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An Ounce of Prevention Is Worth...?   (March 27, 2007)

Knowledgeable correspondent Nurse Dorothy had this thought-provoking response to a recent entry on managed care in the U.S.:

This is in response to the March 14th blog about managed care. In particular I would like to address the issue of preventive care. It is not really our lifestyle that needs to change but our culture. Culture is what drives lifestyle. As an example, being a nurse I meet many people from all walks of life, rich to poor. Whether poor or rich, both sides tend to work long hours, have high stress, lack exercise, and eat poorly all of which leads to chronic disease. Why, because whatever extra money Americans make is spent on stuff.

Our cultureís idea of a "good life" or "quality of life" is based on the perspective that the more "stuff" you have the better off you are. Whoís got the biggest house, latest fashion, nicest car, newest electronics, etc. In America we work our behinds off for a 5000 square foot house with granite counter tops, a flat screen television, and leather sofa where we can sit for hours eating fast food, getting fat and stressing out about how to pay next monthís mortgage, new car loan and credit card bills all the while popping anti-depressants like candy. Thatís the American culture which drives our lifestyle.

As an example, I recently had a conversation with a single friend who makes a very good salary. We discussed the benefits of organic food and her response was that she would love to eat more organic foods but she canít afford it. Meanwhile, she just traded in her 2-year old BMW for a new one "cause itís so cool," purchased a 3500 sq. $400,000 home two years ago with a three year ARM coming due next year, and is thinking about having breast implants.

A culture based on high quality (not quantity) living would value financial stability via savings, leisurely enjoyment of high quality food with friends and family, any extra time spent on physical activity or enjoyment of hobbies, etc. This type of culture leads to better overall health. As an example, the French diet is very high in fat yet their rate of heart disease is less than ours because they eat freshly cooked, low processed foods in smaller portions, they take a long time to eat with friends and family, and are more physically active. (Wine of course has a beneficial affect as well.) Our insane lifestyles lead to the intake of highly processed, low quality foods which are fast and convenient because our culture views time as money and not time as precious.

Dorothy also added a comment "from the front lines" on socialized medicine:

In regards to the March 19th entry: In the past I worked in the operating room for many years and had many citizens from Canada and the UK come for surgery here in the US (combining surgery and a vacation) because the waiting lists were too long in their home country. (Now the trend is to go to developing countries as they are cheaper than we are). It is because of that experience that I often tell others who want socialized healthcare that it is not the best alternative.
Dorothy gives voice to something I felt but could not express as well as she has here: that the obsession with who's going to pay for the skyrocketing costs of marginally effective drugs, operations and care is sidestepping the real issue, which is becoming healthier as a nation. What we should be obsessed with is the prevention of every disease which is preventable via lifestyle changes and diet-- i.e. a significant percentage of the disease we suffer.

The revolution would have to be of values, specifically, personal responsibility. It would no longer be the role or responsibility of society or medicine to "fix" the damage which we inflict on ourselves.

We live with a curious paradox of values: if you drink yourself silly and smash your car into someone, you will be arrested and charged with a crime. No one steps up to pay for your "cure" or for your attorney. Those are your responsibilities.

But if you smoke and get lung cancer, or drink excessively and destroy your liver, or eat to excess and end up carrying 187 pounds on a 5-foot, 5-inch frame and are prediabetic at 21 years of age, then "somebody" is supposed to "fix" you, and pay for it, too.

Does anyone else notice the disconnect here? Just because we can be struck down with diseases over which we have no control, such as brain cancer or mental illness, then we're off the hook entirely for all the diseases we can influence or control? It doesn't make sense.

Human beings respond to incentives and disincentives. If you know someone will magically save you from the consequences of your actions, you respond differently than if you will suffer the consequences, and you will respond in yet another way when the consequences start hitting home. This story by a 21-year old prediabetic is a real eye-opener:

Sugar isn't sweet for her anymore; She's one of 54 million with prediabetes.

When connected to the trend of obesity, these plague-level stats are enough to make news headlines regularly. It's hard to ignore a figure like 74 million, the total number of Americans with prediabetes, Type 1, and Type 2 diabetes.
There is another way of living, of course, a healthier way, and it appears to be centered around exercise. While we obsess over diet, the active, alert 90-year old I know ate a standard mid-century European diet of white bread and sausage. What differentiates him from millions of others is not some astonishingly complicated "healthy" diet and dozens of obscure supplements but his daily routine of long, vigorous walks. Here's an article which substantiates this view:

You Can Stop 'Normal' Aging; New research reveals surprising facts about our changing bodies.

So where do we stand on personal responsibility and health? The young writer with prediabetes mourns the loss of her "carefree" self who could binge on junk food and guzzle six cans of soda a day; when did self-destruction become confused with freedom? When did visibly unhealthy excess become "normal"? Did you really feel great after the 5th or 6th can of sugar-water? Somehow I doubt it.

Perhaps what the writer mourns is her loss of the current hallmark of being American: the ability to indulge in excess without consequences. I can't be the only one who sees a direct link between "judgment-free" debt binging and "judgment-free" food binging, for the idea is the same: I should be able to get everything I want and eat everything I want now, without future consequences, without discipline, without limits and without judgment, i.e. being challenged.

Our health constantly challenges us all. None of us are immune from temptations and the various conditions we are dealt by genes and our environment, and I certainly don't want to minimize the difficulties in staying healthy and fit. I had to lose 10 pounds last year and need to shed a few more because I have borderline high blood pressure (which I've lowered via lifestyle changes, as described here before). I won't bore you with a roster of my aches, pains, chronic conditions, etc. because that's just normal life.

We all have to manage our physical and mental well-being, and adopt routines which get us where we want to go rather than create roadblocks and more problems. It's like all the other disciplines required by life. If it was easy we'd all look like models, just as we'd all be millionaires if making money in the stock market was easy.

It is a stunning indictment of our culture that fully 25% of our entire population of 300 million people is at risk of what is largely a preventable lifestyle illness. Throw in heart disease (ditto), smoking (ditto), abd various other addictions and the total easily exceeds 50% of the population. And we wonder why medical costs are skyrocketing?

It is difficult not to conclude that the loss of wealth and health we face is an unfortunate but apparently necessary step we must collectively get through to restore some semblance of common-sense values to our culture.

Oh, and there's one more tiny little problem. We are rapidly approaching the end of the line in our ability to pay for the nation's bloated, inefficient and mal-adapted medical care. When the money runs out--that is, when the Chinese central bank and the Saudis stop loaning our government hundreds of billions of "free money" via buying Treasury bonds, then we'll rediscover the one great truth of prevention--it's so very much cheaper than any cure.

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