“How Medical Care is Being Corrupted''

There was an article in the New York Times, "How Medical Care is Being Corrupted," that caught my eye this week.

The two author-physicians write about how the policies and expectations of insurers, hospital networks, and regulatory groups are created to get good-looking statistics which then undermine the ability of individuals to obtain the most appropriate care.

"For example, doctors are rewarded for keeping the patients' cholesterol and blood pressure below certain targets. For some patients, this is good medicine, but for others the benefits may not outweigh the risks."

The authors go on to note that these risks are not insignificant, and may include an increased risk of developing diabetes - no small problem - and increased fractures and falls amidst the senior population. 

Physicians are not awarded based on giving the best care to each patient. Instead they are financially rewarded and receive better online reviews if they meet the targets, and are financially penalized and suffer negative online reviews if they don't meet the targets.

These are not the only financial incentives out there. Insurers will pay bonuses to doctors for using preferred medications, even if those aren't the best option for a patient.

The creepy thing about this is that it's done behind closed doors. A doctor who was frank with his or her patients about the influences swaying his or her decisions would surely be fired.

* * *

The authors acknowledge that some health policy experts "argue that it is obsolete for the doctor to approach each patient strictly as an individual; medical decisions should be made on the basis of what is best for the populations as a whole."

Huh? How is having sick people get sicker best for the population as a whole?

The authors come out strongly against this ideology, stating that "Physicians should never have an incentive to override the best interests of their patients." I agree.

* * *

The posts from this week all have a common theme of how the government and corporations (both medical and consumer goods) are powerful influencers in our medical care system, which frequently does not have our best interests at heart.

From the World Health Organization's fact sheet on the right to health:

• The WHO Constitution enshrines the highest attainable standard of health as a fundamental right of every human being... 
• The right to health means that States must generate conditions in which everyone can be as healthy as possible...

It is ironic that here in one of the most powerful and wealthy nations on the planet we have completely failed to "generate conditions in which everyone can be as healthy as possible."

(While this post focuses on the medical care system itself, our nation has also failed on many other counts to create healthy conditions for people. For instance, we subsidize corn which then gets made into corn syrup which then feeds the epidemic of obesity and diabetes. Our cities are made for cars, which creates excess pollution and contributes to our sedentary society, again contributing to our nation's health crisis. The list goes on, and it is way too big to address here in this post.)

As frustrating as all of this is, the take-away for me is, again, that I need to be in charge of my own health as much as possible. Yes, I will continue to use doctors in my care, but I will weigh their advice carefully. 

* * *

This comment of mine begets a topic for another blog post: I am able to do this only after years of practice, and I have the benefit of citizenship, being a native English speaker, having a college degree, and health insurance.

How can a system this backwards possibly be serving the people who need it most?

These perverse incentives serve a few in the short term, but they are shooting the nation in the foot long term. Not only does poor health get in the way of an individual's "Life, Liberty and The Pursuit of Happiness," but it is a huge drag on the economy.

Those who claim that the bottom line should be the metric by which we measure success should have the business savvy to realize that a sick nation is not a firm foundation for financial reward.

Healthcare isn't Perfect

Today's post is inspired by a conversation amongst some of my yoga students yesterday. The topic was vaccinations: laws and standards of treatment in different countries, the number of vaccines given to children today, how effective they are, and what the possible drawbacks are.

One person was angered by what she believed to be government misinformation regarding the safety of vaccines containing mercury. 

While the vaccine debate is beyond the parameters of this blog, her emotions are understandable: she felt betrayed by an authority that she believes is not acting in the best interests of the people it serves. 

And yet, are those authorities ever reliable?

The fact of the matter is, government authorities are not 100% correct all the time. The scientific research public health policies are (hopefully) based on encompasses an enormous amount of information that is ever-changing. Not only is the information in constant state of flux, opinions about the meaning of that information and how it should be acted on can vary widely, even among experts in the same field.

The only information available at a particular time is the only information available at a particular time. Future research can and does upend long standing paradigms of care at any time, and even those paradigms are not universally agreed upon. The best solution we have one day may be considered harmful the next, or vice versa.

For instance, take the example of hand-washing. A standard today, it was initially rejected by the medical community. This practice, attributed to Hungarian physician Ignaz Semmelweiss, was pooh-poohed by his colleagues because of a lack of scientific evidence and was only later adopted when Louis Pasteur confirmed the germ hypothesis. It could have saved countless lives had it been embraced earlier.

Not only is the world of medical research not consistently reliable, but additional issues arise when scientific hypotheses filter out to the public. Media coverage, lobbies, corporate interests, money, miscommunication, the failures of both bureaucracy and individuals can all contribute to less than accurate information being dispensed, either willfully or unintentionally. 

