World events, business, etc.

sorry to interupt. just trying to move davids down the list.

To TH20. I am very familar with the principles of both the Oregon and Kaiser programs, but have never personally involved with either. The Kaiser was one of the the most successful true HMO models in the US. Primary care gatekeepers with restricted med lists, limited access to specialists with little patient input into the decision making. Good care for a good price. Its my understanding that the Oregon model is the closest we have to rationing in the US with very careful monetary considerations limiting health care. I have been involved in similar asthma programs but the hardest point to get across is prevention with avoidance of triggers and regular use of maintenance meds instead of just rescue inhalers usage. I do agree with all that weight loss programs, smoking cessation etc should be covered and some companies do(too few). I know some excellent surgeons who are doing the newset bariatric procedures for patients who fail dietary control. One of them still wears his old belt wrapped twice around his waist(350 lbs now 175.) Lastly congrats TH20 to starting to wade through your research. You've inspired me to finish the talks I have. Bye.

T, I'm not familiar with the Oregon model or Kaiser, this is obviously a subject that you know much better than I do. But it does puzzle me why most health insurance companies pay for cures but not for prevention. Seems to me they could save a lot of money by focusing on prevention, but maybe all that would happen is that they'd end up paying gym memberships for people like me who are perfectly willing to pay for their own.

AN, you don't really expect the news media to present positive news, do you? I refer you to my posts on the old thread "Why I hate TV."

Slight change of subject. For those of us despairing about the direction of the middle east it isn't all bad news. There are many who will be pro-American and pro-democracy for the rest of their lives and will tell their children how the Americans came and gave them freedom. This letter was sent to the US 3d Armored Cavalry Regiment from the mayor of a city they liberated.

In the Name of God the Compassionate and Merciful To the Courageous Men and Women of the 3d Armored Cavalry Regiment, who have changed the city of Tall’ Afar from a ghost town, in which terrorists spread death and destruction, to a secure city flourishing with life. To the lion-hearts who liberated our city from the grasp of terrorists who were beheading men, women and children in the streets for many months. To those who spread smiles on the faces of our children, and gave us restored hope, through their personal sacrifice and brave fighting, and gave new life to the city after hopelessness darkened our days, and stole our confidence in our ability to reestablish our city. Our city was the main base of operations for Abu Mousab Al Zarqawi. The city was completely held hostage in the hands of his henchmen. Our schools, governmental services, businesses and offices were closed. Our streets were silent, and no one dared to walk them. Our people were barricaded in their homes out of fear; death awaited them around every corner. Terrorists occupied and controlled the only hospital in the city. Their savagery reached such a level that they stuffed the corpses of children with explosives and tossed them into the streets in order to kill grieving parents attempting to retrieve the bodies of their young. This was the situation of our city until God prepared and delivered unto them the courageous soldiers of the 3d Armored Cavalry Regiment, who liberated this city, ridding it of Zarqawi’s followers after harsh fighting, killing many terrorists, and forcing the remaining butchers to flee the city like rats to the surrounding areas, where the bravery of other 3d ACR soldiers in Sinjar, Rabiah, Zumar and Avgani finally destroyed them. I have met many soldiers of the 3d Armored Cavalry Regiment; they are not only courageous men and women, but avenging angels sent by The God Himself to fight the evil of terrorism. The leaders of this Regiment; COL McMaster, COL Armstrong, LTC Hickey, LTC Gibson, and LTC Reilly embody courage, strength, vision and wisdom. Officers and soldiers alike bristle with the confidence and character of knights in a bygone era. The mission they have accomplished, by means of a unique military operation, stands among the finest military feats to date in Operation Iraqi Freedom, and truly deserves to be studied in military science. This military operation was clean, with little collateral damage, despite the ferocity of the enemy. With the skill and precision of surgeons they dealt with the terrorist cancers in the city without causing unnecessary damage. God bless this brave Regiment; God bless the families who dedicated these brave men and women. From the bottom of our hearts we thank the families. They have given us something we will never forget. To the families of those who have given their holy blood for our land, we all bow to you in reverence and to the souls of your loved ones. Their sacrifice was not in vain. They are not dead, but alive, and their souls hovering around us every second of every minute. They will never be forgotten for giving their precious lives. They have sacrificed that which is most valuable. We see them in the smile of every child, and in every flower growing in this land. Let America, their families, and the world be proud of their sacrifice for humanity and life. Finally, no matter how much I write or speak about this brave Regiment, I haven’t the words to describe the courage of its officers and soldiers. I pray to God to grant happiness and health to these legendary heroes and their brave families. NAJIM ABDULLAH ABID AL-JIBOURI Mayor of Tall 'Afar, Ninewa, Iraq

VENT and FONDL, are you familiar with Oregon's medical model? Procedures and medical care are rated based on the least expensive care/procedure for the greatest number of people. Immunizations, antibiotics, flu shots, papsmears, and physical exams are at the top of the list. Heart transplants, fertility procedures and care for very young, fragile premies are at the bottom of the list, and rarely, if ever are granted. I know that this was true in 2002 are believe that it still is today.

