Category

The Global Is Local

May 31
0

The Gluten Wars

By | Health, The Global Is Local | 5 Comments

My apologies in advance for the personal biases expressed in the following post, but not very big apologies.

Change takes place on so many different time scales that it truly boggles the mind: Geologic history is too slow to comprehend, and the speed of light is similarly beyond our everyday understanding. In any case, what we are really interested in is ourselves and those around us.

For the most part, this moment in history allows us to surf along on a sea of issues, each with their human connection, each one changing as social pressure influences and reacts to it. This is the story of one of these trends, and how it has influenced me, my family, the country, and the feedback loop that has changed the trend itself.

My parents started a bakery shortly after moving to Vermont in the mid-1970s, and their business has been cooking ever since, although with far greater attention to product quality than profit. Their small operation has not changed a great deal, growing slowly and shifting with their interests rather than with market pressures. They were the first organic bakery in the state, and probably one of the first in the country. (Check out some pictures and their story here, as long as you’re not already hungry!)

They have watched as the American consumer has gone from disdain to grudging acceptance, then cautious enthusiasm, then passion, and in the past decade, spastic cycling through rapid adoptions and rejections of the product they have spent a lifetime carefully crafting.

Their reaction? Mostly they try to ignore these market gyrations and just do what they want to, baking European-style sourdough loaves in their massive French hearth oven, working all the time, and raising a family of bread-loving children.

AdamFrBatard

However, the changes taking place in public attitude over the past ten years have been something of a shock, and my folks and other artisan bakers have certainly had to acknowledge South Beach, Dr. Atkins, and all that followed in the low-carb frenzy that was intended to drop American pounds. The effect of the frenzy, by the way: Americans did not, overall, benefit substantially from their fear of carbohydrates, although the publishing industry certainly has enjoyed the ongoing attention to the issue (just shy of 6,000 titles come up on an Amazon search). My family’s business suffered a bit, but for the most part, it did not seem as though the followers of Dr. Atkins were the same ones who were ordering crusty, sourdough Whole Wheat loaves from our small organic bakery in Vermont.

This has continued to be the case over the past ten or fifteen years as the popularity of strict low-carb diets has waned somewhat, and I believe that this has been due to the separation between two segments of their customer base. On the one hand, there are what I will call Mainstream Eaters, brought up (like my father) on Wonderbread and Skippy, sticking to the traditional (i.e. large chain) grocery stores, and eating a diet that owes much to the cultural norms of the 1940s-1950s. On the other hand are my parents’ customer base, who I will call the Spelt Enthusiasts, a term I lovingly bestow on the many earnest, kind, birkenstock-wearing, kale-eating, home-made-granola eating hippies and their children (of which I am one, of course) who have come to my parents for decades seeking whole grain breads, made by hand using traditional methods. (Spelt, for the uninitiated, is an ancient variety of wheat which has experienced relatively little hybridization and has a somewhat nutty flavor.)

AdamMixing

 

The separation between these two groups has narrowed in recent years, moving in the general direction of the Spelt Enthusiasts as a greater foodie culture has spread throughout the country. The narrowing of this gap has had an enormous impact on our economic and food systems in the U.S., (and arguably the world) as there is now a far greater interest in organic, local, artisan, hand-crafted food and beverages. This trend has given a degree of market power to local producers that has been absent for generations- perhaps since the Industrial Revolution.

Although I would hesitate to describe this as ‘unprecedented,’ as I am not a historian, it isn’t a stretch to refer to this market transformation as amazing. Despite the awesome power of industrial farming, baking, brewing, cooking, packaging, and shipping technologies, individuals using essentially the same ingredients and techniques as their great great grandparents are launching successful bakeries, restaurants, breweries, and cheese making operations all over the country.

