Process Reflection 3

Throughout the course of this semester, we covered a very broad range of topics.  I feel as though I have come out of this class more educated about healthcare in general.   I also feel as though I am more aware of the many problems that we currently face in terms of healthcare, and what potential problems could develop in the future. Before taking this class, my knowledge of healthcare in the U.S. (and the world in general) was sadly lacking, and I feel that the information I have learned is definitely important. In my personal opinion, every person around my age should be aware of the issues that we discussed in class; we are going to be able to vote in the 2016 election, and soon enough it is going to be our responsibility to face and try to solve all the issues that are developing in today’s society.

Looking back over the semester, I think the idea that stands out the most to me or that is most shocking is the disparity between how much money we spend in the U.S., but how bad our health outcomes are in comparison to countries of comparable economic status.  Studying abroad in France made me somewhat more aware of how our system here rations healthcare, but this class has truly opened my eyes to the disparities in healthcare in our own country.  The fact that the United States, a country considered to be a world superpower, does not guarantee healthcare to all of its citizens is completely stupefying to me.  What is a basic human right, if not the access to healthcare? This is just one of the upcoming problems that we face in this country, and it is going to be an especially important topic in the upcoming 2016 election.

Dying at Home

In many of the articles we’ve read and videos we have watched recently in class, a common theme I’ve noticed is many elderly, terminal patients wishing to die at home rather than in an institution. In Fighting to Honor a Father’s Last Wish, Mr. Joseph Andrey was shuttled around between hospital stays and different nursing homes/rehabilitation centers in the months leading up to his death.  His daughter fought relentlessly to get him home and have some sort of home care/hospice to take care of him, but she had no luck.  This is just one of many stories we have heard about this same type of situation, even though the vast majority of people say that they wish to die in the peace and comfort of their own homes.  In Tip-Toeing Toward Conversations about Death, an expert about end-life-care states that “if patients start taking charge of their care at the end of life, the effects will ripple through the system.” But what if that is not enough? What will it take for this country to institute some sort of end-of-life care that is sustainable and will fulfill the wishes of so many Americans?  Would a grass-roots movement help gain momentum, or is this an issue that only government officials can address via the passing of legislation?

Investor Ownership in Nursing Homes

In the study regarding the effects of investor ownership on the quality of care in nursing homes, the researchers found that investor ownership does indeed lead to worse care and less nursing care than non-for-profit or publicly owned nursing homes.  This leads me back to the idea that our healthcare system is frequently motivated by financial gain. Does this study reinforce this idea, and is there anything that we can do to reduce this effect? Also, are nursing homes in other countries facing the same problems, or are they generally non-for-profit like the rest of their healthcare systems?

Boston and the Theory of Constrained Choice

The city of Boston has been in the news in the past few days because of a new proposed piece of legislation: a bill that would outlaw the sale of tobacco products to anyone under the age of 21.  The current law forbids the sale of tobacco products to anyone under the age of 18, so this law would be raising the minimum age by 3 years. The penalties for violating this proposed law would be between $100-$300.  Authorities in recent years have been targeting the age at which it is legal to buy tobacco products in hopes of reducing the number of Americans that smoke. Proponents of this law claim that “about 90% of daily smokers first used cigarettes before the age of 19.”  By raising the age to 21, they would hopefully reduce the number of people who begin smoking during those formative years and therefore reduce the total number of smokers in the United States. However, many businesses and retailers are against the law and claim that this new law would have a negative effect on state revenues and not truly address the smoking problem in our country.

While my own personal opinion does not truly matter in this scenario (although I am in favor of the law myself, and think that it would reduce the smoking rate), I think that this is a perfect example of the theory of constrained choices that we discussed in our last unit. The government of Boston (and potentially Massachusetts as an entire state) would make a decision that would effectively constrain the choices of a certain population, in this case those aged 21 or younger. The people in this category would no longer be able to make the choice to smoke or not- the government has already made the decision that they cannot smoke.  This would now be a constrained choice, just like a mother who does not have access to affordable daycare for her child may have difficulty making positive decisions for her health because of time constraints. The proposed law for a ban on the sale of tobacco products to those under the age of 21 is a real life example of the theory of constrained choices, but in this scenario, it should affect the health of the target population in a positive way.

