Disruptive Women welcomes Personal Trainer Morris White as our February 2010 Man of the Month.

A personal trainer for 22 years, Morris White has both men and women – and even children as young as 12 – as clients. He helps them with basic fitness, sport-specific fitness and self defense. He also trains people with special needs, including those with disabilities and eating disorders, and those recovering from a stroke and heart attack.

In his own life, he is a power lifter and a practitioner of Kung Fu, Yoga, desert hiking and survival quests and sustainable healthy living. He is currently working on a fitness community site.

I can vouch for his impact. I’m now in my third year with him, with regular work outs at 6 AM. The benefits have been worth every trek to the gym in those before-dawn hours.

Morris, I’m pleased to have the chance to talk about fitness with you. It’s an important topic, but rarely addressed in this blogspace. How did you get started training?

There were three very influential men in my young life. It was the 1970’s. My Father was a pharmacist and successful businessman who took me to monthly Toast Masters meetings and had me working in the pharmacy on weekends. He taught me the importance of physical poise and presence. One of his business partners was a Physical Therapist who mentored me in anatomy and exercise, from him I learned about anatomy and body mechanics At about that same time, I was introduced to Kung Fu by my best friend’s Father who was a Master of the art.  Kung Fu combined all the earlier lessons and helped me to develop my personal philosophy on holistic personal training.

Those were the years of my greatest lessons.

I attended Temple University but my advisors could not grasp what I wanted to become and what I wanted to do with my life. The usual response was, “So, you want to teach phys ed?” No.

From there to the gymnasiums I went, working under different titles until personal training evolved and became popular.

 What about fitness and training makes it your passion? 22 years seems a long time.

Seeing my mother die at young age and my father debilitated primarily by an unhealthy lifestyle, has made me even more intent to give meaning to my existence by living and enjoying life to its fullest and helping others to do the same through fitness.  The bonus is that by helping others achieve their personal goals, I get to meet great people that, in turn, enrich my life through their collective experiences and wisdom.

How do you approach training?

My philosophy of training is:

• Safety first. You should never be harmed or injured in the course of training.

• Strict, proper form. The best form produces the best, most efficient results.

• Keep moving. A body in motion tends to stay in motion.

Follow those rules and you’ll keep at it, making progress. You’ll avoid injuries and won’t suffer any set-backs in your workouts. You’ll also see results and be able to have an increasingly better quality of life. Even if you’re already fit, you’ll see improvements.  As I like to say to my clients, “one foot in front of the other and you’ll get where you’re going,”

Oh, and one more thing, never imitate what you see others doing in the gym.  So many people do their exercises incorrectly. Others may do an exercise properly but their routine may not fit your desired goals.  Always consult a professional about a new exercise or routine.

Do you have any dramatic examples of client improvements?

I could tell lots of stories of women who come to prepare for their weddings. They’re motivated for sure. Believe it or not, they’ve bought dresses three sizes too small and now need to fit into them. Plus, the regular workouts really help them with the wedding-planning stress.

But the one client and story that really inspired me was a 280 lb sedentary banker who lost the weight and became a marathon runner.

As he became physical healthier, his self-confidence and self-esteem also improved.  This newfound self-respect gave him the strength to not only run a marathon but to walk right out of a less-than-supportive, troubled relationship and climb the corporate ladder to a promotion.

(Laughing) Of course, I cost him lots of money – he kept having to replace his wardrobe as his body changed.

Have you ever seen anyone who did not see an improvement in working out with a trainer?

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On January 23, the Boston Globe reported that Lawrence DuBuske, M.D., Harvard Medical School Instructor, Asthma and Allergy Specialist and lecturer/consultant to pharmaceutical companies would resign his posts at Harvard and Brigham at the end of the month because remaining there would require he cease his work with industry. Failing to do so would be a violation of the Harvard/Partner’s conflict of interest policy.

If the article is accurate and he followed through on those plans, he’s gone now.

I know how carefully industry vets their speakers and consultants. That should come as no surprise. Any event planner, organization or company engaging a speaker or consultant wants just that – an expert.

I have no way of knowing how carefully Harvard Medical School vets its instructors or Brigham vets its clinicians, but I imagine both to be tailored to assure that only the best and only the experts are hired. Surely, were I a student at Harvard or a patient at Brigham, I’d want just that – and expert.

