Healthcare Reform vs. Health Insurance Reform

Sphygmomanometer - MSThe United States spends the most money per person on healthcare, averaging 2-4 times what other industrialized countries pay.  This might not be a problem if we received the best health outcomes as a result.  Unfortunately, the opposite is true.  The US has the poorest health outcomes in the industrialized world.  The US ranks 33-36 in the world with results that are comparable to Cuba, Costa Rica and Chili regarding health outcome measures such as infant mortality rates, number of chronic diseases and life expectancy.

For decades, complaints have been leveled at various aspects of the US healthcare system that could improve outcomes, but little was changed.  Eight years ago, after repeated reports pointed out that the US healthcare system was the most expensive, yet delivered poor quality outcomes, momentum built to finally succeed in achieving reform.  What resulted however, was a change in how healthcare was paid for rather than modifying factors which delivered better health results.  The healthcare reform that is so sorely needed in this country turned out to be little more than health insurance reform.

who-paysIt is very important not to confuse these two.  Many assume that if you increase the availability of healthcare services to people who cannot afford it because of limited or no insurance, their health will improve as well. The fallacy of this assumption has been demonstrated for decades with evidence measured by groups such as the World Health Organization, Organisation for Economic Co-operation and Development (OECD), and the Commonwealth Fund.

What is needed to improve the health of US citizens is not to increase access to the existing system that delivers poor results. Instead, we need to change factors that improve people’s health, such as who delivers what kinds of services.

The remainder of this article will briefly list some of the issues that impact the quality and types of care that can improve outcomes.  With the 2016 presidential election results, it is anticipated that major change will be coming again to the US healthcare system. This time, let’s keep our eye on what really matters during these discussions (healthcare outcomes) so that we don’t get distracted again by things that turn out to have poor correlations with health (insurance systems).

Potential factors to reform that improve health outcomes include:

  • Preventive services – address causes of diseases rather than waiting for diseases to emerge.
  • Fragmentation of healthcare – establish a new profession supplying a better, holistic method of healthcare diagnosis & coordination of care. A Doctor of Interdisciplinary Diagnosis
  • Objective vs. subjective diagnosis – Objective diagnostic tests measure signs that are visible to an independent observer or verifiable by equipment.  A subjective diagnosis can only be confirmed by the patient and is relatively easy to consciously or unconsciously fake or distort.  Objective testing is currently being severely underutilized for many conditions (i.e. learning, behaviour and emotional disorders).continum-of-palliative-care
  • Symptomatic care vs. treating causes – cure problems, don’t just ‘control’ them.  The state of understanding and research has progressed much faster than is put into common practice.
  • Single vs. multiple mechanism approach – Many diseases have diverse factors that can contribute to causing it. It is important to identify a broad range of potential causal factors, test for which ones are involved and treat all the factors that research evidence points to as being capable of contributing to the condition.
  • Conflicts of interest in healthcare delivery – Do you sell your jewelry to the appraiser or trust reviews written by the proprietors?  Then why get treatment from the person who does the diagnosis?  There is an inherent bias for the doctor to diagnose the condition from the perspective of the treatments they supply.  Diagnosis supplied by physicians trained in a wide range of therapies needs to separated from the provider who supplies the treatment.
  • Regulatory Reform – Government rules and laws are increasingly being written by special interest through revolving door relationships and legitimate or questionable funding mechanisms.  Federal and state governments need to primarily represent the interests of the healthcare consumer.
  • Direct to consumer marketing of prescription medications – The AMA and many other organizations have called for a halt to this practice.  Drug marketing convinces patients to put pressure on their doctors to supply medications, even when the doctors feel it is inappropriate. This practice is only allowed in the US and New Zealand.
  • Mandatory healthcare procedures – Any mandatory healthcare treatment which receives government enforcement measures, requires the highest levels of scientific, research, public and ethical support.  Special interests must not be allowed to mold mandatory policy decisions in their favor through anything less (i.e. media control of public opinion or political influence).  This is most critically important when the mandatory procedures carry with them morbidity and mortality complications.
  • Personalized healthcare vs. protocols – Every person has different genes, chemistry, experiences, diets, lifestyles, etc.  Evidence based treatment plans, insurance coverage and tort reform, needs to allow the flexibility to treat each person as an individual, not by a ‘one size fits all’ protocol book.
  • Health literacy – Informed people make more preventive choices and have less hospital stays and fewer chronic conditions. Special interests have inappropriate levels of influence on all types of health literacy education from: physician education; medical research & journals on through to the mass media and public school education.
  • ‘Mainframe’ vs. ‘mobile’ access – Technology has moved from large mainframe computers to mobile devices worn on wrists.  Regulatory burdens have stifled development of the healthcare market from producing similar improvements in cost and availability.  Sometimes these regulations are the result of a sincere desire to protect public health.  Other times, it is the result of inappropriate special interest influence being wielded to protect market share.

