GlassHospital

Demystifying Medicine One Week at a Time

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Health is More than Health Care

When we think about achieving good health, it’s natural to think of visits to the doctor for “checkups” and age-appropriate interventions like vaccinations or cancer screening.

But here’s something you might not know: The “health care system” as we know it, an American industry on which we collectively spend $3 trillion annually, only accounts for one-fifth of our overall health.

Twenty percent? How can so much spending impact so relatively little of our well-being?

 

Well, it turns out other factors collectively have a much greater impact:

 

Genetics: To whom we are born impacts our health profoundly. If our parents are blessed with long, healthy lives, then we are much more likely to be, too.

 

Education: The better our education, individually and collectively, the more we can achieve in life. Education is tied to income (something we all know), but it also correlates directly to health outcomes in aggregate. Cutting investments in common and higher education is sabotaging our children’s future — not just in earning potential, but in real health: more suffering and earlier death.

 

Employment: The ability to earn a living wage means that people can be financially solvent and participate in the consumer economy. Given a choice, almost no one would choose handouts. People want meaningful work — work that employs our skills and engages our minds.

 

A diverse economy that grows new businesses means more job opportunities that not only pay the bills but allow us to invest in our families, homes, and communities.

 

Environment: It’s well known that those residing in certain Tulsa ZIP codes have life spans on average 11 years less than those in more affluent parts of the city (This difference has actually lessened from 14 years over the last decade.) Mayor G.T. Bynum has made reducing this disparity one of his administration’s central goals, as celebrated in a recent editorial in this newspaper.

 

We also know that when our neighborhoods are safer, we increase the likelihood that we will move our bodies more — which along with nutrition is the single greatest predictor of good health.

 

And of course: Nutrition! Access to healthy food and safe water is something that most of us take for granted. But many areas north, east and west of downtown Tulsa are literal food deserts — places with greater than two-mile gaps between locations where fresh fruits and vegetables can be purchased. And our Tulsa public transportation options barely ease this burden.

 

Nutrition and exercise are the two health determinants over which we have the most direct individual control. (How are you doing with those New Year’s resolutions so far?)

 

We can’t choose our parents, or therefore our genetics. But collectively, if we are in agreement that we want Tulsa to be a place of improving health, we do have a lot of say in how we manage our neighborhoods, our food supplies and our educational attainment.

 

At the University of Oklahoma-University of Tulsa School of Community Medicine the curriculum emphasizes study and advocacy of these so-called social determinants of health — beyond the “traditional” organ-based pathologies. We believe that interdisciplinary understanding of these factors — which can lead to exorbitant stress — will help to reduce the burden of ill health in our population as we age.

 

Tulsa has an opportunity to become a “Blue Zones” city like Shawnee and Fort Worth, Texas, recent cities that have contracted with Healthways to make structural changes to spur better health. The Blue Zones idea comes from the discovery of the five places in the world where citizens live the healthiest and longest lives because of exercise (walking most places), nutrition (more plant-based diets), and social connectedness.

 

We have the ingredients here in Tulsa to take on such a challenge, and working through the updated Community Health Improvement Plan that will soon be released by the Tulsa Health Department, we can all choose to live healthier lives — both individually and as a community.

 

Amazingly, we can do all of this regardless of our need to interact with our “health care system.”

 

Note: This essay appeared as an op-ed in today’s Tulsa World

Holiday Miracles

Dr. Kolbaba and his book

Happy holidays, dear GlassHospital readers.

A book recommendation for the season: If you like hearing positive medical stories, ones that are miraculous even, then order a copy of Dr. Scott Kolbaba’s “Physicians’ Untold Stories.”

Dr. Kolbaba is a longtime internist in Wheaton, Illinois. Over the years he’s experienced things that defy logic and rational explanation. The interesting thing is that neither he nor colleagues shared these stories, fearing ridicule or disbelief, until finally the dam broke.

He spent three years producing the book, interviewing 26 different doctors, all of whom have surprising, heartwarming medical stories.

Dr. Kolbaba includes short biographical material on each of the contributors to his book.

Though the word miracle is used throughout, and the presence of God is alluded to, there is no specific religious tradition espoused in the book–so you can decide for yourself about the degree of providence within.

I hope your holidays bring peace and comfort to you and your families.

Mushrooms: Magic?

3/22/2013--Shelton, WA, USA Pioppini mushrooms (Agrocybe aegerita) from Fungi Perfecti. Paul Stamets, 57, is an American mycologist, author, and advocate of bioremediation and medicinal mushrooms and owner of Fungi Perfecti, a family run business that specializes in making gourmet and medicinal mushrooms. ©2013 Stuart Isett. All rights reserved.