Time to circle back to the title of this piece. The challenge my family faces is the latest iteration of popular science writing, which had previously focused on folk neuroscience and psychology- issues that passed bakers by other than our passive consideration while listening to the radio and rolling baguettes. The cold, hard pen (or keyboard) of scientific terminology and rationale has turned to the issue of diet. The demon of this recent dietary focus is, of course, gluten – the web of proteins that allows bread to rise from a cold, dense piece of dough into a transcendent, glowing, golden loaf crying out for a slice of cheese and tomato. We should be concerned about blind trust in scientifically justified behavioral recommendations with very limited scientific basis.

As Alissa Quart points out in her 2012 NYT piece,

…bogus science gives vague, undisciplined thinking the look of seriousness and truth.

Regardless of your opinion on the issue, there are some facts that most agree upon.
1. Celiac Disease affects .7 percent of the population, many of whom are undiagnosed. The most effective strategy for those with Celiac Disease is to avoid gluten altogether.
2. Allergies to wheat may affect as much as 3 percent of the population.
3. Less clear, but still generally agreed is that a slightly larger group has gluten sensitivities, but not full blown Celiac. This number may be as much as 6 percent of the population, with a very wide range of severity, from profound to scarcely noticeable.

What I feel is missing:

1. Many people do not know what gluten is or where it comes from. Look at the products now proclaiming their gluten free status. Hummus? Juice? Cheese? There is a massive amount of money to be made on gluten-free products right now, and companies are taking advantage of uninformed consumers. How much of this is being driven by profit? It makes an honest assessment of health impacts very challenging.

2. A sense of perspective. Like most effective diets, giving up gluten involves a far greater amount of attention paid to what you ate eating. There is a need for balance, more fruit, vegetables, and legumes, while moderating the intake of animal proteins. If following such a diet makes you feel better, it could be the gluten, or it could be the effect of giving what is on your plate some truly conscious thought.

Celiac Disease is an extremely challenging condition, requiring sacrifice and discipline in order to stay healthy. Those who suffer from it are torn about the recent spike in gluten-free diets, appreciating the diversity of options now available, but frustrated by those who have simply jumped blindly onto the bandwagon.

3. Fads. There is nothing like a fad to push a business operating with high overhead and a reliance on a stable market into a situation that threatens the owners and employees.

People who love eating good food should take the time to be certain that giving it up is a wise health choice. Eating good food is one of the most easily accessible and most important ways to affect the health of individuals and their families.

Fads end eventually, and the artisans responsible for providing high quality bread can only remain in operation after the gluten bubble bursts if conscientious consumers continue to support them. Thanks to the changing attitudes about food and farming practices, these craftsmen and women are likely to be your friends and neighbors, not line workers at an industrial food factory 5,000 miles away.

AdamSesameWheat

Additional image credits to Chuck and Carla Conway, with assistance by archivist Sophie Conway

Pottery class starts next month, by the way! Sign up soon to get muddy and make pots!

May 16
0

Vision Driven Change

By | Health, The Global Is Local | 2 Comments

A few nights ago my wife and I had a conversation with our friend Peter. In contrast to our method of deciding our fate (last minute panic combined with procrastination and our desire to live in the moment), Peter was describing himself as vision-driven in his decision making process. By coincidence, the following morning I sat among a large group, including my fellow ChangeEngine blogger Scott Burkholder, loosely organized around the concepts of social entrepreneurship and a vague but optimistic vision of a better city.

These conversations have given me pause for thought, and to consider the role of this social innovation/social change blog platform. Our group of authors approaches the challenge of promoting positive social change from a variety of perspectives, and most of us have personal investment in the projects and programs that we write about.

I’ve occasionally thought that the quote attributed to Ghandi on a million self-satisfied bumper stickers — “Be the change you want to see in the world” — might be an appropriate mission statement for ChangeEngine. I looked up the phrase and found that he has been misquoted for the purposes of bumperstickerability. As corrected by the New York Times:

If we could change ourselves, the tendencies in the world would also change. As a man changes his own nature, so does the attitude of the world change towards him. … We need not wait to see what others do.”

