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by Castle Connolly and US News

Author Archive

  • New York Times: With Special Clinics, Hospitals Vie for Hesitant Patients: Men

    , May 28, 2014

    From the gleaming limestone lobby to the chocolate and oxblood exam room walls to the percussive address, 555 Madison Avenue, a new clinic in Midtown Manhattan exudes masculinity, and that is no accident.


    Still smelling of fresh paint, it is NYU Langone Medical Center’s health center devoted to men, one of two such centers opened in the last two years by major New York hospitals, within 10 blocks of each other, and using marketing techniques common to lifestyle companies and luxury spas.

    “The glass ceiling has been broken; now there’s a health center just for men,” goes one NYU Langone advertising slogan, with a tongue-in-cheek hint of transgression. Says another: “It’s the gentlemen’s club your wife would approve of.”

    NYU Langone and other medical institutions have long had services devoted to women, an outgrowth of the belief that the male-dominated medical establishment had not paid enough attention to their particular needs.

    Now men are beginning to get equal treatment as hospitals try to take advantage of an enormous untapped market: men who, studies show, avoid doctors for virtually anything short of a bullet wound. The new clinics offer one-stop shopping for services ranging from heart monitoring to hair removal to hormone therapy, from the life-prolonging to the life-enhancing, if medically debatable.

    See Complete Article at: http://www.nytimes.com/2014/05/29/nyregion/with-special-clinics-hospitals-vie-for-hesitant-patients-men.html?_r=0

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  • The Campaign for Junk Food

    , May 28, 2014

    WHEN we began our Let’s Move! initiative four years ago, we set one simple but ambitious goal: to end the epidemic of childhood obesity in a generation so that kids born today will grow up healthy.

    To achieve this goal, we have adhered to one clear standard: what works. The initiatives we undertake are evidence-based, and we rely on the most current science. Research indicated that kids needed less sugar, salt and fat in their diets, so we revamped school lunch menus accordingly. When data showed that the lack of nearby grocery stores negatively affected people’s eating habits, we worked to get more fresh-food retailers into underserved areas. Studies on habit formation in young children drove our efforts to get healthier food and more physical activity into child care centers.

    Today, we are seeing glimmers of progress. Tens of millions of kids are getting better nutrition in school; families are thinking more carefully about food they eat, cook and buy; companies are rushing to create healthier products to meet the growing demand; and the obesity rate is finally beginning to fall from its peak among our youngest children.

    So we know that when we rely on sound science, we can actually begin to turn the tide on childhood obesity.

    See Complete Article at: http://www.nytimes.com/2014/05/29/opinion/michelle-obama-on-attempts-to-roll-back-healthy-reforms.html

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  • To Age Well, Walk

    , May 27, 2014

    Regular exercise, including walking, significantly reduces the chance that a frail older person will become physically disabled, according to one of the largest and longest-running studies of its kind to date.

    The results, published on Tuesday in the journal JAMA, reinforce the necessity of frequent physical activity for our aging parents, grandparents and, of course, ourselves.

    While everyone knows that exercise is a good idea, whatever your age, the hard, scientific evidence about its benefits in the old and infirm has been surprisingly limited.

    “For the first time, we have directly shown that exercise can effectively lessen or prevent the development of physical disability in a population of extremely vulnerable elderly people,” said Dr. Marco Pahor, the director of the Institute on Aging at the University of Florida in Gainesville and the lead author of the study.

    See Complete Article at: http://well.blogs.nytimes.com/2014/05/27/to-age-well-walk/?_php=true&_type=blogs&_r=0

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  • More Math

    , April 9, 2014

    If you didn’t read my last post, you might want to circle back. These have been my “Obamacare for Dummies” or “How I stopped worrying and learned to love (or merely tolerate) the Affordable Care Act” posts.

    Just a brief and wholly irrelevant aside, even since I had my “Breaking Bad” marathon, I can’t write or read the word “math” and not see “meth.” I can’t get it out of my head. Ok. Back to health care mathematics.

