By Glenna Crooks. Over a decade ago, researchers noticed an interesting finding: women who believed they were subject to heart disease were four times more likely to die than women with similar risks who did not hold similar fatalistic views.

Some people called this a ‘nocebo’ effect. The Washington Post called it the ‘evil twin’ of the ‘placebo’ effect, which most everyone knows by now is a treatment that produces a positive effect for patients even when it shouldn’t because is isn’t real.

Nocebos, like placebos, are ‘self fulfilling’ prophesies at work. Apparently, the brain (and body) cooperates with the deception.

A study just published in Science Translational Medicine takes this to new levels.

Healthy people agreed to participate in a pain experiment. Heat applied to their leg caused pain and a baseline of their tolerance determined. On a scale of 0-100, the average pain rating was 66. Placed in an MRI with an IV inserted, they were administered a powerful pain-relieving drug…but not told so. Pain levels dropped to 55, so apparently the drug had some effect. That was Stage One of the study.

Stage Two started when the research subjects were told the drug was now being administered. Average pain dropped to 39, mmmmmm.

Stage Three came next. Even though the drug was administered still, the researchers lied… subjects were told it was stopped. Average pain intensity rose to 64. Very close to the baseline. Wow. Tell the person – the patient – there is no help on board and the nocebo takes over.

These were not just subjective reports. The MRI’s confirmed that the brain’s own pain networks responded in ways that matched the subjective ratings.

Change the expectations…change the response.

So what does this have to do with politics and media? Plenty maybe. You decide.

I’ve been thinking about this for a long time. Here’s why: Long ago and far away, I trained for the Olympics. My sport was Karate. There’s more.

In a training accident, a sparring partner kicked me in the head, bones in the left side of my face were fractured and reconstructed. After successful surgery, for nearly six months I spent the first hour of every morning in a dental chair to get the refining, pain-relieving work done. 

How might other patients be like me?

What if I had not liked my dentist? What if I had not trusted him?  Could I have gotten up every morning and made the drive to see him? Would I have shown-up? Or not? Cancelled my appointments? Not been adherent to the regimen? Walked away angry and disappointed? Litigious?

I can’t even remember his name today, except he was a really nice, funny, skilled, terrific guy. Eventually there was no more pain. I went on my way.

Sometimes, as I watch the anti-healer drumbeat from politicians and the media (old and new) I wonder about other people who need help.

What would it be like to be admitted to the hospital and believe that the surgeons, nurses or hospitalists there were uncaring, incompetent and likely to cause my death, not my recovery?

What would it be like to have a chronic condition and believe that my doctor had no interest in me and my health but only her own selfish interests and income? That she lacked the intelligence or ethics to stave off the influences of the many forces that make it hard to put my interests first? To believe that a pizza for lunch would influence her choice of therapeutic option?

What would it be like to get up every morning to take a medicine and believe that the company who discovered and developed it employed people only in it for the money? And that it was probably poison to boot, likely to cause bad – even fatal – side effects?

While those of us who are patients and those of us who are healers are trying to make healing  happen it seems to me there are others whose interests are not about healing.

It seems to me there are those - politicians – with interests to drive a wedge between patients and their healers in order to get media attention. It makes for flashy hearings.

Likewise it is in the interest of the media to drive that wedge to sell news.

You decide. For yourself. For those you love.

By Glenna Crooks. This is the week many of us will consider – or finally make – Valentine’s Day purchases. Some of us will consider chocolate. Maybe more of us should.

I wondered about that as I saw some disparate bits of data over the weekend. An article on Valentine’s Day spending was informative: couples will spend just under $70 on each other and we’ll spend, on average, $5 on pets, $6 on friends, $5 on teachers and $3.50 on co-workers.

What will we be buying? In all, about $12.B in treats for the day: $3.5B on jewelry, $1.6B on clothing, $3.4B on dinner, $1.7B on flowers, $1.5B on candy (of which $285M will be on chocolate) and $1.1B on greeting cards.