Not surprisingly, Ghandi is a smidge more complex and a tad more profound than the sentiment captured on a bumper sticker.

My conversation with Peter and the breakfast group the following morning centered around the potential for individuals and small groups to generate substantial change. Both interactions emphasized the importance of envisioning a better place, even if the precise vision of a better future is vague. In a way, it doesn’t really matter. The effort counts.

Making an effort toward positive change almost certainly shifts the expectations, changes the conversation, and re-frames the possibilities for a community in need of transformative positive change. If Ghandi were a statistician, he might have talked about shifting or weighting the mean, if he were a talk show host, he might have talked about seeding the audience, but since he was an agent of transformative change, he talked about changing ourselves in order to change the world.

Hasdai Westbrook, our editor extraordinaire and Change-Monger-in-Chief, regularly reminds me to consider the social innovation components of the various issues that I address in my columns, and often this is a challenge for me when writing about burgeoning pandemics in Saudi Arabia. Today, however, I am struck how the health of the city is affected by all of its residents and their activities. Planting community gardens and socially responsible investment are both contributers to the same vision, and are relevant to the health of the greater community.

Barton, H.; Grant, M., 2006. A health map for the local human habitat. The Journal of the Royal Society for the Promotion of Health

My beat is Public Health, with local and global implications. At its core, Public Health is concerned with trends and interventions at the population level. While those in the research and analysis end of the field must be driven by process and procedure, those engaging in interventions must be driven by vision.

No public health intervention is undertaken without a vision of a better future for the population, but I believe that the definition of health intervention should be broadened considerably. From urban farms to the Mayor’s public safety initiatives to public art projects, there are a great number of activities taking place in Baltimore (and around the world) that directly and substantially impact population health. These activities impact the education, nutrition, economics, safety, and appearance of our neighborhoods, which can have a profound impact by shifting the mean toward a healthier city and and a healthier world.

Next time, The Gluten Wars, A Health-Conscious Society Loses Its Mind

May 02
0

I Bike, You Bike, We Bike, He/She Bikes!

By | Health, The Global Is Local | 2 Comments

(The third in a Spring series about bicycling in Baltimore: Who should do it, how, and why?)

Welcome back, whether you are bike-aholic, bike-curious, or bike-phobic! I hope you have enjoyed following the biking series as much as I have enjoyed researching and writing it. Today’s post will be the final in this series, but don’t worry, there will be additional bike-related commentary in this space in the future.

First, Who should bike in Baltimore?

Leading by Example: Mayor Stephanie Rawlings Blake, courtesy of her Twitter feed

Well, if you have read the previous posts in this series, B’more Bike Friendly and Bikemore in Baltimore, you may have gotten the sense that I advocate for more biking by more people. If that hasn’t come through, let me take this opportunity to state clearly that I think everyone ought to bike in the city. If you feel like you want to be connected and informed and involved with the place you live and work, it’s important to experience it outside the sterile environment of your car.

You may or may not already be pedaling your heart out, but that doesn’t mean you can’t be convinced. According to Chris Merriam of Bikemore, there are some accepted statistics about who is and isn’t likely to bike.

The 1%: These people will bike anywhere, anytime. Fearless, possibly a little obsessed, they probably have a giant stash of bikes in their hallway.

The 9%: Confident but Cautious. We in this group, while glad to bike most places most of the time, are willing to admit that there are times and places that biking is not appropriate. Some roads are not safe, some weather isn’t worth it, and sometimes we’re tired and don’t feel like it.

The 60%: Interested, but Concerned. You know how, you may own a bike, you may bike on protected bikepaths in parks, but there are some barriers to making the jump to occasional bike commuter or city cyclist- concerns about safety, for instance.

The 30%: Not Interested. No thanks, no matter what. Chris tells me that he thinks this is OK, not everyone needs to bike, he is interested in focusing on the 60%. Education about sharing the road and biker awareness are his interventions for the 30%.

