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USA HEALTHCARE- GLUTEUS MAXIMUS BACKWARDS

June 28, 2016
  1. The pharmacist calls the physician and says the medicine that was prescribed for the patient can’t be filled because the insurance company has a limit on the quantity from the last prescription.
  2. A CT scan was ordered for a patient with cancer to see if the cancer has come back because the patient experienced symptoms. The insurance company has to give the final approval for authorization and says the process takes up to 5 days. Meanwhile the patient has to wait in fear and agony for those five days. And what happens when the request is not authorized?
  3. A doctor bills the insurance company for $120.00 for service that required 40 minutes of care in front of the patient since the patient’s medical history is complex. The doctor collects $20.00 as a co-pay from the patient and the insurance company pays the doctor $49.79. That is a total reimbursement of $69.79 for the doctor. The doctor has to “eat” the rest.
  4. The doctor prescribes an eye drop for a patient suffering from allergies and uses the brand that best suits the condition. The prescription is not covered by the insurance company because it is a brand product and cost too much. The patient asked how much it would cost to pay cash. The answer: $250.00 for a bottle smaller than the size of your thumbnail. Although the pharmaceutical company paid lots of money to get the drug approved, it now cost them $5.00 to make that bottle of eye drops.
  5. We have a pipeline of new drugs that have come to market; many of them are advertised on TV with names no one can pronounce but did you know most of those drugs are not covered by your insurance company because they cost too much? A class of drugs called biologicals (most end with the letters …mab ) are breakthroughs in science but their use will be limited because of their high cost. The drug Zolair used for severe allergic asthma and other debilitating allergic conditions will set you back about $3,000 per month. If these drugs are of limited use our feedback for further research is limited. I think we will abandon the use of chemotherapy and radiation therapy as archaic medicines to fight cancers and replace them with specific products that just fight cancer cells without destruction of healthy surrounding cells and the part of our immunity that fights emerging cancer cell all the time.
  6. Your health insurance company is extremely proficient at saving costs. They “penny pinch every outgoing expense. That’s fine; just good business sense. But did you know the average PERSONAL salary of your insurances’ CEO is not in the simple million dollar range but 200-300 million dollar ranges and that does not include stock options for those that are for profit corporations. There is an emerging club in the US called the billionaire’s club. These CEO’s along with hedge fund operators often compete as to who make more.
  7. In the sixties and seventies all healthcare insurance companies were non-profit; they did not have to answer to stockholders. When HMO’s emerged and later present companies like Aetna, Cigna, United Healthcare, WellPoint became commonplace, the for-profit healthcare industry emerged. Their PRIMARY interest is NOT your healthcare but satisfying the stockholders. MONEY is the GOD of healthcare in the US.
  8. The reason why most people are not satisfied with their doctor and why most doctors are not satisfied with their profession is because of medical insurance and pharmaceutical greed. In order for doctors or the companies that employ them are to survive economically, doctors must see 6-8 patients per hour. With phone calls or other interruptions, that means your doctor can only spend about 5 minutes with you per visit. It is not that they want to leave the exam room quickly; it is just that they are under economic pressure to survive their career. Now here’s the crazy part. Insurance companies know the doctor visit is 5 minutes and that’s their justification for low payments. So who loses in this cat and mouse relationship? YOU the patient.
  9. State agencies that dictate healthcare policy derive such policy without input from the doctors who actually perform healthcare services. They usually consult or hire medical doctors who are solely administrators and don’t see patients every 5 minutes. These doctors are paid well by their parent companies; many are not given voting rights during corporate board meetings.
  10. It is great to be a pharmaceutical representative; you get a free loaner car, car care and gas when visiting doctors’ offices or hospitals. The pay is good too. You operate on your own schedule. However, when the company’s product that you are advertising becomes generic, you may be suddenly out of a job. They treat the reps well when they are doing well and throw you to the trash when business is not good. It’s like being a coach for the NFL or NBA but you don’t have the financial cushion that millionaire coaches have. Again MONEY trumps everything in the healthcare industry.
  11. I remember during the Clinton Administration, Hilary published a handbook outlying a new healthcare system for the country that had many aspects of The Affordable Care Act that we have today. When that book was published, Hiliary’s life was threatened since her proposal would have upset the power of all those who owned the healthcare industrial complex. It was never mentioned again.

The above are a fraction of complaints that can be logged about our healthcare system. My contention is that healthcare is more about financial gain than care for the human body, mind and spirit. I was taught in church that there is only one God; paganism is an insult to God. Yet it is clear that the American way of life treats money as our primary god. It is the main purpose while we are living beings.

“ Well Dr. Darden what would you to improve the system?” one would say.

