> Gautam Mukunda <[EMAIL PROTECTED]> wrote: > > Deborah Harrell <[EMAIL PROTECTED]> wrote:
> > No mention in the article of the fact that exercise > > raises HDL. Or that avoiding a sedentary lifestyle > > and a diet high in saturated fats would *prevent* > > much of the plaque build-up in the first place... <snip> ...the vast majority of Americans who > > have clinically significant atherosclerosis do so > > because of poor lifestyle choices. > >You know, oddly enough, I'm going to reverse positions > with Debbi here. I'm going to be the one rejecting > Puritanism, and she can be the one preaching reserve > and self-discipline :-) Ah-HA! You swinger-in-the-wind, you! ;) And who you callin' "Puritan!?" Considering I have admitted my (unrepentant!) chocoholism, my belief in sex-as-recreational (well, within the bounds of a genuine relationship), *and* my stated religion as 'heretical Lutheran Deism,' I demand an apology and retraction!!! > In the old days when people tore their ACL, their > doctors told them they should give up tennis. Now we > get surgery, rehab, and go out and play again. That > drives up medical costs, but, well, so what? It's > worth it. Ah, but the other benefits of playing tennis - exercise, stress-reduction (well, maybe!), and social interaction - outweigh (or at least even-up) the costs in the long run. > Similarly. Even working consulting hours, I lift > weights an average of 3 times a week, so I'm not > defending a personal unwillingness to work out here. > > But look, not everyone does enjoy working out. If > medical technology can now allow people to eat what > they want, participate in the activities they want, > not participate in activities they don't want to > participate in, and they don't die from heart attacks > because of it - that's _great_. That's what medical > research is _for_. If we had unlimited resources, I'd agree. And while I don't want to whine about the "disadvantaged poor," there is no question that the impoverished have much less access to fresh fruits and vegetables (I posted an article about this a couple of months ago), and are heavily targeted by advertising for alcohol and tobacco products (there was at least one good study some years ago; I remember disbelieving it and then driving through 'a bad side' of Dallas near Baylor, and being shocked to find that *nearly all* the billboards were for beer/liquor, fast food, and cigarettes). > Finally, the record of behavioral intervention in > lowering cholesterol is so poor, and compliance with > dietary and lifestyle advice is so low (on the order > of 20% in the US - and that's compliance, not success > rates, which are so low it's not even worth talking > about) that really, saying "if only people would act > this way" is wishful thinking. That's because we haven't gone for a massive educational campaign. When intensive intervention is undertaken, as in The Diabetes Control and Complications Trial (DCCT), long-range improvements *have* occurred: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14570951&dopt=Abstract "CONCLUSIONS: The persistent beneficial effects on albumin excretion and the reduced incidence of hypertension 7 to 8 years after the end of the DCCT suggest that previous intensive treatment of diabetes with near-normal glycemia during the DCCT has an extended benefit in delaying progression of diabetic nephropathy." (i.e. thus delaying kidney failure) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12788993&dopt=Abstract "CONCLUSIONS: Intensive therapy during the DCCT resulted in decreased progression of intima-media thickness [of the carotid artery] six years after the end of the trial." (i.e. less arteriosclerosis) Re: smoking and diet vis-a-vis heart disease: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14594779&dopt=Abstract "In the Oslo Diet and Antismoking Trial, 1232 high-risk men aged 40-49 y were randomly assigned to either a lifestyle intervention group or a control group for 5 y. The study showed a significant reduction in ischemic heart disease (IHD) events in the intervention group. Our objective was to examine this cohort 23 y after the start of the trial...CONCLUSIONS: These data suggest that advice to change diet and smoking habits reduced the relative risk of IHD mortality after 23 y in men with high triacylglycerol concentrations. Men with normal triacylglycerol concentrations did not appear to achieve this long-term benefit of lifestyle intervention." Smoking during pregnancy: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12911442&dopt=Abstract "CONCLUSIONS: A multimodal intervention regimen with initial individual counseling supplemented by an invitation to join a smoking cessation program with nicotine replacement therapy as a voluntary option markedly increased cessation rates during pregnancy." [Note: While the actual rates for quiting were 14% in the intervention group and 5% in the controls, which is not high, given the known adverse effects of smoking to liveborn babies (increased bronchitis and other respiratory illnesses, decreased birthweight, etc.), this was probably cost-effective. More intensive intervention might have had better rates.] My personal experience with various patients and various lifestyle-related illnesses was that persistent, compassionate, culturally-sensitive counseling -- not haranguing!(?sp?) -- *did* make a difference, with weight loss, lowered blood sugar levels, increased physical activity (I had them count everything from raking leaves to vacuuming the floor, and included pets if possible {walk the dog, pull a piece of string for the cat to chase around the yard, etc.}), lowered blood pressure levels and reduction in various medications. But such counseling takes time and genuine interest in the person -- most people can spot rote parroting a mile off. > ...So if this discovery pans out, it's > going to save a lot of lives and allow a lot of > people >to enjoy their lives more. If that costs money, well, > that's the whole purpose of money, so that's okay. Yes, but whose money? Or put another way, with so many working people not being able to afford medical insurance now -- the number of Americans sans coverage is ~ 41 million: http://www.jsonline.com/news/editorials/feb03/114794.asp and from the CDC 2003 US Health Report: "In 2001 more than 16 percent of Americans under 65 years of age reported having no health insurance coverage." http://www.cdc.gov/nchs/data/hus/hus03cht.pdf ...will the 'average Joe' benefit from better therapies? What I am saying is that given limited resources, *prevention* is better than *therapy for the full-blown disease.* I'm not against a tiered health care system (what we have now is in fact a hidden rationing system, with the rich having full access and the poor limited access) -- hey, if you want to pay for a gourmet chef to prepare your hospital meals, be my guest! -- but to say that prevention isn't feasible is to buy into the "we don't need a fence at the top of the cliff, but don't take away the ambulance at the bottom!" scenario. (That's the single-sentence version of a much longer vignette.) > Circling back to a previous discussion, I lay high > odds that they work for a pharma company of some sort > (probably a small one) and not the government :-) According to the second-to-last link above, "The fastest growing sector of our health care spending is in pharmaceuticals. In 2001, the last year for which we have complete statistics, prescription drugs cost more than $140 billion, almost 10% of the total. "The problem lies in how the industry spends that money. About 15% goes to research and development. That's money well-spent, but it's far less than what is spent on net profits (19%), cost of sales (25%) and marketing, general and administrative (33%)..." I've seen similar figures elsewhere (and I think I posted them with a link a month or two ago). Until we have unlimited resources, we're going to have to allocate our public health expenditures more wisely. Debbi whose stance on convicted murderers getting organ transplants *could* be described as Puritanical... ;) __________________________________ Do you Yahoo!? Protect your identity with Yahoo! Mail AddressGuard http://antispam.yahoo.com/whatsnewfree _______________________________________________ http://www.mccmedia.com/mailman/listinfo/brin-l