Second, How should people bike in Baltimore?

As we said over the past two columns, there are some safety concerns about biking in an urban environment, so my answer to this would be: Carefully. If you aren’t biking often or at all, but are willing to give it a shot, there are a few ways to try it in a safe and supported environment.

– Bike To Work Day is on May 17th, and there are convoys that will meet at points all around the city to bike in to the downtown area in the morning. They are listed on the Baltimore Metropolitan Council site, join up and ride in! Throughout the city will be stations offering bike maintenance, breakfast and coffee, and educational materials.

– RecRide and BikeJam is a Bike MD event on May 19th where bikers can get out and see the city before coming together for music and food in Patterson Par.

– Bikemore Homebrew Tour is this Saturday, go register, we can bike together and sample local beers!

– Baltimore Bike Party will almost certainly be on May 31st, since it’s always the last Friday of every month.

After you try one of these group events, some recreational cycling is just a short psychological leap, and after that you are well on your way toward joining the happy bike commuters of Baltimore.

Finally, Why should you (or anyone else) bike in Baltimore?

We’ve touched on this before, and I won’t belabor the point. There are substantial physiological, psychological,  and economic benefits to exercise in general. Biking or walking to work magnifies those benefits while contributing to the health of the neighborhood, city, and world. Taking cars off the road during commuting hours is extremely important for local emissions reductions and global environmental sustainability. With billions more people in the developing world joining us in clogging up the roads with lungs and our lungs with their toxic emissions, the global and local truly come together at the spokes of a bicycle wheel.

It’s Spring, go out, get connected, and save the world!

By the way, the new banner by Hasdai is awesome, isn’t it?

Also, shameless self promotion- Pottery Sale in Annapolis on Saturday.

Apr 18
0

Bikemore in Baltimore!

By | Health, The Global Is Local | No Comments

(The second in a Spring series about cycling in Baltimore: Why planning for strictly vehicular travel makes pedestrians and bicycles an unwelcome nuisance rather than a welcome expectation.)

In my last column, we began discussing the bicycle culture of Baltimore. Recently, I had the chance to continue that discussion with Bikemore Executive Director Chris Merriam and Board Member Dave Love. I asked Chris to frame the relationship that bicycling has with public health, how one impacts the other, and how Bikemore’s efforts are designed to improve both the health of the community and the acceptance of bicycles on Baltimore streets.

“There’s a huge public health aspect to what we do,” says Chris, who was recently award an Open Society Institute Fellowship to further Bikemore’s mission of advocating for cycling and cyclists’ rights in Baltimore. “Cycling is a means of addressing the obesity problem in Baltimore — and all over the country of course. This is a working class city, though. It’s not like Washington D.C. or San Francisco. Not everyone belongs to a gym or eats healthy food all the time. The corner store diet of chips and soda is such a pervasive issue here.”

Chris has a background in urban planning, which informs his perspective. He agrees that our transportation system is a major component of public health, and a major obstacle to improving it. “We have a substandard [public] transportation system. For instance,  I’ll see people waiting for hours at a time for buses that will take them to work. A lot of the job sprawl in the area is such that many jobs for lower income people are in suburban malls, in Towson or Whitemarsh. Using public transit, depending on where people live, can take a long time: take one bus, take another bus, take the light rail, and there’s a lot of waiting around in between.”

And yet, despite the obvious advantages of a more bike-friendly city, Bikemore and other bicycling advocacy groups are trying to counteract 80 years of car-based engineering on our cities. Designing both vehicles and cities for strictly vehicular travel makes pedestrians and bicycles a nuisance rather than an expectation, and that is reflected in driver attitudes. Often the relationship between bikers and drivers is fraught with animosity.

Dave thinks that this may change due to sheer volume of bikes on the road, remembering his time in Berkeley, California: “Regardless of where I’m going, there would be three or four people on the same path, at a stop light five or six bikes back up. We wait just like traffic…If we got enough people on the roads, we could be looking at a sea change.”