I would have to remove the premise that human health be put in the same category of goods and services that our economy is based on. Human health is precious and cannot be equated with a certain value. Just ask a person who just lost a child to gun violence or a drunk driver accident. Love ones would sacrifice everything to save another loved one from dying; material wealth has no meaning at that time.  That means that health be removed from our system of economics and consolidated into a right and not a privilege. Just as we have a right to liberty and the pursuit of happiness lets add in that part that says LIFE. So that puts healthcare solely in the lap of government and not in institutions that exist only to make money. If you visited India (much less wealthy than the USA) and got sick or required surgery or mental health care, your services would be free whether you are a citizen or not. If you went to Germany or France or Canada the same would be true. Now I know that to change our healthcare system that dramatically would never happen. So let’s begin perhaps with using our existing insurance companies but requiring health insurance to be non-profit. Those insurances that want to abandon this approach could do so and revert to life and indemnity plans not involving healthcare. Blue Cross and Blue Shield are non-profit so let those companies “take the lead.”

The other item of change would require a salary cap of the CEO’s of all companies now that they would be non-profit. The third leg of the triad would involve the pharmaceutical companies since they too are “fleecing” the healthcare business of trillions of dollars. Remember when new HIV drugs came out and only Magic Johnsons of the world were able to afford them?  Now those same drugs are available via Medicare and Medicaid. The problem with pharmaceuticals involves the high cost of research and development and drug companies say they must charge very high prices for new drugs to re-coup this cost. The ultimate solution to this problem would place drug research only in government institutions such as NIH. Private companies could still invent new drugs but there would be a cap on their retail price in line with the government based drugs.

Such a system would certainly lower healthcare cost in the USA; it’s just that no one would become billionaires working in the system. Where is the value in that amount of greed anyway?

Dr. “D.”

HEALTHCARE OVERLOAD

November 25, 2015

I was reading an article in Contemporary Pediatrics (Oct. 2015 p. 14) where 20 to 50% of mothers (N=1,000) were not receiving advise from the pediatrician about sleep position, sleep location, pacifier use and breast feeding. That’s a high percentage!!

Now the American Academy of Pediatrics, the American Academy of Family Practice, and the federal and state health departments would be very unhappy to hear this. The Academies are organizations to provide data and protocols for care to the federal, state and local health departments, private insurance companies and to the providers of healthcare themselves. The state health departments are responsible for the implementation and monitoring of these policies. If a state is doing poorly following advised national protocol, then someone in the health department is not doing their job well.

So the people that actually deliver the services are the “providers” (i.e. doctors, PA’s and nurse practitioners- we’re not called doctors by the insurance industry anymore). That means that the “providers are the end of the line service group. If they don’t do their job then the local, state agencies fail. If you have been to the doctor lately, you probably have noticed that the doctor is looking more at a computer screen than they are looking at you.

Computers are great but many times there are buffering holdups or problems the doctor has with the software that was recently installed. It seems that the doctor is having an appointment with the machine and not you.  Now here is something you may not know unless you are a physician or “provider.”

The requirements for the providers as mandated by the respective state health departments include a list “a mile long.’ In pediatrics there are over 50 questions that the “provider” must somehow get answers to, distribute various forms, perform a physical exam, review the chart, chart vaccine status, give injections or prescriptions, and answer questions in what the insurance industry feels should be done in 10 -15 minutes.

Doctors who work in large groups as an employee are generally expected to see 6 patients in an hour. Now if you do the math you can see there is a major disconnect; in ten minutes you have to perform what would ordinarily take 40-50 minutes. What’s also important is that the insurance company will pay you for just ten minutes of time. So the doctor may bill $100.00 for that ten minute visit and receive $10 from the copay and $34.95 from the insurance company. Now if the “provider” spends 40 minutes with you to achieve all the mandated tasks, the insurance company will still pay you $34.95.

I recently had a heating company come to my house to inspect and clean my furnace for the winter. The technician removed the cover, looked around with his flashlight, replaced the filter (that I purchased) closed the cover and charged me $119.00.  With a $200,000.00 tuition bill for medical school, the prospective doctors need to take note.

So this is where computers come in. They can memorize anything we put into them and “spit” gobs of information out at the push of a button. Electronic medical records (EMR) use expensive software that can store all the information that the health agencies require and “spit” it out at a moment’s notice.  Now it doesn’t mean that the doctor is going to ask all fifty questions but the computer will automatically assume that these questions have been asked and record them as being satisfied. Your doctor’s visit may have lasted only ten minutes but if an auditor asks to see a report the computer will produce 5 pages of “documentation” that everything has been satisfied, thus allowing the “provider” to move on to the next ten minute encounter.

So there is this chess game between “providers” and auditors. As long as the mandated requirements are documented that’s all the auditors are concerned about and you pass there test with flying colors. The doctor is happy that the audit went well but is concerned about the real quality of the encounter with the patient. “I didn’t go to medical school to pass audit surveillance testing,” one might say. Now if you ignore the mandated requirements and focus on real interaction with your patient, you may feel you are doing the right and just thing, but the reality is that you may not be able to practice medicine very long because of non-compliance with state regulations. So what happens is that the “providers” feel unsatisfied with their purpose and certainly the patient feels unsatisfied with the quality of service. Clearly there is a disconnect here. So patients, if you feel your doctor is not meeting your expectations, it’s not the doctor’s fault; they simply are complying with state mandates so they can keep their job.