While we supposedly have a right to health care (article 25 of the United Nations Declaration of Human Rights - not that a single one of those is universally respected,) 

Healthcare will never be perfect.

While that may seem obvious, saying it highlights that flawless healthcare is often an underlying, unexamined expectation in our society. We put our public health organizations, research institutions, and health care providers from the fields of allopathic, alternative and complementary care on pedestals, expecting the impossible, and feel angry when they fail to deliver.

That doesn't mean we shouldn't attempt to hold organizations and individuals to the highest standard possible. It's just that the highest standard possible often isn't good enough, and who's to say what the highest standard possible is in the first place?

* * *

In my experience with my health challenges, I needed to adjust (not lower) my expectations. Once I realized that no one was going to rescue me, and that my success was dependent largely on my actions, I stopped looking for the magical individual who could provide me with the perfect cure. I slowly started a long process of learning how to accept where I was while still moving forward.

I do and will continue to make mistakes. None of the self-care and healthcare choices I make are perfect. I have a health problem that is poorly understood and little researched, and therefore most of the choices I make are made based on paltry information, guesses, and shots in the dark. So it goes.

Somehow, through a long twisting maze, I managed to get better anyway.

For me, accepting that healthcare is part of the mystery of life reduced the burdensome anxiety so common with chronic illness, and supported me as I imperfectly worked to improve my situation.

“Underwareness": When Corporate Ad Campaigns Trump Education

Have you seen the "Underwareness" print ad campaign for Depends?  It features models fully dressed on top while wearing nought but Depends adult diapers (and for the ladies, high heels) on the bottom, with the slogan "I dropped my pants for Underwareness."

It is accompanied by a flashy website detailing events such as their launch party and fashion show (featuring Depends) and encouraging people to share the campaign on social media outlets, with the incentive that for each post, tweet, or link they will donate a dollar to charity (United Way and the Simon Foundation for Continence.)

I am so cynical about this.

Why?

NOWHERE on the site does it say that incontinence is treatable. Instead there are links to pages where you can purchase Depends or get a free sample.

Always the optimist, I hope that the effects of the campaign are not all bad. It will perhaps assist in de-stigmatizing a common health problem (incontinence affects 25% of the American population, according to Depends.)

Another point in it's defense is that the purpose of corporations is to make money - why shouldn't their marketing campaign dollars go to marketing their products? 

And yet it is frustrating that our knowledge of health and anatomy is so limited in our country that most people don't know incontinence is preventable and treatable, which allows an ad campaign like this to thrive.

* * *

Consider just one contributor to incontinence: pregnancy and delivery. I couldn't easily find statistics on the rate of postpartum incontinence in the United States* - an indicator of how little we value women's pelvic health here - but anecdotally it is common for women to chalk up incontinence as an unavoidable and untreatable result of carrying and birthing the next generation.

Just yesterday I was eating brunch at a kitschy restaurant with various witty sayings on the wall ("Tis better to have loved and lost than to live with a psycho the rest of your life!"), including one that read "I laughed so hard tears ran down my leg!" That wouldn't be viewed as funny if stress incontinence was known to be curable.

Another common cause of stress incontinence is athletic pursuits. In a YouTube video from 2013 made at the CrossFit Games, athletes laugh about how they pee during workouts and competition, and brag that it is a sign of intensity. The video even feature a gynecologist who claims that "In my professional opinion it is okay to pee during double-unders." (Double-unders are when you jump rope, but swing the rope under your feet twice before landing.)  

Yikes. This is a disturbing example of miseducation regarding pelvic health. When even doctors don't know the facts, how can we expect people to know that continence is an attainable goal?  

Thankfully various physical therapists wrote in response to this video, to educate people that incontinence is indeed a dysfunction. You can find some of the many responses on MoveForwardPt.com, PhysioDetective.com, and PelvicGuru.com.

* * *

I understand that the Depends promos are advertising and not a public health PSA, but I am angry that they take on the veneer of an educational campaign when they are not. This is a blatant example of a company putting the bottom line ahead of the wellbeing of their customers, made even more insulting by putting forward a calculated image of "do-goodery."

Yuck.

It is frustrating that this supposed do-goodery (Spread the word! We'll donate when you do so!) encourages people to share the ad campaign by making them feel like they are promoting health when they are not.

Another gripe: the ad campaign is, like many ad campaigns, sexy and fun. While humor can go a long way in making people comfortable with taboo subjects, since when are health problems sexy and fun??!! 

"Hey baby, let's make love, and don't mind if I unintentionally urinate on you - it's hot."

How on earth is that reasonable? By framing a health problem this way it ignores the very real suffering of the people struggling with it, and makes it seem that help is not available, necessary, or desirable.

* * *

So the Depends campaign is out there, but surely there must be substantial alternative resources where the public can find accurate and complete information on treatment options?