But getting Baltimore drivers not to see red when they see a skinny person in spandex “in the way” is more than just a matter of numbers. Culture has to change too, and Bikemore realizes that Baltimore is a city with its own needs, and certainly its own culture.

People cite Portland as the ultimate case study. But remember, Portland is largely homogeneous, doesn’t have a lot of conflict, has a lot of taxpayers, is relatively young, etc. We can learn lessons from other cities, but we need to be wary of the ‘if they can do it, why can’t we?’ game.

Chris and Dave believe that these problems can be solved, but it will take effort on three fronts: education, infrastructure, and policy. They are leading in all three of these areas, but if you see the Bikemore sign around town, you are seeing education in action. Whether it’s a Bike Valet stand at the Food Truck Gathering or a presentation to a group of innovators at a conference like Reinvent Transit, Bikemore is constantly encouraging awareness and mutual respect between bikers and drivers.

Housekeeping: I wanted to address a couple of questions that came up in comments last time. First, the marked gender gap in bike commuters. I have two thoughts on factors that might be contributing to the disparity:

  1. It seems likely that there are safety-related differences in male and female biking behavior, as there are in many other activities. These safety concerns are related to both the perceived and actual intrinsic dangers of the activity itself and the external threats associated with being a single woman without a protective (vehicular) barrier. This study here comes to some similar conclusions, but I welcome any comments.
  2. There is reporting bias of some sort. This study from Stanford refers to a bias on survey forms that minimize or aggregate the kinds of trips that women tend to make (leaving aside the 50’s housewife stereotype slathered on the surface of the whole premise).

Second, how to get involved:

There are a number of groups that are active in the City, Bikemore being today’s obvious example. Velocipede and other bike shops and coops are all educators and advocates worth knowing, and of course join the Bike Party on the last Friday of each month.

Next Time: Who should bike in Baltimore, how, and why?

IMAGE CREDIT. Benson Kua
Mar 22
0

When Government Lets Us Down

By | Health, The Global Is Local | No Comments

If you have read a few of my posts over the past couple of months, you have probably realized I’m in favor of government; I think it has a place and serves valuable functions. A few of my favorite examples (when done right) are the regulation of pollution, the oversight of food, chemical, and product safety, and police forces committed to protecting our rights.

It is distressing, therefore, when this entity that provides us the space and safety to be here — the government — doesn’t do its job, namely to protect the citizens. Because I spent many hours looking at hopeful and uplifting HIV/AIDS news earlier this month, it was particularly sad to see that the ongoing budget battles will cut funding that provides therapeutic interventions for the most vulnerable AIDS patients in this country — the poor. As we learned last time, HIV/AIDS has a disproportionate impact in Baltimore. Global AIDS funding is being cut as well, despite earlier presidential promises to the contrary. This is unfortunate, since international AIDS funding gets far more bang for the buck, so to speak, and addresses regions where the need is incomprehensible to us here in the U.S.

Just to balance things out, however, there is an initiative taking place in the Oliver neighborhood that is essentially a blitz of Baltimore City services –– filling potholes, installing smoke detectors, offering access to drug rehab services, arresting drug dealers who frequent the area, and removing trash and debris. Whether or not this is what the neighborhood needs to pull out of its perpetual slump is uncertain, and probably a matter of opinion. Clearly, though, the reason for engaging in this effort is at least an attempt to make life better for the residents, which is the role that government ought to provide.

A  couple of updates in the “You Heard It Here First” category:

SARS Redux? recalled the Severe Acute Respiratory Syndrome (SARS) epidemic of 2003 and drew an uncanny parallel to an emerging coronavirus that has been causing an alarming respiratory condition in several patients in the Middle East. Several recent news items have called attention to this condition, confirmed that it has the potential to spread from person to person, and traced the spread from the Arabian Peninsula to the United Kingdom.

