the “health care situation,” placing blame is an exercise in futility.  The state of health care is a product of its past.  Past decisions (among all stakeholders) have made turf protection modus operandi.

Some very good people are working hard to fix all kinds of problems.  But solutions can’t be constructed in a vacuum.  Unanimous agreement is (for all intents and purposes) impossible.

Collaboration is the answer.   Our form of government, our way of living, our economic system warrants this approach.  An appeasable solution allows for all parties to be successful.

It has to, it’s our only way out.  Here’s to collaboration.  A lot of it.

27. Community Activi(ty)sm

A new survey released by the Centers for Disease Control and Prevention pegged the percentage of obese adults in the United States during 2007 at 26 percent.  That number is down from 34 percent in 2006.

We’re getting skinnier!

Not so fast.

Heights and weights were self reported.

From the Associated Press article:

CDC officials believe the telephone survey of 350,000 adults offers conservative estimates of obesity rates, because it’s based on what respondents said about their height and weight. Men commonly overstate their height and women often lowball their weight, health experts say.

The CDC conducts a more reliable study in which researchers “actually weigh and measure” participants.  That is where the 34 percent number comes from—its much more indicative of actual obesity levels.

Another AP article reports that we can do something about our staggering obesity issues.  An analysis by the Trust for America’s Health and several public health groups says that if we spend $10 per person over five years we would have the capital necessary to fight obesity resulting in significant annual cost savings.

Here’s the math: $10 x 300,000,000 American population x 5 years = $15,000,000,000.

The end result: reduced obesity levels resulting in annual savings of $16,000,000,000.

Full disclosure: research has been conducted suggesting that treating obesity doesn’t save money.

Regardless, the point is that this is about making Americans healthier.

Some local programs have already been implemented.  Read the article for examples.

It is time for all hospitals to jump on board.  A public health focus will be better for all of us.

Principle #27: Our Own System realizes the role of health care in a community is to help people be healthy.  Most of the time that means caring for patients with medical conditions.  It can also be about promoting healthier lifestyles before they arrive for treatment resulting from unhealthful behaviors.  The hospital’s job is to do both.  Promoting healthful activity is the basis of community activitysm.