I have been skeptical about Obamacare since the law was passed. I have tried to stay clear of the politics. My concern from the start has been, “What the heck is inside that law? How will it actually work in terms of the practice of medicine?” Hardly any details were released, and it now seems that some legislators may not have read it, as indicated by all the surprised lawmakers who are currently upset about cancelled pre-existing health insurance policies.
So now that the controversy is looking past the incompetent roll-out, and assuming that insurance plans will soon be available to purchase on the exchanges, the conversation is moving to the details about the insurance policies themselves.
Naturally, if one is worried about the practice of medicine, paying attention to health insurance is essential. The President promised that we could keep our existing plans and doctors if we want, giving the impression that the ACA was essentially about the non-insured.
He also gave the impression that the insurance exchanges would give private insurance companies the chance to compete in a free enterprise marketplace. But now we see that no company can get their policies into the exchanges unless those policies are designed just the way the government demands they be. As a result, millions of people are losing their existing plans.
Evidently this aspect of the ACA is hidden somewhere inside the huge pile of papers that make up the bill. It’s just that it was kept under wraps until now when so many Americans are getting those surprise letters.
So now that people are being dropped (including nearly 1 million in New Jersey) from their existing plans, the administration defends what’s going on by saying that those pre-existing plans are “crummy” and not worth keeping in the first place. Why are we hearing this news for the first time now?
So we get to the crux of the problem: The public is too stupid to understand what one needs in an insurance policy to get quality care. But history shows us, including what happened in the ’80’s and ’90’s regarding “managed care/HMO’s,” that people do know what they need. They just have to be educated about the particulars, and the bureaucrats who are running Obamacare, have assiduously avoided telling us the truth until now, and more hidden truths will keep oozing out of the ACA as the smoke screen continues to fade.
AMA Morning rounds 5/20/13: An editorial in the Washington Post says the Affordable Care Act’s “most contentious days” may still be in front of it. The Post argues that while the law’s potential problems “shouldn’t be swept under the rug,” neither should “the law’s noble and useful goal: ensuring that as few Americans as possible go without health care.”
Blogfinger Medical Commentary by Paul Goldfinger, MD , FACC
This Washington Post editorial says that there “might be some bumps in the road ahead.” Are they serious? There will be cavernous sink holes in the road ahead. The ACA may have a “noble goal” in ensuring quality healthcare for everyone, but noble goals do not necessarily translate into reality.
As with the administration, the WP refuses to be honest and wave some warning flags about foreseeable problems in providing quality care to those new millions of patients who will get insurance by 2014. These issues include finding providers of care and then figuring out where to go for the best quality.
Recent polls show that 64% of young people (under age 40) believe that the cost of health insurance premiums will go up, although many of them are willing to pay those increases. Young people will help cover the costs of those who are older and sicker.
The AP (2/8, Marchione) reports, “Deep-fried foods may be causing trouble in the Deep South. People whose diets are heavy on them and sugary drinks like sweet tea and soda were more likely to suffer a stroke,” according to a study presented yesterday at the American Stroke Association’s conference in Honolulu. “It’s the first big look at diet and strokes, and researchers say it might help explain why blacks in the Southeast – the nation’s ‘stroke belt’ – suffer more of them.”
The Los Angeles Times (2/8, MacVean, 692K) “Booster Shots” blog reports that in a statement, lead researcher, Suzanne Judd, a nutritional epidemiologist at the University of Alabama, explained, “Fatty foods are high in cholesterol, sugary drinks are linked to diabetes and salty foods lead to high blood pressure.” These “are all factors in the risk of cardiovascular disease.”
ABC News (2/8, Wasson) The “researchers found that people who regularly ate foods traditionally found in the southern diet had a whopping 41 percent increased risk of stroke – and in African-Americans, it was 63 percent higher risk.”
Blogfinger Medical Commentary by Paul Goldfinger, MD, FACC:
Stroke is the fourth leading cause of death in the US. In the 1950’s, scientists established a strong link between diets high in saturated fats and the risk of heart attacks. It has been assumed for years that the high risk diets associated with heart disease would also be risk factors for strokes, but it hasn’t exactly been proven. We do know that blacks have a higher risk of stroke than whites in this country, and there are risk factors which are common in blacks that clearly increase the risk of stroke including obesity, high blood pressure and high salt intake.