Outbreak discussed the nationwide fungal meningitis outbreak linked to contaminated pharmaceutical products made by the New England Compounding Center.  The outbreak is expected to continue to cause illness and death across the 20 states affected. The supply chain that provides us with the medicines we rely upon should remain under close public scrutiny or be expected to fail again.

Next time: Biking in Baltimore: awesome, terrifying, or obvious choice?

Unrelated sidebar: If you are interested in trying your hand at pottery, and possibly discussing health, politics, food, and the environment with yours truly, check out the Mesh Baltimore site this week.

IMAGE CREDIT. Library of Congress Flickr Photostream.
Mar 08
0

AIDS Cure? Check.

By | Health, The Global Is Local | One Comment

This week, we found out that HIV has been cured.

For one patient.

For now.

Sort of.

The child was born to an untreated HIV-positive mother, which generally results in an HIV-positive baby. This child was given a more aggressive treatment than is common in this kind of circumstance, and which seems to have resulted in a cure. There are some nuances in the story that I am skipping over because:

1)      I am not a clinician

2)      I do not entirely understand them (see #1)

3)      I feel they are unimportant.

Oh, calm down, not that kind of unimportant. Clearly curing AIDS is important. All I mean is that the science and medicine behind this apparent breakthrough are not the most interesting part of this narrative. Instead, this event is the latest of some very unusual blips in the HIV/AIDS timeline that have taken place in the past six years.

Since the first published cases of AIDS in 1982, there have been fits and starts in the efforts to respond to the disease. Once HIV was isolated in 1984, the Centers for Disease Control and Prevention (CDC) predicted there would be a vaccine available by 1990, now overdue by 23 years. The first anti-retroviral drug for AIDS treatment, AZT, was approved in 1987 and was followed by many iterations of pharmaceutical interventions that have collectively treated patients and redefined HIV as a chronic disease rather than a rapid death sentence. [This information is sourced from this excellent timeline by POZ.]

However, starting with the Berlin Patient about six years ago, a new thread of the story of AIDS has emerged, one that finally seems to suggest that there is potential for something beyond prevention and disease management. (These two tools will remain the most effective options for some time, and prevention will always be the ideal.) The Berlin Patient, Timothy Brown, was given blood stem cell transplant treatment for leukemia from a donor who had a genetic mutation which is resistant to most strains of HIV. The resistance was transferred to Brown who is virus-free and has not needed HIV medications since 2007. Two patients in Boston had similar treatments last July, and have demonstrated positive results, and a number of unusual patients in France are reported to have “functional cures,” viral loads so low as to be almost undetectable. In a related development, a leukemia patient was successfully treated last year with a modified version of the virus that causes AIDS.

The impact on Baltimore of a true cure would be massive. The disease burden of HIV weighs more heavily here than many other places. Maryland, and Baltimore in particular, has among the highest rates of HIV in the country. Baltimore’s HIV prevalence rate is worse than that of all but the very hardest hit countries in the southern part of Africa.

Comparing statistics in a discrete urban area to an entire nation does not present an accurate picture, obviously. But, just in case you were thinking that this problem is a world away, know that it’s closer. More like a couple of yards.

The infant who has turned out to be disease-free this week is just the latest in a string of incidents that shows growth and promise in this seemingly intractable problem. This story is exciting, but it’s even more exciting to step back and take a look the accelerating changes in the epic tale of HIV/AIDS.

 

IMAGE CREDIT. Wikimedia Commons.
Feb 22
0

Disease Prevention is Sexy

By | Health, The Global Is Local | One Comment

Preventative health care is sexy. This is true in politics — as a means of addressing our long-term cost issues — but also to providers and patient advocates in terms of quality. We have heard a lot about preventative care in the last few years, especially with the discussion and passage of the PPACA (the Patient Protection and Affordable Care Act), a.k.a. “Obamacare.” But some argue that preventative care is just as expensive as the alternative.