So where is the solution? Healthcare may be good on computer hard drives but not in reality. Imagine it is the year 2022. Medical care in the USA is divided into two separate entities, preventive and wellness care and disease care. Providers who choose to deliver preventative and wellness care are nurses, nurse practitioners and those with master’s in public health (MPH). The medical doctors are not at all involved here. In a sense, medical doctors no longer practice “primary care.’ Their job is to fight illness, control or cure disease and to repair trauma. Using insurance terms, they are indemnity “providers” only.

Internal medicine doctors will treat cancer and control your diabetes but things like diet exercise, meditation, yoga, sexuality, happiness and stress will be handled by the preventative and wellness personnel. You are required to visit the health and wellness providers if you desire to have coverage for indemnity care. If you choose not to attend wellness clinics, then indemnity care costs comes out of your pocket.

In this system both sets of providers I feel would do a good, thorough and honest job that is satisfactory for the health providers and patients. If we don’t change the concept doctors will be VERY disinclined to go into “primary care” as we call it today and simply go into fields associated with major disease, trauma and fat paychecks.

The Affordable Health Act has revolutionized the coverage of healthcare from insurance companies; now it is time for the healthcare system to undergo its’s own revolution and deliver the care that people expect and desire.

….just a thought…….

 

See ya!!!

Dr. “D”

THE VALUE OF HARD WORK

May 21, 2015

The other day I saw in my office a new patient for a physical exam. She was a nine year old girl from Sierra Leone who arrived here with her parents just three months ago. She came with her father and mother. Now, one would anticipate some shyness and reluctance from a nine year old girl from another country to visit the doctor and that he was a man. Remember in Sierra Leone, war has been a constant, Ebola virus has been rampant and nine year old girls are not always treated as nine year old girls; rape is common.

I was greatly impressed that she held her head high with direct eye contact. I was impressed that she extended her hand for handshaking even before I could do likewise. I was impressed that her command of English was perfect. I was impressed that she began giving me her medical history without my prompting.

After learning from her that the people of Sierra Leone speak in Creole, I became confused because I only associated Creole dialect with Louisiana and its French infiltration. She corrected my miseducation by saying that Creole was an African dialect and that the reason it hit New Orleans was because most of the slaves that came to that port were from Sierra Leone.  WOW!  Was I ever so impressed!

Well, I began to bring up an issue in my own head that I have discussed numerous times before. Why aren’t American children of that caliber? When attending graduations, I notice the valedictorians many times are kids from other countries like Viet Nam, Jamaica, India, Nigeria, Cameroon or China.

This nine year old told me with her father that “back home” in Sierra Leone, many of the children had fairly hard working chores such as collecting fire wood and hauling water sometimes miles away before the breakfast tea could be served and before the children started their long walks to school- all before 8AM!

So we buy our kids $180.00 sneakers and find they traded them with other students because after a month the shoes became boring. Our kids have to walk no more than half a block to catch the bus; that is if they don’t ride in air conditioned and heated cars and dropped off at the front door. I find that many children don’t have household chores anymore other than when the bedroom gets way out of control. In essence, in comparison with other cultures we spoil our kids. I am not exempt. I think it becomes a way of thinking that, assuming that we dearly love our children, we want them to have a “better life” than what we had as kids. I never had my parents buy outrageously expensive items for me; they bought me what was needed. Anything else we had to buy on our own accord. I will never forget a stereo system I bought in high school that I put on lay away for the entire summer until I was able to pay the balance. That stereo would last me all the way through med school. Christmas was the only exception; I got a real drum set that I still own today after 50 years!

I, like many of you, hate to see my kids suffer or go without. But are we doing the right thing by not balancing the value of working hard for the luxuries we have in life?

Here is the point; at some time in our children’s life, they MUST experience some level of struggle, of difficulty, of hard work. It may be painful for us as parents to watch but we must understand it is for their betterment in their adult lives.

Get your teenager to cut the grass and tell the lawn service you won’t need their services anymore. After thorough teaching, have them prepare Sundays’ meal and/or take care of the household’s laundry (not just their own). For those kids who are driving, get them to go on their own to the grocery store with your list for the family. Teach them how to use a sewing machine. Teach them how to change a flat tire. Teach them the basic tools of plumbing and carpentry. Don’t worry I am just as guilty as you for not pushing these things. But when I see such a mature and “ready for the world” nine year old from Sierra Leone, I get inspired to start changing my ways.

HARD WORK, IT NEVER HURT ANYONE!!!!

See ya in the summer!

Dr. “D”

MEASLES…………Oh noooooooo!!!!

February 12, 2015

MEASLES…………Oh noooooooo!!!!