Do any of you have Kaiser insurance? I've heard some complaints, but the doctors there saved a friends life when her polypharmacy of street drugs was deadly. It only cost her $5 dollars for the paramedics to transport and admit her for two days. A wonderful Kaiser female doctor I worked with looked like Bo Derek and was about the same age. She was so good to her patients and they loved her. She had been an RN for a few years, before going to medical school. Her bedside manner was really efficient and elegantl! One thing about Kaiser is that their formulary list is limited. They want to prescribe the least expensive medicine possible.

One of my young patients had had two unsuccessful kidney transplants. She came in 3 times a week for dialysis.

VENT, are you familair with the open airways program? I taught a six week course to elementary school kids. Every one of them had been to the hospital and had faced death. I taught them about allergy triggers, how to properly use the rescue inhalers and how to tell when the inhaler is empty. I taught this class because the #1 reason for 911 calls to the schools in this area was for escalting asthma episodes.

A few weeks later another student and I wrote a protocal flow sheet on the care asthma patients in the ED. It was fun presenting our ideas and the ED adopted our protocal. We had a respiratory tech or a pulmonologist (?) evaluate the pt., in addition to the ED doc and care from nursing staff. This was during my last year of a BSN program.

I stayed up all night last night and organized many drafts of chapters and articles into manilla folders and will sort through themagain to find the most recent chapters and put the older versions away in a file box and change the file name of the current chapters to work only with current work. I still have articles and boxes of handwritten ideas and printed pages in the livingroom and in my bedroom. If I work on this project daily,and accomplish daily goals, I will finish and graduate this semester.

This is a long message, guess I'm a little wigged from staying up all night.T

Some insurance companies reimburse patients for their monthly Weight Watchers meetings. I think that this is good giving people positive reinforcement for taking good care of themselves is considerate. The meeting are $12 or $14 per week if the patient goes every week.

I worked for a physician who had a Bariatrics practice (weight loss). The patient needed to see the doctor every third week and could schedule all of their appointments with hin. Many of the patients scheduled their two 30 minute appointment with me. Many patients were tense when they first entered the office. I'd wait a few minutes, then take their pressure again. After talking with them about their award winning roses, animals or something they loved their pressure was always lower.

Every night when I went home I felt so incredibly wonderful. I watched these patients change in an incredibly wonderful way. I would be beaming in the office, outside to my car and hours later at home. Many patients lost more than 50 pounds and some about 80 pounds. I'd draw blood, spin it in the centrifuge and collect the red blood cells for the lab to pick up and analyze. some patients took Phentermine HCl 15 or 30 mgs, other were on medifast powdered shakes and others had limited calorie diets. I felt so good witnessing their success and literal make-over. I observed people change from shy and uncomfortable to confident, self-assured and outgoing. Their sense of humor almost always returned, as well.

This doctor encouraged me to become a nurse and after

I think the major hurdle to widespread rationing is on what basis do we decide? And who decides? For example, if we deny the smoker a lung transplant and the drinker a kidney trasnplant, do we also deny the speeder emergency medical assistance when he has a serious auto accident? Same logic applies. All things considered, I think we're better off letting the insurance company make the decisions rather than some government agency, at least we'll be spared most of the PC biases and the decisions are likely to be more rational.

Vent, you've hit on one of the major reasons for rising health care costs. Those of us with insurance generally have regular doctors who we see whenever we have a problem. But many people without insurance use the hospital emergency room for their problems because they don't have a relationship with a doctor. Needless to say the emergency room is much more expensive.

When you talk about rationing, the question is, who does it? Currently in most cases it's the insurance companies. Seems to me there ought to be a better way, but I hate to see the government role expanded, they're generally even worse than the insurance companies at stuff like this.