But this trial of 20,000 adults 45 and older looked specifically at stroke risk related to diet. If you are familiar with southern foods, sometimes called “soul food,” you find a great deal of deep fried foods like chicken, fish and potatoes. In addition there are processed meats like jerky and lunch meats, whole milk and bacon which are part of the problem. On the other hand, plant based diets were associated with reduced stroke risk.
So now we know about dietary relationships for heart disease, cancer and stroke. The best bet for staying healthy is a modified Mediterranean diet with low saturated fats and cholesterol, low salt, high fiber, no fried food, good oils, modest amounts of red wine, fish, poultry, low carbs, and generous amounts of fresh fruits and vegetables. Stay away from processed foods and don’t eat anything your grandmother wouldn’t recognize as food.
From the American College of Cardiology: The AP (4/24, Stobbe) reports that according to a report released today by the Centers for Disease Control and Prevention, “only 13 percent of US adults have high total cholesterol.” Health experts theorize that “it’s largely because so many Americans take cholesterol-lowering drugs, but dropping smoking rates and other factors also contributed.” CDC researchers released the report after examining data from “interviews and blood tests of nearly than 6,000 US adults in 2009 and 2010.”
Blogfinger Medical Commentary: by Paul Goldfinger, MD, FACC (Note: Cholesterol levels are written as 240 mg/dL, but we will just write the number.)
This data from the National Center for Health Statistics is a big thrill for those physicians who have been active in promoting cardiovascular prevention. The CDC was surprised by this result, since they expected that 17% of the adult population would have high total cholesterol (i.e. over 240,) whereas the result came out to be 13.4 %. In 1999-2000, the result was 18.3%. This change since 1999 represents a decline of 27% in total cholesterol levels. (Total cholesterol refers to all the cholesterol in the blood—good and bad)
There were other observations that were of interest when the data was broken down into sub-categories. Given the lifesaving potential of cholesterol control, it is worrisome that 1/3 of adults were not screened with blood tests for high cholesterol over the last 5 years.
When the total cholesterol numbers were checked according to sex and age, in the age group of 40-59, the trend downward occurred for men, but not for women. This finding requires further analysis. Women came out better after age 60.
As for the reasons for the declining cholesterol numbers, this is complicated and was not discussed in the CDC report.
There is one caveat:
This trend analysis uses 240 as a cutoff, saying that levels above 240 are “high” and that 87% of adults over age 20 have levels that are not high. But that doesn’t mean that any number under 240 is “low” or “safe.” The average cholesterol level in the US has dropped from 222 to about 200 in recent years. The American Heart Association says that anything over 200 carries an increased risk. The average cholesterol level for patients with coronary heart disease is 225.
There are countries where the average cholesterol levels are 150, and those places have the lowest risk of coronary heart disease. There is no number which is “normal,” and each person who is assessed for cholesterol risk has a target number which the physician chooses by looking at all the risk factors and medical history of a particular patient. The graph below, from the current CDC study, shows the percent of men and women who have “high” cholesterol plotted against the years. Note that female levels are higher than males across the board.
This graph is part of the CDC report. Below is a link to that report.
Undoubtedly, one reason that these numbers have improved is that Americans are more conscious of eating “heart healthy.” I do believe that the widespread use of statin drugs is also affecting the results. Diet, especially including reductions in saturated fats, will improve total cholesterol numbers, but the results are often not dramatic. The quote below is from our 2011 book “Prevention Does Work: A Guide to a Healthy Heart” by Paul and Eileen Goldfinger:
“It is important to realize that most low fat diets generally lower cholesterol levels by only modest amounts (usually in the 10-20% range). The amount of cholesterol lowering that occurs with diet is quite variable, depending largely on genetic factors and patient compliance. Diets form the foundation of efforts to correct abnormal blood lipids, but often medications must be added in order to achieve excellent results.”
When was the last time your doctor gave you information about a healthy diet?