I’ve not met Dr. DuBuske, but ‘on paper’ he seems to be just that—an expert. He’s ‘passed muster’ more than once to gain – and retain – positions at elite institutions. The fact that he has associated with major, respected institutions is a credit to his qualifications.

In addition, he has achieved Fellow status in five major clinical societies: the American College of Physicians, the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, the American College of Rheumatology and the American College of Chest Physicians. I’ll forego mentioning those organizations in which he is only a member, his European affiliations and all the awards except one – 2004 Distinguished Fellow of the American College of Allergy, Asthma and Immunology.

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Healthy New Year everyone!

Like many people I’m starting the year with healthy – and preventive care – intentions. How about you?

That put a few items on my holiday ‘to do’ list:

• Get a pap smear,
• Find H1N1 vaccine,
• Wrestle the results of a recent bone density scan (Dexa) out of the hands of the medical center and into the hands of my physician, and
• Confirm with Morris White, my trainer, that I’d continue workouts.

The pap smear was easy – this time. I’d not been able to get one during my late-summer vacation visit to the doctor because the appointment was two weeks prior to the annual date of the prior test. That required another trip. Holiday downtime was a good time to do that. Check that off the list.

In doing so, I finally found an H1N1 vaccine dose! Getting a seasonal flu shot was easy at www.phillyflushots.com, but even after calling several immunization providers and both of my physicians at least twice monthly since H1N1 became available, checking websites and following news reports of shots at pharmacies – well, no success. Luckily, my doctor had just received a few doses of H1N1 that day of the pap smear. Check that off the list.

Results of a bone density scan months ago had still not shown up at my doctor’s office. Holiday time was a good time to badger for the ‘results,’ though it was hardly worth the trouble. Turns out  my physician is not part of that medical center’s ‘network’ and can’t get detailed results. Only a note: ‘normal.’ Sorry, that’s not good enough. Neither my physician nor I know whether there has been any change in bone mass since prior tests. Sure, the test results might be ‘normal,’ but the measures might also be trending in a direction that means I’m losing bone mass, something we both should know about. No check there, still on my list.

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The following post by Glenna Crooks, PhD, founder and President of Strategic Health Policy International, Inc, is part of Disruptive Women’s “The Value of Health: Creating Economic Security in the Developing World” series.

Glenna Crooks solves some of the toughest health care problems of our times by distilling chaos and complexity into recognizable and easily digestible, action-oriented insights. Her clients, businesses and governments around the world, have used her Centricity Principle™ approach to create successful organizational, national and global transformational strategies.

The converse is also true. Improving health is an economically wise and productive investment.

In fact, that’s the reason that health systems were established – by the King and the employer – documented as far back as 4,000 years ago.

There is good news to today’s world: a positive cycle of gains in both health and economic security occurs as either one is improved.^[1]

Have we taken the value of health for granted? I think so and find that especially the case among those of us in the health community. We talk endlessly about improving health outcomes as if those outcomes were an end in themselves. We have fallen victim to the notion that health expenditures are a cost, rather than an investment. We have forgotten our origins in economic growth and security. We have set our sights too low.

It’s high time we set higher goals. Disease creates barriers and slows progress towards economic status and security. As health improves, people experience both immediate and long-term economic benefits. Individuals become more productive; they enhance not only the quality of their lives but their capacity to enrich economic well-being.^[2] “Health is an economic engine.”^[3] This is true not only for individuals but also for families and societies.

World Health Organization (WHO) and World Bank benchmark reports outline the relationship between good health and economic development; good health is not only a means to reduce poverty, but also a means to accelerate national and personal economies.^[4],^[5]

• Individual health increases personal productivity and earnings. Extending healthy years of life increases the number of working, income-earning years. Healthier workers are more productive economically during their working years as well.
• Good health reduces the funding required to treat disease, allowing people and nations to invest in other needs.
• A healthy population encourages foreign investment, technology transfer, and facilitates access to global markets.^[6]
• Healthy children are more prepared for school, miss fewer days of school, attend school for more years, and learn more while in school.  In addition, longer life span is associated with more years in school and each year of schooling results in a 15% higher starting wage and a doubling of the rate of subsequent salary increases.^[7]
• Natural resources previously inaccessible due to disease (e.g., agricultural acreage unusable because of malaria) are made available for production and farming.^[8]

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My initial enthusiasm for blogging on the subject of adherence policy “carrots and sticks” faded the more I contemplated the disputes that would arise by suggesting “sticks,” so mostly I’ll – pardon the pun – “stick” to “carrots.”