I have learned since the Ebola crisis and now the measles outbreak how influential the media is on American society. So let’s talk about measles. I have heard many comments on talk radio and the news programs including the following:

  1. It causes autism
  2. It has mercury in it
  3. The vaccine doesn’t work
  4. It will cause brain injury
  5. “I won’t worry about my child being vaccinated because all the other children are vaccinated which keeps the incidence to a minimum”
  6. “All these vaccines are just a way to keep the pharmaceutical industry rich”

I remember seeing active measles cases when I was a medical resident in California. I will tell you those kids get very sick; there’s the 106 fever, the blood shot eyes and the malaise that scares anyone who witnesses the disease. If a child gets uncomplicated measles the child would be cared for at home, not hospitalized. The fact that it takes about 10 days to recover is challenging for those care givers who have to work. Looking at these children makes you wonder if the child is going to even “pull through.”

Well, what about the vaccine? The vaccine does NOT have Thiomersal (mercury) in it at all. The following ingredients are in the vaccine:

  1. Buffered salt solution
  2. Vitamins
  3. Amino acids
  4. Fetal bovine (cow) serum
  5. Synthesized Human albumen
  6. Sucrose (sugar)
  7. Phosphate glutamate
  8. Neomycin (antibiotic)

The viruses are grown in chick embryo and human fetal fibroblast cell culture before they mixed with the above ingredients. But notice: NO MERCURY! I have given MMR vaccines for over 32 years now and I can tell you I have never experienced any side effect from that vaccine (MMR).

The researcher in the United Kingdom who published the article in The Lancet medical journal is presently incarcerated and stripped of his medical license for falsifying data in his research. The fact that autism appears around the same time that the vaccine is given makes this a plausible hypothesis; it just did not “hold water.”

Does it work? Most current doctors have never seen active measles. It is rare solely because of the mandated use in most states. In Maryland for example, children cannot attend daycare or school if they have not had their MMR vaccine between 12 and 15 months and again at 4-5 years of age. The use of the vaccine has made a huge difference in the incidence of the disease; so yes, it works!

Can your child get MMR vaccine if they are allergic to egg (remember the virus is grown in chick embryo egg)? Unless, the person has had a life threatening reaction to egg exposure requiring hospitalization and ICU care (anaphylactic reaction) all children including those with mild to moderate egg allergy tolerate the vaccine well. In fact the American Academy of Pediatrics states that most of those with anaphylactic histories to egg tolerate the vaccine well under close supervision.

Children who have any form of thrombocytopenia (low platelet counts) can still get the vaccine but monitoring of the platelet count is required.

So who CAN’T get it? Children under the age of 12 months or children with cancers with altered immunity should not get the vaccine.  Don’t let the media frighten you; if your child has been vaccinated, they are protected. If not vaccinated, it’s not too late- GET VACCINATED.

See ya in the Spring!

Dr. “D”

KEEPING OUR CHILDREN ALIVE

June 5, 2014

On May 17th at a local high school in Prince Georges County Maryland, a symposium was hosted by me and my wife to educate teenagers, young adults and their parents about avoiding situations that could alter their life. In response to the killing of Trevon Martin and Jordan Davis, we felt such a proactive program was needed for our kids.

We were fortunate to have the HBO award winning writer and director of the film THE TOMBS come from New York to participate in a panel discussion and to show his 20 minute film. Jerry LaMothe has won many awards for his thought provoking films but this film was pertinent in that it emotionally showed the story of a man going through the police station after being arrested and being detained until arraignment. It showed our audience the pitfalls of our legal system especially when one is devoid of money and resources. The other panel members included a pastor, a defense attorney, a representative from The National Action Network, police officers from the District of Columbia and Prince Georges County as well as representatives from the States Attorney office and a delegate from the State of Maryland government.

Often when attending discussion panels the question that arises is “what are we going to DO about it?’ Talking is fine but it gets you nowhere if there is no action. The action that I had to take before the program could emerge was exhausting. I had to find a venue, design and print flyers, pull together a panel of volunteers who would commit, and advertise. I starting getting the program off the ground about 3 months prior. Hitting the pavement to barbershops, salons, car washes, store fronts and grocery stores throughout the northern part of the county was hard and time consuming work. Talking to school counselors and principals, visiting the post office many times to send out posters and flyers were part of the commitment. Then there was the financial cost. Ever wonder why a budget always gets out of whack? I figured the total cost would be about $1000. The rule of thumb is to take your projected cost and simply double it. The $2,000.00 came out of my pocket and this event was FREE to the public. There was never any plan on making money out of this venture- it was a service to the community. Doing a little suffering never hurt anyone. Do you believe that it is better to give than to receive? Producing such an event will test your belief in this statement. In fact I would suggest you try a test on your morality: Instead of putting one or five or even ten dollars in the plate at church, just once, write a check for double or triple the amount you usually put in or write a check to your kid’s school PTA for any amount you can afford or donate some time to any worthwhile venture and see how you feel. I can tell you that the reward is a private one between you and your maker. It gives your mortality meaning in the sense that before you pack your bags and leave this planet, you know you have tried to do something GOOD. I am going to tell you another secret (and this is really weird) once you try giving without the expectation of receiving, it becomes addictive. You’ll want to give more and more.

