Chronic Disease

Profile of Dr. Bernard Lown in the Boston Globe

July 31, 2012
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Boston Globe health reporter Chelsea Conaboy has a brief profile of Dr. Bernard Lown in the most recent edition of the Boston Globe Magazine. It covers some of the most important moments in a truly remarkable life, including our conference this April on Avoiding Avoidable Care. Check out the piece here.

If you haven't seen it yet, you can also read more by and about Dr. Lown at his blog.

My Own "Avoidable Care" Experience

June 12, 2012

Earlier this year I was sitting in the student lounge of UT Southwestern Medical School searching for health policy internships in DC.  I was stunned by how many opportunities I came across, but few seemed like such a perfect match as the opportunity here at the New America Foundation.  Part of the reason for this has to do with my own experience with "avoidable care”—an experience that sparked my interest in health policy and preventive medicine.

My high school anatomy and physiology class fascinated me.  Whether it was dissecting a cow heart, learning about air exchange in the lung, or passing my skeletal examination, anatomy and physiology fueled my desire to become a doctor.  In college I applied to a summer doctor shadowing program through the pre-med advisory office.  When asked for my top preferences of physicians to shadow I chose all the "exciting" fields, like neurosurgery and cardiology.  But since there weren't enough neurosurgeons or cardiologists to match my enthusiasm, I was instead paired with a doctor at the local Wound Care and Hyperbaric Medicine Clinic.  Needless to say, I was disappointed.  I had never even heard of a "wound care doctor." Besides, I wanted to see doctors performing lifesaving stroke interventions and cancer therapy—not taking care of some old guy's stinky foot sore.  Grudgingly, I settled myself in for a long, boring summer.
 
Almost daily I watched the physicians at the clinic work with patients who presented with seemingly incurable open wounds, loss of feeling, amputations and other maladies.  The vast majority of these wounds were due to poor circulation in the lower extremities.  Many times we would send these patients for a "dive" in our hyperbaric chamber, where they would breathe 100% oxygen at high pressure.  This would ensure that high levels of oxygen would percolate to every inch of their bodies, regardless of their poor circulation, and accelerate the healing process.  These procedures, however, were costly and very time consuming—a typical prescription called for 20 to 30 ninety-minute sessions of hyperbaric therapy.
 
After a while I began to realize that many of these patients with the incurable wounds also had type II diabetes.  While doing the rounds with the physicians one day I asked him about my discovery.  He sadly explained to me that most of his patients could have their diabetes under control if they could eat healthy and lose weight.  I was stunned!  All of these visits to the doctor, negative pressure treatments, wound cultures, hyperbaric treatments, discomfort, amputations, prosthetics, and medicines (to name just a few of the discomforts these patients had to deal with) could largely be avoided with a healthy lifestyle.  
 
My "boring" internship ignited a fire inside me that day.  I finished with a whole different perspective on what medicine is—it became more than just scrubs and scalpels, more than a prescription pad and prostheses.  It was now about empowering my future patients, about working through policy, public health and medicine to bring about changes that allow them to conquer the most costly, debilitating medical problem of my generation.

The Sidebar: A Flood of Fossil Fuel and the Behavioral Economics of Soda Bans

June 8, 2012
Host Elizabeth Weingarten talks to Steve LeVine about the environmental downside of the impending oil and natural gas boom, and to Jamie Holmes about whether New York Mayor Michael Bloomberg's soda ban can really change consumer behavior.

Graphic Interlude!

September 16, 2011

We don't often post raw links or pictures without commentary, but the last few weeks have involved a few great ones that we couldn't pass up.

First: via the new Washington Post Wonkblog (congrats on the new site, guys!), Dr Seuss explains the medical arms race in the video to the right! (Watch it fullscreen--it's worth it!)

How a 20-Minute HIV Test Could Save Millions of Lives

  • By
  • Jamie Holmes,
  • New America Foundation
August 15, 2011 |

Five years ago, hundreds of protesters took to the streets in Kenya in tribute to a murdered 15-year-old orphan boy, Isaiah Gakuyo. An uncle had apparently stabbed Isaiah with a pitchfork because the boy was HIV positive - the child’s mother and grandmother had both passed away from AIDS-related diseases.

