AMA Advocates 7 Principles for Health System Reform (HSR)

Following the news regarding legislative proposals for Health System Reform (HSR) can be stressful for all of us, with all of its complexities, and our concerns about the future availability of quality, affordable care.

In my search for sources of information that look at the facts of current legislative proposals, I believe that the American Medical Association (AMA) offers a perspective that is truly concerned about patients having access to quality, affordable care.

The AMA has studied health system issues and advocated for constructive reforms for over 20 years. As an organization that is driven by the time, energy, and experience offered by volunteer physicians, the AMA advocates for 7 guiding principles to achieve meaningful health system reform.

As we follow the debate and proposed legislation, the AMA continues to monitor proposed legislation as measured against these 7 guiding principles, commenting on how well legislative proposals live up to these principles.
-Provide health insurance coverage for all Americans.
-Enact insurance market reforms that expand the choice of affordable coverage and eliminate denials for pre-existing conditions or due to arbitrary caps.
-Assure that health care decisions are made by patients and their physicians, not by insurance companies or government bureaucrats. This sacred bond should include the right of patients to privately contract with physicians, so that their health care choices are respected.
-Provide investments and incentives for initiatives that improve quality and enhance prevention and wellness.

-Repeal the Medicare physician payment formula … a formula that will trigger steep cuts and threaten access to care for senior citizens.

-Implement medical liability reforms to reduce the cost of defensive medicine.

-Streamline and standardize insurance claims processing requirements to eliminate unnecessary costs and administrative burdens.

The AMA web site has lots of useful information for patients and their families, in addition to their perspective on the latest legislative proposals, and how they “measure up” to each of the 7 principles. You can find more information at http://www.ama-assn.org/ama/pub/patients/patients.shtml

H1N1 Vaccine: What to do?

H1N1 Vaccine: What to do?


“THE MEDICAL LETTER” is a publication that has provided credible information to healthcare providers about medications for over 20 years. It is funded by subscriptions and does NOT accept no funding from any other source, including pharmaceutical companies.
The October, 2009 issue reviews the H1N1 vaccine for prevention of flu. The article concludes that the H1N1 vaccine “is prepared in the same way by the same manufacturers as the usual seasonal vaccine. Those who are at increased risk of flu complications should receive the vaccine first…[they include] pregnant women, people who live with and provide care for infants <6 months old, all persons 6 months – 24 years old, persons 25-64 years old with illnesses that increase their risk of flu complications, and healthcare workers.”



I believe that credible sources such as the “THE MEDICAL LETTER” provide reliable information to healthcare providers and consumers, helping us to make the best possible decisions about risks vs. benefits of medical treatments. For further detail, consult your healthcare provider.

Is it OK to take medication for a long time for anxiety or mood disorders?

In my experience and according to scientific research, chronic anxiety and mood symptoms are extremely common. I think that, for many people, these symptoms can be due to being overloaded with all of the things that we expect ourselves to do (parent, spouse/relationship, work, friends, other family, etc, etc). When stressful life events happen, these are often “the straw that breaks the camel’s back.”


From my point of view, the important thing is for each individual to find out what works to feel better and function better, by that person’s own idea of "better." This means that the individual is better able to accomplish more of what they want & need to do, and to get more pleasure & fulfillment from those people & activities that are important to them.

It's always best to emphasize non-medication techniques as much as you can actually do, in the real world. These include exercise, spending time in green spaces, prayer/meditation, relaxation techniques, massage, stress management, and counseling/therapy.

No one that I ever known has been able actually do all of the non-medication techniques that they could/should do due limitations of time, energy, & money.

Even if you could, clinical research and our experience indicate that non-medication techniques are only of limited benefit for pain, anxiety, mood and/or sleep disorder symptoms that have been present for a long time, or are beyond a mild level of severity.

If medication works to do the good things (reduce suffering and improve ability to do things you want and need to do), and is not causing significant side effects, then I believe that it is actually having a positive healthy impact on the central nervous system and overall health, with benefits that often include reducing the impact of stress on things like chronic pain, IBS, PMS, headaches, asthma, blood pressure, as well as risk for heart disease and immune system disorders.

As a rule, I think it's good to learn about possible side effects that can occur from any medication that you're taking on a regular basis and for more than a few months, and to always call your prescribing physician if you feel worse in any way, especially after a dosage change.

