good for your health

A story posted on CNN today confirms what I have been saying all along. Recessions are good for you. You smoke less, eat less, eat out less, and drive less. Add in less shopping and more exercise and you can see why we all need a recession. Given the current wave of obesity, make that a long recession. Nothing will do more for public health than a severe reduction in consumption.

The recession has other beneficial effects as well: it decreases air pollution and the production of greenhouse gases. It slows global warming. There is less traffic and less cargo being shipped around. We decrease ocean pollution. All those things are good for the planet (which really means our habitat on the planet, because the planet itself does not really care) and ourselves. Another good thing is that people rein in their reproduction and that helps with overpopulation.

It appears that even the increased stress from losing one's job, or worries about providing food and shelter for one's family is rather insignificant compared to the gains we make elsewhere. Remember, there is no free lunch, ever. And to stay on theme: suicides do increase during recessions and depressions, but that effect is so small as to be negligible.

If anything, the research confirms how flawed, misguided and unhealthy our economic model really is. Rather than bring good things to us -isn't that the way we think about a thriving economy? That it is good for us?- a thriving economy cuts down on our life-expectancy, both as individuals, and as a species on this planet.

No, you are not better off when you have a bigger house, a bigger SUV, a bigger TV, and a bigger stereo. You are not better off when you can buy all the soda and food you like. You are not better off when you can travel to faraway places. Those things don't make you healthier or happier. All that talk about health and happiness is just false advertising and it is about time that someone cracks down on it.

You will not feel better if you eat out. You will just get fatter and fatter. You will not be better off if have a faster car. Quite to the contrary, you may feel frustrated more often in the inevitable traffic jams. You will not be healthier if you have a bigger house. You will just have a bigger headache to worry about and you will have to yell louder to find your family members. You will not feel better if you take long hot showers, you are drying out your skin and may contract a deadly lung infection. The list goes on and on.

fear mongering

Even though the Bush administration is now history, its fear-mongering tactics are alive and well. Pushed by none other than Mr. Cheney himself, who takes every opportunity to remind Americans how well the Republicans really did before the Obama landslide rolled over them. Not surprisingly, Mr. Cheney's fear-mongering works as well as it did before. It seems people never learn.

Mr. Cheney is not alone. The health care industry is also reviving their old fear-mongering tactics. Harry and Louise are back to let us know how the government is going to prevent us from accessing our preferred doctor, how we are going to be added to endless waiting lists, and how the bureaucrats are going to make health care decisions for us. Wait a minute? Isn't that already happening? Isn't that what every respectable HMO excels at?

Of course, no amount of reality can remove irrational fears. We all think there were no major terrorist attacks after 9/11. So we are eager to believe that whatever the Bush administration did must be responsible for that. It never occurred to us that terrorists do not have the resources to mount repeated frontal attacks of this magnitude on the same target. Especially not when the element of surprise is lacking. Terrorists did attack the West after 9/11, both in London and Madrid, but in our book, that does not really count.

One cannot help but noticing that fear works very well in America. During the cold war, Americans were more on edge about the Russians invading Western Europe than Western Europeans were. And there are plenty of other examples too.

One reason fear works so well in America is because people are very isolated. They are often displaced, i.e. far removed from the friends and family they grew up with. They are living among strangers, people they hardly know, and people they cannot really count on. Furthermore, they are exposed to a constant barrage of commercials and "breaking news" stories that remove all context, all critical thinking and all common-sense averaging.

Americans are also kept on edge by uncertainty. Most of us have no job security, no health security, none of the basic securities that people in other advanced societies enjoy and that make them less vulnerable to turmoil and less likely to be swayed by ads.

All that is not good, but I suspect some people think it is just the way they like it. It is good for business. People who are on edge spend more and they spend more often. They use more resources, they pursue more paths. They make better consumers.

a primer on insurance

We are told insurance works to protect people against unforeseeable and unexpected tragedy. The concept is fairly simple: a number of people facing risk pool money together so it can be paid in times of need out to the few who become actual victims. There is no cheating, everyone knows they may not become a beneficiary unless something bad happens, and most would choose not to ever "have to benefit" from this arrangement.

Occasionally, a participant will try to cheat and issue a false claim. That is a bad idea, and the industry has the full backing of the government and law enforcement to make sure these bad apples are punished in a highly publicized and visible fashion. This type of cheating does not pay. Besides there is a far easier way to reap benefits. One where the government will give you a helping hand.

First, add a little capitalist twist to the story and you get the insurance company. In return for orchestrating all the logistics the company is allowed to make a profit. That is easy since the company can invest the money people provide and get a return hopefully before it will have to pay the few unlucky souls. Nobody objects to the company charging a bit extra either. People don't even object to companies rejecting those who are considered high risk. Or charging more to those who are high risk but nevertheless "acceptable." After all, companies have to make money.

In short, this arrangement seems rather straightforward and easy.