 

Link to article: http://www.bostonglobe.com/metro/2015/11/28/state-weighs-raising-legal-age-for-buying-tobacco/GEwThzhE1ZJx9ZaDPGZ1tI/story.html?s_campaign=bostonglobe%3Asocialflow%3Afacebook

A Patient’s Story

In reading the excerpt from Jerome Groopman’s novel “How Doctors Think”, one quote in particular stuck with me. The physician he was interviewing, Dr. Myron Falchuk, was discussing his interaction with the patient whose story begins the novel.  He said “But I believe this that this technology has also taken us away from the patient’s story. And once you remove yourself from the patient’s story, you no longer are truly a doctor.”  I thought that this was a really strong quote that also related to the Ted talk that we watched last week in class. The speaker talked about how he would set up a preliminary appointment just to listen to his patient’s story, and felt that in doing so he established a better relationship with the patient and was able to have better communication with them.  In light of all the technological advances of modern medicine, do you feel that the story of the patient becomes superfluous? Does all the technology we have today, in terms of diagnostic tools and imaging techniques, render the patient’s oral history or list of complaints obsolete? Or, as Dr. Falchuk and the Ted speaker have expressed, is listening to what the patient has to say truly the first step in making a correct diagnosis and establishing a proper treatment plan?

Sociological vs. Medical Models of Illness

In this week’s readings, we read a lot about the two different models of illness.  Growing up as the daughter of a doctor and and aspiring to be a doctor myself, I had always taken more of the medical perspective.  Reading the article “The Social Construction of Illness: Key Insights and Policy Implications” actually made me think a lot differently about the concept of illness.  However, it was really difficult to accept this point of view because I had always thought of illness as having one single, biological cause and that it could be treated with a biological agent. I can understand the sociological model, that assigning an idea to the illness itself changes how we experience it, but the two models seem like two antagonistic ideas.  Is there any way to reconcile these two ideas, to take into account that a biological agent may cause a disease but that social factors also shape how we experience that disease? Would a model that takes both of these ideas into account not give us a more expansive view of human illness or disease?

Correlation Between Lack of Sleep and Weight Gain

You have too much homework to do, so you stay up late to get it all done. Then when you get up late the next morning, tired and sleep deprived, you don’t have time to eat a healthy breakfast, so you grab something quick on your way to class.  Before you know it, this becomes your daily routine.  We have all been there, and not thought much of it. But now, researchers have linked a routine such as this with weight gain in college students.

In a study recently published in the journal of Behavioral Sleep Medicine, researchers followed the sleep habits of 132 freshmen at Brown University.  After the first six weeks of college, nearly half of the participants had gained almost 6 pounds.  Researchers suggested several different causes for this weight gain: not getting the recommended 9 hours of sleep, going to bed too late, and the variability in their bedtimes.  When the students did not have a regular bedtime, they had to readjust their metabolic rates.  They are also more likely to be too tired to exercise, and also more likely to eat foods that give instantaneous energy but are not healthy in the long run. The researchers then go on to point out that the four years spent in college are crucial for development of healthy habits to turn into healthy routines; if college students form unhealthy habits now, they are more likely to last into our adulthoods.

The information in this study is, in my opinion, actually very crucial and relevant to all students in college.  While it is difficult to maintain a constant sleep schedule, especially if you have classes at very different times each day, it is still important to do so.  I know that I personally feel healthier and have more energy if I go to bed at a set time and wake up at a set time each day.  Over the summer, while shadowing a primary care physician, I heard her emphasize this same point to all her college-age patients.  She encouraged them to have a set sleep schedule, and to implement a set exercise schedule if they did not already have one.  She also emphasized the importance of these schedules, and told them that the habits we form now as college students will be the habits that we stick to as adults.  I think that this study has very important implications for students our age, but that only very few students realize the gravity of it.

 

Link to the article: http://well.blogs.nytimes.com/2015/10/26/poor-sleep-may-spur-college-weight-gain/?ref=health

Race Differences in Healthcare

In the past week, we have read several articles and watched several movies about the difference causes of inequality in healthcare.  One of the biggest contributors that was mentioned in everything we’ve read or watched is the difference of race.  In the article by Williams and Sternthal, they say that biologists have found little differences on the genetic level between different races.  That should mean that, biologically speaking, our bodies should not react in different ways to the same disease or health-related situation based solely on race.  Yet, in one of the movies from class, they talk about an African American woman who was of relatively high SES whose daughter was born prematurely with a low birth weight. Yet, white women of the exact same SES, income level, education level, and occupation status as this African American woman consistently carry their babies to term, and their babies are born with a normal/healthy birth weight.  This suggests that racism negatively affects our health, even in today’s society that has supposedly eliminated all racist ideas and supposedly guarantees equality for all.  What, as a nation, can we do to reduce these negative effects of racism on health? Is there any sort of governmental policy that can address this, or would it take a full scale ideological revolution?