I get interested in items like this when I hear that we ‘can’t afford health care.’ I’ve noticed over the years how we can spend more on the launch of a blockbuster movie in a weekend than we spend immunizing our children against measles, mumps and rubella in a year. 

In the past, I might have gone on a rant about that but this weekend another set of statistics caught my eye as well; those related to chocolate. Seems that chocolate-making companies have higher margins than other food companies, raking in 11.7% profits over the 8.1% of others.

Chocolate is a discretionary, luxury item and – though some friends will disagree – not at all essential to a person’s health or well-being, so we need not quibble over those margins, argue for price controls or suggest the industry become a public utility. That same article cited per-capita rates of chocolate consumption, however, which got me to thinking that consumption of chocolate appears to be correlated with two items we care about in health care: expenditures and satisfaction.

Sure enough! Though not a perfect correlation, it’s directionally so. Countries with higher rates of chocolate consumption have lower rates of dissatisfaction with health care and lower per capita health care spending. Wow!  Note in particular the difference between Switzerland and the US. The Swiss eat twice as much chocolate, have a dramatically lower percentage of people who grouse about healthcare and spend nearly half per capita as Americans. 

The policy wonk in me says perhaps we ought to make chocolate a covered benefit and promote its use! And, I’m only half kidding.

By Glenna Crooks. I learned an expression last week: “A whole lot of dirt flying, but no holes bein’ dug.”  It comes to mind when I watch attempts to repeal health reform.

Let’s get real about what the law is and isn’t.

Health reform…isn’t. To ‘reform’ means to ‘return to a former good state.’ What ideal state are we trying to reclaim? Did we ever have one? When was care idyllic? Was it when people believed the evil spirit Febris sent fevers? Or when as a child my Mother saw her Dad die, a victim of infectious disease in the pre-antibiotic era? When Marcus Welby practiced with great bedside manner but without today’s diagnostic and therapeutic armamentarium? Or more recently when my Mother saw her son die, a victim of infectious disease in the antibiotic-resistant era?  

We don’t need to reform the health care system. We need to transform it. Unfortunately, the law…doesn’t…transform, either.

It does not address how we will meet the unmet medical needs for new therapies. It does not address all – or even the most important – components of health.

The law fails to address the biggest determinants of health, which according to my friends Mike McGinnis and Bill Foege are what we do for ourselves each day (40%) and the quality of our social and physical environments (20%). According to Bill and Mike, only 10% of our health is determined by the health care we receive – the primary focus of the current law. Is that focus a bad thing? Is it so limited and flawed as to merit repeal?

The law does not transform health or health care, but it does transform the financing of care. We needed a wise dose of that. We needed some wise doses of other things as well, but financing is a step in the right direction to address issues that – however difficult – must be accomplished in order to move forward.

Repeal would be a giant step backwards towards a past no one argues was ideal.

I’ll admit to being disappointed initially that the law was so limited, but no longer. I’ve come to terms with my frustration, believing that those involved probably did the best they could at that time and we won’t get anything better for a long time to come.

Now, we need to stick with it and make it work. Tinker at the margins? Yes. But repeal? No.

It’s going to take years to figure out how to make the current financing components work. It’s going to take decades to figure out how to get more therapies developed for those who need them, how to change our communities to make them healthier places to live and how to change our own behaviors to control the components of health – and drivers of cost – we can.

Now is the time for digging that lays that foundation for the future. Plenty of people in patient groups, among employers, insurers and especially in the states are hard at work figuring out how to do that.

They could use some help. The efforts to repeal the law don’t qualify.

By Glenna Crooks. Robin has already wished everyone a Happy New Year. To those wishes, I add mine: a Healthy New Year, too!

Got plenty to clean off your desk? Probably.

A pile of papers, postponed ‘to do’ list items and accumulated emails? Likely.

Is that competing with New Year’s resolutions to exercise more?

Is it stressing you beyond your promises to remain calm, unruffled and Zen through 2011?

Are you already planning to postpone the workout (for just one day) and have some high fat, high calorie comfort food to relieve that stress (just for today)?