So, does preventative care actually save money?

Regardless of whether or not it works, lowering costs by increasing preventative care is far from a new idea. A very brief search yielded this 1977 article touting the cost-effectiveness of preventative care. The theory is straightforward, and I will not belabor you with the details. In brief, however, it goes like this:

Some kinds of health care are expensive, and are often tied to chronic physical or psychological conditions. Treating those conditions early and often — improving habits and monitoring various indicators — rather than late and intensively should lower costs overall, since emergency or acute care in hospitals is very, VERY expensive. Oh, and health care expenditures are going up, in case you hadn’t heard.  (And although Medicare and Medicaid are part of the problem, they are far from the biggest part of the story…)

https://upload.wikimedia.org/wikipedia/commons/9/91/U.S._healthcare_GDP.gif

US Healthcare Spending as a Percent of GDP

That’s the short and sweet version. Feel free to look out there on that world wide web for far more in-depth discussion and articles, or look into one of the many excellent books on the subject. Also, I recommend the blog post by my colleague, , who provides analysis of one of the Affordable Care Act’s major provisions, State Insurance Exchanges.

In some form or another, earlier, preventative interventions are the basis for many of our health reform efforts, both current and past. Usually there is some lip service to quality of care, too, but savings sell. They’re sexy.

So what is the problem? Take care of people before they are sick, save money doing it, pat yourself on the back and call it a day!

The problem is simply that preventative care is ALSO expensive. In addition, if preventative care is successful, it may simply delay future costs. This argument is not new either, as Marcia Angell writes in the Journal of the American Medical Association in 1985: “Although preventive care may improve our health, it cannot be assumed to reduce medical costs, since a later death may be as expensive as an earlier one.” There’s also a fantastic study often cited by health economists by Manning et. al. proving that smokers and drinkers who die early based on their unhealthy behaviors actually are a net gain on the health economy.

Let’s circle back to the original question though: Does preventative care lower costs?

To help me answer this question, I had the pleasure of speaking with Doctor Jay Sanders yesterday. Among many other roles, he is a Professor of Medicine at Johns Hopkins University’s School of Medicine. He was quoted in Tuesday’s Kaiser Health News report on health kiosks in Walmart stores. These unmanned kiosks are self-service booths that allow customers to respond to questions about their health, diet, and family health history.

Dr. Sanders argued that the Preventative Care/Cost Reduction situation has been misrepresented. He pointed out that in the short-to-medium term (1-15 years), increased preventative care will almost certainly not decrease costs and instead probably drive them up. This does NOT mean that preventative care will cost more overall. Long term costs will likely come down, but the specifics are yet to be seen, and the time factor has been left out of the discussion.

To be successful, according to Dr. Sanders, health care needs to get smarter, more targeted, and more present for patients. He cites technological innovations, some of which are being developed and implemented here in our region, as potential game-changers. For instance, Under Armour and Zephyr are making items of clothing with embedded technology to monitor vital signs for athletes and gather other information for their coaches. Soon these items will be affordable consumer products that can be tied to our mobile devices, gathering data for us to share with our doctors about heart rhythms, activity levels, and asthma symptoms, among other metrics.

Finally, Dr. Sanders pointed out, the onus is on us as individual patients to generate better outcomes. Smart phones, apps, and wearable technology should make us more aware, at the least.

I agree with him, and I draw a tenuous parallel with democracy. We deserve the health, or government, that we get. If we want something different, we really ought to be more involved. If the Affordable Care Act is successful, we should not necessarily expect that success to be immediate. Instead, a long view is necessary, a chance to allow the experiment to take place.

As a parting thought, keep in mind that our spending as a country has not exactly yielded great results in the past. Quite frankly, a new approach could hardly make things worse:

Life expectancy vs health spending

 

IMAGE CREDITS,  University of California at Santa Cruz Health Atlas;
Organization for Economic Cooperation and Development