So what did we take home from this symposium? I learned that the teenagers and young adults today live in a digital world. To make an impact on them YOU have to enter that digital world. The movie was very intriguing to the kids but once our panel of esteemed professionals began our discussion, you could see the kids tuning out. On came the smart phones and away began the texting and video watching. As the older generations, we need to connect to the young folks through the visual media; auditory connection is dead.

It’s the same reason your teens don’t want to place an old fashion phone call anymore. They need to see the communication either by the visual words or pictures. Hence, wouldn’t it be great for the social activists, politicians and community leaders to hook up with the new generation of movie makers and present messages via the visual-digital world. This may not necessarily be 90 minute movies (although that’s all good too) but shorts can go viral on Vines and U-Tube and Facebook and the like. Kids love comedy; even though our messages are more serious than watching Kevin Hart, we have to inject some comedy in our presentations. The nice thing about the internet is that to produce an influential piece of entertainment you don’t have to go through an agent and spend gobs of money.

There are some practical things we “took home” from the adult discussion however:

  1. It is not against the law to record any encounter with a police officer (Maryland law) although most of the panel thought this may provoke the officer and advised against it.
  2. After putting on blinkers and slowing down, you have the right to drive to a well-lit place when pulled over by a police.
  3. It is best to turn the interior lights on in the car when pulled over by police at night.
  4. If you are associated with a group and one member of the group is charged with anything illegal (drug or handgun possession) you will likely be charged as well and will have to report to the police station until the details of the individual encounter is straightened out. It does not mean that you will have an arrest record if you are released.
  5. It is not conclusive that oral sex (alone) can spread HIV.
  6. IF you choose to smoke marijuana, it is better to be caught on campus as a student than out in the community. However, it is important for the parents and students to know in depth the consequences of this action at student orientation. Even if you are in a state that has legalized the drug remember that if you are under 21 it is still illegal.
  7. Although criticized as almost “bowing down” to a police officer, it was agreed that teens exemplify respectful behavior when interacting with a police officer. Often, but not always, this may avoid harassing situations like auto searches or pat downs.
  8. Further discussion groups like this should include teens on the panel to keep their attention.
  9. Further discussion groups like this should have teachers on the panel. So start you own panel discussion groups at your school. I think the principal and PTA groups would be amenable.

Time restraint kept us from getting to other pertinent questions. Overall, (especially with the movie) most thought the program to be valuable and worthwhile. Many parents said to me “we have to do this again.”

So start you own panel discussion groups at your school. I think the principal and PTA groups would be amenable.

Until next time…….see ya !!

Dr. “D”

Marijuana and College Campuses

March 17, 2014

Many of my patients are now on college campuses throughout the country.  Certainly, as a freshman, they are almost always living in a dormitory; unless they attend a commuter college.

I have learned through feedback from college students that there is a subject that needs our attention as parents so we can better prepare our kids; smoking marijuana in the dorm.  Now, you noticed I said “in the dorm.”  Smoking, possessing, paraphernalia may pose different punishments if they are caught in the city off campus or even on campus outside the dorms.  Of course, this will vary from state to state and their respective laws;  but,  because most students are below 21 years of age, it would still be considered illegal.

Here, I’d like to focus on “the dorm” issue.  I know this will vary with the region of the country,  whether you are in a state school or private. Where I went to undergrad in a very small private New England college drug use and experimentation was a non issue; the college didn’t care as long as you didn’t burn down the building.  NO ONE was reprimanded or punished for such action. However, in large state supported schools there seems to be a no nonsense policy that if caught smoking in the dorm, them your right to reside in any of the dorms either that year or for the remaining time you are at the college is taken away. You are left with finding your own living space off the campus grounds. That may not pose a problem for the upperclassmen and women since they would probably welcome the idea and parents would relish in the cost savings.  It does pose a problem for freshmen who generally don’t have cars and can’t legally sign for rental cars and apartment leases. This is where the parents are brought in for the added costs and inconvenience of providing alternate living space falls on our shoulders.

I guess the philosophy is that if a student uses drugs in the dorm that such behavior may ”infect” or affect other students and possibly convert them into “druggies.” Generally college campuses don’t expose such behavior to the local police; they would rather handle the issue internally. Alcohol (equally illegal for those under 21) is handled differently. There usually is a “three strikes you’re out” policy for alcohol possession so it gives a little more allowance.  It would seem to me that drugs use should be handled in the same way since young students will make mistakes in their judgment. I would think since accepting the student in the first place that the school would have an investment in their students and give them warnings prior to being put in the “slammer.”