Experience has taught us to beware of such easy and straightforward schemes. There is ample room to cheat here. People pay upfront and if you can somehow avoid paying them back later, you can pocket all the money. The easy way to do that is to refuse coverage to those who need it, when they need it. You can start by refusing claims, or making it hard for people to file claims. That will turn a lot of them away, while others may die before they can benefit. 

It is now so common for health insurers to deny claims that patients expect to have to argue with their carrier at one point or another. Today's WSJ had some tips on how to argue with your insurer in case a claim is denied. But it doesn't stop there. Insurance companies also try to ditch you when you file claims for more than a few pennies. They will go to great lengths to uncover technicalities in your record that will allow them to break the contract.

It is one of those tactics insurance companies find acceptable or evidence of good business practices. You know, protecting shareholders? How else would you explain their stance on California's bill AB1945?

The bill prevents insurance companies from retroactively rescinding coverage. Mind you, it still permits insurance companies to drop customers who intentionally submitted fraudulent applications. But that requires proof and meaning extra work and smaller profit margins. Better to avoid it when we can.

AB1945 is a straightforward honest bill. Yet the insurance companies are fighting it tooth and nail. A spokesperson for the industry said -with a straight face- that they are trying to protect consumers. Not the shareholders, folks, you. You, the insured. They are trying to protect you from those fraudulent cheaters that are causing all our problems.

It turns out insurance companies like to rescind policies retro-actively. They like to dump patients with expensive medical conditions that were diagnosed years after they were approved for coverage. Recently, Blue Cross was fined for dumping 1,770 members, while Blue Shield dumped 450. Kaiser Permanente, Health Net, and PacifiCare were also fined for dumping patients. Dumping it seems is part of the way insurers do business.

Governor Schwarzenegger personally knew someone who was diagnosed with cancer and had his coverage rescinded. According to the insurance company, the patient had a pre-existing condition and should not have had coverage. What was that pre-existing condition, you ask? A knee injury sustained years earlier. The governator was so shaken by this incident, he decided to do something about it. Only so far it hasn't happened. And if the insurance industry gets their way, it won't happen. Because all the money they save goes into their shareholder's pockets. That my friends is their true mission: to collect people's money and stuff it into shareholder's pockets.

In case you doubt if insurance is profitable, look no further than Warren Buffett. And if you wonder what happens when insurance companies do dumb stuff and end up losing money, look no further than AIG. As you can see, the insurance business is a very good business with very little downside risk.

in sickness and in health

The CDC released its 2007 National Diabetes Fact Sheet recently. Among the notable findings, 24 million Americans suffer from diabetes, with another 57 million in a pre-diabetic state. 90-95% of these are type 2 diabetes, also known as non-insulin dependent or adult-onset diabetes. It is by and large a preventable form of the disease.



While pre-diabetics don't always progress to diabetes, a very significant percentage do. Type 2 diabetes is strongly associated -among other things- with being overweight and being physically inactive. Many people with type 2 diabetes can control their blood glucose by losing weight, following a healthy meal plan, and exercising. In most cases, their doctors will add a blockbuster oral drug for good measure. If all that fails, insulin is the only option.

However, even when treated appropriately with all the life-saving medications the pharmaceutical industry can offer, diabetes is nasty killer. Its victims suffer increased infections, blindness, limb amputations, kidney disease that may lead to dialysis, heart attacks, strokes, and other ills. It is not a pretty picture.

Diabetes is more common in certain ethnic groups, many of whom also happen to suffer from very high incidences of obesity. There is little doubt that, in many instances, diabetes is a life-style disease. You could say, it is part of the price we all pay for cheap oil. A tax on gas so to speak.

You may have seen those anti-smoking ads that the State of California put out recently. In it they take down the glamorous Marlboro man image to that of a sick person, sitting in a wheelchair with oxygen supply lines in their nostrils. For now at least, smokers are free game. Not so for the overweight and the sedentary. At least not yet. However, it would not be hard to imagine a similar ad that takes down the image of the successful macho SUV driving male to a similarly more realistic representation.

medicine and health

It is often said that doctors are the only professionals that seek to make themselves unnecessary. It sure sounds good. But do we really believe that this is true? Are doctors really out to make themselves obsolete? Although many are driven by higher motives, I found a surprisingly large number of pre-med students willing and even proud to admit that they were in it for the money. Even those that do aspire to higher goals have little choice. Given the high cost of medical education, and the resultant outstanding loans that many young doctors are stuck with, most could not afford to put themselves out of business even if they wanted to. Fortunately there is little real danger of such a situation materializing. That makes it easy to take the high road.

The pharmaceutical industry is "struggling" with the same dilemma. The "struggle" is largely an internal matter though, as pharmaceutical companies are businesses so they can freely state that their primary goal is to make money. As indicated before, they have a duty to make money and their officers are bound by such duty to maximize revenues and profits. That means the true struggle for pharma is one of communication and public relations. It is key to appear to the public as if profits were an afterthought. This is a serious matter and all pharmaceutical companies try to outdo themselves in this important area.