If you've been taking a particular medication on a regular basis and for a long time, I think that it's always good to speak with your prescribing physician about trying a step down in the dose for a short period of time. If you feel worse and nothing gets better, then you can go back to the original dose. If your symptoms are not in complete remission, then speak to your prescribing physician about a trial of a step higher in the dose, with careful continued monitoring for benefits vs. side effects.

If you feel better on a lower dose, then you can talk to your prescribing physician about taking another step down in the dosage.

"The Body Toxic: How the Hazardous Chemistry of Everyday Things Threatens Our Health and Well-being" by Nena Baker

(I watched this program and felt this was worth sharing. There are some very credible scientific sources that are used. The following are excerpts from her presentation about the material contained in her book & on her web site. Although I am not necessarily advocating this, I felt it was worth posting).


Nena Baker contends that the chemical make-up of several of the products that make contemporary life easier and more convenient may be responsible for serious health problems. Ms. Baker argues that the Toxic Substances and Control Act of 1976 was ineffectual in regulating potential industrial contaminants and presents her research on products that she deems of possible danger, which range from the non-stick coating on cookware to several different types of plastics. This event was hosted by Google at their headquarters in Mountain View, California.


About the Author: Nena Baker has been a reporter for United Press International, The Arizona Republic, and The Oregonian.


From End Of The Program:

“I’m often asked what changes I’ve made in my life based on what I’ve learned, and why I’ve made them. I don’t obsess about chemical pollutants. I make informed decisions based on my understanding of the hazards of pesticides, plasticizers, flame retardants, and stain protectors.
When I know something contains suspect substances, I ask myself ‘can I find an alternative?’. The answer is usually ‘yes’ but sometimes I decide that the benefit of using a certain product outweighs the risk.


I would be more careful if I were at a younger age & considering having children, or if I had children in my home.


Regarding individual choices, & what each of us can do to make a difference in our own lives, she states: “It would be easy to [just resign yourself to the fact that there’s nothing you can really do to make a difference] & continue to buy & use the same things. But small adjustments in your own life can lessen your exposures and risks.”

“I’m frequently asked what I do to reduce my exposure to the types of chemicals that I write about, so I wanted to share my own list. Here, in no particular order, is what I’ve done to lighten my chemical load:”

“I buy organic foods whenever possible because they’re pesticide free;

I gave up microwave popcorn because of chemicals (fluorotelemers) contained in the packaging [that shield the paper from the grease but also get into the popcorn];
I got rid of my plastic food containers because they leech hazardous substances into the food when heated in the microwave; better to use glass or ceramic containers instead;


I canceled my monthly pesticide service for both inside & outside of the home. I use non-toxic ways to control pests, rather than potentially hazardous chemicals used by pest control services [see her book for detail];

I decline all optional stain resistant coatings for furniture upholstery or floor coverings;
I use no or low DFC paint for home improvement projects;
I don’t use [hard plastic bottles] for water or other beverages; I use an (aluminum bottle);
I vacuum home & office at least once/week because dust contains many hazardous chemical pollutants (PVDE’s) that are of concern;

I’ve replaced my old Teflon cookware with hard anodized aluminum cookware;

I ask retailers questions about things I buy, and if they don’t know the answers, I call manufacturers;

I read labels about products I’m considering purchasing;

I share the changes I’m making and why I’m making them with friends & family.”

“You can find information about non-toxic products in online resources such as “The Green Guide” http://www.thegreenguide.com & “the environmental working group” http://www.ewg.org ;”

For more information: www.thebodytoxic.com

My Thoughts On Ted Kennedy, Jr.'s Speech At His Father's, Edward Kennedy, Funeral

Though I did not always agree with Senator Edward Kennedy on political and legislative issues, I was struck by the reaction of so many people, often holding opposing political points of view, to countless stories of his often inspiring statements and actions from his life outside politics.

I was particularly struck by a story told by his son, Ted Kennedy, Jr. at his funeral, about a father helping his 12 year old son as he struggled to deal with the consequences of severe medical illness and resulting physical impairment:

Ted Kennedy, Jr (son) speaking at Ted Kennedy Memorial (7-29-09)

When I was 12 years I was diagnosed with bone cancer and I remember a few months after I lost my leg, there was a heavy snowfall…my father went to the garage to get the old flexible flyer sled and asked me if I wanted to go sledding down the steep driveway. I was trying to get used to my new artificial leg, and the hill was covered with ice and snow and it wasn’t easy for me to walk, and the hill was very slick, and I struggled to walk. I slipped and started to cry, and I said: ‘I can’t do this. I’ll never be able to climb up that hill.’
And [my father] lifted me up in his strong, gentle arms and said, ‘I know you can do it. There is nothing that you can’t do. We’re gonna climb that hill together, even if it takes all day.’

