GE Moore MD's blog

"Go Outside and Play"!

Those 4 words were often the instructions I got when I was young. And, apparently, I was not the only one who was told to come inside when the street lights came on. Or so I learned from Bill Sells and Tom Cove on March 4th, when they opened the Sports and Fitness Industry Association (SFIA) National Health Through Fitness Day, in partnership with the American College of Sports Medicine (ACSM).

When there are lots of ways to do something, it’s a good bet that none of them work. Everyone uses a technique or tool if it really is superior. So with the internet, bookstore shelves and junk mail bins filled by peddlers selling motivation...hmmm. Since getting patients activated – actively engaged in maintaining their health – is a huge element of plans to improve population health, it’s worth examining how that might work.

Dr. Ezekiel Emanuel published a misguided and extremely myopic op-ed in the New York Times on January 9. He recommended that everyone forgo annual physicals by their primary care physician (PCP). Annual physicals are often conflated with health checks or wellness visits, in which it may be appropriate to have a focused physical exam. A more constructive call would have been for Dr.

As 2015 opens, here are some thoughts on 5 challenges facing us in health care.

In prior blogs, I’ve written about the need for our heatlh care system to tear down the silos. One area of this is the use of health risk and social/behavioral assessments - what Sustainable Health Systems calls health ecology. There is lots of good activity going on in these domains, but it’s as if nobody is looking from the 40,000 foot view, and particularly not with the view of how the pieces will fit together when it’s all done.

ROI from worksite wellness programs is difficult to measure, is generally positive, and varies widely by type of program. Most authorities quote a range of saving $3.50 - $5.00 for each dollar spent. A great buy, but employers tend to follow the lead of the C-suite - investing in wellness if leadership “Believes” in wellness, not investing if leadership are "Non-Believers".

But what about physician wellness visits? Are those a good buy?

When I was in training, I was often advised to individualize care. This admonition was troubling, because it was inevitably the last comment and there were almost never any details on exactly how to individualize care! What factors should be considered, how are they prioritized, what nuances are needed?

This week, Apple announced their forthcoming watch. I'm skeptical that this new wearable tool will be the 'next big thing' in health, in part because of the pricetag - $349 and a new iPhone 6 (a minimum of another $200 and a 2-year contract with AT&T). A couple of colleagues rebutted me on the price tag issue, noting that lots of lower middle-class and poor folks have what one might call fancy stuff - smartphones and flat-screen TVs (aren’t TVs almost all flat screens now?). One of these colleagues is African-American and does research among urban poor.

Diabetes is one of America’s biggest lurking health system catastrophes, which concerns us greatly at Sustainable Health Systems.

Here is the CDC (Centers for Disease Control) map of diabetes in 2011, about 95% of which is type 2 diabetes.

Americans are getting heavier and more sedentary, with an ever increasing prevalance of pre-diabetes and type 2 diabetes, with subsequent development of vascular and kidney disease.

A June, 2014 update from the CDC says:

9.3% (~1 in 11) of Americans have diabetes, and 1 in 3 Americans have prediabetes

Total annual cost of diabetes = $245 billion