Anti-Aging Medicine / Age Management Medicine. What is it? Is it real? Are there real controversies here? In a word, yes. Can it be fulfilled in today’s guideline, task force, economic environment?
We are poised at a very important juncture. Anti-aging medicine offers promise of a goal oriented path to optimal health and well being. Or we can pursue restrictive policy driven, algorithms of cookbook medicine.
What needs to change? What gives it the stamp of approval? Is it science or politics? As the great philosopher Schopenhauer said:
“All truth passes through three stages. First it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.”
There is a plethora of terms that have been spun off to better describe this new field. Longevity Medicine, Age Management Medicine, functional medicine, integrative medicine. These are all descriptions in pursuit of a new paradigm.
All medicine has from the beginning, most notably Hippocrates, been an effort to mitigate illness and suffering with the implicit goal of increasing life span. One yardstick could simply be life span or longevity. But we are more interested in quality of life. And here is the key. Increasing HealthSpan. It is about “squaring the curve” — living longer in a healthy, vibrant, vigorous, independent, and happy state of health and well being.
The paradigm shift is tectonic. We don’t have a health care system. We have a disease management system. All ICD-9 (now ICD-10) codes are a codification of disease. If you feel weak, fatigued or just “not right” you may not be suffering from a disease. You can have a battery of tests and nothing will “show positive” for a disease. You have a dysfunction. Pre-menopause is not really a disease. Yet it lasts for upwards of 4-5 years and can be seriously disabling. A dysfunction. Andropause is not even widely recognized as such. It is also a dysfunction that men suffer later than menopause. There is no formal ICD-10 code for andropause — just hypogonadism.
The wonderful medicine of the last 50 years has been disease-based , pathology-oriented with the goal of finding the right drug to cure or mitigate your disease. But there is a rapidly growing residua of conditions and patients who are not right, dysfunctional, that do not respond to the conventional or traditional approach. …
It was never about Health. It was never about universal health care. Access does not equal care and certainly not quality care. Yes, one side “won.” This is not a victory for you.
It is not a left-wing agenda. It is not socialized medicine. This is the first time the Federal Government has mandated the purchase of a private party product. And from the very racketeering group that is the root cause of the problem in the first place. What a travesty. Another government subsidy. Effectively amounts to another “government bailout.”
As Michael Moore wryly said:
The larger picture here is that the private insurance companies are still the ones in charge. They’re still going to call the shots. And if anything, they’ve just been given another big handout by the government by guaranteeing customers. I mean, this is really kind of crazy when you think about it.
This is not the same as a state mandate for auto insurance.
The State of California is unrelenting on this point. Driving is a privilege! It is not a right. If you do not drive, you are not mandated to purchase auto insurance. Furthermore, the reality is auto insurance does not cost $5000-12,000 annually.
This is the first major landmark piece of legislation in American history that was passed by such a narrow margin without a single Republican vote. Social Security passed with bipartisan support in 1935 — 81 Republican Congressman and 16 Republican Senators. In 1965 Medicare passed with bipartisan support — 70 House Republicans and 13 Senate Republicans. In 2010 there was not one single Republican vote. And the margin in the House was razor thin — 220 to 212.
It also violates a well-tested political strategy — sell it first to the American people who will then pressure Congress to pass new legislation. The public is not aboard. The latest Quinnipiac and Washington Post polls show the public still opposes this landmark Act.
AT&T has already made plans for a $1 billion write-off in advance of cost shifting. And legal staff is hard at work looking for technical loopholes. This just in from Robert Peer at the New York Times:
William G. Schiffbauer, a lawyer whose clients include employers and insurance companies, said: “The fine print differs from the larger political message. If a company sells insurance, it will have to cover pre-existing conditions for children covered by the policy. But it does not have to sell to somebody with a pre-existing condition. And the insurer could increase premiums to cover the additional cost.”
Everyone is giddy about “the win.” This is only the end of the beginning.
Remember the Telecommunications act of 1996? It was enacted to guarantee local competition amongst the major carriers. It never happened.
Too often have I written about the endgame. Shades of Mark Twain — reports of my death are exaggerated. But this really is the ninth inning. The problem is the president is looking for the long ball — the out of the park home run. When he should have been hitting singles, or emulating the great Joe Montana — short yardage high percentage gains — not Hail Mary passes.
Ave, Imperator, morituri te salutant
The secret fate of all voting democratic House members. The arm twisting in the house rises to epic proportions not seen since the days of the infamous Tom DeLay – the Hammer.
This will be a bad bill. You are all unwitting pawns in this game. It will solve nothing. It cures nothing. It has emboldened the insurance racketeers and Big Pharma. It has only one potential good outcome — Rush Limbaugh has promised he will leave the country.
They have rolled Howard Dean and Dennis Kucinich. Other voices have been marginalized – Bernadine Healy, Robert Reich, Norman Goldman of Talk Left, Marcia Angell. And who will benefit from a fatally flawed passage? The rising unaffiliated — the independent vote. This is a Greek tragedy. A Pyrrhic victory.
We are all too aware of the right wing echo chamber. A well orchestrated score promoting stereotyped rat a tat answers. How do they do this?
The same may be true in on the left as well. We hear platitudes and assertions over and over again without challenge.
1. United States ranks number 37 in the world in healthcare.
Why repeat this assertion over and over and over again? Because it makes a false point.
This figure is derived from life expectancy in the OECD (organization of economic cooperation and development) countries. The spread is narrow – less than five years.
My friend Burton Goldberg, one of the most successful publishers of alternative medicine, constantly beseeched me on this issue — investigate life expectancy derivations. Life expectancy is a highly complex mathematical formula that balances death with infant mortality.