To TH20 I presume you're more the perfectionist(I'm an optimist) than some other deep seated fear. I agree that obesity is a HUGE problem. Sorry couldn't resist. The biggest issue is with children where parents tire of working full time then having to bus the child to an organized sport. After a period of time if they aren't in varsity sports(middle school on up) it becomes harder and harder to generate interest in their friends to play. In adults they are now recognizing the metabolic syndrome causing obesity. Ant idea would be a step up from the inactivity that our general population suffers from. To Fondl: I basically agree that we should not pay for the "sins" of others. I have a hard time generating enthusiasm over smokers getting lung transplants or drinkers transplanted livers. IT happens but doesn't make a great deal of sense. I do disagree a bit about the rationing. I was speaking more of general care. If you walk into a hospital in the US with a serious medical problem, they can't refuse you reasonable care. In the case of transplants I think of it more that the criteria have shown little benefit and poorer results above a certain age. There are always monetary considerations but is it rationing that I don't drive a Porsche. No its economical considerations in what I can afford. I often see situations deemed hopeless where care is continued because of a vocal family member in spite of several opposing medical opinions. If we were to really be rationing this is where it would start. Just a thought.

T, I believe that at some point we may come to view parental behaviors that lead to childhood obesity as a form of child abuse.

Vent, we already ration health care and we always have. Some current rationing is done by age (eg. you can't get some types of transplants beyond a certain age), some by income (eg. insurance plans won't cover some procedures because they're too expensive so if you can't afford it out of pocket you won't get it - people who are well off financially have always getten better health care than poor people in the US.) And many health insurance plans won't cover pre-existing conditions. So, for example, if you've been treated for a certain form of cancer in the past and try to switch health care plans, that cancer won't be covered if it reoccurs within a certain period of time. Those are all forms of rationing.

I'm suggesting that at some point your lifestyle decisions may be taken into account too, especially when it comes to the cost of your health insurance. In fact I believe that some insurance plans already charge you more or won't take you at all if you are a smoker. Seems to me it's a small jump to do the same for obesity. And it also seems to me that's a fairer way to ration than either income or age because it's something we can all control.

Vent, I like your idea about not procrastinating. I can talk about the outcome of the study but when I read all of my drafts and ideas I get a little bit overwhelmed and start rewriting another draft. I'm sure that a psychologist would say that I have a fear of success or that I'm a perfectionist - that's not it though. I'll set a time line for the next few days.

Obesity/inactivity will likely become the single most MODIFIABLE risk factor some day. People don't usually become smokers until their second decade of life. Kids start drinking milk full of hormones and developing their sedentary lifestyle and unhealthy eating habits before age 5.

Okay, here's an idea. Perhaps the measurement device will serve a dual purpose and become a motivator in achieving a desired amount of exercise. Let's say a triaxial unit, no those are too bulky and expensive. What about a pedometer?

I've talked with someone who developed the reliability and validity several ped. models and have more than a dozen R & V journal articles. For healthy adults a common daily goal ts is 10,000 steps. If children were issed a pedometer and given a goal of 10,000 or 14,000 steps and had achieved 85 or 90% of their desired steps, some may be motivated to reach their target goal. When a person attempts a pre-determined goal and is able to reach that goal, well after awhile that goal may become a healthy habit. Exercising can be a healthy addiction. The release of pheramones (sp?) - just teasing, are you still with me? -- dopamine is very pleasant. Some runners call this a runner's high.

Now how to get this population to achieve their goal or a chunk of it, that's what the study is about.

Remember how things were when some of us were growing up? Playing until the sun went down. Now a lot of kids never walk or ride a bike to school; it's not safe because of traffic or child molesters. Some kids never develop a nice, athletic body. Earning Presidential Physical Fitness awards is no longer valued. Many of the schools are hung up on test scores and don't value physical activity. What good is a bright mind in underdeveloped, unhealthy physical body? When middle school kids can't even run a lap around an athletic field or touch their toes because their tummies are too big - well, that's just unacceptable.-T

T, I think the family participation idea is a great one. I'm really diappointed with the weight loss shows on TV because they make it look so hard, they suggest that you have to kill yourself in a gym to lose weight, which isn't true. I think they're doing more harm than good. I guess that's because they're main focus is entertainment not education. But it would be nice if they tried to be a little more honest. But then TV never does.

It's funny that you raise the issue of exercise as a cure for depression. That's exactly how I got the exercise bug. I've always been fairly active but 10 or so years ago I experienced a period of depression and turned to daily exercise as a cure, and it really worked. I still exercize almost daily and I haven't had any more problems with depression.

