Eat, Drink, and Be Merry

Piggyback Ride in Nepal - Photo by JoAnn Sturman

Scott Sturman
fliesinyoureyes.com

One pill makes you larger. And one pill makes you small. Grace Slick 1966

Medical insurance premiums are outrageously expensive. My family subscribes to a health savings account (HSA) with a $4000 individual deductible, which is the closest product to a catastrophic coverage plan available to us. We have no health problems, so until March of this year we still paid the insurance company about $1000 per month to negotiate discounted contracts with health providers in case we need their services. This month the rates skyrocket 20% to over $1200 per month for the same service. With a greater than 95% confidence level the deductible will not be exceeded, the insurance company could not be happier than to serve customers like my family.

A primary reason for these outlandish insurance rates are the high cost of pharmaceuticals, and the public’s over willingness to take pills rather than adjust personal lifestyles. Last year a pharmaceutical company aired a television commercial showing an obese woman dressing for an evening on the town as she primped in front of her bedroom mirror while listening to up beat music. Plenty of food and libation awaited her... but then there was this problem with her diabetes. Fortunately, the advertised product allowed her to check her blood glucose level without a painful pin prick on the finger. Now she was free to take insulin without the slightest inconvenience.

The commercial went beyond describing the merits of the product by implying serious medical conditions need not be bothersome or get in the way of indulgence. When it comes to having fun, weight and caloric intake need not be a concern. Just as the First Amendment guarantees freedom of speech, we have the same right to waive caution and do whatever feels good. The message is clear: If one's blood sugar is too high, there is no need to worry - just take more insulin.

The pharmaceutical industry produces scores of drugs which benefit the public, but in some ways the drugs are too good. They frequently treat the symptoms and not the cause, making it all too easy to ignore the latter. This is particularly true in regard to the country's number one cause of self induced morbidity - obesity. If blood pressure is too high, it is far more convenient to take an expensive drug than lose 30 pounds. If more weight gain ensues, then simply take a second or third blood pressure medication. If diabetes becomes a problem, then an oral hypoglycemic medication is available, and if that is not enough then insulin is the next option. There are plenty of antibiotics to treat a diabetic's high risk of infection. If coronary arteries begin to plug as a result of diabetes and hypertension, there is a virtual pharmacopoeia of remedies. When the kidneys fail, dialysis is at hand. As knees, hips, and backs fail under the strain, they can be replaced or repaired. When signs and symptoms expand, so do costs and patient suffering.

In our practice it is not unusual to see patients who take 15 or more different medications daily. Ingesting pills becomes a way of life, as modern lifestyles demand quick fixes to problems which have been years in the making. For every patient who is over medicated, there are doctors who for varying reasons write prescriptions with little regard to cost or ultimate efficacy. Perhaps it is time to ignore slick drug commercials, watch the calories, exercise more, and ask the doctor what needs to be done to reduce the number of prescribed medications rather than upping the ante.

Fat, Poor, and Blameless

Bad Water, Death Valley - photo by JoAnn Sturman

Scott Sturman
fliesinyoureyes.com

'If you don't read the newspaper you are uninformed, if you do read the newspaper you are misinformed.' -Mark Twain

Barbara Anderson's article in this week's Fresno Bee was like manna from heaven to every overweight person below the poverty line. Alas, to be obese and on public assistance is to be blameless! According to her, if one is poor then individual responsibility has little to do about being overweight. There are too many fast food restaurants. Parents are too busy to prepare meals at home and when they do cook, it is unhealthy fare. Nutritious food is beyond their means, and the real eye opener from the University of Washington's Dr. Adam Drewnowski,“the obesity epidemic among the poor has very little to do with individual motivation or even genetics or metabolism.”

Could this possibly be true? No, the contention is absolutely preposterous and contradicts the most basic elements of common sense. This front page news item has “enabling”stamped all over it. It is far easier to cast someone as a victim of circumstances beyond personal control than to identify the actual source of the problem. Today's journalists are in the business of assuaging egos and sparing feelings rather than developing conclusions that may involve sacrifice, introspection, and a solution. The fact remains the obesity epidemic has to do with personal excess, changing demographics, and a food stamp program which literally is killing the people it is meant to help.