In recent weeks these blog pages have been filled with ways to support patients: reviewing insights about human behavior, the young, the old, reminder systems, games and team care. In fact, this series could have continued all month and we’d not have exhausted the ways in which patients are supported, encouraged and cajoled to be adherent.

Yes, we’ve dispensed plenty of sugar to make the medicine go down, but we’ve not proposed any “sticks” in the event it does not. Let’s face it; we’re not ready for the outrage in the public policy world if we seriously suggested that patients somehow should be held accountable.

In the private sector, some accountability-style policies exist (though not to my knowledge regarding medicines). For example, one major company warns employees that if they have an automobile accident requiring hospitalization and committed a moving violation or failed to wear a seat belt, they’ll be responsible for paying an additional $1,000 deductible. It’s a policy that requests responsible behavior in return for a benefit. I don’t sense that we’re ready for that same kind of “tough love” talk with patients. Not yet.

I liked Joyce Cramer’s notion of the “patient as willing partner” and wonder if we, as patients, sit at one side of the partnership table, what does “the other side” offer us?

In fact, it offers us a lot in the way of benefits, opportunities and “carrots” regarding our medication needs.

• Availability. More medications are available today than ever before, brought to us by public funding and policies that underwrite the cost of basic biomedical research, science education and advanced graduate training. Public policies also provide intellectual property protection to those who successfully innovate to produce new medicine solutions and then – after a time – allow that intellectual property to be used by others to produce cheaper, generic copies of those once-innovative products.
• Assurances. Medications are studied, reviewed and regulated virtually continuously, by regulatory agencies and major health care systems to assure safety, effectiveness and appropriate use. We can report side effects and are encouraged to do so. Those data are monitored and used to further improve pharmaceutical care.
• Accessibility. Medications are more accessible than ever. There is a pharmacy – on average – at every square mile in the US, each one staffed by experts in the use of medications and the management of complex combinations of multiple products for those of us with multiple chronic conditions. These experts can generally tell “in a heart beat” if the side effect we suspect is the medication or the way we’re taking it. For those locations where the “on average” does not apply, mail order pharmacies fill the gap.
• Affordability. Medications are more affordable than ever. The range of generic and therapeutic substitution options allow clinicians and patients to consider the cost of medicines and to pick affordable choices for the vast majority of conditions treated today. Public and private sector coverage for medicines has never been better and every company has a patient assistance program for those who do not have coverage or cannot otherwise afford the medications.
• Alternatives. In this chronic disease epidemic era a large share of the medications we take are intended to treat conditions that could have been prevented. Public policies have invested in understanding the drivers of preventable illness and educating us on everything from nutrition and exercise to stress management and back-injury prevention. Surely not everyone, but many people can practice the alternatives if they choose.
• Accountability. Those who develop, manufacture, prescribe and dispense medications are held accountable for their mistakes. A company that misrepresents the safety, efficacy or indications for their product is subject to legal sanctions and litigation. Clinicians who inappropriately prescribe or pharmacists who inappropriately dispense are subjected to similar consequences. Preventable errors in hospitals are reported and related care is not reimbursed.

Each of these is important and as patients we’d want nothing less. Can we legitimately ask for more? In some cases, yes.

Those with multiple or serious chronic conditions requiring some of the newest biotechnology solutions face great financial burdens. They can legitimately ask for relief. The same is true for people who suffer from cancer and some rare diseases with very expensive therapies. Then, there are those with currently incurable conditions; they can legitimately ask – if not for a cure – then at least for a treatment.

In return for what we have been given, can something be asked of us as patients? I’d like to think so, but I know of none that would gain traction in today’s debates. Are we ready to suggest that the non-adherent hypertensive patient be charged more for heart attack or stroke care? I don’t think so.

Until we are, we may as well ramp up the “carrots,” so many of which have appeared in these pages, stop the handwringing about the cost of non-adherence and haul out our collective checkbooks.