Tempting, even for me, trying to practice what I preach about prevention.

Maybe this will help: a reminder that health has a number of important contributions for us and the people we care for in the work we do. It brings them not only longer, better quality lives but also the ability to create economic security for themselves, their families and their nations.  Good health for us means likewise and helps us stay ‘on the job,’ addressing the challenges of working in today’s health care sector — piles of papers, unanswered emails, stress and all.

This is worth the time – piles of papers and all! It’s a wildly entertaining, short presentation on a value of health we rarely discuss…that of creating wealth.

Hans Rosling is a master – of data and communication about the value of health.

http://www.flixxy.com/200-countries-200-years-4-minutes.htm

If you like this one, though this next link will take you to earlier versions, you’ll find them additionally entertaining and informative….

http://www.ted.com/index.php/talks/view/id/92.

Happy and Healthy 2011 to you!

By Glenna Crooks.  I’m on the Finance Committee of my condo association. A few weeks ago, the Board accepted our recommendation to raise monthly fees by 3%, of which the majority will build a larger reserve fund. The increase will no doubt be controversial.

We have insurance against the usual risks but can foresee events that insurance won’t cover, like work that will improve the ‘street appeal’ of the property or upgrades required by changes to city building codes. I agree with the approach; it’s better to be prepared than to be caught short and ‘paying as you go’ to build reserves is less painful than the alternatives.

Leadership of other buildings in our neighborhood were not thoughtful and owners were caught short when  city inspections required roof repairs or new fire codes required new alarm systems. As a result, owners faced multi-year assessments – in the range of $30,000-40,000 annually for up to three years. Many people, but especially the elderly on fixed incomes, could not afford the amounts. They had no choice but to sell, placing a large number of units on the market, driving prices down and finding prospective buyers reluctant to buy property encumbered by special assessment price tags.

I was one of those prospective buyers and so one item on my list of property specifications was the quality of condo leadership. I wanted a Board that was smart and visionary, with a President willing to act like a leader. Better to invest small amounts along the way than to deal with disastrous consequences from the failure to do so. 

Does this relate to innovation in health care? You bet it does. Plenty.  Where health care innovation is concerned, we have many needs but precious few reserves and leaders don’t seem to notice.

Perhaps you don’t care about US-based innovation. I do. For many decades, the US has been the source of most of the world’s health care science-driven, venture-supported innovation. I’d like that to continue, but it appears those days are over. I’m declaring that the US innovation patient has a terminal illness, likely to be dead within my lifetime unless a miracle happens.

How did this happen? We not only helped rebuild the health care infrastructures in Europe and Japan after WWII, we built our own and then we reached out to others in the world. Some magician did not pull today’s health care capacity from his hat. The ‘Great Generation’ came home from the war and went to work. Clinicians, hospitals, diagnostics and medicines are here for us today because taxpayers, employers, investors, entrepreneurs, philanthropists and patients did the hard work of making it happen. They invested in it and paid for it. They took risks. Sometimes they succeeded; sometimes they failed. Or more likely, what they set out to do did not work, but they learned something from that failure. In a very real sense, then, they did not ‘fail.’

They made the US the source of the world’s innovation. Yes, we paid for it. Yes, health care was more expensive here. Yes, lots of the world got a free ride. So what? It was an investment in our lives and productive capacity and it paid off well in the highest standard of living anywhere. ‘A car in every garage and a chicken in every pot’ promise became multiple cars, multiple houses and more food discarded in a meal than many of the world’s people eat in a day. (more…)

By Glenna Crooks. Sorry, this blog is not about sexy new vaccines – you know, ones that will prevent smoking, cure all cancers, stop obesity or eliminate wrinkles. This is about more ‘here and now’ matters. It addresses vaccines, vaccinators and non-vaccinators, contains a proposal for moving forward on immunizations and some folks – including my friends – are not going to like it. But then, they don’t call this a ‘disruptive’ site for nothin’.