Health care investors can be even more blunt and they often are. It has been remarked by some famous healthcare analysts that there are only two disasters that happen during a clinical trial for approval of a new drug. One is that the drug does not work. Obviously that is a bad situation and the company will have to forgo a major opportunity to make money. The other equally grave disaster is that the drug cures the patients. That may sound counter-intuitive until you realize that drugs that cure diseases cannot make money. To be truly successful, a drug must mitigate a condition enough to make a difference, but not so much that patients can ever stop taking the drug.

It is fairly easy to see that the best drugs are the ones you have to take for the rest of your life. And the best conditions to focus drug development on are the ones where people survive for a very long time after diagnosis. Both of these are necessary ingredients for the so-called blockbuster drug. Blockbusters are drugs that sell in excess of $1B a year and major pharmaceutical companies are set up to pursue blockbusters and blockbusters only. Considering that patents offer exclusivity for about a decade (17 years to be exact but one needs to subtract the years it takes for approval), and that a drug, once developed is practically speaking all profit or margin, it should not surprise us that pharmaceuticals are big business. The top selling drug today is Pfizer's Lipitor, a medication for high cholesterol levels that brings in a nice $12B a year for the company.

Note two things: high cholesterol levels (in nearly all) result in no symptoms or signs, and drugs for high cholesterol need to be taken for life. High cholesterol is a condition that is linked to a higher incidence of heart disease and stroke. It is not an illness per se (again with few exceptions). The linkage was established through population studies. You may note that possession of a car is likely equally strongly linked to almost any predominantly Western disease.

Just as it behooves pharmaceutical companies to focus on drugs that nearly everyone can take for the rest of their lives, it is advantageous for healthcare providers to focus on patients with chronic, but largely stable conditions. Doctors thrive on hypertension, high cholesterol, diabetes, and especially chronic complaints. Although MDs often state that the latter are their least favorite patients, the economics shows them to be essential to the well being of the practice.

In short, healthcare, like so many other things in life, is a playground for consumers and providers. Consumers of services, devices, and drugs. In that sense it is not so different from other areas of the service economy. It is equally sensitive to over-consumption and waste. Which means, unfortunately, that its net impact on health is rather trivial.

drugged nation

In a further indication of the sorry state of American health, it was reported yesterday that over half of insured Americans are on drugs. And we are not referring to the occasional pain killer. These are chronic drugs that are taken for extended periods of time, some for life. Many believe the percentage of drug users will only go up in the coming years.

While some in the medical community were quick to point out how good our drugs for chronic conditions have become, others were not so upbeat. Among the dissenters some pointed out the relentless and extremely effective direct-to-consumer advertising used by pharmaceutical companies. There is little doubt that many are taking medications they don't need. No matter how good these are, none are free of side-effects and not all side-effects are harmless. Given the numbers of drug users there is no doubt that many a premature death is caused by medication.

Apart from all that the real issue here is the declining public health. If over half of the population needs medication to live something is seriously wrong. Perhaps not surprisingly a lot of drug-taking was linked to obesity, diabetes, and heart ailments. All these conditions are negatively impacted by a sedentary life-style, lack of exercise, and over-consumption of food. These are suburban illnesses, brought about and reinforced by an unnatural life-style that some believe is the pinnacle of achievement and success.

It reminds me of the commercials for a smoke-free country. They start out by highlighting all the glamour put forth by tobacco companies. You can be successful, a movie star, the Marlboro man, an adventurer, a socialite. Then the images fade and a very sick person attached to an oxygen tank appears. The message ends by saying this is the true face of smoking. Similarly, we could envision a commercial showing a big suburban mcmansion, two huge SUV's, an oversized lawn, tons of power tools, and other accoutrements of the good life. Now fade to sickly obese inhabitants, huffing and puffing to lift themselves out of the couch reaching for their life-saving drugs.

There were startling findings in the study, such as the fact that two thirds of women over 20 were on medication. These are women in their prime reproductive years. Think of the potential harm that can be done to the unborn once these women get pregnant. Then again, over one quarter of children and teens are on chronic medications as well and three quarters of the elderly. It appears that Americans are drugged from the womb to the grave.

The pharma industry is unrelenting in its search for illnesses that fit their drugs. It is called "label expansion" and it is something that makes many investors drool. The drug industry is not alone however. The medical profession also does its part by bringing more and more conditions within the medical realm. Children are no longer difficult, they suffer from ADHD. People are no longer sleeping less as they get older, they suffer from insomnia. And then there are the ever dropping numbers of acceptable cholesterol levels and blood pressure readings. Without any consideration as to the cause, the zealots are out to drive these numbers into the ground. Already signs are appearing that lowering blood pressure isn't always a smart thing to do. It often leads to premature death. How come you never hear about this in the mainstream media? Here is a hint: there are plenty of medications to lower blood pressure, and these have to be taken for the rest of one's life. The same holds for cholesterol.

Come on America, time to take another pill. Forget about your bicycle. It is too hard in any case.