A country with a high infant mortality has a lower life expectancy rate – at birth.
For the most perplexing reasons, the United States still has a relatively high infant mortality rate. If the figures are adjusted for life expectancy after the age of 60 we rate number 5 in the world. If life expectancy figures are adjusted after the age of 80 we rate number 3 in the world.
In other words, as we advance in age, the effect of infant mortality is factored out and the real life expectancy becomes more apparent. We are not number 37 in the world. We are in the top three. Life expectancy figures beg a revised definition.
Furthermore, life expectancy is a dreadfully inadequate measure of the health of a nation. It says nothing about the quality of life. HDI, (Human Development Index) may be a better measure.] It says nothing about vibrancy, activity, mental health, social health, sexual health, or productivity. It simply means that you crossed the finish line at a particular age. No matter whether you dashed across or fell across the finish line and died.
In Anti-Aging Medicine, we talk about “squaring the curve.” Increased Health Span and not Life Span. A healthy life until old age followed by sudden death. Not a slow inexorable painful march to the end.
2. The medical system suffers from over utilization.
Not as I see it. Quite the opposite. I see scores of patients who have pleaded for years for adequate and thorough lab testing only to needlessly suffer through unnecessary dysfunctional states This is a natural consequence of HMO and PPO medicine. Bottom-line cost-recovery medicine is a zero sum game.
3. If you do not pass this bill everybody will end up in the emergency room.
There is such an appalling lack of medical input in this entire debate. Urgent care medicine had its roots in the 1980s. Originally funded and promulgated by astute entrepreneurs and ex-emergency physicians, these facilities answered the need for acute medicine outside of an emergency facility. There are more than 8700 Urgent centers visits vs. 4600 emergency departments. [And by the way, Emergency care represents less than 3 percent of the nation’s $2.1 trillion in health care expenditures while covering 120 million people a year.]
This is market-oriented medicine. A workable and elegant solution in response to a market demand for immediate care outside of exorbitant emergency rooms. They are successful and see all comers. In Atlanta alone, my good friend Jordan Rice, one of the leading Urgent Care entrepreneurs in the country boasts of the ability to see any and all comers — Medicaid and cash paying patients.
Even the original Medicare bill of a 1965 garnered 13 Republican votes in the Senate and 70 Republican votes in the House. To pull every legislative trick in the book only underscores the thinness of support for this ill-conceived rewrite of our society. To be honest, Michelle Obama’s anti-obesity campaign could have more far-reaching effects that all 2700+ pages of this legislative lunacy.
Last night health care reform died. What went wrong? A plethora of explanations from all the usual suspects to follow. You will hear some rumblings of dissent — press on.
The simple answer: everything was wrong. This never was about health care reform. This was always an attempt at health insurance reform. And in that regard it was a miserable failure. The bill, as passed by the Senate, was a cruel proposition. The ultimate lay away plan: pay me now and you might be able to enjoy your coerced purchase in four years. Do you know how much can change in four years? Everything.
Half a loaf? No, worse. Here is your pre-Christmas present — a big lump of coal. Let me simplify and make clear my assertion. You are ill, in need of medical care. You want the best. Whose wise counsel and help do you seek? You want someone who is sympathetic, skilled and competent.
This debate has never been about Health. Certainly not your health. For the last six months I have steadfastly maintained the large insurance racketeers will not lose this one. They have thrown all their money into the ring. It has paid off handsomely. Their paid surrogates have performed well. Like their Wall Street kin, the pirates have won again. Robert Reich pulls no punches:
In other words, the private insurers are winning and the public is losing.
Howard Dean at his most articulate and unambiguous self. The time has finally come. There is nothing left to support. It’s now face saving time. It is not about Joe Lieberman. He’s just become the Mannie Ramirez of the Senate.
“It’s not health care reform … and it’s too bad it’s come this.”
“You are going to be forced to pay, on average, 27% of your money to pay CEOs $20 million a year…”
Single payor is not the answer. But this is an illuminating sketch of “HealthCare 101” coming into the bottom of the 8th inning. What is missing is the critical distinction between big business vs small business in medicine. Your old fashioned GP was in small business much as he/she always protested to the contrary.
Where is this train wreck headed? Wending its way through the various Senate and House subcommittees, the health care reform debate of 2009 is approaching a crescendo. What do we have to show? The question I posed in a previous post still has yet to be answered – just what is the problem? Is the problem greater access? Is the problem escalating insurance premiums? Is the problem stratospheric and ruinous hospitalization bills? Is the problem rapidly declining quality of care? Or is this simply become a matter of whose team wins? The bill fails — the president sinks.
Andrew Weil concludes:
But what’s missing, tragically, is a diagnosis of the real, far more fundamental problem, which is that what’s even worse than its stratospheric cost is the fact that American health care doesn’t fulfill its prime directive — it does not help people become or stay healthy.
We have seen the emergence of “evidence-based medicine” in the last 10 years. This has been an effort to further legitimize and give scientific basis to common medical therapies. A medical version of “show me the money.” I have always thought this was rather inane, since it presumed that all medicine for the last 2000 years has been unscientific and irrational. Although the reality is medicine is not nearly as scientific as asserted. Only 10-20% of medical practice is based on sound scientific principles. This rankles most physicians who believe that conventional medicine is scientifically-based. The highest form of medicine is the practiced art using scientific principles and technology.
A series of US Task Force recommendations are being rolled out by the Department of Health and Human Services. These are well-intentioned and rational. Examining the literature and epidemiology of medical practices in an effort to determine what is safe, sane, practical and effective. The trap is “effective” as you will see.