It comes from my attendance at a CME course on vaccines held by Philly’s Children’s Hospital last weekend. I was privileged to hear great presentations and meet fantasic folks. Despite my work in vaccines over several decades in both government and industry, some information was ‘new’ for me, crystallizing issues and controversies in vaccines.   

 Here’s the good news:

Pediatric vaccines continue to prevent suffering, save lives and money. CDC studies show 14 million cases of disease prevented, 33,000 deaths, $9.9 Billion in direct medical costs and $43.4 Billion in savings to society. New vaccines have been added to the schedule. Is that cool or what? When I was in government, companies were leaving vaccines in droves. They’re coming back. Good news.

Rates of underinsurance for children’s vaccines have not increased, despite the new numbers of vaccines (and therefore additional cost for fully immunizing a child). Insurance and Vaccines for Children (VFC) funding is covering kids pretty well.

Pediatricians and their nurses remain unsung heroes, not getting nearly enough credit for the complexity they manage in the number of vaccines and the cost of the inventories they carry, despite the reality that they’re not adequately compensated. They could have long ago abdicated this aspect of a child’s good health. They haven’t. That’s very good news.

Kids aren’t traumatized by having many vaccines administered at once. In fact, research has demonstrated that only the first shot creates the ‘cortisol-raising’ indication of a stress reaction, subsequent shots (sometimes 3-4 others) administered at the same time, don’t.

We’re actually putting fewer antigens into kids today than at any time in history, even though we give many more vaccines! Wow, who knew?! In 1900, the smallpox vaccine had 198 antigens. In 1960, with DTP and polio added, that totaled 3,200 antigens. Today, it’s only 166-169 antigens, in part because we’ve eradicated smallpox and in part because vaccines have been improved. 

Kids – even babies – can handle those vaccines immunologically. Humans develop the capacity to respond to foreign antigens at 14 weeks gestation. There are few foreign antigens present in utero, but babies’ immune systems are challenged right from the moment of birth and have enormous immunologic capacity. And, right from the moment of birth babies can be exposed to the diseases that vaccines prevent. They’re at risk and we need to protect them, when they can be immunized they need to be and when they can’t herd immunity is needed to protect them. (more…)

By Glenna Crooks. I still remember the first patient advocate I ever met – Henrietta Aladjem. She outlived predictions of imminent death from Lupus and despite her condition helped others, providing information, inspiration, advocacy and hope everywhere she went. Gracefully. Persistently.

Since then I’ve met more than 10,000 advocates – some of them children – in 26 countries. In their work they help millions of patients and families address hundreds of diseases and the consequences patients face to get insurance, education, housing, employment and civil rights. In many cases, they or a loved one were in dire need of help they did not receive, so they vowed to help others. It was  a way to reclaim  power, to work through grief or to constructively use anger.

It’s impossible to be with advocates and not respect their dedication, courage and energy. That is especially the case for those working ‘closer to the ground’ where the real suffering of effected people is most palpable. I especially admire them when they venture into unfamiliar policy arenas to tell the stories they hope will create better solutions, particularly from governments. As Chair of the National Commission on Rare Diseases, their stories touched my heart and I still remember their faces.

Regardless of how well they succeed on behalf of any one patient , with one policy maker or in one disease situation however, there will always be more to do. I’ve seen advocates respond to this; having met their initial objective they band with others to help in new ways.

(more…)

Debates continue about the impact of health reform on small businesses. Mine is a small business so I’ve been paying close attention. I’ve even read every line of this legislation – three times. And every pundit analysis I can get my hands on.

My role as a strategist requires that I understand the law. My role as a business owner requires that as well. Most analyses make broad-brush statements and it’s not possible to know the full impact until each business does its own analysis. Here’s mine.

Unfortunately, there are no ‘upsides’ for my employees or business:

• My company is too small to be required to provide health insurance. That’s of no matter, I’ve been providing it all along.
• My company is unlikely to grow to the size required to provide health insurance. That’s of no matter, I’d do it anyway. As an employer I know the value of a healthy workforce.
• My company is too busy to even consider applying for grant funds for worksite health promotion and disease prevention. We’d lose productive work hours watching for RFPs, framing proposals and even more complying with paperwork. That’s of no matter, I’ve been providing that all along as well.
• My company is composed of workers too highly compensated to qualify for insurance tax credits, and I suspect no company like mine will qualify either. My employees are knowledge workers with advanced degrees and compensation above the $50,000 annual ceiling for the tax credit provisions.