There's a long list of possible treatments listed on the Simon Foundation's website which may be worth a gander. I'm not a medical professional and can't speak to their efficacy, but I'm wary since not only is the website pretty shoddy and not appear to represent a robust organization, this Foundation is apparently willing to take loads of money from a corporation who will benefit from them not doing their job. 

Is there perhaps a better place to direct you to? Interestingly enough, the Google searches "incontinence research," "incontinence education," and "patient education incontinence," turn up not a single first page result for an American organization dedicated to incontinence research and education. (There was an Australian one, sponsored by the Australian government - they have nationalized health care.)

While there are results from reputable resources as the Mayo Clinic and the National Institutes of Health, there are also plenty of sketchy ones.

It is disturbing that such basic health research and information is not prioritized, funded, and made easily available to the public.

* * *

What to do?

• If you or a loved one is suffering from incontinence, check out the Women's Health Section of the American Physical Therapy Association's website. They have a PT Locator where you can find a local PT who specializes in either urinary and/or bowel incontinence. Again, I am not a medical professional, but it's a start.
• Tell me if you are aware of any other reputable resources for continence treatment; I'd love to share them.

And... tell your friends not to drop their pants for "Underwareness," but rather to

Drop your pants for a solidly trained PT.

* * *

*FYI I did find one small study from Norway that was published in the International Urogynecological Journal of Pelvic Floor Dysfunction in 1999 that showed 48% of women had symptoms of incontinence during their pregnancy, and 38% after delivery. The abstract concludes not that pregnant women should start wearing adult diapers, but that "This documents the needs for a strategy to prevent and treat urinary incontinence during these periods." 

Victory Lap for Danielle!

Hey all! Let's celebrate some good news from Danielle Lavieri, which can be found on her blog at www.daniellelavieri.com. You can read all about her good news in the post "The Meaning of Remission" here.

Prepping for the Holidays

It's November, yo. Thanksgiving is but two weeks away, kicking off a month and a half long parade of winter festivities.

Do you have a plan?

I ask you this because in my humble experience poorly managed holidays can be really stressful. Amidst the whirl of activities, shopping, gift-giving, decorating, and cooking, there is the underlying cloud of expectations.

Rarely are these expectations clearly defined or articulated, but there they are, lurking in our subconscious and those of everyone around us.

Not only may you not be aware of your own hopes, but also the hopes of everyone else around you. Your boss and co-workers; your family; your friends; your community. They are pulling on you, asking for attention, and we feel compelled to respond to them even when we don't even know what they really are.

Despite (or because of?) their vague-ness, when these subconscious expectations are not met, they can lead to all sorts of tension, disappointment, and hurt feelings.

By bringing my own expectations and desires to light, and looking ahead at everything I expect of myself and what others will expect of me, I am able to sort through the mess, make adjustments, and plan for a wonderful season.

* * *

I have dealt with the holiday bluster in many ways over the years, in often a less than graceful manner. It's been tricky for me since I have chosen the option to (until recently) keep my pain disorder private; people haven't understood why I am not thrilled at the prospect of cutting down a Christmas tree or decorating cookies all afternoon. This has made things pretty dicey, and I have walked on my share of of eggshells. In the process I have repeatedly disappointed those around me.

My family likes to do Christmas to the power of ten, and my lack of enthusiasm was alternately viewed as bad behavior, not being a team player, poor attitude, and, most threatening of all, a sign that I didn't love them. 

Rising above this tangle and creating an enjoyable holiday season for me has required

• taking care of myself first
• articulating to myself what I do and do not like about the holidays
• maintaining strong boundaries.

Selfish? Oh no. It's not selfish to change my own behaviors with the goal of better participating in the group. On the contrary; it would be selfish of me to attempt to change everyone else so that they met my expectations. 

After all, my friends and family prefer to spend time with me when I am happy and grounded. Who wants to celebrate the holidays with the bat-shit crazy version of a loved one? By doing myself a favor I do everyone a favor.

(Bonus: my behavior shows those who routinely take on too much stress during the holidays that there are other options.)

* * *

It's been a rough ride and I have ruffled a lot of feathers, but things have smoothed out. By knowing what my expectations and boundaries are, I keep my head above the roiling emotional waters swirling around me.

Over time, my family has slowly come to accept that I appreciate keeping things light and simple, and I have seen people relax their own high standards in response. 

We are more comfortable with having people celebrate in different ways (me not decorating cookies does not preclude someone else from doing the same) while maintaining the most important tradition: loving each other.

All the work of sticking to my guns has been worth it. By focusing on what brings me the most joy, and minimizing or avoiding the stuff I find draining, I make it though December without turning into a Grinch or a cynical burnt-out shell. When the New Year comes along I am happy to greet it.

And that makes for the Happiest Holidays of all.