Here’s where the real problem lies: The issue of alcohol and drug use almost always is in any given school’s handbook regarding code of conduct. It is discussed (sometimes lightly) by Sophomore RA’s and not anyone of adult authority. Since the penalties can be grave, you would think that all students during freshman orientation be given a clear warning BY AN ADULT in charge of student housing.

So, what do you do? ……..   Kids on campus WILL take risk and use poor judgment with alcohol or drugs. It is unreal for a parent to tell their freshman son or daughter to “don’t do drugs or alcohol” and believe that will “stick.”  So my advice would be “If you must indulge, DON’T DO IT IN THE DORM!!”   “I can’t afford to pay for your dorm room AND an apartment.”

For any parent attending orientation for their child in college, I think it would be very important for you to clearly understand the school’s policy and have it in writing including the right for appeal process. It would be very valuable for you the parents and your child to talk to upperclassmen about this subject as well.

ENJOY THE SPRING !!

Dr. “D.”   

OBESITY & HIGH FRUCTOSE CORN SYRUP

October 5, 2013

In 2011, the CDC  (Center for Disease Control) conducted a study of obesity in the United states and found that since 1980 the rate of obesity and type 2 diabetes mellitus sky rocketed over 100% of what the rates were in the 1960’s and 70’s.  What went on since the 1980’s to have such a drastic effect on this rate? In the 1980’s small farmers were drastically losing control of their farm business because of the emergence of big corporate food industries like Monsanto and Sysco.  There used to be small hardware stores in most neighborhoods until Home Depot and Lowes took over.  It’s hard to find a corner hardware store anymore. The same thing happened with the food industry. Small farmers could no longer compete. Well, if you now have a large conglomerate, for profit, public company, the number one priority is developing large enough profit margins to satisfy stock holders and maintaining the financial health of the company.

The tip of the human tongue has receptors that detect sweetness.  This is a very powerful stimulus to the brain that habit formation is quick to develop.  Who doesn’t like sweets?  Prior to the 1980’s most of our drinks and foods that called for sweetness used cane sugar. In fact, many other foods that we normally don’t associate with sweetness will have a small amount of sugar to create a habit for that particular brand. Caffeine is a good analogy here because neurologists certainly are aware of the habituation we humans have toward the drug and hence food and drink manufacturers added this to their products (i.e. soft drinks) so that we would be sure to come back and get that product again. Sugar cane does not grow well in the USA; most of its production comes from Central American countries like Trinidad, Haiti and the Dominican Republic.  This is one reason why these countries were so valuable to the French and other European countries because this “new spice” was even better than those found in the East Indies and China.

So, to use sugar in your foods as a major company you had to import the stuff and that cost money.  It’s logical that a major company, in order to increase the profit margin, would adopt a policy of “spending low and selling high.”  In the 1980’s chemical scientists working for the food industries began working on a new sweetener.  After much experimentation, they found the answer. Take corn which grows readily in the USA and extract its starch.  Dry the starch and what you have now is corn starch. Corn starch contains two sweeteners called fructose and glucose.  You simply had to add an enzyme chemical to the corn starch and you get these two products. Glucose didn’t pass the test for a sweetener because it simply was not sweet enough. Fructose was somewhat sweet (it’s the stuff that makes fruits sweet) but not as good as cane sugar.

So what the researchers did was to concentrate the fructose making it taste like cane sugar.  Now you have what we call high fructose corn syrup (also called modified corn syrup, modified corn starch, corn syrup solids).  It passed the taste test!!  Since then food manufacturers have been using high fructose corn syrup in everything!  Check the ingredient labels of your food in the pantry and as you go grocery shopping and you will be surprised as to how many products contain high fructose corn syrup.

Now here is where gets is “kinda” technical.  When we consume cane sugar (also called sucrose) it has to be broken down in the intestines.  This takes time and SLOWLY the products of cane sugar enter the blood stream.  The pancreas is the organ that takes the sugar in the blood (glucose) and acts like a security clearance agent that allows the glucose to enter every cell of the body for energy.  The more glucose, the more the pancreas has to work; the less glucose the less the pancreas has to work.  Fructose does not have to be digested and it RAPIDLY goes into the blood stream right after consumption. Well, this is OK to some degree (such as eating fruits) but if we have highly concentrated fructose rapidly enter the blood stream it overworks the pancreas.  When the pancreas is overworked the level of insulin produced by the pancreas is high and this is a signal to the brain to increase fat stores and do everything possible to increase body fat.  Since the pancreas is overworked, it will eventually become exhausted and fail at its function. This is when diabetes steps in.  The more we consume concentrated fructose the worse things become.  Down the road, heart disease, kidney disease and certain forms of cancer develop.

It’s cheap for the food industry but it is a slow poison to us consumers. This is the reason we are seeing not only high frequencies of obesity in children but also the emergence of type II diabetes. Pediatricians never thought they would be treating adult type diabetes in 12 or 13 year olds. We never though some of our patients would become so obese that the scales to weigh them were inadequate.  We never thought that our blood pressure cuffs couldn’t fit around their arms because of such obesity.  The life expectancy of those with extreme obesity certainly will be cut short. I will never forget a 15 year adolescent who was over 400 pounds and died that year from sleep apnea and heart failure because of his weight.

