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The Most Potent Prescription Ever: Take Time for Yourself, As Directed by Your Doctor

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Dr. Norah Neylon was caring for a 50-year-old woman who was overwhelmed with care-giving responsibilities of her own. The woman’s mother was experiencing early signs of dementia. Five of her relatives had died in the past three years. She frequently had to fly back and forth from California to the Caribbean to take care of members of her extended family. Oh yes—and her blood pressure was dangerously elevated at 210/115.

So Neylon gave her a prescription. I’m not referring to the blood pressure pills she prescribed. Instead, I’m referring to another script, which read:

“Permission to put your needs first. Use at least once a day for thirty minutes, do not exceed the stated dose, this is potent medicine.”

Neylon’s patient laughed when she saw the script, and then began to cry. She hadn’t been putting herself first, and her health was suffering as a result.

Neylon relayed this story in a recent JAMA article “The Prescriptions I Write.” It’s a beautiful essay.

Many health problems are self-inflicted: Some of us bring illness upon ourselves by smoking or drinking too much, or sleeping and exercising too little. Other people become sick because they don’t take time to care for themselves.

(To read the rest of this article, please visit Forbes.)

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Obamacare Is Experimenting on Us (Does That Make Us Frankenstein or Fusilli?)

(Photo by Joe Raedle/Getty Images)

Obamacare is a large, unwieldy law. Despite its complexity, most people are familiar with its most important elements. They know it created a marketplace where people can shop for healthcare insurance; many are even aware that the cost of that insurance is subsidized for people with lower incomes. Others realize that Obamacare encouraged states to expand Medicaid. And of course, almost everyone has heard of the now defunct individual mandate which required people to purchase insurance or face a tax penalty.

But most Americans probably aren’t aware of what, in the long run, could turn out to be the most impactful part of the Affordable Care Act. The crafters of the ACA recognized that the science of healthcare delivery hadn’t advanced far enough to identify the best ways to improve healthcare quality while lowering healthcare costs. So, lawmakers set a slew of experiments in motion, designed to test ways of accomplishing these goals.

Results of those experiments have been coming out of the lab lately, raising the question of what kind of creatures Obamacare has been creating—are they like Frankenstein’s monster, terrifying but misunderstood? Are they like Edward Scissorhands, loved by suburban moms until they realize how dangerous he is? Or are they like a less renowned creature—Fusilli Jerry, the pasta stick figure that Kramer made for Jerry Seinfeld on that eponymous 1990s sitcom?

I side with the latter, because I view the Obamacare experiments as a type of pasta-flinging exercise. People at CMMI, the federal agency in charge of running these experiments, have been cooking up a bunch of ideas, throwing them into a pot, pulling them out one at a time, and then flinging them against a metaphorical wall to see which ones stick—which ones are ready for public consumption. Some relatively recent studies serve as a good introduction to what Obamacare has been cooking up for the American healthcare system.

(To read the rest of this article, please visit Forbes.)

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Frank Thomas – Baseball’s ‘Big Hurt’ – Hurts People by Promoting Harmful Supplements

(AP Photo/Kathy Willens)

Frank Thomas is a 6 foot 5 inch hulk of a man, the 7th player in MLB history to retire with a batting average greater than .300 and more than 500 home runs. He was also thought of as a clean player, despite playing in the steroid era, and even advocated for drug testing when the rest of the league was purposely, and lucratively, looking the other way.

So why is he now hawking testosterone supplements?

Frank Thomas, appearing in ads with fans praising him for looking fit enough to still be playing, credits testosterone supplement NUGENIX® (“GNC’s® #1 selling male vitality product”) for his current level of fitness.

(To read the rest of this article, please visit Forbes.)

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Mass Shootings: Tragic for Victims, Great for Gun Manufacturers

In the aftermath of the Parkland High School shooting, we are having lots of debates about the role of the NRA in shaping gun legislation. Politicians who take money from the NRA are said to be in the organization’s pockets. But don’t forget where the NRA gets its money: gun manufacturers. And while no manufacturer celebrates gun violence, the facts are clear: mass shootings are good for their business.

