I keep hearing all this talk about how the emphasis in medicine needs to be on prevention of disease, and not disease management or cures. As a nurse with over 20 years experience in a variety of clinical and business settings, most recently in mental health, I would like to suggest the new paradigm of prevention first is a bit mis-guided and unrealistic.
First, what is prevention? How do you realistically "prevent" obesity, high blood pressure, diabetes, heart disease? There are only 2 ways to affect these chronic diseases: education or dictate. The health community has focused on education for 40 years. Constant repetition on message has slowly changed the numbers of unintended pregnancy, smoking, STDs, and AIDS related illness. There are other examples too, but changing behavior is a slow process. Education alone does not prevent chronic medical problems, at least not quickly.
So the new health reform thinks they can prevent first, limit the expensive care to a few choices at the end of life, and suddenly every one in this country will have excellent universal care that is cost effective, paid for, and even reduce the deficit. Only one problem: you can't dictate behavior.
This is the only way large scale changes could lead to the kind of Utopia one side of the spectrum is envisioning for this county. If you punish behavior that causes chronic disease, it is the only way to effect change rapidly. So, your freedom to choose is taken away, "for your own good" because people left to their own devices will not make smart choices. Outlaw transfats, outlaw tobacco (so why is it still legal if you really want people to quit smoking?) Outlaw sugar, outlaw meat (global warming), remove all snacks except fruit and vegetables from the school vending machines, tax complex carbs to reduce useage, mandate 1 hour of exercise daily for all citizens, fines for BMI over 30, fine smokers. I know - maybe you could just remove food and use compressed supplements with all the recommended nutrition. And those weak humans to do develop diabetes, or high blood pressure, or have too much fat? What do we do with them, after all our "help" controlling their weakness?
Maybe it is time to re-read Brave New World, Farenheit 451, Animal Farm, and Soylent Green. As for me, I prefer the education route, and continue to fund research in to cures. This may be a bit tongue-in-cheek, but this pie in the sky talk about prevention, not cure or treatment of disease seems to ignore the human factor and the gift of free will. I don't want government to take that away from me. Positive reinforcement has always worked better to change behavior than punishment, and yet in this new world of reform, the only way to prevent disease is to punish the behavior that causes it.
I don't know from your moniker, if you teach OB to nurses or patients. As mine indicates, I teach patients, in as critic-less a way as I can. Smokers, obviously those still smoking today have poor self esteem (or they'd want better, longer lives) and a lot of anger!
One of the first things people (especially those beginning families) need to know, is that we eat far more protein in America (which is the most expensive part of any diet), than is good for us. Most other societies, including Native American/indigenous populations have considered meat, chicken, fish as condiments, embellishing fruit and vegetables and carbs. That explains the high rice intake in Asian and Mexican ethnic groups, whose fiber is consumed through the high fruit and veggies they eat. When much protein is consumed, it satisfies hunger easier, and keeps hunger at bay longer, which in turn minimizes the intake of other necessary food group, due to feeling "full". That has been responsible for cardiac disease, some cancers, adult onset diabetes, and who knows what else!
You're right that behavior modification takes time, and it is worthwhile, I think. It does require minds that think positively about themselves. That, I think, is the single most important disease preventive aspect. In childhood, we grow up feeling adequate based on others' (mostly our parents) opinions of us, and whether we have existing disease already, and how that is regarded (increasing already challenged parental roles, or bringing out the best we have in us). Yet as parents, how many of us have discredited our children as not wanting to go to school, when they claim illness (maybe because we did that?).
I remember being taught in elementary school that our bodies are like cars, requiring gas/food to do what we do. Well that went right by me, as my family didn't have a car, an we girls wouldn't mess with cars. Can you imagine kids today learning that, knowing that stopping for gas is an inconvenience, expensive and a heart wrenching degrader of budgets?
Earlier in my career, I used a visual aid created by psychology students for the American Cancer Society, for kindergartners. It wasn't about food or other disease coping skills, but was about self esteem. the song in it that I still can't get out of my mind (which I hope stayed with the kids, too) was repeated choruses of "I feel good about, good about, good about myself, as I should about, should about, myself". I haven't looked for one, but I sure hope they did a follow up study on that. As we know from psych patients, (not to oversimplify the etiology of their illnesses) that aspect of their psyches was all too often neglected in their childhoods.