Perhaps you’ve seen it: the grocery-shopping mom, complaining about a sugar tax, saying it’s hard enough to raise a family in these times.

I saw it, and could not believe it. Was this ad actually claiming that families need sugared sodas to make it through tough times?

It took watching it on line at http://www.nofoodtaxes.com/ads/ several times to see that yes, indeed, that’s what it claimed.

I’ll agree that a soda and other sugared items are a nice occasional treat, but I see no evidence that they’re necessary to keep a family happy – or that there are no alternatives.

I’ve begun talking to kids about what they drink. Here is what I got:

• I used to drink apple juice, now I drink water.
•  I drink water; that’s good for you.
•  I drink milk when I eat and water other times.
•  I used to drink (naming a brand soda) but now I drink water. The (soda) made my feel icky and I did not know how much until I stopped drinking it all the time.

Personally, I’m not a huge fan of plain water. I like a slice of lemon in it.

What about you?

Do you have a favorite alternative to sugared drinks?

Do you have any recipes for the beleaguered Mom trying to keep her family happy in these tough times? Do you have any tricks for weaning a family off sugared drinks?

We start this short Labor Day week on a hopeful note. The President will speak to the nation on health reform in just two days. Perhaps this is the tipping point we’ve been hoping for and it will break the logjams, bring all the players back to the table, keep them there and forge the next steps forward.

Recently, however, is unsettling debate about the value of prevention – saying it costs more and won’t help our health care crisis. Yes, prevention will cost more health dollars. Let’s get over it and move on – and beyond – that. I did on August 1, 2001, just six weeks before that fateful September 11 day.

I was the wrap-up speaker at a conference focusing on resistant pathogens and the problems that could ensue for the American hemisphere from emerging diseases. The audience as comprised of public health, medical and national security experts. The session was broadcast globally to 80 nations in three different languages. I opened with these remarks;

“We began this session stating that our goal was better health outcomes. I would like to propose a bigger goal: world peace and prosperity—for everyone, not just in this hemisphere, but throughout the entire globe.

Peace and prosperity will not be possible if we fear our neighbors for the pathogens they may harbor in a handshake. These will not be possible if we spend our money treating diseases that we could have prevented. These will not be possible if we are burying our loved ones precisely at the time when they are the most economically productive, or, when they are very young or very old and not enriching our economies, but enriching our hearts.”

The reaction was stunning. People cried. Afterwards, when the telecast was done and I came off stage I saw what it might be like to be a rock star. I was surrounded. They came to touch me and to tell me how I had touched them. It was then that I realized how weary we all are of working our best to shave another cent from the health care dollar and how much we all wanted a higher purpose for our work.

Regardless of what transpires in health reform debates, I hope that policy makers will realize that health – though valuable in-and-of itself – is an instrument of bigger goals.

I hope they will not set their sights too low and act as if it’s all-and-only about cutting costs. I hope they will see that a healthy population is a productive one and in this economy that’s exactly what we need: people who are capable of managing the stresses of these modern times, who can work more productively and work longer to bring this nation – and the world – forward to its full potential of peace and prosperity for all.

I just finished a great book: Why She Buys. I was stunned to learn just how much of the US economy is controlled by women: 65% of apparel, 52% of all auto and truck, 45% of consumer electronics and 70% of travel purchases. If influence over purchases is considered, women influence 80% of auto and truck, 91% of home, and 61% of consumer electronics purchases.  

Wondering about health care? It turns out that Dr. Mom makes more decisions than Dr. Welby; directing 80% of expenditures. It’s not just Dr. Mom, I’m guessing, but Dr. Wife, Dr. Sister, Dr. Friend and Dr. Daughter (or Daughter-in-Law) who help others with the health care maze.

A great book. I recommend it, though it raised my ire and blood pressure more than once as I realized how even with that level of seeming economic power that product design, marketing and purchasing is not woman/customer/consumer-friendly.