Unfortunately  there are ‘downsides’ for my business, all related to new IRS rules.

Section 9006 mandates that about 18 months from now, my business – which really means my Executive Assistant, who is already plenty overloaded – will be required to issue 1099 tax forms to any individual or company from which we buy more than $600 in goods and services.   

We already issue an IRS Form 1099 to people like freelancers who are not ‘incorporated’ business entities. In any given year, that number ranges from 10-14.

That means we don’t send a 1099 to other incorporated businesses, that is, to Amazon, Amtrak, US Airways, Continental Airways, British Airways, Air France, Westin Hotels, Marriott Hotels, Holiday Inns, Kinko’s, Federal Express, Staples, Office Supply, Office Doctor, IT Edge, Samsung, Independence Blue Cross…I could go on.  

This new 1099 reporting is intended to capture currently unreported income to generate more government revenue and help offset the cost of reform. It’s been defended as an alternative to raising taxes on small business and is seen to be a fair trade for $35 billion in tax credits small businesses get under reform. It’s an attempt to collect the nearly $300 billion of income that the IRS says goes unreported.

I have three problems with that:

• First, my business won’t see any of that tax credit benefit, 
• Second, my business will incur additional costs, not only in staff time for obtaining tax IDs from every vendor, but also in accountant fees for processing and mailing the forms, and
• Third, my business is being required to help the IRS monitor tax reporting compliance of other businesses.

At this point, we estimate the number of 1099s we will file will increase to 1,000. I’m not sure how a small firm like mine is going to find its way through the mazes of large companies to get the information, but I’m angry that this law – touted as having so many ‘upsides’ – provides none for my firm but asks us to carry an additional burden that drives up the cost of doing business.

I can live without the ‘upsides.’ I’ve provided insurance and promoted wellness all along and will continue to do so.

But now, I’ve been mandated to become a de facto agent of IRS enforcement. Surely, the IRS has better tools for finding unreported income than asking small firms like mine to do it for them.

By Glenna Crooks. On Sunday July 4, HealthDay News reported on a June 30 Environmental Health Perspectives item that the health benefits of cycling in an urban environment outweigh the risks. Huh? I asked myself.

I live in Center City Philadelphia and far too many cyclists – I’ll go out on a limb and say a majority – are a menace. They ride on pedestrian walkways, sometimes IPod hearing-impaired, weaving through pedestrians. They ride on the wrong side of the roads, the wrong way down one-way streets and weave between traffic lanes. They do not stop for red lights. In fact, some bikes don’t have brakes.

I’ve been nearly hit twice by cyclists running red lights, coming from between trucks and therefore not visible to a pedestrian until they appear suddenly, inches away. And, at 6:10 AM several months ago, while taking a work-out jog on a paved path along the Schuylkill River with my trainer Morris (March Man of the Month), was rammed from behind by a cyclist. Though it was clearly past dawn, he did not see me, perhaps because his head was down to lower the drag created by an upright body, going fast on a path that is frequented by walkers of all ages.

The accident has cost me nearly $500 a month in out-of-pocket expenses since, to address the back pain it caused. I’m lucky, though. Around that same time two pedestrians were killed in my neighborhood by cyclists.

I had visions – no, nightmares – of public policymakers seeing this report and encouraging more cycling in the US. Who on earth would believe that cycling was safe, I wondered? How could I change their minds? I had to read beyond the first sentence to understand. (more…)

By Glenna Crooks. Rittenhouse Square in Philly, a holiday weekend and great weather made for the perfect place for light reading this weekend. I got magazines with the intention of doing just that – and did. It was great to be outside on warm, breezy days.

However, my mood soured about half way into Spirituality&Health, reading an article about a possible new cancer therapy.