If the government is concerned about the health of the indigent and the costs of dealing with the secondary effects of obesity, what is the rational of supporting a food stamp program which allows the recipient to receive any food commodity with the exception of tobacco products and alcoholic beverages? Would it not make sense to remove the temptation and restrict food stamps to the acquisition of only healthy food? It is immoral to provide soft drinks, cookies, and potato chips to the poor if it undermines their health, but their liberal supporters insist they have the same access to lousy food as anyone else, while the food industry is delighted to sell as much of it as possible.

My parents went through hard financial times, but despite my brother's and my pleading our mother never took us to McDonald's. She grew up in the depression in a large family mired in poverty where obesity was not an issue. In her opinion despite the modest price, fast food was not healthy to eat and more expensive than eating at home. Like many other compulsive mothers, she was never too busy to do the right thing for her children.

After being involved in the medical field for nearly thirty-five years, it continues to amaze me how many MediCal patients have only a rudimentary knowledge of nutrition and do not understand the comparative values of food. Mothers of children in this cohort are more likely to be single, young, distracted, and have developed bad eating habits that will be imparted to their offspring. It is hard to get it right if one does not know what food is good and what is not, if you are a single mother with several children but without a high school diploma, and the State of California wants to buy all the junk food you can devour.

Just once I would like to open the Fresno Bee and find a compelling answer to an important social problem and not the same tiresome list of excuses intended to make people feel good about themselves. We live in the most productive agricultural area in the world where produce is abundant year round. A person does not become 100 pounds overweight by osmosis. For those living on heavy carbohydrate diets, try eating 2000 calories per day rather than 6000, use the difference in cost to buy fruits and vegetables, walk around the block instead of viewing television, and watch the pounds melt away.

Feeding Obesity

Wires in Kathmandu, Nepal - photo by JoAnn Sturman

Scott Sturman
fliesinyoureyes.com

Public health policies and government sponsored social programs are often at odds with sound medical judgment. In fact these programs which intend to benefit recipients often jeopardize the well being of those receiving assistance. Unless sensible health practices are implemented, costs will continue to soar. A major culprit adversely effecting health across all ages, sexes, and races is obesity, the primary cause of self induced morbidity in the country. Ironically, government run nutrition projects contribute to the epidemic.

I see him at the gym when we exercise on the Stair Master. As he begins his routine, his initial comments never change, “This machine is a killer, but seven years ago I lost 109 pounds in seven months without pills or surgery. I felt horrible and was disgusted with myself, so I talked to my doctor about a diet and exercise program. I stopped drinking alcohol and started coming to the gym three times a weeks for two hours each session. It's not easy, but I'm a new person now.”

The Stair Master is a killer. At level 8 without arm support a 20 minute work out burns about 250 calories. Sadly enough, these calories can be replenished in seconds with a 20 ounce soft drink or a panoply of fast food readily available on the way home from the gym.

Not long ago when I had children at home, I visited the grocery store every week. On one particular occasion I noticed a very large customer with her very large children at the check out counter with a shopping cart brimming with candy, soft drink, chips, and cookies. She paid with food stamps and left the store with virtually nothing of nutritional value.
When it was my turn to check out, I asked the clerk, “Are there any restrictions on products which can be purchased with food stamps?”
“Only cigarettes and alcoholic beverages.”

If society has a moral responsibility to provide low income people with adequate nutrition, then is it equally immoral to encourage them to indulge in eating habits which are detrimental to their health?

Public service announcements proclaim the importance of eating wisely and maintaining proper weight, yet food stamp programs allow acquisition of limitless quantities of junk food. It is as if one were told to empty a full bathtub with the faucet turned full open – the outflow of exercise and metabolism cannot compensate for the inflow of unrestricted caloric intake. As a consequence rampant obesity devastates many low income citizens. Heart and kidney disease, hypertension, diabetes, stroke, and joint failure are inevitable and very expensive to treat.

Food stamps or their equivalents should be used to purchase only healthy foods sanctioned by the American Dietetic Association. Bar coding and modern cash registers allow retailers to identify these products and to receive payment for them from debit cards which maintain a running balance of credits on the account. To minimize fraud the recipient should not be eligible for a “cash back” option, and the card must be presented with a valid photo identification.
The adage “physician do no harm” can just as well apply to government welfare programs.