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Doctors Die Differently

Posted July 31, 2012

A 26-year history of show prep 3 hours a day for a 6-day a week, 3-hour syndicated talk radio program has left me with a lifetime habit of reading medical journals and scanning the popular media or “the lay home medical  journals” for research, opinion pieces, and any article related to health issues. I remain intrigued today just as I was 30-years ago discovering doctors with stories about how allopathic symptom-driven health care failed them or their family, science-based lifestyle medical research, the politics of healthcare, and the wealth of information available through search engines online or trusted sites. Clearly, the American health system, termed a disease care system by some, while replete with amazing technology often fails to deliver cost effective care or the best care for that patient’s respective needs.

A recent Saturday article in the Wall Street Journal that delved into the fact, backed by research, that doctors die differently written by Dr. Ken Murray, click here to read further, along with a column from Jane Brody in the New York Times entitled “Too Much Medicine and Too Few Checks”, click here to read further was a wonderful opportunity to connect the dots when considering the real possibility of mandated government health care thanks to a recent Supreme Court ruling. An editorial in Business Week five years ago spoke of the fallacy of U. S. health care.  More specifically, more money does not necessarily equate to more medicine and as importantly, more medicine does not mean better care or better outcomes.

The most striking fact from these two articles is that 64% of doctors had executed “advanced directives” versus 20% of the general population indicating they expressly choose not to have extraordinary means used to extend the length of their lives. Dr. Murray pointed out the general population believes, for example, that CPR has a dramatically higher rate of saving a life than is actually factual. With the real possibility that Medicare will soon ration care and those over the age of 70 (according to a professor of medicine from Georgetown University of Medicine) will be not offered certain medical therapies that, say, a 40-year old would take for granted, that sounds a bit depressing for aging baby boomers, right?  Not necessarily, if we follow the model Dr. Murray reveals most doctors would for their own personal health care. And, Jane Brody’s aunt who is a textbook example of poly-pharmacy points out to us the real downside of many expensive medical tools. Statistics teach us that the most money will be spent in our last year of life.

Yet, few of us are educated to make an healthcare choice when faced with conditions that consume nearly 87% of our nation’s health care dollars. These conditions are the chronic degenerative conditions of heart disease and diabetes in particular.  Diabetes and its common consequences of poor circulation, kidney impairment, eye diseases, nerve-related conditions, and failure to heal wounds is now coming into scrutiny. Modern medicine has followed the lab results or blood sugar levels, specifically, and new research indicates the outcome is not optimal. That truly is a game-changer to the mind-set of blood sugar testing and the balance of sugar controlling medications. The growing revelation is that a focus on lifestyle choices, nutrition, activity, and stress management reaps not only benefits but positive side effects. Type II diabetes that affects or may affect as many as 1 in 3 Americans (20% of Americans are known to be diabetic and nearly 40% of us are pre-diabetic) is related to insulin resistance.

Yet, few, if any, family practitioners, general practitioners, primary care physicians, or even endocrinologists have been educated to the topic of fasting insulin levels that can predict type II diabetes a full ten years before the actual diagnosis. And, medical school education is uniformly lacking in the science-based lifestyle choices that reverse insulin resistance in the U.S.(Just a note, type II diabetes is hallmarked by an over-production of insulin to which the body’s cells become resistance. The cell membranes fail to take up circulating blood sugar so that blood sugar levels as measured by lab blood tests.)

The work of Dr. James Anderson at University of Kentucky was pioneering research that processed carbs vs. the carbohydrates found in whole grains, fresh fruits and vegetables including beans and nuts were processed very differently by the body. Normal protein (not high protein but the 1 gram of protein/2lbs. noted in textbooks of physiology) is critical for cell membranes to maintain insulin sensitivity. Sufficient good fat (Harvard research notes that as many at 85% of Americans are good fat deficient) is also essential to modulate inflammation, a critical risk factor for type II diabetes. To echo the work of public health educators at Harvard, up to 90% of type II diabetes can be prevented or even reversed with adhering to simple nutritional guidelines including:

* Each as many fresh fruits and vegetables daily as possible

* Eat no bad fats

* Eat some good fat daily

* If you eat a grain, make it a whole grain

We all can appreciate if you are stressed, your immune system is stressed. Think Christmas and the cold or  flu that hits just when you are the most rushed or pressed. It may be eye-opening that laughter alone can inactivate up to twenty-plus genes that control blood sugar. Stress can adversely affect blood sugar control.  Activity has a profound positive effect on insulin sensitivity. Two days of inactivity can negatively impact inflammation markers which translates to poor blood sugar control. Ohio State University researchers have proclaimed that exercise is medicine, and good medicine. Daily activity is part of the multi-factorial lifestyle plan noted above by Harvard School of Public Health researchers that help to prevent ninety percent of type II diabetes.

Several years ago, I had the opportunity to consult with a medical doctor making the transition from emergency medicine to functional or integrative medicine. I marveled that in the 21st century, American medicine remains focused on symptoms. A 55-year old woman presented taking a staggering 26 different medications. Her primary care doctor prescribed a medication for her high blood pressure, high blood sugar, high blood lipid levels, well, you get the idea. Every abnormal test result or symptom resulted in another prescription. The patient had no idea that taking more than 10 medications translated to a 100% chance of a complication simply from the combination of medications. I have no idea what the combination of 26 different drugs meant in addition to an empty pocketbook to her well-being.

Yet, Jane Brody notes in her article that “more than 40% of people over the age of 65 take five or more medications.” Government studies indicate those over age take 30+ medications during the course of one year. Drugs can be life-saving and certain have an important role to play in modern American medical care. Yet, there were no headlines to herald the incredible good news that simple dietary choices, regular daily activity, and stress management could save 90% of those destined for a poor quality of life and potentially a poor end of life due to type II diabetes. Not one mention in our popular lay-home medical journals. Medications are heralded as block-busters with an efficacy of 40%.  American consumers are known world-wide for smart choices. It is time each one of us learns the lessons our personal physicians practice when it comes to their personal health. “Doctor, what would you do if it were you?” may become the most important question each one of us learns to ask.