Tropical - Maybe you could pitch the exercise as constructive family time. Also include other outdoor activities like basketball, tennis, ect. I know that we did all of this stuff as a family and I was much better off because of it. (Closer relationships and better health)

FONDL, I'd like to work with people to encourage improved health through increased physical activity. I want to coordinate walks with people and hopefully get entire families participating. Our modern society has become so fast paced. I notice a sense of well-being after just a few minutes into a long walk. I feel more relaxed, less worried and happier. A lot of people who are depressed would benefit from regular moderate to vigorous physical activity.

Kind FONDL, you're helping me get focused so I can overcome my fear of getting this paper written. Thank you.-T

Death rates from our two biggest killers, heart disease and cancer, are both falling. Not because they are becoming less common but because new and expensive treatments are extending the lives of people with these diseases. But that's putting a tremendous strain on health care costs. Rationing of some sort, which we've always done one way or another, has to increase. How we do that rationing will become a huge political issue.

I have a close friend who is a doctor and has his own family practice. Most of his patients are older Medicare patients. He gets extremely discouraged by the large number of people who abuse the system. He says that many of them have nothing wrong other than that they're overweight. But they don't want to hear that, they want some pills to cure all their problems - at government (read you and I) expense of course.

AN: Thank you for your information regarding the energy fiasco.

FONDL: Your ideas are good, obviously you've given this some thought. Smoking used to be the most important modifiable health risk factor. With fewer people smoking, inactivity (contributing to obestiy) will become the important modifiable risk factor for Americans to change to increase health.

Diabetes II (a.k.a. adult onset diabetes) used to be a disease adults were diagnosed with in their forties or fifties. Our current generation of children has a 1 in 3 chance of developing this disease and many are diagnosed w/Diabetes II before completing high school.

I'm familiar with the obestiy studies and heart disease studies. There will likely be a current generation of children whose life span will be shorter than their parents or grandparents, due to inactivity/obesity and the associated co-morbid diseases.

Health insurance is strange. If you have a pre-existing condition ie: diabetes, heart attack or HIV/AIDS it is difficult to obtain private health insurance or even life insurance, unless the person is willing to pay huge premiums.

Thank you, FONDL, for your insight.

Wow, FONDL actually has some good ideas about something.

T, my thoughts on raising activity levels, by which I'm guessing you mean exercise, have nothing to do with sex. Let me first put the issue in context. Health care costs in the US are rising at an alarming rate. Three main causes are: (1) people are living longer, (2) the medical community has developed many new and expansive treatments that prolong life, and (3) large numbers of people are making lifestyle choices that lead to poor health. Those three items are in conflict and I don't think that can continue.

As we learn more and more about the dangers of poor lifestyle choices, it's my belief that at some point people who make healthy lifestyle choices are going to tire of subsidizing those who don't. Auto insurance rates are based on the choices you make about your driving habits. But your health insurance rates are irrespective of your lifestyle choices. I think that will change.

Our society has already declared war on smoking - in many cities you can't smoke anywhere in public. We've declared war on drinking - my wife and I can't share a bottle of wine over dinner anymore and drive home without breaking the law. I think obesity is next. Strong educational efforts already underway combined with financial incentives (eg. insurance rates) will lead to better eating habits and increased exercise. Those who refuse to live a healthy lifestyle could ultimately lose their health care benefits, just as you void the warranty on your car if you don't maintain it properly.

T- Here is a collection of articles aqbout the California energy crisis. As I recall the "deregulation" scheme consisted of having the utilities sell off generating capacity and becoming energy distributors, preventing the distributors from entering into long term contracts so that they had to but their electricity on the comodities market, and then capping the retail prices. When you are capped on your selling price that is a problem when the price you pay to procure rises. When California set up the system the electricity prices were low. As they rose in the late '90s into 2000 the companies were litterally forced to sell at a loss to the point they could no longer afford to buy the energy they needed and they were too bankrupt to buy on credit.

swlearning.com

As far as the demonstrations go if it is in Syria, it's government sponsored. Probably true in Egypt too. In Iran there are non-government demonstrations, but they get broken up very quickly and violently since the demonstrators are very pro-US in the Iranian democracy movement.

The number 666 is most likely a mistranslation of an old text. Gotta love History channel.

FONDL, I did a pilot study and now it's time to finish the write up. I don't want to mention too much about the population or instruments used to measure activity. It's non-sexual. I imagine that your unconventional exercise is actually some type of sexual aerobics. I'm I close?