More than 32,000 Americans die each year from gunshot wounds. Few of these people are criminals shot by innocent victims defending themselves or their loved ones. Some gun-related deaths result from criminal violence. A tragic number result from accidents. And a tiny number, less than 1%, result from mass shootings.

Yet it is these mass shootings that dominate the news, and that drive gun sales. The publicity surrounding such shootings scares many people into purchasing guns, in hopes that having a gun on hand will help them stop a shooter before he can do more damage. Mass shootings also lead people to purchase guns because, in the aftermath, some politicians call for gun control efforts, which cause people to purchase guns before they are banned.

(To read the rest of this article, please visit Forbes.)

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The U.S. Healthcare System Is Back to Its High-Spending Ways

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For a few years, U.S. healthcare spending seemed to be under control, rising no faster than the economy as a whole. The proportion of our GDP spent on healthcare was flatter than a Nebraska cornfield in November. Here’s how much we spent on healthcare, relative to the economy as a whole, between 2009 and 2013:

  • 2009: 17.3% of GDP
  • 2011: 17.3% of GDP
  • 2013: 17.2% of GDP

That’s a historically low rate of healthcare inflation. But much of that flattening resulted from the great recession that started in 2008. And now, it looks like healthcare spending is once again on the rise, already equaling 17.8% of GDP.

(To read the rest of this article, please visit Forbes.)

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A Drug to Treat Cancer and Heart Disease (Miracle Cure or Media Hype?)

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In a recent New York Times article, physician-author Siddhartha Mukherjee wrote about a clinical trial that he characterized as “beautiful,” for potentially illuminating a surprising connection between heart disease and cancer. Mukherjee is a justifiably acclaimed writer, who publishes regularly in The New Yorkerand The New York Times, and who won a Pulitzer for his bestselling book The Emperor of All Maladies. But I wonder whether the demands of popular writing have caused him to hype a treatment that, while promising, is far from proven.

The treatment targets inflammation by inhibiting an interleukin molecule. Researchers conducted a huge clinical trial to see whether the treatment would reduce the kind of inflammation that damages arteries. But Mukherjee didn’t write about the drug because of its ability to prevent heart attacks or strokes. Instead, he was excited about the trial because a secondary analysis of the data showed a “drop in all cancer mortality” and a “stark decrease” in deaths from lung cancer.

Mukherjee knows that secondary analyses like this need to be viewed with caution. Measure enough outcomes in a clinical trial, and the statistics of chance predict that the intervention will falsely appear to reduce some kind of medical problem or other. He even acknowledges that this cancer finding needs to be replicated. However, he isn’t content to urge readers to remain in a state of scientific caution, proclaiming that “if the benefit holds up in future trials, interleukin-1-beta inhibition could eventually rank among the most effective prevention strategies in the recent history of cancer.”

Holy moly, that’s a misleading sentence!

(To read the rest of this article, please visit Forbes.)

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Want to Avoid Unnecessary Antibiotics? Be Careful What Time of Day You See Your Doctor

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Too often, people with viral illness leave the doctor’s office with prescriptions for antibiotics. That’s a real problem. Antibiotics don’t treat viruses, often cause side effects, and when taken too often, lead to drug resistance.

So when you have a bad cough and go to the doctor, you should hope to see someone who is careful not to prescribe unnecessary antibiotics. Oh yes, and you should see that doctor early in the morning, or first thing in the afternoon, or you risk the chance that fatigue will cause your physician to prescribe an antibiotic you don’t need to take.

That’s the conclusion drawn by Jeffery Linder and colleagues, after they analyzed data from 23 primary care clinics in the Boston area. Disturbingly, Linder and colleagues found that doctors prescribe unnecessary antibiotics with frightening frequency, almost regardless of the time of day.

(To read the rest of this article, please visit Forbes.)

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Bait and Switch: The Sneaky Way Your Employer Just Passed Healthcare Costs onto You

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If you get health insurance through your job, beware: you might be picking up more of the cost of your medical care than you realize. With increasing frequency, employers are directing their workers to the kind of high deductible, high out-of-pocket insurance plans that leave workers financially responsible for a surprising portion of their healthcare expenses.