In order to pursue health we have to feel that we deserve it, want it, can have it, and it's worth some wait time. Immediate food "fixes", like other short lived gratification, often are secondary choices forced on us by circumstances, like fatigue and inadequate time/skill for cooking, as well as habits learned earlier in life.
I also remember being taught in high school, in "Domestic Science" (for girls only, while boys took "shop" - which I thought was shopping) to make tomato soup from scratch. I know that each and every participant in that exercise, never did it again, since opening a can is easier - these days the more tasty ready-made hot soups in grocery and "health food" stores are more expensive, effortless substitutes, but today we know about advantages of abundant licenes in hot tomatoes that play an intrinsic role in preventing illness.... dried tomatoes are gourmet food with a side benefit in pasta. Add a can of tuna or salmon or chicken, more veggies, and there's a nutricious, economic dinner for a family! Put some cooked brown rice in it, and fiber a plenty results. Eat hearty, y'all.
OMG you aren't talking about those green tomatoes the food industry injects with gas to make them red are you.
Did you ever live on a farm? Have you ever actually picked a tomato from the vine?
Specializes in PICU, NICU, L&D, Public Health, Hospice.
It is true that our ancestors afforded health care without insurance. It wasn't until the 1920s that the cost of the care began to exceed what people could afford out of pocket. A group of people (teachers I think) started a plan with Baylor hospital to accept a monthly fee from the group in exchange for care, room, board, etc. That was sort of the beginnings of modern health insurance.
Well, I feel better. I was afraid no one cared about this issue, and if you ignore the personal references, I see some very good debate finally on this topic. Just a couple of things to add:
I am an RN who used to work at Blue Cross/Blue Shield, which is a non-profit and has been since the beginning, over 50 years. Someone said they would rather send their money to a "non-profit government entity" than an insurance company. Government isn't exactly non-profit, unless you accept the idea that every dime you send them goes back in to the government to make itself bigger. It certainly does not go back to the people for their benefits! I also was a case manager for Citizen's Insurance Company of America. Managing risk is essential for a viable business. I know there are stories about folks getting dropped as soon as they got sick - I have never seen it happen. You can certainly see why a for profit company may not want to give you insurance if you are already sick - bad risk. Blue cross insures everyone, regardless of pre-existing condition, it is just that your premiums are higher. Just like your car premiums go up if you get in an accident.
I think it is important to remember that just 80 years ago folks paid the Dr directly for medical care. They decided to buy insurance to offset the risk of major expenses of an illness, the same way you buy homeowners insurance in case your house burns down. How did it happen that suddenly having health insurance should be a right? You have a right to health care (you can afford) Why isn't car insurance, homeowners insurance, renters insurance, boat insurance, nursing home insurance, flood insurance a "right"? It is all about managing risk. You manage your risk by buying insurance, they manage theirs by charging more for high risk folks. That is freedom to choose.
I am only saying this because I think some have forgotten how insurance companies got their start. And having worked in them, I know they are full of good people who do their best everyday to help their customers find the help they need. I also know there are folks who feel they entitled to Cadillacs when they live in a garage, just because they paid their premiums. And there are folks who don't own a garage who file claims for Cadillacs too (figuratively speaking, of course) As a case manager, we approved many things that were questionable just for good customer relations. Every denial was based on written policy, not arbitrary decision making. The policies were negotiated by the EMPLOYER who paid for the group policy. If Weight Watchers was covered, it is because the employer agreed to put it in the agreement. By the way, states decide by legistration what insurance policies are mandated to cover, it is not the insurance company that comes up with these things. They do have the right to refuse to pay for treatments that are considered experimental; I guess that does limit off label uses of certain treatments the doctor may like to try. It will be much worse when the government makes the rules.
And to the person who said eating protein causes Adult Onset Diabetes - you got that one wrong. Higher protein (lean) diets are much better for diabetics; high carb diets have been debunked and can make it impossible to control blood glucose levels through diet alone. The research has changed on this in the past few years, and high protein diets kept type I diabetics alive before insulin was produced commercially. To many carbs makes us fat, not too much protein. I graduated 28 years ago, and just recently began buying books and reading about the current research in to diabetes - we need to make sure we stay informed and not just teach what we learned years ago. There are still a large number of practitioners who blame fat people for becoming diabetic, and then tell them to eat more carbs and less protein and fat.