Sooooo,  What are we to do?  For all of us, get out and do something physical!  The body will pay you back for it. The next thing is to try reducing your consumption of high fructose corn syrup.  Do your grocery store research; look at the ingredients.  If it has high fructose sweeteners,  PUT IT BACK!  Although more expensive, there are usually substitutes that taste just as good if not better.  The body takes its time adjusting to new lifestyles; so be patient. After 4 to 6 weeks you will notice and see changes that will make you smile; not simply because of the way you look but more importantly, how you FEEL.

….till next time,

Dr. “D”

CHILDHOOD SAFETY

February 19, 2013

This blog is geared mostly to parents who have toddlers and young children but not limited to that age group.  I am going to assume that you have certain safety practices in place such as a car safety seats, guard rails and even outlet plug covers. Over this Winter I had encountered several accidents described below that should serve as good reminders.

A two year old boy “eyes” a coffee mug belonging to the parent near the edge of the table.  The cup contains hot tea that the mother just brewed and took a sip from. Mom was quick at catching the child’s desire to grab the cup and moved the tea toward the center of the table. You would think that all is well but moments later, when Mom was “off guard” the toddler pulled a chair over to the table, proceeded to climb onto the table and grabbed the cup. Well, that hot tea poured over the forearm resulting in a second degree burn, a trip to the hospital, lots of pain and parental guilt.

A four month old infant was placed on the exam table by the mother prior to my arrival so that a fresh diaper could be applied. The mother was by herself. When turning to retrieve a new diaper, WHAMM! Down goes the baby onto the floor. The intense scream caught my attention and upon my arrival the mother was understandably frantic with tears streaming down her face. Fortunately, the baby was not harmed.

A two and one half year old boy was in his crib as usual and one morning finally was able to exert enough muscle power to “pole vault” the crib’s guard rail. All was doing well when the toddler was at the top of the rail but when trying to descend toward the floor for freedom the right foot got caught and the boy was suspended head hanging downward and screaming louder than the alarm system. When the parents came to the rescue, they noticed the right thigh was grossly swollen. The emergency room evaluation revealed a spiral fracture of the right femur bone requiring surgery. The battle with Child Protective Service did not make it any easier for the parents. The child did well after all was said and done.

We had a round glass coffee table in the living room that was about three quarters inch thick. There were no sharp edges and the top was heavy enough that it seemed to present no problems.  My son (why is it always the boys?) loved to run into that room and use the table as a brace to stop his momentum. This went on for months so it was considered safe.  Well, one day the usual impact resulted in the table top tipping over. The weight of the top certainly would have caused a fracture of the foot or toe but what was earth shattering was that the glass broke in half right in front of him. Thanking all angels in heaven, he was not cut or injured in any way. We, as parents, were mortified. The table was never replaced.

The case I will never forget involves a one year old girl who, while exploring the floor, found Mom’s recently lost diamond earring stud. When Mom saw the child with it, suddenly time slowed down as Mom saw the child place the earring into the mouth and swallow it despite Mom’s attempt to run over and abort the mission. After finally reaching the child’s mouth, yep, it was gone! “My child has eaten my precious anniversary given diamond ear ring stud!” That’s when I got a call. Syrup of ipecac was given (over the counter) by mouth and after drinking some water the child vomited and the ear ring was recovered.

Over the 2012 year I cared for about 12 children involved in fairly serious auto accidents many involving the total destruction of the vehicle. I am presently involved with driver training for my last child, and what I realized, is that when you are teaching a teenager to drive defensively, you realize how inconsiderate other drivers can be even when there is a “rookie driver” sticker on the car. Despite the wide use of money making photo cameras throughout the D. C. area, when the coast is clear you see the release of frustration by many drivers speeding and cutting in and out of lanes. Placing your child in an automobile is one if not the most dangerous things we do to our children and we do it almost daily. When strapping them in simply give thought that this may be the time you get into a bad accident.

Just a few more comments.  While raising children there is one thing I’d suggest you NEVER have; a deep fryer. Third degree burns give rise to lifelong scars that surely will influence the psyche of that person eternally. Every child will have accidents no matter how hard you try to avoid them. Don’t be so hard on yourself with blame; assuming that you are doing your best.

See ya!

Dr. “D”

ABOUT OUR TEENAGERS

June 1, 2012

I was in a McDonald’s restaurant one Saturday afternoon after doing yard work and noticed four teenage males sitting at a table and having fun with their rambunctious conversations. The volume was loud and became louder. The cursing was mild and then became volatile. The “MF’s” the “N” word were in every sentence. The hats were carefully placed upon manicured braids and dreads. The blue jeans were tightly wrapped around the thighs so the “proud” buttocks could be imagined under the dirty underwear.