It describes the observations of Mamdooh Ghoneum, PhD: cancer cells are attracted to, ‘eat’ heat-killed baker’s yeast and then die. That’s good news. It happens in labs and in mice, who apparently suffer no side effects. That’s good news, too. Approval for testing in other animals is pending. I hope he gets it. We need progress in the healing of people with cancer.

Why the sour mood? Dr. Ghoneum is hero enough for making the observation and following through with studies. He’ll be all the more heroic if he continues and learns from whatever comes next.

The article does not stop with the ‘scientist vs disease’ heroic tale, however. It goes further to paint an unfortunate and ill-informed, biased contrast – between an altruistic pioneer using his personal savings and fund raising efforts to find a cure vs a greedy, patent-dependent industry hungry to return to shareholders the $800M – $2B quoted as the cost of developing a medicine. It asserts that industry would never develop a ‘natural’ product, saying: “Nowadays, a cancer cure that is all natural, non-toxic, simple to administer and inexpensive to produce has become an economic non-starter.”

Drug Development and Approval. Dr. Ghoneum is currently at the drug ‘research’ phase. This is the easy part. Get past animal research and the ‘development’ phase begins. Move into humans and the costs pile up fast – so do the failures. He’ll face institutional review boards, numerous negotiations with FDA over appropriate surrogate markers and end points, challenges of getting patients into clinical trials, careful management of clinical research sites and exquisite documentation at every stage. This is the phase that washes out all but 1-2 of every 10,000 drugs discovered.

Add to that, this is a yeast product – a biological – which means he’ll have to satisfy FDA that there is ‘batch to batch’ consistency in the product as he scales up for clinical studies and, if the product succeeds, eventual market use.

Since he intends to develop a treatment safe, effective and affordable enough for poor people around the world, he will also face regulatory requirements, and perhaps clinical trials, in those nations as well.   (more…)

By Glenna Crooks. During my years in the Administration I was sometimes directed to draft responses the President would send in reply to letters he’d received from individual citizens.

Sometimes, rather than drafting the letter for him, I’d be directed to reply on the President’s behalf. Such was the case when the White House directed I write to a young boy from Texas.

His father – a young, healthy man – collapsed and died suddenly during an after-work run on the local high school track. Later, at the funeral home, the director complimented the boy’s Mother about her generosity in having donated her husband’s corneas. But there was a problem: it had not been her decision. In fact, until that moment she had not even know her husband’s corneas were removed.

The ‘donation’ was made under Texas law that provides for the ‘presumed consent’ on the part of deceased individuals. A medical examiner was allowed to remove corneas from a deceased person if the examiner was not aware of the relatives’ objections. The law did not require that the medical examiner ask the family before doing so, however. In other words, every one is ‘opted in’ to organ donation unless they ‘opt out’ and the medical examiner knows about their ‘opting out.’ This family, like most in Texas, had never been asked. The wife had never been given the opportunity to ‘opt out’ for her husband.

The boy wanted the President’s help to change the law. He was distressed that his Father was now in heaven and, without corneas, could not see God. He wanted others spared a similar tragedy. I can’t recall what I wrote to this boy in response; I do recall it was a hard letter to write and I doubt my reply did justice to the pain of his loss and his grief over his Father’s blindness in heaven.

That experience came to mind when I saw an AP report that a New York Assemblyman, whose daughter had been helped by two kidney transplants, intended to pass legislation to ‘presume consent’ for not just corneas, but for donations of all organs in the state. If he succeeds, New York won’t be the first state to try, but will be the first state to succeed in enacting that type of legislation.

More than 6,000 people die each year in this country awaiting donor organs. Improvements in surgical techniques and post-transplant medications offer hope to people who only a few decades ago would have had none.  I have seen lives transformed by organ transplants and we need more donated organs, that’s for sure. But can it possibly be a donation if the person or their loved ones are never asked? Is ‘presumed consent’ donation, or is it just plain ‘taking,’ in this case endorsed by legislators?

I think it is ‘taking’ and for that reason, I oppose it.

