Rahul Parikh

IMG_1534-leveled

Off and on during the current health reform debate, politicians, leaders and pundits have raised the issue personal responsibility. For instance, take these comments from the John Mackey, the CEO of Whole Foods:

“…many of our health-care problems are self-inflicted: two-thirds of Americans are now overweight and one-third are obese. Most of the diseases that kill us and account for about 70% of all health-care spending—heart disease, cancer, stroke, diabetes and obesity—are mostly preventable through proper diet, exercise, not smoking, minimal alcohol consumption and other healthy lifestyle choices.”

That is a refrain many of us who think and discuss American medicine are used to hearing.  In fact, I wrote an article over a year ago in Salon emphasizing the role of individuals in taking care of their own health.  That being said, though, I think (especially after having read my readers’ comments about that piece) the view doesn’t take into account the socio-economic factors that pressure many Americans into chronic illness.

Let’s look at obesity as an example that illustrates this.  Almost one-third of adults and children are obese, a problem that costs us $100 billion dollars a year.  In California, where I live, our State Controller estimates that “the economic cost to California of adults who are obese, overweight and physically inactive is equivalent to more than a third of the state’s total budget.”

Those are the facts, and as Mackey so obviously says, a proper diet and exercise can help to prevent obesity.  But for many, that’s not so easy.

To illustrate what I mean, consider the following experiment:  a while ago, I decided to take a trip to the grocery store with $40. I spent half of that money on fresh, healthy foods and the other half on processed foods.  I took my grocery bags home and counted up the calories per dollar that I spent on both types of foods.  For the healthier choices, I got 140 Calories per dollar; for the processed foods, I got 370 Calories per dollar.

That little experiment has real-world implications when you think about middle class families, with two (or one or zero given our current unemployment numbers) working parents, trying to make ends meet.  Even people living paycheck to paycheck know what food choices are good for them. But if you’re one of the millions of families just scraping by, popping a couple of DiGiorno pizzas in the over for dinner is cheap and calorie-laden enough to soothe your hunger pangs. It also leaves one less battle to fight with your kids between getting them to finish their schoolwork and getting them ready for bed.

Add the consequences of my little experiment to some other factors, like the lack of access to fresh foods in poorer communities (Mr. Mackey, do you have any stores in low-income areas?), or a lack of safe places to get out and exercise, and you can see that prevention has as much to do with class, income, and communities as it does with personal responsibility.

Dr. Rahul Parikh is a Pediatrician in the San Francisco Bay Area and a frequent contributor to Salon.com and THCB. Dr. Parikh practices with the Walnut Creek Medical Center and Kasier Permanente.

Share on Twitter

ParikhWow. I’ve just taken care of three patients in 12 minutes, and I didn’t do it by “churning” them through my office as if it’s some sort of factory assembly line. Rather, those patients (their parents, more specifically — I’m a pediatrician), e-mailed me over a secure network with questions and descriptions of signs and symptoms.

One mother attached a digital photo of a rash on her 3-month-old daughter’s face; it turned out be nothing more serious than baby acne (it’ll go away in a month or so). Another mom had noticed that her son was missing one of his pre-kindergarten immunizations (she had pulled up his shot records online) and requested that I order it. And the father of a 5-month-old boy told me that his son has been constipated off and on for the last month. I e-mailed him a questionnaire so I could determine whether the family should try something at home or bring the child to the office. Continue reading “The Doctor Is In and Logged On.”

Share on Twitter

When I was a kid growing up in Los Angeles, there was this local TV show my dad used to enjoy  watching called Fight Back with David Horowitz.  Basically, Horowitz, a TV reporter and consumer advocate, used to put the claims a manufacturer made about their products to the test—whether it was if Samsonite luggage could withstand abuse from a Gorilla or Bounty really was the “quicker picker upper,” it was on its show and ended up either endorsed or debunked by it.  It was Consumer Reports come to life, if you will—pitting products against one another to see which one was worth putting down some hard earned dollars for.

Now, over 30 years later, we in medicine are just getting around to doing the exact same thing that Horowitz was with retail way back in the 1970s—comparing the claims made by drug and device makers about their products.

Continue reading “The Case for Comparative Effectiveness Research”

Share on Twitter

Like most doctors, I was busy seeing a full schedule of patients when President Obama addressed members of the American Medical Association at their annual meeting in Chicago.  The speech was billed as a crucial confrontation over health reform, and anticipation had been building for quite some time.   So I was too busy to learn anything about his remarks and the response until I got home.