Redistribution of Goods/Resources- Too Close to Socialism for America?

In reading the assigned article for this week, “Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence, and Policy Implications”, I learned about the theory of fundamental causes.  Part of this theory is that greater access to resources that minimize the effects of diseases can lead to better healthcare.  The authors argue that reducing the stark resource inequalities that we see in our country today can lead to better healthcare for all our citizens.  The other side of this coin is that if we continue to see these inequalities of resources and do nothing about them, then we will continue down this path of inequalities in healthcare.

The authors then go on to argue that if there were some way to redistribute resources amongst everyone in country, then we could begin to reduce these resource inequalities and therefore the inequalities in healthcare. Right after I read this article, I turned on the Democratic Debate last night, only to hear Democratic candidate Bernie Sanders addressing a very similar issue.  He was arguing that our country should have universal healthcare, that America is the only industrialized nation that does not guarantee healthcare to all its citizens.  He then went on to say that we should have a single payer system that would have a tax on higher income families/persons in order to help the poorer pay for their healthcare.  In other words, he was saying that we should try to redistribute goods in order to reduce inequalities in healthcare.

However, in my mind, there is one small problem with what Bernie Sanders (and the authors of the article for this week) are arguing: America does not like socialism.  Bernie himself said last night in the debate that he is a Democratic Socialist, but in the past, Americans have balked at the idea of socialism in our country. Many Americans were opposed to the ACA in its earlier days, labeling it as “too socialist”.  Is there a way that we can begin to reduce these resource inequalities and therefore healthcare inequalities without dragging socialism (something that our country is very opposed to) into the picture?

New App Really the “Wonder App” for Weight Loss?

In this day and age, you can find a smart phone app for just about anything, from games to comparing gas prices, from ordering pizza to maps, from medical journals to photo editing technologies. One of the biggest fads to sweep the App Store recently has been fitness apps that help you keep track of how much you have exercised, how many steps you have taken, how many calories you have consumed, your changes in weight, and so much more. All iPhones these days come preloaded with Apple’s own version, called Health, that acts a pedometer on its own, but also gives you the option to put in your own health data ranging from your body measurements to how much you sleep at night. When you type “fitness” into the app store, there seems to be hundreds of different apps available- there’s no end when you scroll through the different options.

One such app that was recently released, tentatively called “myCircadianclock”, takes a slightly different approach from most of these apps. The app had its first round of users take a picture of everything that they ate or drank, including the background in the picture. The app then time stamped each addition, and calculated how many calories were consumed and how many hours a day the person was consuming calories. Their findings showed that many people eat more for than 15 hours a day, with at least a third of these calories being consumed after 6 p.m. The goal of this app is to study the timing of food intake in humans and find a healthier way for people to eat. After the analyzation of these original findings, the subjects of this preliminary study were advised to eat for only a 10-11 hour period and at regulated times while still maintaining the types of food they consumed. They then reported feeling more energetic and healthier, and on average, lost about 3.5% of their excess body weight.

While the findings of this preliminary study do seem promising, there are several inherent problems associated with it. This first group of subjects participated for 3 weeks, and the company reported that most participants would regularly submit the pictures of the food they were consuming, but it is easy to submit a picture for three weeks rather than perhaps a year in the bigger picture. When first starting a fitness routine or diet such as this, many people are extremely compliant in the beginning stages. However, as time passes, they get more lax about it and forget to record their calories or skip going to the gym. Therefore, as people submit less and less of what they are consuming, the feedback from the app will become less and less relevant. A second problem would be the type of food that people are consuming. While people that changed the hours they were eating but maintained their current diet reported losing weight, eating unhealthy foods could still have negative impacts on our health. Even if you lose weight, eating foods high in fats or cholesterol will have negative consequences. Weight loss is not the only area of our overall health that we should be worried about. Before hailing this new app as the wonder app for weight loss and the elimination of unhealthy eating habits, there are definitely some things to consider.

Link to article: http://www.salk.edu/news/pressrelease_details.php?press_id=2116