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April 2006 - Posts
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I was delighted with both participation and feedback we received from our first DocTalk Web seminars . If you missed the first session or you want to review the information you heard, you can view the recorded version anytime you want by following this link:
Key areas of future interest which we will cover in much more depth in subsequent DocTalks are nutrition, fitness and exerise, weight loss, medication use and misuse and finding and interacting with your physician(s) to improve your care and your health. If the presentation of the "Top 10" seemed skewed to the behaviors which YOU control and which YOU can undertake to improve your and your family's health and reduce your health care costs . . well, its what the EVIDENCE shows. Its not Doctor Mike's opinion. Take a peak at Dr Bob's book and share it with your loved ones.
Final quiz Lumenos consumers: What proportion of Americans can answer "yes" to all of the following 4 questions:
1) I am a nonsmoker
2) I'm within 5 pounds of my ideal body weight
3) I eat a balanced diet with 5 portions of fruits and vegetables a day.
4) I am physically active for 30 minutes most days of the week.
50% - nope. How about 25% . . incorrect. What about say, 10% . . closer but still way off. 3%, yes 3 of 100 of us can say yes to these 4 questions.
At Lumenos, we've designed our health improvement strategy, plan designs, tools, behavior change programs and Personal Health Coach high touch care support for you to not only understand your health and care . . but to live longer and better. Til next DocTalk . . get off our computer and lets get moving!
Doctor Mike
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The wt burn-off idea is terrific if it helps us get serious about shedding those extra lbs. Again we're all about helping folks find a way to lower their risk factors - excess weight being a big (no pun intended) one. But if you're like me, you can use a little help sometimes. That's why I called the people at Healthy Lifestyles Healthy Weight® Program. Many of the Lumenos clients have signed up for this program. If you haven't got it, you may want to talk to your HR dept about putting it in place. That's not a sales pitch and you may want to hold off on talking to them until you hear the rest of what I have to say.
I'm going to give it a try and chronicle my progress (I hope) here. Feel free to follow along over the next few months. I made the first call this afternoon. The woman I talked to was very nice and asked some basic questions - age, height and of course weight. Guess I qualified for the program because she put me right on the schedule. We'll have our first wt loss phone call (this is all done over the phone) in 2 weeks after I review the materials she is sending.
My goal is to drop 15lbs. I'll combine exercise and diet (not sure what that means, they'll give me some help) and target for 1 lb a week over the next few months. Sounds like a reasonable plan but as usual the devil's in the details/execution.
Drop into this blog and follow my progress. And feel free to ask me how things are going. Should be interesting!
posted Tuesday, April 25, 2006 4:52 PM
(re-posted on 11/8/06)
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All:
Several of you have asked about "a diet book" or "that diet book." A good medical colleague, Dr David Katz at Yale who also is the medical columnist for "O" Magazine (as in Oprah for those of you who don't buy groceries but only hit Mickey D's!) has written a no-nonsense, practical book that has received excellent reviews in both the medical and lay community.
It called "The Way to Eat: A Six-Step Path to Lifelong Weight Control" and can be located at:
http://www.amazon.com/exec/obidos/ASIN/1570719837/qid=1099668955/sr=2-1/ref=pd_ka_b_2_1/102-2992591-7426542.
Take a look at some of the comments - I think you may find it helpful.
And no, I don't get any commissions!
Dr. Mike, Chief Health and Medical Officer
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After 6 years at Lumenos, I thought I knew how to be a good consumer of health care. I've paid attention to costs, used online tools to get health information, paid close attention to my own health behaviors, and actively engaged with my son's pediatrician's in the diagnosis and treatment of his asthma. Despite that, I had an experience last week which reminded me that sometimes being a consumer -- in health care -- takes a little bit of effort.
I was seeing a new provider for a non-serious respiratory issue. While he was polite and professional, I had trouble getting him to explain what he meant by "sounds fine" or "nothing major." When I asked about treatment, he produced a sample of a drug I had not heard of, handed it to me to take and reached for the door. Pointing to the prescription on the counter he just said - "if things don't improve in a week, just come back in." I didn't ask the questions I wanted to ask, and was left feeling uncertain about my diagnosis and uncomfortable with the prescribed treatment.
But then I remembered that I could still be a consumer even after I left the room. I went home, researched the drug prescribed, and read more about the diagnosis. Armed with this new information I called the provider and informed him that I just wasn't comfortable with the drug prescribed (too new to the market, too expensive and too many headlines). The provider was supportive and took the opportunity to answer my questions and revise the prescription recommendation.
The lesson for me: it sometimes takes an effort to be a good consumer, but it's always a worthwhile effort because it can produce a better and more comfortable outcome.