Not long ago, having insurance coverage meant your costs were largely covered. Americans could count on their employers to offer health insurance plans that covered the vast majority of their healthcare expenses. What’s more, employers even chipped in generously to cover a good chunk of people’s monthly premiums. As a result, Americans with good jobs could live their lives unafraid that they would be financially devastated by an unexpected acute illness.

But this generosity came at an increasingly unaffordable cost for American companies, with the price of health insurance threatening their bottom line. In response, companies have looked for ways to get their workers to pick up more of the tab.

Enter high out-of-pocket health plans.

On the surface, these plans look like bargains, because they cost less each month than other plans. When signing up for insurance, many people are attracted to these plans, knowing they will have less of their take home pay diverted to an insurance company. But then they discover that even a minor illness can turn that bargain to a burden.

(To read the rest of this article, please visit Forbes.)

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Everyone Agrees Obamacare Prices Have Been Rising Rapidly (But Everyone Is Wrong)

(Photo by Joe Raedle/Getty Images)

It has been well publicized that premiums for Obamacare insurance plans have been rising at a disturbing rate. Local news is filled with reports of 21.5%36.3% and even higher price hikesPresident Trump complained in February that Obamacare premiums “have increased by double and triple digits,” even remarking that premiums in Arizona “went up 116% last year alone.”

If the cost of buying insurance were really rising this rapidly, we’d have a reason for bipartisan agreement that the Obamacare insurance experiment is a failure. But the rise in Obamacare premiums isn’t even close to the magnitude we are hearing about from reporters and politicians. And it is not because of fake news or dishonest discourse. It’s because everyone is looking at what’s for sale rather than what’s being sold.

Not sure what the heck I’m talking about? Then consider the Nike Mag 2016, a sneaker touted as “sensing the foot and lacing itself,” because, you know, it is so exhausting to tie your own shoes. Nike made less than a hundred pairs of these battery-powered, motor-driven sneakers, which now sell for an average of $26,000 a pair.

Suppose, for purposes of illustration, that before the Mag came to market, Nike had five lines of basketball shoes on the market. They sold for an average price of about $200. Then in 2016, it brings out the Mag. If healthcare reporters and politicians commented on these shoes, they would tell you that Nike prices have risen more than 2,000%. That’s because they’d be calculating the average price of Nike’s shoe offerings, as if people bought an equal number of each type of shoe. If you have five varieties priced at around $200 and one that’s priced at $26,000, you’ll have an average price of over $4,000.

But that’s an insane way to describe the price of Nike basketball shoes. To know how much their basketball shoes cost, on average, we need to know what shoes people actually buy. With hundreds of thousands of people buying the $200 sneakers and a handful of people buying $26,000 sneakers, the average price of Nike’s shoes won’t be much more than $200.

(To read the rest of this article, please visit Forbes.)

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Make Sure Your Doctor Is Treating You and Not Your Blood Tests

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He came to the ER with chest pain, shortness of breath, and atrial fibrillation with a heart rate of almost 120 beats per minute. It wasn’t a heart attack, and it wasn’t some rare disease. He was emergently ill because his physician overreacted to blood tests, and prescribed a thyroid pill he didn’t need.

If your doctor tells you that your thyroid is underactive—that you have “subclinical hypothyroidism”—do what you can to make sure you don’t receive thyroid medicine that could do more harm than good.

According to an article in JAMA Internal Medicine, the 72-year-old patient described above had gone to his doctor several months earlier, with mild, nonspecific physical complaints. The doctor ordered a blood test, which showed a slight elevation in his TSH, or “thyroid stimulating hormone.” TSH is the molecule your body releases when your thyroid isn’t producing enough hormone. When TSH is elevated, it can be a sign that your thyroid gland is underperforming.

In this patient’s case, even though his TSH level was high, the level of thyroid hormone was normal in his blood. That means his situation isn’t straightforward. Suppose his TSH had been elevated at the same time as his thyroid hormone was low. And suppose that he was also showing specific signs of thyroid problems—maybe he was cold all the time, or had a slowing of his heart rate. This constitution of signs and symptoms would be strongly suggestive of hypothyroidism—that extra TSH in his bloodstream might not be up to the task of prodding his thyroid to do its job. In that case, it would be reasonable for his primary care physician to prescribe thyroid hormone replacement, and see if he got better.

(To read the rest of this article, please visit Forbes.)

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