Let’s create true healthcare reform in this country and deliver the results that are commensurate with the amount of money we are investing.  I look forward to hearing your feedback.

Written by Dr. John M. Wallman, President – Diagnosis Foundation

Issues That Impact Learning: Potential Causes & Methods of Diagnosis

difficulty-learningThis is a very broad topic that covers learning issues ranging from totally normal through to severe disabilities.  They can be grouped into major categories such as:

  • Internal – poor self-esteem, depression, anxiety, & obsession
  • External – inattentive, hyperactive, impulsive, oppositional, disruptive
  • Processing – difficulty with: reading; speaking; writing; listening; or interpreting nonverbal communication

More specifically, these issues refer to anything that impacts the rate of nerve growth or proper function.  They can be further broken down into classifications based upon:   help-for-student

  1. Which parts of the nervous system are involved
  2. What symptoms result from the abnormal nerve function
  3. What is causing the learning issue

Classifications & Methods of Diagnosing

Which classification system, clinician and diagnostic methods to use will be based upon your clinical goal.

  • Anatomic Location – This classification is helpful when the goal is to prepare for surgery or similar interventions. Here imaging studies, (MRI, CAT scans, Ultrasound, etc) will be particularly helpful diagnostic tools.
  • Symptoms – When the goal is to suppress or control symptoms with medications without attempting a cure, reviewing the patient’s history using the DSM-5 criteria is applicable.
  • Cause – When seeking an improvement in the underlying function or attempting a cure, diagnostic methods will start with a review of patient symptoms but will then shift to more laboratory and physical testing. Imaging studies may be used to rule out pathologies. Some of the newest imaging techniques targeting brain functions are specific enough to give insights into anatomic locations as well as certain causes.

If your goal is surgery, consult a surgeon. If your goal is to control symptoms using drugs but not to seek a cure, consult a medical doctor. If your goal is to improve function by addressing the causes, consult a doctor of functional medicine or a clinical nutritionist. 

complete-neuron-cell-diagram-wcPotential Causes

  • Nerve & myelin cell membrane integrity — structural parts of the brain that ensure proper nerve function and insulation that prevents nerves from ‘shorting out’ on one another.
  • Neurotransmitters —serotonin, dopamine, epinephrine (adrenalin)
  • Nerve inflammation—allergies, prostaglandins (chemical inflammation regulators), internal corticosteroid regulation
  • Nerve fuel supply— blood sugar regulation (hyperglycemia, hypoglycemia), ATP production (converting sugar to energy at the cellular level)
  • Nerve blood supply—high or low blood pressure, plaques, capillary regulation
  • Neuro-toxins— heavy metals, pesticides, food colorings, drugs, etc.
  • Nerve metabolism – thyroid, adrenals, kidneys and liver regulate chemicals that can influence nerve function
  • Brain scars — i.e. from brain trauma, transient ischemic attacks (mini-strokes), stroke, anti-oxidant deficiency (vitamin E, C, A, etc.)