I can’t stop thinking about that 10 year old boy and his distress. Like him, I don’t want other families to suffer that fate. The joy of one family for the life of a loved one saved by a transplant does not justify the pain inflicted on another family whose loved one’s organs are taken without consent.

By Glenna Crooks. Full disclosure – I’ve practiced yoga fairly consistently for decades. It’s been good for me.

In grad school it helped me stay focused – and calmer – through killer statistics classes. Later, it was a way to unwind at the end of a workday. Still later, it saved me from surgery to correct fairly severe scoliosis. It’s not cured the deformity but I’m virtually pain free most of the time – no small feat for one who spends 18-24 hours on flights and 8 hours standing to facilitate meetings.

More disclosure – I am certified to teach, though I don’t. The same erratic travel schedule that prevents attending classes on a regular basis precludes committing to teaching them. I trained to be able to practice on the road. It was a good investment of my time and funds.

Yes, my time and funds. Anyone familiar with yoga knows that for the most part, students pay a small amount for a class – or series of classes – out of their own pockets. Sometimes, yoga is offered in schools, hospitals, churches, workplaces and prisons and the cost partially or fully paid by some third party. Sometimes teachers donate their services as part of the ‘selfless service’ that embodies the lifestyle.

Recent weeks presented an interesting confluence of events in my life as a yoga-practicing health policy analyst: health reform passed and Yoga Journal published a major article on methods, issues, controversies and implications of yoga research.

I started a yoga research literature review a few years ago. It was to be the opening chapter of an adaptation of my grantseeking guide (see www.strategichealthpolicy.com for a free download), revised and updated for yoga teachers intending to seek and secure third-party – including health insurance – financing support for classes.

I abandoned the project for many of the issues raised in the Yoga Journal article: research methods were relatively undeveloped, uncontestable positive results were scant and within the yoga community both were controversial. That’s right, even the need for research to demonstrate the value of yoga is controversial. Many thought there was proof enough.

Proof enough for an individual to pay? Yes, that’s been well-demonstrated. Thousands of times each day, people around the world pay out-of-pocket to attend classes. Proof enough for a third-party to pay? Far from it, at least as we have defined proof within the American health care sector.

Now, the health reform era is upon us, some people will press for yoga services as a covered benefit and if a serious discussion takes hold – and succeeds – in adding yoga to American health care armamentarium, yoga teachers will face issues common to other product and service providers. Clearly, not all yoga teachers will want to participate and none will be forced, but those who choose to do so will need to address – at a bare minimum – questions commonplace to physicians, hospitals and drug companies:

First, is yoga effective? Any prevention or treatment modality used in health care is expected to be safe and effective, demonstrating that it performs as advertised, promoted and hoped.

That means prospective research, such as trials comparing yoga against a non-intervention, a placebo or a standard therapy treatment, or a study of a sufficiently large population through ‘natural observation’ to gather similar evidence over many years.

Research such as this will raise questions about whether the ‘style’ of yoga matters, how many sessions might be required to achieve results and whether results last after classes are stopped. People in the study will be carefully selected and ‘assigned’ to each intervention group. They’ll be asked about other aspects of their lifestyle to assure that they’re not confounding the results with other possibly-effective therapies.

Side effects will be monitored. Injuries in class or suicidal thoughts outside of class (if any occur) will be noted so that cautionary warnings and contraindications can be addressed in coverage and reimbursement decisions. Other unintended consequences – weight loss comes to mind – will be documented but can’t be claimed a benefit unless the study was specifically designed to test for it.

Research might also need to tease out yoga’s “mechanism of action” as is the case for medications; for example, by what mechanism does yoga breathing techniques reduce hypertension?

Researchers will be required to seek approval from Institutional Review Boards protecting patients, may be required to vet research methods with regulators or payers, will likely be required to disclose financial interests in yoga and if any are found might be precluded from doing research and/or might be restricted from committees that address yoga policy and financing issues – all to assure research subjects are protected and conflicts-of-interest are prevented. (more…)

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 – an 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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