I didn’t budge very much since this is commonplace in the Washington D.C. area as probably in all urban areas. I kept reading my book as I continued to refresh my thirst with my cold drink.  Two fellows got out of their seats and began to play “tag” running around the eating area like four and five year olds.  The other two proceeded to do the same.  After a while the eating area transformed into a circus; the four teens acting like fools and the audience very quiet but attentive to what was going on.  I looked at the members of the audience and there was fear in their minds.  “I’m not going to get involved” I could imagine them saying.

At this point, my mental kettle began to hiss. I wasn’t sure I was upset at the teenagers or whether I was mad at the “do nothing” patrons. After a few more seconds, my primitive brain took over;  I couldn’t take it anymore!  It was deplorable behavior and frankly embarrassing to me because these kids were of my own African American race.  I stood up, came over to one of the boys, injected a very serious look into his eyes and told him to “cool it right now!!’ “You guys are acting like you WANT to be arrested when a patron secretly calls the police. What could have resulted in a confrontation with me and the teenagers turned into them looking at me with fear and eyes so wide open and apologetic. “I’m sorry mister” he said to me. I later sat down with all of them and explained how Michelle Alexander’s book, The New Jim Crow, explains how their behavior is profit material in the new prison industrial complex. THEY ACTUALLY LISTENED like no one has ever explained this to them before. They were all quiet now, sitting and apologetic again.

I then left what could have turned into a bad scene.

The lesson here is about fear. “You shouldn’t get involved; they may have a gun” is what we adults all hear. “Let the police take care of it.”   The above may all be true.  Approaching a teenager in public requires a great deal of sensitivity, however.  Let them know you have concern for them;  after all,  you are protecting them from what could result in a lifetime of derailment and an emerging hostile adult.  Be firm but not accusatory.

You will be surprised and renewed about the power you have as an adult. It may help when you have to chastise your own teenager when they challenge you,  often to the point of confrontation

They may look threatening but they are just physically grown up kids still.  Remember that.

…….talk with you soon,

Dr. “D”

MUSIC TO MY HEART

February 24, 2012

I was entering the exam room the other day to perform a routine physical exam for an eleven year old child. Nothing was unusual. Smiling faces from child and mom lifted the spirits and pleasantries were exchanged. What immediately flashed in my eye was a brand new iPhone with bright pink and silver ear plugs attached to the child; nothing unusual.  Since I am a music lover way back to elementary school, I am always curious as to what the young folks are listening to. “Can I listen to what you are hearing, I said.” As the ear phones were placed into my ear, I immediately started tapping and bopping to the rhythm. It was a female rapper. I inquired as to who it was but that info is not pertinent to my main take home message. What was different with this song was that I could clearly hear the words she was saying. What was more surprising was WHAT she was saying!!

I realize sex and all of its subsidiaries are central to lots of rap lyrics. It’s also central to American capitalism.  So to hear about sexual content on a rap lyric is no big thing as long as there is some discretion. What I heard on this piece was absolutely appalling.  The artist began begging her partner to explore and manipulate EVERY orifice of her body with every conceivable part of his body. (This is a nice way of saying that if there was such a thing as audio only pornography, this was it.)  There were no metaphors (which I could have better tolerated) to captivate the art of suggestion. Clear cut wording was what I heard. And by the way, the foul mouth cursing seemed mild compared to the content of her words.

So what is up with this experience?  I continued to bop and tap to conceal my astonishment and slowly removed the ear plugs from my ears. What bothered me was this was an eleven year old girl listening to this in front of her mother. I did not make a big deal out of this then because I had to calm my emotion of shock in order to be balanced. Obviously it continues to bother me so this is why I write about it.

Mom’s and Dad’s, I know you like your music relevant to what you grew up with, but do your own “study” on what your kids are listening to. Ask them to inform you of the latest rappers and video artist. Listen to them TOGETHER with your kids (they may be embarrassed but that’s ok). It’s a good intro into having family discussion about sex anyway. Our culture is such that this kind of entertainment WILL be out there for them no matter what. It is your job to put all of this into context as to:

  1. Maintaining your own morality within a sea of immorality
  2. Understanding that immorality sells
  3. Look at the target audience and surmise what influence media moguls would like to mold you into.

By the time that eleven year old begins his or her introduction to sexuality, there is already a preconceived acceptability about sexual inappropriateness. Sex and sexuality is part of being human. It is a very wonderful and enjoyable entity. I tell this to teenagers. It is a process however and not an immediate act to be followed because famous celebrities (and their money suppliers) promote it. The process should be slowly started by Mother Nature and guided by adults. Only then will the result be a healthy sex life which is important for long term adult committed relationships.

Oh, and by the way, don’t think that I am not going to bring this subject up to the mother I mentioned. I am sure the mom bought the IPOD; she has a right to listen to everything on it!

….talk to you later this Spring….

Dr. “D”