One Cause – Many Symptomsall-for-one

Many of the causes of behavior issues can give different symptoms for each person.  This is because some mechanisms result in stress to many parts of the brain simultaneously, but it is the nerves that are the ‘weak link’ that will exhibit symptoms first.  For example, some people have chronic inflammation of the brain. With one person, this will cause swelling in the part of the brain controlling depression, in another, the ‘weak link’ will be in their speech centers.

One Cause – Many Reasons3-musketeers

Each mechanism that is diagnosed as involved for a person with learning issues can have different reasons for why it is involved. For example, chronic brain inflammation may be from a gluten sensitivity. For another person, it is because they have an adrenal gland that cannot produce enough cortisone. For a third person, the chronic brain swelling may be because they have high mercury levels.  To improve function, do not stop looking when you find the first cause of a learning issue.  Seeking causes needs to continue to deeper levels.

Summary

Behaviors impacting learning include a wide range of issues.  What type of clinician you consult and diagnosis methods you use will depend on your clinical goal.  Each cause of a learning issue can give different symptoms for each person.  Each mechanism causing abnormal nerve growth and function, can be for multiple reasons.  Persistent diagnostic work increases the understanding of the multi-layered causes and the potential for successful outcomes.

And The Category Is…”Essential Nutrients”

cornucopia-public-domain-photosLet’s start with a quick review of what an essential nutrient is.  It is a chemical that must be taken into to a person, digested and absorbed to reach a certain level in the blood or tissues in order for a person to function properly.  Briefly, you need to eat enough of each of these chemicals in order to:

  • Live
  • Repair
  • Grow and
  • Reproduce

If any of the essential nutrients gets too low in the body, one or more of the above functions will not happen.  These are the basic chemicals that people must ingest on a regular basis or something bad will happen to their health.  Deficiencies of essential nutrients have been linked to every major disease that humans get including: cancer; diabetes; high blood pressure; stroke; colitis; hyper & hypo thyroidism; etc.

How Many Essential Nutrients Are There?

countingThe answer to this will vary a little bit depending on who you ask, but they should all be close to 42.  The reason for the variability is that each candidate for essential nutrient status must go through a rigorous scientific process to meet the definition criteria.  People who write about essential nutrients are not always in agreement with research interpretations, or haven’t read the same studies, or have different standards of how many times a project must be repeated to be accepted, etc.

The essential nutrients fall into the following categories:

  • Essential Amino Acids
  • Essential Fatty Acids
  • Vitamins
  • Minerals

Essential Amino Acids

protein-chain-wcThere are approximately 22 different amino acids that humans use.  Out of these 22, there are 9 that are essential.  If you get enough of these 9, your body can convert them into all the rest of the 22.  Here are the 9 essential amino acids.

  • Isoleucine
  • Lysine
  • Leucine
  • Methionine
  • Phenylalanine
  • Threonine
  • Tryptophan
  • Valine
  • Histidine

Essential Fatty Acids

fatty-acidsThere are hundreds of fatty acids (fats & oils).  Your body can make all of these if you only make sure to get enough of two in your diet (three for children).  The essential fatty acids are:

  • Linoleic Acid
  • Linolenic Acid
  • Arachidonic Acid (for children)

The body can convert these essential fatty acids to all the other fats your body needs.  One of the recently discovered issues with fatty acids is getting the right ratios of these in your diet.  Get the wrong ratio and you will have difficulty with pain and inflammation regulation, difficulty learning and athletic performance and a whole host of neurological problems (i.e. depression, anxiety, obsessive compulsive disorders, etc.)

Here’s one example about the importance of linolenic acid.  This fatty acid is converted in your body, or in plants and animals that we eat, into omega 3 fatty acids.  One of these molecules actually makes up about 15-20% of our brains.  It plays a major role in producing the myelin sheaths that surround many nerves, providing a type of ‘insulation’ around nerves.  If your body is deficient in the omega 3 fatty acids, or gets too much of its competitor, omega 6 fatty acids, the brain will have a large number of problems.

