The Decline of Medical Care in America--What we can do about it.

[Guest guest]

This guy was on Fox News this morning. While I don't necessary jump in with both feet on the Anti-aging medicine boat, I do believe there are valuable contributions toward understanding health and healing from doctors like this one...things we can implement at home into a healthier lifestyle that will keep us from going into a faster decline. He lists them....read on.

The Decline of Medical Care in America-- What Can We Do About It?

by Jeffry S. Life, M.D. Ph.D.

We have just ended a century of unprecedented advances in medical knowledge and technology. Serious medical conditions that were once considered disabling or a death sentence are now curable. Most devastating disease conditions that exist today are now manageable. In spite of all the amazing medical advances in recent years, there exists a great paradox in health care today—we simply cannot afford it! The economics of today’s health care has made all of the advances in medical science less and less available to just about everyone—including even those that are willing to pay for them.

In an attempt to control increasing medical costs, managed care organizations were formed near the end of the last century. Under the rubric of managed care, the practice of medicine has radically shifted from physicians dedicated to the patient’s best interest, to individuals and organizations bound primarily to the best interests of corporations. Today, the benefits of our state of the art health care system are methodically and systematically limited or completely denied to those that need them the most by organizations that stand to benefit the most financially from withholding these benefits—managed care companies!

As medical costs continue to soar, patients are increasingly being denied coverage for crucial services by their insurance companies. Managed care is condemned by the people it covers, the professionals it employs and contracts with, and even the lawmakers who make the rules for it! Recently, managed care systems have taken the financial control over their patients to even greater heights by transferring the process of authorization and denial of medical services from treating physicians to administrators. Many doctors now find themselves inadvertently forced by managed care administrators (many of whom have had no medical training) into utilizing their medical knowledge, expertise, and experience for the benefit of the plan’s utilization and economic goals—not for what is best for their patients! This, obviously, is a very dangerous system of rationing.

Now physicians—not the plan’s administrators—have been put in a position that can jeopardize the care they provide their patients. That’s right. Today your managed care physician has had the awesome responsibility of controlling managed care costs added to his or her responsibilities. This manifests itself by influencing what medications are prescribe for you, whether or not diagnostic tests or blood work that may signal the onset of silent disease are ordered for you, whether or not you are referred to a specialist, and whether or not you are admitted to a hospital. These decisions directly impact your provider’s salary. Economic rationales have now replaced clinical judgment. Except for those rare cases in which a physician has completely rejected managed care, virtually every medical decision made by a physician today is affected in some way or another by the changes wrought by managed care.

Doctors no longer practice autonomously. It’s easy to see how all of this could impact disastrously on the quality of your health care. This form of rationing of medical services is extremely dangerous and smacks directly in the face of the Oath of Hippocrates, in which all physicians take a vow “to follow that method of treatment which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.” Managed care has finally succeeded in redefining what is best for their patients on their terms. No other health care system in the entire world is like this.

Clearly, these are troubled times for the recipients and providers of health care in America. Price pressures increasingly leave doctors feeling rushed, harried, and second-guessed. According to a recent study, more than half the physicians in the US believe that their ability to provide quality health care has deteriorated over the past five years. Medicare continues to institute cutbacks for medical services. And, as if all of this isn’t bad enough, the number of primary care providers, understandably, has continued to decline year after year.

This is frightening because the better a country’s system of primary medical care the better is the health of its citizens, according to a s Hopkins School of Public Health study involving 13 industrialized nations with populations of 5 million or more. Interestingly enough, in this study the US along with Belgium, France, and Germany were found to have the weakest primary care infrastructures.

So what can we as patients do to avoid all of these problems and receive the best health care possible? The answer is really very simple—don’t get sick! We must do everything possible to avoid disease and maintain excellent health. Disease prevention is definitely the key to America’s health care crisis.

The question, then, is how does one go about obtaining top quality preventive health care? Unfortunately today’s medical practice devotes little, if any, time to teaching patients about preventing disease, maintaining quality of life as people age, promoting the virtues of exercise and proper nutrition, and the importance of hormonal balance and optimal hormone levels in preserving vitality. Most of today’s traditional physicians do not know how to incorporate these areas into their own life style, let alone, into their medical practice.

In addition, all efforts to screen for silent disease markers and to promote preventive health measures are discouraged by insurance carriers. They state that these important medical tests are “unnecessary.” This must change. The medical system should serve patient interests, instead of those of the insurance companies.

Most Americans want much more from their physicians than just ten-minutes visits dealing mostly with managing isolated problems and writing prescriptions. Detailed and ongoing counseling on how to manage the aging process and prevent disease must become an integral part of each and every office visit. We must all learn how to maintain our quality of life and zest for living, how to prevent the accumulation of body fat and how to get rid of it if we already have it, and how to prevent or reverse the loss of bone and muscle tissue.