AN, I like the cartoon headlines. The group of angry people is interesting. Those rioting are testing their boundaries and it makes it that much easier to organize and take to the streets in the future. Q: If the US is the "Great Satan" and an angry group wanted to make an impression in the world; what date would they strike? A: 6/6/6. I'm not trying to stir up sh*t; I am merely concerned about the unrest. I'm not worried to the degree I was in September '01. I'm concerned by the Iranian leader's previous comments and the stirring up that his hateful talk has caused. -T

The latest manufactured outrage in the muslim world at least gives us some great headlines.

"Bush Calls For An End To Cartoon Violence"

There goes my Roadrunner collection

"Cartoon Protesters Direct Anger At US"

Wylie Cyote and Yosemetie Sam are apparently not happy with our copyright policy.

AN, you are correct as usual. If it wasn't so sad, I'd find it highly amusing that after decades of criticizing the US for how we treat our minorities, it turns out that they have been treated theirs much worse.

T, what physical activity levels are you talking about? Do you mean getting people to exercise more? I have some very unconventional thoughts on that if you're interested.

FONDL, one of the reasons the europeans are always so eager for more diplomacy and process and talks and meetings is because we've subsidized their defence for so long they no longer have any options outside talking a problem away. As the threat to their countries from within becomes more real they'll either recover some backbone and remember the world does not care if you outlaw war, or you'll see Sharia as european law.

T- Don't look at me, I quit with an ABD. I've written a number of papers, but my last dissertation was only masters level and that was 15 years ago.

AN: Your current assignment, if you really want to help involves helping me to get my dissertation completed. The topic involves increasing physical activity levels. I did a qualitative and quantitative study and made the write up of the project so big that I'm having trouble finishing it. I have 52 files related to the paper and about 200 journal articles. My results are significant. Sound complicated?

AN is right on about us subsidizing the rest of the world's pharmacetuicals. But then we subsidize the rest of the world in almost every other area too. In spite of all their shortcomings, democracy and the free enterprise system have shown beyond all doubt that they are far superior to any other political and economic systems ever invented. And that really pisses the rest of the world off.

For all the talk of how intolerant evangellical christians are you don't see them threatening to execute people who blaspheme Jesus.

When is my next term paper due? Can I pick the topic?

Interesting topic. A few thoughts.

1. Unfortunately smoking is still our number 1 risk factor for health in the US. It has such a wide range of effects emphysema, coronary artery disease, peripheral vascular disease and cancer(lung,laryngeal,gastric,bladder etc.) and continues to have these effects for such a long time that it will not soon be replaced.
2. Obesity is a national issue especially in our children. With the advent of the computer age(internet to gameboy) the average child is spending infinitely more time on line etc than the children of 20 years ago. We have to adjust society's attitudes back to a more reasonable compromise.Regular exercise and dietary adjustments(stop supersizing) are the keys. With exercise you decrease your risk for arteriosclerotic disease, improve your conditioning and generate endorphins to get you out of that depression.
3. We are the US and you will not see rationing of health care. The health care costs are astronomical because we as Americans accept and demand the best!! If the physician denies you this he is more prone to be sued. There are already some financial disincentives in some insurance plans for smokers, morbidly obese patients stc. but I don't think it will ever get to the point of denying care. 4)On average 25% of your lifetime health care costs will be spent during your last 3 months of life. We're also living longer but if your mother wants everything done at age 89 so she can live to see 90 are you going to deny her that? There are no good answers since people's expectations are so high that medical health care should cure anything, whether its self induced or not and that they are entitled to that.
4. Finally to TH20. Good luck on your dissertation but you need to set a timetable for yourself to finish it. I know if you've gotten to this point you know how to organize your thoughts. Don't be daunted by the size of the project just take one day or two a week where you'll work on it. I know how it is for me when I know the material but have to put it together to give a talk but procrastination is never the answer.

P-man - I like your ideas. Thank you.

FONDL, I know about depression. I injured my ankle on a trip in August and haven't been to a club for 2 months, because after working a couple of shifts I'd do more damage to my ankle. I don't feel that my depression is serious enough to warrant a prescription. My child has issues with inattentiveness, but then again the kid's in middle school with all of those hormones and distractions from the opposite sex. My kid's behavior isn't "bad" it's just that the grades are no longer straight "A's". It's hard to concentrate on my paper because I've made this project too big. I will get it done and published, though and I'll let you know when it's done.

God, getting this paper written and the stress and of raising a middle school kid, by myself, is enough to make a person nuts (temporarily, I hope)!!!

My ankle now feels good enough to resume my 3.4 mile walk. Thanks guys!