Then again, I’m not a member of the AMA.  I never have been.  Neither are very many of my  physician friends and colleagues.  In fact, the odds are that your doctor isn’t a member of the AMA, because at best, only between 25-30% of the approximately 800,000 doctors in country belong to it.  And a good percentage (up to half of members according to one report) of those include residents and medical students, who get big discounts on membership and a free subscription to a journal when they join. Continue reading “How Relevant is the American Medical Association?”

Share on Twitter

Wow. I’ve just taken care of three patients in 12 minutes, and I didn’t do it by “churning” them through my office as if it’s some sort of factory assembly line. Rather, those patients (their parents, more specifically — I’m a pediatrician), e-mailed me over a secure network with questions and descriptions of signs and symptoms.

One mother attached a digital photo of a rash on her 3-month-old daughter’s face; it turned out be nothing more serious than baby acne (it’ll go away in a month or so). Another mom had noticed that her son was missing one of his pre-kindergarten immunizations (she had pulled up his shot records online) and requested that I order it. And the father of a 5-month-old boy told me that his son has been constipated off and on for the last month. I e-mailed him a questionnaire so I could determine whether the family should try something at home or bring the child to the office.

Continue reading “The Doctor Is In and Logged On.”

Share on Twitter

FROM THE VAULT

The Power of Small Why Doctors Shouldn't Be Healers Big Data in Healthcare. Good or Evil? Depends on the Dollars. California's Proposition 46 Narrow Networking
MASTHEAD STUFF

MATTHEW HOLT
Founder & Publisher

JOHN IRVINE
Executive Editor

JONATHAN HALVORSON
Editor

JOE FLOWER
Contributing Editor

MICHAEL MILLENSON
Contributing Editor

ALEX EPSTEIN
Director of Digital Media

MICHELLE NOTEBOOM Business Development

MUNIA MITRA, MD
Clinical Medicine

Vikram Khanna
Editor-At-Large, Wellness

THCB FROM A-Z

FOLLOW US ON TWITTER
@THCBStaff

WHERE IN THE WORLD WE ARE

The Health Care Blog (THCB) is based in San Francisco. We were founded in 2004 by Matthew Holt and John Irvine.

MEDIA REQUESTS

Interview Requests + Bookings. We like to talk. E-mail us.

BLOGGING
Yes. We're looking for bloggers. Send us your posts.

STORY TIPS
Breaking health care story? Drop us an e-mail.

CROSSPOSTS

We frequently accept crossposts from smaller blogs and major U.S. and International publications. You'll need syndication rights. Email a link to your submission.

WHAT WE'RE LOOKING FOR

Op-eds. Crossposts. Columns. Great ideas for improving the health care system. Pitches for healthcare-focused startups and business.Write ups of original research. Reviews of new healthcare products and startups. Data-driven analysis of health care trends. Policy proposals. E-mail us a copy of your piece in the body of your email or as a Google Doc. No phone calls please!

THCB PRESS

Healthcare focused e-books and videos for distribution via THCB and other channels like Amazon and Smashwords. Want to get involved? Send us a note telling us what you have in mind. Proposals should be no more than one page in length.

HEALTH SYSTEM $#@!!!
If you've healthcare professional or consumer and have had a recent experience with the U.S. health care system, either for good or bad, that you want the world to know about, tell us about it. Have a good health care story you think we should know about? Send story ideas and tips to editor@thehealthcareblog.com.

REPRINTS Questions on reprints, permissions and syndication to ad_sales@thehealthcareblog.com.

WHAT WE COVER

HEALTHCARE, GENERAL

Affordable Care Act
Business of Health Care
National health policy
Life on the front lines
Practice management
Hospital managment
Health plans
Prevention
Specialty practice
Oncology
Cardiology
Geriatrics
ENT
Emergency Medicine
Radiology
Nursing
Quality, Costs
Residency
Research
Medical education
Med School
CMS
CDC
HHS
FDA
Public Health
Wellness

HIT TOPICS
Apple
Analytics
athenahealth
Electronic medical records
EPIC
Design
Accountable care organizations
Meaningful use
Interoperability
Online Communities
Open Source
Privacy
Usability
Samsung
Social media
Tips and Tricks
Wearables
Workflow
Exchanges

EVENTS

TedMed
HIMSS South x South West
Health 2.0
WHCC
AHIP
AHIMA
Log in - Powered by WordPress.