More women are in the workforce, complicating the activities of daily living.  Have children, a special-needs child and/or get divorced and life gets more complicated still. Time compression and multi-tasking is a way of life. How I wish that health care was like Ryland Homes, who designs and builds for the life a woman leads: a window over the kitchen sink to watch younger children in the back yard as she prepares dinner in open-plan kitchen-family room while supervising the older children’s homework, and of course, a computer workstation to check her own emails. Her day likely starts at 5 and ends at 11, errands are saved for weekends. Getting to the gym? Well, someday…..

Of course, that assumes she’s able to afford a Ryland Home. Many women are not. They face those chores in neighborhoods where the kids are not safe playing outside.

Heaven help any woman if she or someone she loves gets sick. Yeah, heaven help her, because it’s likely that health reform won’t. For women, the “unintended effects” of health policy decisions are not hypothetical. There’s a fight on, a battle, a war on the Hill and we’ll be left to deal with the collateral damage.

Drawing on some insights offered by author Bridget Brennan, sifting them through what I experience and what other women tell me, here are some reasons I’m not buying…

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Should managed care sue patients?

We arrive at the dawn of yet-another health reform effort with laws and regulations already in place to protect patients. These arose in past decades when the healer-patient relationship was eroding, presumably at the hands of uncaring clinicians and for-profit medical enterprises.   

The list of those rights was extensive and today’s debates are adding to the mix – guaranteed coverage despite pre-existing conditions comes to mind. The discussion of patient rights has always been politically attractive and I won’t denigrate any one of them. I’m not just writing from a policy perspective, but a personal one as well. I’m a patient, too.

The discussions of patients’ rights, however, has neglected the flip side of rights—responsibilities on the part of patients, and the support that we all need from our communities to be healthy people. Today’s healers are beset with immense responsibilities, yet with few reciprocal rights of their own in their relationships with patients or communities.

As patients, communities and a nation, we all too frequently fail to follow medical advice or practice healthy behaviors, and yet expect that helath care will ‘make it right’ when we become ill or incapacitated.  We smoke, abuse alcohol and drugs, carry guns, drive fast, forget seatbelts, neglect immunizations, shun prenatal care and spread sexually transmitted diseases. We ignore social problems until they create health care consequences—low birth-weight babies, elderly who lack social acceptability, and teens suffering gun-shot wounds. When these risky behaviors result in chronic or high-cost illnesses and disabilities, health-care providers are expected to assure that we get the care we need, insulating us from the cost of our choices by providing whatever we need within a fixed budget. The time has come to broaden all of our health policy and political discussions to encompass the realities that, with rights come responsibilities.

So some questions:

• If managed care has a responsibility to meet all the patients’ needs, do patients have the responsibility to practice healthy lifestyles?
• If patients have the right to sue health-care providers for the failures to meet the patient’s expectations, do health-care providers have a similar right—to sue patients for the costs incurred from their failures to follow medical advice?
• At what point do patients who have rights also become citizens who have responsibilities, particularly as we all—collectively—pay for each other’s health care?
• If the community has a right to call on health-care providers to keep us all productively at work and at school, do communities have a responsibility to do their share as well?
• As the population ages and more health-care costs are attributable to lifestyle, can we afford not to hold patients and communities more responsible for their own health-damaging, cost-increasing behaviors?

What will it take?  Will clinicians, payers and managed care groups be forced to sue patients and communities to get the debates going?

Consider hypertension. (more…)

I don’t think we in health policy really understand how complex our systems are and what manner of challenges – some of which we created – present themselves in clinical care.

It was Dr. Christine Sinsky who enlightened me. She said that just five years ago, a patient with a 143/82 blood pressure, 1.4 creatinine, 128 fasting blood sugar and 189 cholesterol was advised to exercise and lose weight. Today, that same person has hypertension, stage 3 kidney disease, diabetes, hyperlipidemia and is a candidate for four medications and ongoing monitoring.

Citing data from the New England Journal of Medicine, she added that a Medicare patient with diabetes, hypertension and depression with a complaint of headaches is subject to 56 different quality measures.

The complexity of those – and other – clinical situations is something she manages with smart system integration; no doubt you’ve seen her publications on those methods. I can’t help but wonder if CER – not as it is imagined and promised, but as it will be realized – will help or hurt clinicians like her and patients like hers. As a policy maker of longstanding, I have to admit that we generally had the best of intentions, but always created negative unintended effects.