Sure enough, he held me around my waist, and we slowly made it to the top.
You know, at age 12, losing your leg pretty much seems like the end of the world. But as I climbed onto his back and we flew down the hill that day, I knew he was right. I knew I was going to be OK.

You see, my father taught me that even our most profound losses are survivable. And it’s what we do with that loss, our ability to transform it into a positive event, that is one of my father’s greatest lessons. He taught me that nothing is impossible.

BASICS: Brain Is a Co-Conspirator in a Vicious Stress Loop

An interesting article from The New York Times entitled, "BASICS: Brain Is a Co-Conspirator in a Vicious Stress Loop"
By NATALIE ANGIER

Chronic stress changes the brain, but relaxation can change it

http://www.nytimes.com/2009/08/18/science/18angier.html

Look forward to your feedback.

Have a great weekend!

Dr. Blotner

Help with Losing Weight & Improving Health

This past weekend on Book TV on C-Span-2, I watched David Kessler, MD speak for 1 hour to an audience at a bookstore about his new book, “The End of Overeating: Taking Control of the Insatiable American Appetite.”

http://bit.ly/1aMHez

Dr. Kessler served as Commissioner of the U.S. Food and Drug Administration from 1990 to 1997 & is a former Dean of Yale University Medical School.

For this book, he spoke with several scientists, physicians, and food industry insiders, and reviewed scientific evidence that suggests that American bodies and minds have been “reprogrammed” by too much sugar, salt and junk.

He also revealed his own seemingly endless struggle with losing and gaining weight over many years.

In his book, Dr. Kessler suggests that our bodies and minds are changed when we consume foods that contain high content of sugar, fat, and salt, resulting in profound biological impact on brain’s pleasure centers, and contributing to serious long-term health problems.

He suggests that the high levels of these ingredients, certain food industry practices, advertising, and lifestyle changes combine to impact core brain self-regulating biological mechanisms of a large percentage of Americans of all ages.

He suggests that food manufacturers manipulate sugar, fat, and salt content to stimulate the brain mechanisms that control craving and consumption of food, resulting in patterns of uncontrolled irrational eating, and (ultimately) obesity and other serious health problems.

When these unhealthy foods are associated with advertising, some individuals develop a “conditioned” behavioral response. This means that the brain’s biological craving for these foods is triggered by reminders contained in advertising, leading to “conditioned hyper-eating,” which Kessler believes is a disease rather than a failure of willpower.

This also provides an explanation as to why it is so difficult for so many to resist these unhealthy foods, despite knowing that these foods contribute to their health problems.

Dr. Kessler then suggests ways individuals regain control over their eating habits, supported by his review of scientific research.

He presents a simple food rehab program that help us identify cues that trigger overeating, changing the way we perceive these foods, and reducing the impact that advertising has on craving and consumption. For example, one person in one of the studies stated, "I think of the French fries as my friend. I know if I'm feeling bad, [fast food restaurant] French fries make me feel better."Dr. Kessler suggests that we begin to think about the French fries differently. He suggests that we think of French fries as a combination of sugar, fat, and salt designed to turn on pleasure centers in the brain and to cause craving, not unlike addictive substances such as alcohol, habit-forming medications, and illegal drugs. By thinking of unhealthy foods as we would think of addictive substances, we become more aware of the potential for harm, reducing our craving, making it easier to reduce the consumption of these unhealthy foods. For example, most people know that small amounts of alcohol on a few days per week does not seem to cause significant harm, but large amounts of alcohol on a frequent basis can quite harmful. So, most people are wary of the potentially addictive nature of alcohol. Regarding public policy, he suggests that the public’s health would be best served by adopting some of the same changes that have occurred with tobacco over the past 15 years.

He states that tobacco has been marginalized in the culture due to public policy changes and educational campaigns, and that similar tactics would have a positive impact on reduction of craving & consumption of foods that contain high content of sugar, fat, and salt, with resulting benefits to the health of individuals and the public at large.