Dr. Corso's med blog: February 2007

Saturday, February 24, 2007

Baby Boomers Feel In Charge of Their Health

UPI Poll: Most feel in control of health
WASHINGTON, Feb. 21 (UPI) -- Nearly all U.S. respondents to a UPI-Zogby International poll said they feel they have control over their personal health.


At first I just thought that these people must be deluded, since from my point of view, we are losing access to our health care providers. Every phone menu option or human screening we must negotiate our way past to get in touch with the physician is a new obstacle. Every minute shaved off the ever-decreasing length of the office visit lowers how well we can be heard.

But then I realized that personal health has very little to do with the doctor, especially these days when information is available to all us baby boomers at the touch of a mouse. Two important trends in which patients are starting to take greater control of their health and well-being came immediately to mind:

Lay people are becoming more educated:
It is now possible to extract accurate information from the web and media about what tests, treatments and behaviors will truly extend life and promote well-being – and, conversely, to identify the hype and nonsense.

Consumers are willing to spend more on their health:
More and more of us baby boomers are taking advantage of new medical practice models that afford a return to the more intimate relationship between patients and physicians as well as enrolling in medical wellness programs such as HealthWise. This demonstrates a growing willingness to go beyond the restrictive menu of one’s health care benefits and invest a little cash in one’s own health.

A final thought. People “largely feel in control of their health.” But are they? In my professional experience, many such people die way before their time. They thought they were obeying “Nature’s Rules” for healthy living and so neglected to search for, or adequately deal with dangerous medical conditions they didn't know they had – conditions we now have the medical technology to find and cure.

Friday, February 16, 2007

The skyrocketing costs of health care

I was recently asked about why the costs of healthcare are skyrocketing and what consumers, employers and healthcare providers are doing to adapt to the situation.

Here’s a countdown of three big areas of increased cost: (a more detailed discussion of each, which you may wish to use, is provided at the end of this email.)

#3 on my short list, but often first in the news and in the complaints I hear from patients and consumers is the high cost of pharmaceutical medications. The percentage of health care spending devoted to expensive new drugs certainly has risen from about 8% fifteen years ago to about 16% today. HOWEVER, this is actually a huge value because the number and cost of hospital stays, surgeries and doctor visits that result directly from the diseases these new drugs treat has fallen proportionately – and the patients are healthier. Our extraordinary new pharmaceuticals actually represent one of the best values in medical care today. The advancement in technology mirror the pace of computer progress: exponential. So is the cost, not the least of which is caused by increased demands from the FDA to prove safety and efficacy – hundreds of millions of dollars per new drug.

#2 Second is the fact that consumers now demand that all matters of health and wellness be covered by their insurance – everything from cancer treatment (a good place for insurance) to the purchase of Viagra, birth control and even therapeutic massage (more a lifestyle choice in many cases.) This is a financial disaster, because as insurance companies compete to expand the services they cover to meet their customer’s expectations, they must raise rates for everybody. No one had their insurance pay for medication twenty years ago, and mammograms were not covered either. No health plan would have the nerve to deny a mammogrom today! Imagine in the automotive world if you could make your car insurance pay for oil changes, stereo/iPod upgrades or a new paint job for your SUV whenever you felt like it. The skyrocketing cost of car-care benefits force many a motorist to drive uninsured.

#1 Last is the insurance industry itself. All we need to do is step back and take a look at enormity of this profitable bureaucracy. When I started practice twenty years ago there were, on average, 1.8 employees per physician. Now that number is between 4 and 5 and is matched or exceeded by an equal and opposite contingent of paper pusher in the offices of the insurance companies and government health plans like Medicare. I must hire a person to bill their person who sends it back for more information before clearing a bill for payment. The volume of families whose lives are supported health care dollars is simply enormous, and growing every day as new laws such as HIPPA (the federal patient privacy act) spawns whole industries that healthcare providers must pay to make sure they are in compliance with these unforgiving laws. (and we thought OSHA was tough!) We’ve helped buoy up unemployment but have darn near sunk the health industry.

What have doctor and patients and employers done in response to skyrocketing costs? For the most part, employers have been forced to scale back by:

* Denying benefits for part time employees and limiting new hiring to only part time status.
* Removing family members from employee’s existing plans.
* Increasing the portion of the health premium that employees must pay themselves.
* Switching to lower-cost health plans which are more restrictive about who a patient can see or what medications they will pay for.

A promising trend in large companies like Jeld Wend and Les Schwab Tires is to take health care in-house. My experience is a much more efficient and cost effective system, since the for-profit middle man is cut out. We can get things done faster and better.

As a physician, I personally sought to cope by starting Oregon’s first retainer-based medical practice, also called "concierge" or "boutique" practices. They are often misunderstood as being for rich people only, and nothing could be further from the truth; many of my patients, even with low incomes have actually saved money in such a model.

Tuesday, February 13, 2007

Avoid second hand smoke, but do it for the right reason!

I was recently asked about the danger of lung cancer from second hand smoke since Television spots about such tragedy are now getting a lot of airplay. I think avoiding second hand smoke is great but I prefer a bit more accuracy. There are close to 170,000 lung cancer deaths each year in the US but only about 3000 cancer deaths can be attributed to second hand smoke. And there are a whole lot more nonsmokers than smokers, millions and millions of us. So if lung cancer was the only danger from passive exposure, it would be a relatively rare occurrence.

However, tobacco smoke, whether first or second hand, has now been convincingly demonstrated to be highly toxic to heart health, resulting in added heart attack risk, about 80% as much in second hand exposure as in the actual smoker.

The toxic effects of tobacco smoke on the coronary arteries is almost immediate. This is in contrast to other cardiac risks such as chronically elevated blood pressure or high levels of the “bad cholesterol,” which increase heart attack risk gradually over time. Certain compounds in tobacco smoke represent an acute “assault” on the delicate inner lining of the coronary arteries, the endothelium. These effects can be measured within 30 minutes of smoke exposure.

Although I don’t know of any specific data regarding the timing of second-hand smoke exposure and an actual heart attack, it is well known that when a smoker dies of a heart attack, it is commonly during or within minutes of smoking a cigarette.

Fight to avoid second hand smoke! But do so because of real king of death in America – heart disease.