Most US diets have excessive omega 6 fats which are very common in processed and fast foods.  This results in slow learning, poor nerve repair, and contributes to many of the neurological disorders which are epidemic in our country right now.

Essential Vitamins

fruits-and-vegetablesThis is the category of essential nutrients that most people are familiar with.  They have the longest history of research and the best understanding of their wide-ranging health implications.

  • Vitamin A – Beta-carotene, retinol
  • Vitamin B1 – Thiamine
  • Vitamin B2 – Riboflavin
  • Vitamin B3 – Niacin
  • Vitamin B5 – Pantothenic acid
  • VItamin B6 – Pyridoxine
  • Vitamin B7 – Biotin
  • Vitamin B9 – Folic Acid
  • VItamin B12 – Cobalamin
  • VItamin C – Ascorbic acid
  • Vitamin D2 & D3 – Ergocalciferol, cholecalciferol
  • Vitamin E – Tocopherol
  • Vitamin K – Naphthoquinoids

Essential Minerals

mineral-infographic-lifehackIt may seem redundant to use the term ‘essential’ in front of minerals and vitamins.  As the understanding of these nutrients has improved, it has become evident that many chemicals which were originally called vitamins turned out not to be essential, and many minerals do not have an essential function in the body while others are actually toxic (i.e. lead, mercury, cadmium)
  • Calcium
  • Chloride
  • Chromium
  • Cobalt
  • Copper
  • Iodine
  • Iron
  • Magnesium
  • Manganese
  • Molybdenum
  • Phosphorus
  • Potassium
  • Selenium
  • Sodium
  • Zinc

Carbohydrates

carbohydratesYou may have noticed that I did list any essential nutrients in the carbohydrate category.  Carbohydrates are sugar molecules or chains of sugar molecules (starches). There are no nutrients in the carbohydrate category that are essential in human nutrition. This means that you can live, grow, repair and reproduce without eating any carbohydrates.  It is very important to keep clear that I am referring to the carbohydrate category which includes nutrients such as: glucose; fructose; starch and sucrose.  I am not referring to foods that are rich in carbohydrates such as: grains; fruits, breads; vegetables; candy and cakes.  Some of these foods are generally regarded as very good to eat while others are considered a major detriment to health.

There are a couple of concepts in this topic however, that deserve greater explanation.

  • Fiber – There is a group of carbohydrates that are collectively known as ‘Fiber’.  They all share the properties of being: long chains of sugar and; having molecular configurations that make them indigestible for humans.  They will enter the human digestive system and leave with basically the same molecular structure. Even though they do not supply anything in the way of chemical nutrition directly to humans, they do supply mechanical properties that improves our health.  This indigestible material keeps the colon more completely full. This allows for proper intestinal transit times and prevents constipation which in turn prevents a host of potential problems such as bacterial overgrowth, autointoxication and diverticulosis.
  • Calories – Carbohydrates are a very common source of calories that are converted by the body into energy molecules that keep us alive.  Other nutrient categories such as proteins and fats can also supply our caloric needs.  Carbohydrates are so dominant in our societies for supplying our caloric needs that many people consider them essential, but diets that are carbohydrate free can be maintained for extended periods of time without ill-health (i.e. specialized Total Parenteral Nutrition, Atkins Diet).
Conclusion

conclusionThe basic concept is this, essential nutrients are chemicals that must be maintained at adequate levels in the body otherwise performance, health, safety and eventually life itself will suffer.  So many people who have very limited training in nutrition say, “just eat a well-balanced diet and you will be fine.”  This idea is not supported by research data which shows that almost everybody in the United States is low or deficient in one or more essential nutrients and by definition, almost everybody in the US is suffering sub-optimal health that could be relatively easily cured.

When is the last time you were tested for all of your essential nutrients by somebody who is trained in clinical nutrition?