Yes, yes, yes, It drives me batty when someone gives a diabetic with low blood sugar OJ with three packs of sugar. Why not give them orificenic? I always encourage my alert diabetics to have peanut butter, crackers, and milk. To keep their blood sugar level. Not spiky. I had a diabetic once in NM who had a morning BS of 43. She had eaten scrambled eggs and toast, coffee. I gave her 1/2 amp of D 50, not the full amp. Why drive her sugar off the wall. 45 minutes later she was fine with a BS of 135. The doc wanted to change her insulin regime all around. I told her NO not for one hypoglycemic incident in 10 years.
The protein diets, once you get through induction are actually low CALORIE diets. You don't have to eat bacon every meal. Loading up on protein dampens the appetite and allows the body/mind to adjust to low carbs. So the first 2 weeks you do eat alot of protein.
It's funny that people would recommend a low protein diet for diabetics when our dieticians are incouraging protein for ESRD patients. Their albumin levels are lo becasue pre-ESRD they were restricted on protein. But once your kidneys fail you can't damage them any more. The highest cause of ESRD is DIABETES. We are telling our diabetics to increase protein not decrease it.
Specializes in OB, NICU, Nursing Education (academic).
I don't know from your moniker, if you teach OB to nurses or patients. As mine indicates, I teach patients, in as critic-less a way as I can. Smokers, obviously those still smoking today have poor self esteem (or they'd want better, longer lives) and a lot of anger!
I'm a college professor. Believe me, I am very diplomatic with patients.....I'm no critic of their habits, nor will I allow my students to be. Non-judgmental, period.
But, that being said.....I do hold my own personal opinions. And, it's my opinion that healthy food would be more affordable if the cigarettes and alcohol were off the grocery list.
I'm a college professor. Believe me, I am very diplomatic with patients.....I'm no critic of their habits, nor will I allow my students to be. Non-judgmental, period.
But, that being said.....I do hold my own personal opinions. And, it's my opinion that healthy food would be more affordable if the cigarettes and alcohol were off the grocery list.
The AMERICAN government subsdizes many foods. Milk is a great example. I'm in NH currently. Milk is $4.89 a gallon. In Vermont, just over the border, it's $2.89 a gallon. In both places 2 liter bottles of soda are .99 cents.
Cigs and alcohol don't come into the mix. Apples are $1.69 a pound. What's that 3-4 apples. Chips are 2/$1.00. That's why Americans eat poorly.
This healthcare system many want will be anothe subsidy. Pure and simple. No other way to look at it.
How will we be able to give equal care to those in Alaska and Hawaii. We all know everything there is more expensive. Many of the countries people want to compare us to have very small populations. Not one of those countries has over 300,000,000 people.
I am an RN who used to work at Blue Cross/Blue Shield, which is a non-profit and has been since the beginning, over 50 years.
While all the BC/BS organizations did start out as non-profit cooperatives many decades ago, if you check you will find that many, if not most, of them now been bought out by various for-profit companies and are no different from any other private-for-profit insurance company. And while you may have had a wonderful experience in your jobs working for insurance companies (and I'm not suggesting that I doubt your account), there is plenty of documentation out there of the "dirty tricks" practiced by many of the companies these days to protect the bottom line and boost their profits.
sorry, one more thing: if you have ever gone on a diet, you know that living on fresh fruits and vegetables, lean meats and salads if very expensive. For a family of four living on $35,000 a year, next to impossible. Just the milk alone in my house costs $12 a week. I also would object to protraying smokers as having low self-esteem. Please. Nicotine is highly addictive, period.
Having noticed people smoking outside buildings that they'd rather be inside, and hearing the comments they make about restrictions on their smoking, and addiction, I don't see them having high self esteem, except for angry, defensive, disbelieving denial of scientific evidence. So many have told me of parents and grandparents who smokled 2-5 pkg of cigarettes a day, and lived into their 80s and 90s, it seems nothing would kill them.
$35,000 is poverty level, if you live where milk costs $12/week. May I suggest that you put half powdered milk and water with regular milk? After an hour in the refrigerator, it tastes the same as regular milk. Meat is the most expensive element of Americans' diet, yet it consists of a much greater proportion than we require, or that is healthy. It sounds like you live in a city where agricultural products are pricey. Try going out to the countryside and stopping at roadside stands, for fruits and vegetables in season. Learn how to preserve them, and you'll enjoy them all year long.
If you want an addiction to stand as a financial need, it's not. That's like saying "Heroin/cocaine/ meth is so expensive, but I'm addicted to it. There are inexpensive programs to deal with addictions. It takes a willing, health seeking mind to do that.