This becomes critically important as we age if we are to avoid nursing home care, chronic pain, immobilization, mental deterioration, and prescription drug dependency. Everybody must become proactive in managing their own health, preventing disease, and maximizing the quality of their lives. Patients desperately want and must be allowed to have a say in their health care.

I have provided a chart shown below that lists all of the tests each of us should request on a routine basis to help us take action early on to prevent disease. These tests will provide valuable baseline information that can be used to stay vital as you age. Remember, we don’t die of old age—we die from degenerative diseases, many of which have easily obtained “early warning” tests that can prevent or delay their onset.

Physicians must start spending more time with their patients so that all preventive health care issues can be adequately addressed. A frequently asked question these days is why don’t our physicians do more to help us understand the need for establishing the baselines of aging as we approach 50 or 60? Why don’t they counsel us on the imperatives of nutritional supplementation, the value of exercise, the benefits of hormonal modulation, and the philosophical grounding to prevent physical and emotional disease?

The answer, I believe, is that the vast majority of primary care physicians are not allowed the time to do this well and, as I said before, most are not trained in these areas. Fortunately, however, there is a new medical specialty that deals specifically and exclusively with all of these issues—Age Management Medicine.

Age Management Medicine (AMM) is an exciting new medical specialty that is dedicated to the science of healthy aging. AMM emphasizes the enhancement of health over the treatment of illness. Traditional medical practices follow a “fix it when it breaks” or “diagnose and treat” approach. AMM, on the other hand, focuses on disease prevention, wellness, and quality of life. Its goal is to promote a more dynamic life throughout middle age and beyond by utilizing scientifically sound, 21st Century strategies that enhance health, quality of life, and longevity. These strategies include the promotion of optimal key hormone levels combined with specific exercise and nutritional programs specifically designed to lower body fat, increase muscle tissue and strength, reduce risk factors for illness, and improve overall cardiovascular fitness.

The concept of Age Management Medicine was born on July 7th, 1990, when the famous Dr. Rudman published a landmark article in the New England Journal of Medicine. Dr. Rudman looked at the effects of supplementing growth hormone in men between the ages of 61 and 81 years who were basically healthy. In this group of 21 men, Dr. Rudman managed to increase their lean muscle by 8.8%, decreased their fat mass by 14.4%, increase their skin thickness by 7%, and increase lumbar bone density by 1.6%, simply by giving injections of human growth hormone 3 times a week over a six month period. The results of Dr. Rudman's study were confirmed and even extended in a study recently completed by the National Institute on Aging and s Hopkins University, headed by Doctors Mark Blackman and Mitch Harmon. Similar findings have been demonstrated with several other studies as well.

We must all change our thinking about aging. Older does not mean sicker. The majority of us have a strong enough genetic makeup to live beyond 85. The key is to make the best of the genes we have. By incorporating AMM practices into our daily lives we can compress the time we are sick to the very end of our lives. We can’t stop the aging process, but we can definitely manage it much better than previous generations have. We can avoid premature disability and death. After all, what are the benefits of living longer if we end up in a nursing home locked into a body or brain that doesn’t work during the last 20 to 30 years of our life?

Important Tests That Empower People to Maintain Optimal Health and Lower Disease Risk

Test

Optimal Result

*

Bone Density of Skeleton, LS Spine

T Score >= 0

& Hips (Men & Women)

*

Complete Eye Exam (Glaucoma Testing

Negative

& Amsler Grid)

Cancer Screening

*

Colonoscopy

Negative

*

Mammogram (Women)

Negative

*

PAP/Pelvic/Breast Exam (Women)

Negative

*

Digital Rectal Exam of Prostate (Men)

Negative

*

PSA (Men)

0-3 ng/mL

Blood Sugar Control

*

Hemoglobin A1c

< 5 %

*

Insulin (Fasting)

< 5 miu/mL

*

Glucose (Fasting)

65-95 mg/dL

Cardiac

*

Cardiac Stress Testing

Negative

*

Homocysteine

< 9 umol/L

*

C-Reactive Protein

< 1.0 mg/L

*

Lp(a)-C

0-10 mg/dL

*

LDL

< 70 mg/dL

*

HDL

> 50 mg/dL

*

Triglycerides

< 100 mg/dL

Hormones

Thyroid

*

TSH

0.4-3.0 mu/L

*

Free T3

230-420 pg/dL

*

Free T4

0.8-1.8 ng/dL

Gonadal

*

Total Testosterone

Men 700-900 ng/dL

Women 50-70 ng/dL

*

Free Testosterone

Men 130-190 pg/mL

*

Women 6-8.5 pg/mL

*

Dihydrotesterone (Men)

25-75 ng/dL

*

Estradiol, High-Sensitivity (Men)

10-40 pg/mL

Adrenal

*

DHEA (Men & Women)

350-500 mcg/dL

*

Cortisol (AM)

< 18 mcg/dL

Pituitary

*

IGF-1 (indirect assay of growth hormone)

250-320 ng/mL