I can fuss at overweight people and smokers, but they’re not going to change until they’re ready. As doctor, I had more questions about mattresses than diet.
By Mike Gorback, MD, for WOLF STREET:
Once upon a time, there was talk of reimbursing doctors based on certain parameters. It’s typical for bureaucrats to tally what they can, instead of what they should. For instance, one proposed measure was how many of your diabetic patients had acceptable hemoglobin and levels.
No doctor can control that. Who can make sure their diabetic patients are eating right, taking their insulin, or exercising? If you’re my patient and won’t follow advice, I’m going to punt you out of my practice because I’ll be punished for your behavior.
You know what talks and what walks. These days it’s about Accountable Care Organizations (ACOs) that keep costs down. I think that redefines the mission to financial health and brings up whether you want your doctor to be a doer or a not-doer.
The biggest strides in health have not been due to doctors but rather public health. Dysentery killed more soldiers in the Civil War than bullets.
Vaccines have also played a huge role so medicine gets some credit, but it wasn’t an army of doctors across the land spraying penicillin. It was a relative handful of researchers. Who do you know that died of smallpox, polio, diphtheria, pertussis, or tetanus?
Think about air quality. People bitch about smog but in the 1800s there was horse shit all over the streets. Horses and pedestrians ground it into the dirt and then rain would mix it all together.
Then the sun would dry up the street and all the foot traffic would stir up the shit dust for people to breathe.
The automobile changed that, but as I like to say, the solution to a problem creates a new problem.
Thomas Midgely was a prolific genius who came up with leaded gasoline for engine knocking. Nobody seemed to take the hint when workers at the chemical plant died of lead poisoning. Midgely himself got lead poisoning.
He also invented CFCs, including Freon. Before that cooling systems used ammonia, sulfur, and propane which had an unfortunate tendency to burst into flames or even explode. They were also toxic. Freon was a welcome relief.
I know about Midgely from reading Bill Bryson’s A Short History of Nearly Everything. Bryson said Midgely had “an instinct for the regrettable that was almost uncanny.” That included his manner of death. Midgely got polio and was severely disabled. He devised a complicated rig to get in and out of bed. He died of strangulation when he got tangled up in it.
A less kind observer said Midgely had “more impact on the atmosphere than any other single organism in Earth’s history.”
Changes in air quality, clean water, housing codes, and other measures completely changed the major causes of death.
In 1900 the top three were pneumonia/influenza, tuberculosis, and diarrhea. Now only one – influenza/pneumonia – are in the top 10. The top 3 now are heart disease, cancer, and cerebrovascular disease.
Sanitation has prevented more disease than all the doctor counseling in the history of the world, not surprising since tobacco was once considered medicinal. I think the theme will catch a lot of people on the back foot.
Nutritionists are the Hari Krishnas of health care. Always in your face about it, but the science is fuzzy (unlike Hari Krishnas, who are bald).
When I was a medical tadpole, I remember two debates. One was eating too much cholesterol. I was in the unpopular camp that said our bodies make cholesterol, so why would exogenous cholesterol be bad? I was also really pissed about the unavailability of whole milk. 2% fat milk? Blech. I was right. It’s way more complicated. Egg yolks are good for you now. A rich source of omega-3.
I also used to advocate avoidance of refined sugar and carbs. I had a real toe-to-toe with a pharmacy professor decades ago who maintained that sugar is sugar. Well, now we know that refined sugar pops your blood sugar and unleashes holy hell.
Ironically, I pulled a Midgely on myself. My favorite drink used to be bourbon and ginger. Then I had a kidney stone. My urine was filled with uric acid crystals and my blood uric acid was high. The nurses forgot to strain my urine after I passed the stone so we can’t be 100% sure, but I’m 99.999% sure it was a uric acid stone. I grieve for that lost stone, who I planned to name Rocky after my favorite squirrel. How many people give birth to their own pet rock?
You know what’s the worst? Beer. If you have gout drinking a beer is like praying for a kidney stone. I’ve had one beer since I passed that stone in 2017. OMG did that taste good. Blue Moon Belgian White.
Ginger ale contains high fructose corn syrup. Alcohol plus sugar raise uric acid levels.
My family doctor prescribed allopurinol for my gout. I never took it because I knew what I had to do. Dietary counseling never came up. My urologist never said a word. Now I drink martinis and tequila. Olives and citrus fruit like limes are good for you. Big Macs contain protein, grain, and lettuce – health food. And remember, ketchup is a vegetable…
By Mike Gorback, “screw the formal MD crap; we’re all in this together.” He also wrote, Enter GreedCare, where the White Coat is Supplanted by the Grey Pinstripe of Corporate Conglomerates
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