If you answered “never,” this book is for you: Prevention Does Work: A Guide to a Healthy Heart
If Paul and Eileen Goldfinger have their way, you’ll rarely eat another burger (unless it’s turkey). Or mac n’ cheese. Or BLT. Or one of any number of cholesterol-loaded foods that can clog your arteries and threaten life. Instead, you’ll become a regular at the fish counter and stock your pantry with staples that can make even the most prosaic piece of chicken a gourmet’s delight.
Just published, the Goldfingers’ book is subtitled “A Cardiologist and a Cook Present the Facts and the Foods” It’s stuffed with facts and larded with recipes designed to make typical Americans revamp their diet.
But that isn’t all. Says Paul, “We do stress nutrition, but we also cover a variety of important topics including drug therapy, blood pressure, smoking, exercise, mental health, women’s issues and obesity. I want patients to understand that ‘prevention does work,’ meaning that scientific research has proven the life-saving benefits of measures described in our book.”
In the area of nutrition, Paul says, “I tried to cover every issue known in the field of prevention including chocolate, olive oil, red wine, the Atkins diet, and the Mediterranean diet, among other subjects.”
Paul, the founder of Blogfinger, was a practicing cardiologist for 32 years. In medical school, he estimates that no more than an hour was devoted to nutrition. Even today, doctors are focused on immediate results. They don’t push the long-term effects of diet. Nor can they. Fifteen-minute appointments barely give them time to do more than hear a complaint and check a patient’s medications.
Paul at Starbucks
During his years of practice, as one study after another suggested that diet could deter heart disease, Paul began to question the American diet. The Japanese, heavy consumers of fish and vegetables, which are low in fat, had a low incidence of heart disease, as did fish-eating Eskimos. Scandinavians, whose diet is heavy in fat-rich red meat and cheese, did not.
In time, rigorous scientific evidence proving that lowering cholesterol prevented heart attacks convinced him that a low-fat diet was essential for his patients. “As more and more results came out,” he said, “it solidified my opinion that doctors aren’t doing their job.”
Paul began to give his patients three-page informational handouts, the forerunner of Prevention Does Work. The book’s chapters are devoted to helpful definitions — from “acute myocardial infarction” [a/k/a heart attack] to “vascular,” referring to blood vessels — the basics of cardiac treatment and the fundamentals of nutrition. The language is clear and simple.
Eileen prepares a heart-healthy feast in her OG kitchen,
Meanwhile, Eileen, Blogfinger‘s food editor, developed “heart healthy”recipes for her husband’s patients. “We found out that patients and their families did not know how to prepare heart-healthy meals, especially with sea-food,” Paul says. “Eileen collaborated with me in developing recipes that met the prevention criteria: low fat. low salt, fiber, fresh ingredients, low calories and portion control. These recipes emphasize the use of seafood, vegetables and poultry. Our book is a reference source — a guide — to be kept in the kitchen”
Eileen says she aimed for recipes that were simple and didn’t require arcane ingredients. While many of the book’s 30 recipes do feature seafood and chicken, for people who can’t do without pizza there’s a low-fat version, likewise for chili.
Paul emphasizes that healthy eating “is not a diet you’re on but a lifestyle change.” At the same time, he doesn’t expect every reader to follow his advice to the letter. “If people could just find something — switch from butter to margarine, eat fish twice a week, do a little aerobic exercise,” he says, “they’d be better off.”
Prevention Does Work is currently on sale in Ocean Grove at the Comfort Zone, or it may be ordered on amazon.com, barnesandnoble.com or iuniverse.com.
2023 update by Dr Goldfinger: Although this third edition is from 2011, most of it is still true because it covers many explanations, definitions and certainly recipes which do not go out of date.
There are a number of more updated BF posts that add some knowledge such as huge clinical trials that have proven the preventive value of the Mediterranean diet. Use the search engine above right.
The purpose of this book is to fill a void where doctors do not provide sufficient information about prevention and often know nothing about it. That leaves the public to rely on Internet nonsense by snake oil salesmen.
Thanks to Mary Walton for her review and fine work in helping us in the Grove. She now lives in Philadelphia. You can Google her–she is a remarkable professional investigative reporter who has written books, reported for the Philadelphia Inquirer and Blogfinger. net, lectured at universities and more.