    We all know the story of the young woman who is treated for breast cancer and then changes jobs and then loses her coverage for her “preexisting condition.” Each and everyone of us knows some variation on that story and universally, we think it stinks. I would say most of us know of a story where someone was quite ill and their benefits ran out. Now sometimes that happens in absurd end of life decisions and I’ll write about that another time. I’m again thinking of our young woman with breast cancer who survives her disease, but loses everything else. If you don’t think that these events are wrong, please stop reading this and don’t read anything else that I ever write. In fact, please don’t talk to me or anybody in my family. If you belong to a church, temple or mosque; quit. There’s no hope for you and any higher power would be embarrassed by his creation.

    If you’re still with me then you have a thread of human compassion and decency and I think that is all that I am going to need. This brings us to “the mandate.”

    How can basic human decency be equated with a government compelling its citizens to buy a product; in this case health insurance. Well, once again it comes down to math (with an ‘a’). Let us say that Congress passes the “Human Decency in Health Care Law” which states that no insurance company can deny an individual health insurance or cap the benefits what would be the decision of the rational consumer. Well, clearly, everybody who is sick and has been denied coverage will rush to their computer and sign up. What will the rational healthy people do? Nothing. If you cannot be denied coverage the logical person will not be paying for insurance when they are healthy. They will pay their occasional costs out of pocket, but the minute that they get sick, they would quickly purchase insurance. in fact, I am sure that there would be a special insurance broker in this setting. Just as we once bought “flight insurance” from a kiosk in the airport (what a scam that was), we could imagine insurance being purchased in emergency room waiting areas.

    I know that healthcare is expensive. The point is that by having a large pool of covered lives, expenses can be predictably managed. Costs are kept reasonable by having a fairly healthy group of people. When the pool consists of only the sick, insurance can only become more and more expensive and ultimately unsustainable. We can only have our insurance equivalent of basic human decency by compelling the healthy to be insured.

    Sure, we could have done this all through tax dollars and funded a single payor Medicare-Universal (wouldn’t that name have worked better than the Congressional Democrats term “public option.”) We have opted, for now, for a “free market” approach. The biggest problem is the fine is too little. In 2014 it’s only $95 or 1% of income. Over the next few years the fine will increase. Ultimately, it will need to be more expensive than basic bronze level insurance for people to be rational and be insured.

    I know. Sometimes after going through insurance issues you feel a desire to reach for Walter White’s blue crystals. It’s understandable and we won’t count it as a preexisting condition.

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  • It’s About the Math

    , April 8, 2014

    A patient came in today with more “Obamacare Alerts!” If this whole thing wasn’t so serious, I would just break down and laugh. You see, he was telling me a horror story about this poor family that lost the insurance that they had.

    I’ve written many times that the thing that I hated the most about a small business was shopping for group insurance. First, my needs were rarely the same as my employees and second, boy those choices were confusing. And, of course, the options were expensive. Sometimes, I would take a look at the individual insurance policies that I could find. They were cheaper and I was tempted. But then I looked into them in a little more detail. They had a flaw that was so epic it belonged in an Ancient Greek Homerian Epic Poem. These individual insurance policies were great until you got sick. That’s right, they charged a low fee and you felt like you were insured, but they could cancel you out as soon as you got sick. Now, I never bought any of those policies, but I have been on the other side dealing with a patient who was insured until he actually needed insurance.

    Well, when they went about creating the Affordable Care Act someone decided that insurance that vanished on people when they got sick should disappear. Insurance that individuals buy would have the same protection as the group insurance that employers provide. When you read about the people who have lost their insurance, these are the people. A bad product has been removed from the market place. Sometimes I think that if Obama came out against sour milk, Fox news would rant about how he was taking away our rights to drink vile toxic beverages.

    Here’s the problem. Insurance that will actually be there when you get sick is going to cost more than insurance that they can take away when you get sick. It’s not rocket science. If I can’t dump you the minute you cost too much, I’m going to be more expensive. Can’t get around that.

    So, I’m sorry that people miss their cheap insurance. I guess that they liked the feeling of having insurance without having to pay. But I promise that when they have their first heart attack or breast lump, they will be happy to have these replacement policies.

    Tomorrow will be another math day, so bring your pencils.

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