Variation Marks the Spot

August 11, 2011
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A new study in the Journal the American College of Cardiology finds that doctors at different hospitals vary widely in their assessment of who qualifies as an appropriate candidate for elective coronary angiography (a way to look for clogged coronary arteries).  If Jack Wennberg and his daring band of disruptive Dartmouth Atlas docs have taught us anything, it’s that variation marks the spot for the inconsistent -- and often inappropriate -- use of health care services.

According to researchers at Duke University Medical Center, different hospitals use wildly disparate criteria for determining which patients need non-emergency coronary angiography.  The authors found that hospitals with a lower rate of positive tests -- meaning they test a lot of people who end up not having heart disease -- tend to be more likely to perform angiography on younger, asymptomatic patients. Out of more than half a million medical records examined, the researchers found some hospitals with rates of positive tests as low as 23 percent.

Combating the Obesogenic Environment

August 16, 2011

Two weeks ago, American Beverage Association President Susan Neely took issue with Mark Bittman’s New York Times Magazine article, in which he advocated taxes on soda and other unhealthy foods. Bittman’s justification was that raising the prices of those unhealthy foods relative to more nutritious foods would encourage people to eat more healthfully, and so help combat the national obesity epidemic. Neely said in her response, “Obesity isn’t about “good” and “bad” foods. It’s about an imbalance between calories consumed — from all foods and beverages — and those burned through physical activity.”

She’s right, of course: many factors contribute to obesity, but the problem isn’t as simple as “eating bad foods makes you obese.” The thing is, that’s not what Bittman was saying, either. The ultimate goal of his tax proposal is to change the food environment in which we live.

Public health advocates believe that Americans live in an obesogenic environment: not one where anyone is forced to eat unhealthily and become obese, but an environment with forces that encourage overconsumption of calorie-dense, low-nutrition foods.

The Civil War That Killed Cholera

  • By
  • Charles Kenny,
  • New America Foundation
March 22, 2011 |

This Saturday marks the 40th anniversary of Bangladesh's war for independence from Pakistan. Given how bloody the war proved to be, and how limited development progress in the country has been since then, it might seem like a dubious occasion for those of us far from Dhaka to celebrate. But the war does have one unambiguously positive legacy: It gave the world an approach to dealing with cholera and other diarrheal diseases that has since saved many more lives than were lost during the fighting.

QUALITY: Going for the Gold [Star] in Cleveland

October 20, 2010
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Here's my latest column from the Altarum Health Policy Forum:

Over at my “home” health policy blog at the New America Foundation, I’ve written (here and here) about the Robert Wood Johnson Foundation’s Aligning Forces for Quality project, which has challenged and assisted 17 communities across the country to do a better job in managing chronic disease and reducing disparities. I thought it would be useful to take a closer look at one of these initiatives, “Better Health Greater Cleveland.”

Better Health, which began in February 2007, involves more than 20 stakeholders including health systems, hospitals, payors, and state and local government. More than 45 participating physician practices -- most of which have electronic health records that allow tracking and measurement -- take part in learning collaboratives, and report on outcomes and care twice a year in the  “Community Health Checkup.” Those online reports are clear and accessible, with features like a cyber “gold star” for outstanding -- and improving -- primary care practices. (Click here to Better Health Greater Cleveland in action.)

HEALTH CARE: Stamping Out Soda?

October 12, 2010
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Should people be able to use food stamps to buy sodas and other sugary beverages? New York City thinks not.

As we’ve often noted, food policy will increasingly play a large role in health policy, as we institute programs and policies to curtail the obesity epidemic threatening the health of our nation. New York City, a city always at the top of fashion and food, has already begun a public education campaign about sugary beverages. It is now contemplating further action.

Nearly 57 percent of adults in New York City and 40 percent of children in New York City public schools are either overweight or obese. The potential health consequences are frightening, and obesity rates are particularly alarming in New York's low income neighborhoods (30 percent in the poorest neighborhoods versus 17 percent in the richest). Obesity-related health care conditions cost New Yorkers nearly $8 billion a year in tax dollars, or $770 per household. (That's one reason that the city was at the vanguard of the move to require menus to display calorie counts, now a part of the national health care law.)

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