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Check out the vending machines - healthy snacks are priced at $.25 (yes they have Dr. Mike's sign-off) and unhealthy snacks are priced at $1.25. Let's face it, America is fat. If we don't do something about encouraging healthy eating things are just going to get worse. This will be an interesting experiment with our own employees to see if we can have any impact on snacking habits. See Deb Loyden's entry with pictures. There are some great (good tasting) snacks that won't put on the lbs. Let me know what you think - as if you wouldn't Rudy.
Doug Kronenberg - Chief Snacking Officer
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One of the reasons we built this blog and community is to give our consumers, and people with opinions, and even our detractors, a place to talk about us and our concept of healthcare. The very first objection from just about everyone is "but it will just be a place for people to complain!" To which I respond: so what? We are not a company to bury our dirty laundry: if our customers have a complaint, I want to know about it, and I want them to have an easy way to tell us, and an easy way for us to respond. Hopefully Ignite becomes just such a place.
But in the meantime, you can actually check out what other real people have to say about us (not all of it good) by searching the blogosphere for "Lumenos" using one of these tools:
http://www.technorati.com
http://blogsearch.google.com
You will find:
- Doctors who strongly oppose our business model
- Customers who love us to death
- Lumenos employees who wrote about us on their personal blogs, and probably never thought anyone would find them
- Industry insiders talking about the hot wave in consumer-driven health
- People who are understandably baffled by how to use their health insurance, and are angry at everybody
- One of our clients who set up a blog so it's employees could talk about our benefit plan amongst themselves
Like I said, it's not always pretty, but it's awfully fun to read, and it makes clear just how confusing the American healthcare industry has become. I hope those people who found time and enery to post negatively can find this blog, and let us have it, so we can get on to fixing it for them.
Update:
http://blogs.usatoday.com/iraq/2006/03/hawijah_iraq_lt.html
http://www.typepad.com/t/trackback/4541207
This article by the USAToday.com blogger Kimberly Johnson, embedded with the 101st Airborne in Iraq, shows an interesting effect of what I describe above. The battalion commander reacted to a blog post referring to a rather, hm, colorful phrase inscribed by a soldier on a hand-grenade. The colonel understands the power of this medium:
The commander says he’s actually in favor of having journalists embedded with his battalion because it’s a way to tell his soldiers’ story. “There are risks associated with that,” of course. But, he added, “I’m going to turn you loose and hope for the best.”
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A new study of 50,000 men and women in Norway gave much more specific, and sobering, data on who smoking shortens life in "middle age" - that is between the ages of 40 and 70.
In simple terms, here's the proportion of men and women who were nonsmokers, smokers who quit and continuing smokers (by # of cigarettes) who died between ages 40 and 70:
Women (% died) Men (% died)
Non-smoker 9 14
Previous but quit smoking 12 19
1-9 cigarettes per day 17 31
10-19 cigarettes per day 19 34
20-24 cigarettes per day 24 38
>25 cigarettes per day -- 43
Conclusion: Tobacco use is not an "old person's" cause of death for either gender and increasing smoking leads to increased risk of early death. Despite all the studies done to date on tobacco, this one was the largest and best at demonstrating just how powerful tobacco is at what ages and how increased use leads to increased risk. So if you've quit, are trying to, or are cheerleading someone who has (we ALL need cheerleading), keep up the good work.
Dr. Mike, Chief Health and Medical Officer at Lumenos
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A Health Section of the Washington Post reviews the composition of "Airborne" - a commercially available product getting lots a buzz . . but, as in most OTC "cures" or "preventives" - no science to support its claim to prevent or treat colds, flus or respiratory illnesses.
Its a concoction of vitamin C (nope, not effective and in high doses causes stomach upset), echinacea (nope, not effective as reported in prestigious New England Journal of Medicine recently), vitamin A (megadoses of this have been shown to produce birth defects), chinese herbs (small dose or who knows what dose of this and products like it are not regulated by the Food and Drug Administration), zinc, manganese, ginger etc - none shown to be effective.
Save your money.
Wash your hands frequently. Don't sneeze into them. Exercise (walk outside even - warm your breath if you have to - cold doesn't cause "colds"). Eat right with 5 fruits and vegetables a day. With a well balanced diet (see our Web site) you don't need multivitamins (food is better) - unless you're pregnant of course.
All of these will "boost your immune system", reduce your risk of infection and make the symptoms bearable - and are PROVEN effective. Unlike the 5-6 tablets of Airborne at 75 cents each per day!
Have a great day.
Dr Mike.
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The tragic deaths of Kirby Puckett and Dana Reeve remind us of what we know and frankly, what we don't in medical science. I've attached an email from the National Business Group on Health commenting on Kirby's untimely death at age 45 from stroke - an almost 100% preventable condition through our behaviors. Please read it.
Dana Reeve, the wife of Christopher Reeve, sadly died at 44 of lung cancer. Unlike Kirby's death however, hers was not linked to risk factors which we understand and can reduce with our current level of scientific knowledge. 90% of lung cancer is directly related to cigarette smoking - as in Peter Jenning's case. Dana was not a smoker!!