Having noticed people smoking outside buildings that they'd rather be inside, and hearing the comments they make about restrictions on their smoking, and addiction, I don't see them having high self esteem, except for angry, defensive, disbelieving denial of scientific evidence. So many have told me of parents and grandparents who smokled 2-5 pkg of cigarettes a day, and lived into their 80s and 90s, it seems nothing would kill them.
$35,000 is poverty level, if you live where milk costs $12/week. May I suggest that you put half powdered milk and water with regular milk? After an hour in the refrigerator, it tastes the same as regular milk. Meat is the most expensive element of Americans' diet, yet it consists of a much greater proportion than we require, or that is healthy. It sounds like you live in a city where agricultural products are pricey. Try going out to the countryside and stopping at roadside stands, for fruits and vegetables in season. Learn how to preserve them, and you'll enjoy them all year long.
If you want an addiction to stand as a financial need, it's not. That's like saying "Heroin/cocaine/ meth is so expensive, but I'm addicted to it. There are inexpensive programs to deal with addictions. It takes a willing, health seeking mind to do that.
I live in the Northeast. Not many fresh fruits or veggies here in November. And I don't believe I've ever seen an orange growing up here. I did cut my milk when I was first married. That's how I got to skim milk.
Actually, local small farmers are less green than the major producers.
Having noticed people smoking outside buildings that they'd rather be inside, and hearing the comments they make about restrictions on their smoking, and addiction, I don't see them having high self esteem, except for angry, defensive, disbelieving denial of scientific evidence. So many have told me of parents and grandparents who smokled 2-5 pkg of cigarettes a day, and lived into their 80s and 90s, it seems nothing would kill them.
$35,000 is poverty level, if you live where milk costs $12/week. May I suggest that you put half powdered milk and water with regular milk? After an hour in the refrigerator, it tastes the same as regular milk. Meat is the most expensive element of Americans' diet, yet it consists of a much greater proportion than we require, or that is healthy. It sounds like you live in a city where agricultural products are pricey. Try going out to the countryside and stopping at roadside stands, for fruits and vegetables in season. Learn how to preserve them, and you'll enjoy them all year long.
If you want an addiction to stand as a financial need, it's not. That's like saying "Heroin/cocaine/ meth is so expensive, but I'm addicted to it. There are inexpensive programs to deal with addictions. It takes a willing, health seeking mind to do that.
Some how I don't see President Obama as having a low self esteem.
i'm a college professor. believe me, i am very diplomatic with patients.....i'm no critic of their habits, nor will i allow my students to be. non-judgmental, period.
when do you see patients? do you follow students to the hospitals where they do their clinical experience, and listen (undetected by them) while they comment (confidentially) on their patients?
but, that being said.....i do hold my own personal opinions. and, it's my opinion that healthy food would be more affordable if the cigarettes and alcohol were off the grocery list.
i love to say to those who get cigarettes at supermarkets (and elsewhere) - unjudgmentally, of course, "if you didn't get those, what would you buy instead? with smokers, show you care about their health.
I live in the Northeast. Not many fresh fruits or veggies here in November. And I don't believe I've ever seen an orange growing up here. I did cut my milk when I was first married. That's how I got to skim milk.
Actually, local small farmers are less green than the major producers.
Trader Joe's markets are a great source of less expensive fresh fruits and vegetables. I looked at their website for locations of those stores in the northeast, and saw many in New Hampshire, Mass, NJ, etc. They're very "green" and the milk there is inexpensive (relatively, for Organic products). They get oranges from Israel, FLA, CA, Spain, and other countries that cost the least in the country. Their frozen products are the best, and seldom come from countries with lower standards of production. In winter, you don't need a freezer.....
Some how I don't see President Obama as having a low self esteem.
He makes only $35,000 a year? Oh, I got it, he smokes - and speaks very bashfully about it, if at all. In regard to that habit, he does have low self esteem - he certainly wouldn't want his wife or daughters to smoke! Becoming a politician in Chicago isn't for those with low self esteem, he had a ton of stress, and dealt with that in an unhealthy way (not recommended). Maybe he'll have acupuncture for it.
He works side by side with those who make less than that, though, and his fight is their fight. He learned humility from experts, in Kenya, Asia, and DC.
You had me pegged for a supporter of Obama, which I am.
Onekidneynurse
475 Posts
OMG you aren't talking about those green tomatoes the food industry injects with gas to make them red are you.
Did you ever live on a farm? Have you ever actually picked a tomato from the vine?