Will we do that again? Have good intentions but negative effects? Only time will tell. Since all of us will soon be walking the territory, I’m offering the beginnings of a map in this blog; a map intended to navigate the territory better. I look forward to the ways others might add to our collective understanding of the landscape. The map is not the territory, as they say, but I believe that the better we explore it now, the better will be the chance that those who traverse it can avoid Donner Pass scenarios.

I currently see 7 components on the CER Map, and each of those has a set of interrelated policy issues. I’m interested if you see the territory differently and if you have components and policy issues that illuminate this endeavor further. As you do, remember Dr. Sinsky and Donner Pass.

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No, not politically right. Right, as in “correct.” And not politically correct, just “right, correct.”

In fact, in the past few years I’ve been politically incorrect according to a number of my critics. I have said that patients have a responsibility to play in the course of their own health and care.

It’s something I believe as a patient myself and as a policy maker as well.

My critics believe that in saying so I am “blaming patients” for their illness. Quite the contrary. I believe I am empowering – and I hope activating – them. I’d prefer that I – and they – not be a victim of whatever has befallen us. The best way I know to do that is to get activated and involved – even if that means something as simple and helpful as breathing well through the worst of times.

My views were confirmed when I saw the award-winning “Smile Pinki” on HBO last evening. This compelling documentary of the work of The Smile Train¹ broke my heart. It also healed my soul. What an organization! What a venture into providing free surgery to care for children with clefts in India (and other countries)!

The circumstances of these young lives are devastating, but the eyes of the children, the obvious potential of life within them and loving tenderness of their parents keeps you watching. It was late, I was tired and faced early calls today, yet could not walk away from the TV.

Then comes the soul part for me, the part that makes me forget the angry attacks I’ve received. A hospital worker provides discharge instructions to a group of parents on how to care for their children at home and delivers the empowering message.

To paraphrase, she says, “Since this hospital has helped your children, you have the responsibility to help others, to tell others about us and to help them get the 200 rupees to come² here. This hospital is useless without patients. You are heroes, this is a big country and we can cure others. Tell them about us.”

The film ends with a sense that the parents will do just that. Despite illiteracy, the economic poverty and hardships of their circumstances, the discrimination encountered by their children and the blame from and rejection by their in-laws, you get the impression the message got through.

The parents took bold steps for their children and the children showed amazing spirit and courage themselves. That’s taking responsibility at its best and it will be good enough if they stop there. I suspect, however, that they’ll do even better and reach out to help others. And it does not get any better than that.

If they can do it, so can we.

Why am I smiling? Not because I was right, but because I followed up on my soul’s leading and checked out The Smile Train. Then, I donated. Our firm supports projects to improve the health of women and children in the developing world. Today, in some small way, we helped to heal the smile of one child and the heart of that child’s Mother.

References
1. www.smiletrain.org
2. Care provided to the children is free, but parents must provide for transportation and food costs.

Medical ethicists have made amazing contributions to health care.

They’re heroic in their fearless pursuit of better care for beings – especially the human ones. They seem never to forget that is what they do. They work on the edges of what we know and are usually ahead of what we believe. They poke and prod us to do better. God bless ‘em.

Bob Veatch – one of my very favorites – has written a brilliant new book¹ on the subject and I recommend it highly. It is a product of decades of deep thinking; he’s produced yet another gem.

Unfortunately, the title does not reflect the depth of his thinking; it’s far shallower than that.

The text pushes the edges of what we know and is ahead of what we can produce in health care today, but the title pushes it over the edge. I suspect some editor or publisher picked it. The Bob I read, have heard speak and have once met is better than that.

I recommend it as required reading for anyone – legislator, regulator, staff, advocate, clinician, institution, payer or reporter – involved in health reform. It is brilliant, thoughtfully constructed and engagingly-read.

So, why do I dislike the title? For two reasons:

First, I don’t see Bob arguing that the patient heals themselves – or even can. Rather, I hear him addressing the myriad of uncertainties that accompany any clinician-patient interaction, the complexity of the health care system we have produced and the lack of any one, clear culprit in the mess we face today. It is full of cautionary tales for those who think another set of regulations, EMRs and financial incentives will “fix” it all.

Second, my review of the history of healing says that no culture has ever believed that patients are healed ‘on their own.’ My read of today’s health care crisis agrees.