©2013 Stuart Isett.

In ‘study of the week’ news, major media outlets reported on two small studies looking at the possible benefits of the chemical psilocybin, the ingredient found in psychedelic mushrooms.

Both studies were conducted in volunteers with cancer, who also had concomitant depression and anxiety–assumed related to their cancer.

The interesting headline-grabbing finding was that after a single dose (“trip”) with psilocybin, a majority of patients in both trials reported improved mood, decreases in mental health symptoms, and positive experiences with the drug (i.e. good trips).

Here’s the kicker: 6 months after their trips, without additional drug, many of the study participants still reported improved mental health.

Study 1 was conducted at NYU and involved 29 patients. The study found that at 6.5 months, “60-80% of the participants continued with clinical significant reductions in depression or anxiety.”

The second study was conducted at Johns Hopkins, involved 51 patients, and had similar findings. Note how the second study describes the orchestration of its sessions:

Psilocybin sessions

Drug sessions were conducted in an aesthetic living-room-like environment with two monitors present. Participants were instructed to consume a low-fat breakfast before coming to the research unit. A urine sample was taken to verify abstinence from common drugs of abuse (cocaine, benzodiazepines, and opioids including methadone)….

For most of the time during the session, participants were encouraged to lie down on the couch, use an eye mask to block external visual distraction, and use headphones through which a music program was played. The same music program was played for all participants in both sessions. Participants were encouraged to focus their attention on their inner experiences throughout the session. Thus, there was no explicit instruction for participants to focus on their attitudes, ideas, or emotions related to their cancer.

Both studies appeared in the Journal of Psychopharmacology. While I agree this news is of general interest, I think the media reporting on the studies is overly sensational. Many doubts remain about the safety of psilocybin. Cancer patients–and indeed the lay public–are vulnerable to this sort of unchecked hype. Issues unaddressed:

  • Negative effects of psilocybin (i.e. no reporting on any adverse effects)–which were listed in the studies
  • Cost
  • Alternatives
  • Small sample sizes in the studies

Overall, I’m glad that researchers are reconsidering ideas long thought too risky or out of bounds. But more science needs to be done before psilocybin is ready for mainstream use.

Gleaning up after Thanksgiving

food-bank-frontWith the holiday season upon us, our thoughts often turn to those in need — of food, clothing and shelter.

I recently attended the Oklahoma Food Security Summit and was struck by a presentation about the practice known as gleaning, a term I’d never heard before.

The U.S. Department of Agriculture defines gleaning “as the act of collecting excess fresh foods from farms, gardens, farmers’ markets, grocers, restaurants….or any other sources, in order to provide it to those in need.”

In other words, getting food that would otherwise go to waste to those in need. This is how many food banks originated.

I interviewed Katie Plohocky, co-founder and director of Tulsa’s Healthy Community Store Initiative about one of its programs called “Hands 2 Harvest,” which is a gleaning effort for much of Tulsa.

In a nutshell Plohocky gathers volunteers to go to local farms and harvest crops that would otherwise be left to rot or plowed under because of minor blemishes or lack of farm labor. She then either sells this produce in her mobile grocery or distributes it to the Community Food Bank of Eastern Oklahoma or other local food pantries.

One of the things Katie and I discussed was how food distribution often is misaligned between food available and folks’ needs. Seems like there should be an app for that…

Also because of the season, the ever-reliable Oklahoma Policy Institute posted this video debunking myths about food insecurity. Great minds, as they say…

Anxiety

How are you feeling post-election?

In the practice of medicine, we use validated questionnaires like the PHQ-9 to screen for depression or the GAD-7 to screen for anxiety.

My wife, a family doctor, administered the GAD-7 to a patient of hers this week; post-election, I started wondering how many Americans could be diagnosed with generalized anxiety disorder* right now.

Go ahead and take the quiz yourself:

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What’s your score?

A score of five or more indicates mild symptoms. Ten or more moves you to moderate. Fifteen or more means you are highly likely to have diagnosable anxiety disorder–what the experts call generalized anxiety disorder.*

If you’re in this highest category, think about getting help. You can start with your primary care physician. She can help you directly or refer you to other community mental health resources that can be helpful.

*Generalized Anxiety Disorder (GAD), according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):
Note: Only one item is required in children.

  1. Restlessness or feeling keyed up or on edge.
  2. Being easily fatigued.
  3. Difficulty concentrating or mind going blank.
  4. Irritability.
  5. Muscle tension.
  6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

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