While we wait for better science for what we don't know, let's make sure that we try to live and model for our loved one's what we DO know can lead to a long and healthier life. Its the 7 things that healthy people know. Eat right, don't smoke or stop, physical activity for 30 minutes a day (walking trails and pedometer), know and shoot for your ideal body weight or BMI, alcohol if at all in moderation, know how to relax and relieve stress, and get your preventive care (blood pressure, selected screening exams and basic lab tests as cholesterol).
It's really NOT rocket science.
Dr Mike, Chief Health and Medical Officer at Lumenos
Here's Helen Darlings message to all employers:
Subject: Kirby Puckett's Premature Death Could Save Others
The early death of Kirby Puckett should be a reminder that even a young (45!) and once very active person can be struck down suddenly and die or be severely crippled for many years with a stroke. Family members’ lives are changed forever and children who lose a parent never fully recover from such losses early in their lives.
I urge all of you to use the sad premature loss of Hall of Famer, Kirby Puckett, as a time to communicate with all of your employees, retirees and dependents about the devastating effects of strokes, and all that people can do to reduce their risks of stroke. According to the new reports, although only 5’ 8”, Kirby Puckett’s weight had risen to over 300 lbs.
First, every person should have his or her blood pressure monitored and actively treated if it is too high, remembering that today what is too high has actually been made lower so even if an individual was told that he or she had normal blood pressure earlier, it may no longer be considered within normal limits. Every individual should be checked at least every year or more often based on risk status.
Second, depending on the individual’s race, gender and family history, he or she may be at much higher risk and should be monitored and perhaps more aggressively treated than others. Death rates from high blood pressure are much higher for African Americans ( male 46.8 per 100,000) than Caucasions ( 12.8).
Third, other risk factors that must be reduced, controlled or eliminated are diabetes, cigarette smoking, high blood cholesterol, obesity and heart disease. At the risk of being a reverse sexist, men are particularly resistant to getting care and following the doctor’s recommendations. Maybe this high profile death will be a wake up call for them and for all who think they can live without taking care of themselves and they will only be affected when they are “old.”
Fourth, everyone should know the symptoms of stroke and call an ambulance or get to a hospital immediately. (Ideally a so-called stroke-ready hospital but that is a subject for another memo).) Be sure to tell them that you or your loved one might be having a stroke so they will spring into action. This is a time to be really demanding as a patient or family member since time to proper treatment is critical to survival, success and recovery. For the list of symptoms and how to recognize a stroke, please go to http://www.americanstroke.org. Attached also is our Issue Brief on An Employer Approach to Advancing Evidence-Based Hypertension Care that should help you improve health benefits to support evidence-based medicine and improve the health and quality of life of your workforce and their families.
Now is a great time to reach out to all, especially those at the greatest risk.
Helen
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We decided to enroll in a Lumenos HRA primarily based on cost - the Lumenos plan had the same monthly payroll deduction as the former PPO, and we calculated that the out-of-pocket costs would be moderately lower. That was the extent of our expectations. We were in for a surprise.
First, somehow those health dollars became ours. We had a pot of money that we could use or save for medical care. So the smorgasbord approach to health care was over (all you can get for one co-pay). Who new how expensive cholesterol drugs were? Certainly not us. Being frugal former New Englanders, we decided to substitute diet and exercise for dollars (drugs). And it’s working. Our BMI has moved into the healthy range, increasing self-esteem and energy. Well, there is the downside of having to buy entirely new wardrobes.
Second, this health insurance company actually invited us to dinner. And then actually listened to what we said. There must be something in the water. I’m beginning to think that Lumenos is some sort of cult. Has anyone seen Dr. Mike jumping up and down on Oprah’s sofa? I think they’re turning me into a Lumenos poster child.
And so a change in health plan based primarily on cost has turned into a change to healthy lifestyles.
How have your Lumenos experiences been?
Vic Maslanka, Lumenos consumer
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Why are "older" drugs that have been on the market preferable from a safety perspective than "newer" drugs just licensed?
In recent years, the FDA has been pressured to allow "expedited approval" for drugs to get them to market. While "safe", many of these drugs had some concerns which prompted the FDA to require that the drug manufacturer fund and undertake studies AFTER the drug was on the market to assess safety. The FDA required that 1,200 "post-marketing" studies be performed in recent years.
However, only 1/3 of the studies mandated by the FDA for these newly-licensed drugs have even been initiated - yet the drugs in many cases are not only on the market but being actively marketed.
So if you're physician wants you to try an "old standby" that she's comfortable with - go with her advice. The "new, new thing" you may have seen on television or which she may be providing as a 'free sample' may not be the proven, safest alternative over time.
Have a healthy day.
Dr. Mike
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