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According to local news, PETA sent a letter to Penn Health System CEO Ralph Muller urging him to follow the lead of hospitals in England, reducing their carbon footprint and improving patient health by eliminating the availability of meat for patients, visitors and employees.

HUP is one of my local hospitals; a place where friends have been treated for cancers, and last month, for heart failure. It’s got a big footprint in this town and I’m glad it was there for my friends.

If my hospital got a letter, maybe yours did, too.

A hospital spokesperson says they’ve not received the letter, but if CEO Muller wants my reaction – here goes.

Please don’t. I have five reasons:

Reason #1: Personal experience. I’ve been a vegetarian for nearly 40 years. It was not an easy transition to make and not an easy lifestyle to live even though I was already – and still am – healthy, highly motivated and made the choice voluntarily.

• The physical impact of the transition took a year and was rough sledding. I can’t imagine asking a person as ill as those recently hospitalized to take that on.
• The skill challenge is substantial, entails difficult re-learning and supports for doing so today are only slightly better than decades ago. In 40 years of care by a number of different physicians – including some who were vegetarians themselves – it was only recently that one took the negative health consequences serious, explored – and found – an important deficiency in my diet, for example. Vegetarian cook books have beautiful covers and great recipes, but few covers show – and few recipes guide – adequate alternative protein sources for a lifetime.
• The genetic challenge cannot be ignored. Genetics play a role in nutritional needs and some people – the Dali Lama, for example – will never be able to successfully make the transition.
• The practical challenges are many. For anyone who travels, does not or cannot cook or readily control food choices, it’s hell. Airline, banquet and restaurant meal planners are not savvy about how to provide non-meat alternatives and I was eventually forced to return to fish for protein. Men I know who do physical labor say that despite their best efforts, vegetarian diets have not satisfied the physical demands that labor requires.
• Finally, it can complicate life with other chronic conditions. For me, it came five years ago as my Irish genetic ancestral predisposition to celiac showed up – as it can later in life. All that good whole grains if wheat, barley and rye I was eating were, in fact, killing me. I easily adjusted to this new condition for at-home meals, but it complicates an already challenging dietary life style in travel and social situations.

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On April 2, Julie Connelly reported that “Doctors Are Opting Out of Medicare.¹” The article focuses initially on specialists but quickly turns to primary care clinicians as well, noting that 29% of Medicare patients surveyed last year were looking for primary care physicians.

Note to my health reform buddies working towards universal coverage… apparently having insurance coverage is not enough.

It’s a surprise to me that it took so long for this problem to hit the presses. About five years ago I had the opportunity to travel across the country with a small group of medical and employer leaders, facilitating discussions between physician groups and local employers collaborating to improve access, quality and cost dynamics in their local areas. To prepare, I called local physicians to “take their pulse and find out where it hurt.” They hurt plenty.

When we started on the East Coast, physicians said they were worried that “one day they would not be able to take Medicare patients.” Moving westward, by the time we reached Dallas later that year they “no longer accepted Medicare patients.” By the end of the year, in the Pacific Northwest, they did not take new patients aged 60 because “in five years they would be on Medicare.”

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Medpedia launched recently. It’s a great idea, a ‘wiki-style’ source of authoritative health information. You can find it at www.medpedia.com.

It will distinguish itself by limiting contributors to those MDs, and PhDs credentialed to address the clinical topics.

So far, so good. What could be better? Three things.

- First, include contributions from “credentialed” patients and caregivers themselves – that is, those who have encountered the disease “up close and personal,” who have demonstrated that they understand it, have managed it and survived it – or not.

That important patient information could be in a separate segment, perhaps, or noted as such, but it should not be ignored. Patients and caregivers have important contributions to the overall understanding of the condition itself, as well as to the experience that other people will have. Credentialed clinicians might well know how to describe metastatic cancer or viral replication dynamics, but only a credentialed patient can offer insights into the interior state of the person who has that experience. Likewise for the caregiver who helps them.

Yes, it’s true that those patient insights can be found on other sites, but those sites may not be as accurate as Medpedia seeks. Lacking these patient insights Medpedia is replicating on the web what happens far too often in clinical settings – clinicians and patients talking different languages and “past” each other, rather than “with” each other.

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