Tag: FDA

Life, Liberty and the Pursuit of Health Care

Even though the United States does not officially have “socialized” health care, a large proportion of our medical care is funded by the federal government. Even though I know that, I was still surprised by statistics in a recent article, which stated that  the federal government accounts for

40% of healthcare  spending
$1.3 trillion /year
Covering 100 million individuals

(stats from 2016)

Through 4 federal agencies

  • Department of Health and Human Services 
  • Department of Defense
  • Veterans Administration
  • Department  of Homeland Security

(JAMA (Journal of the American Medical Association), June 21, 2016)

The  United States Congress passed the Patient Protection and Affordable Care Act (ACA) in 2010 to guarantee basic health insurance to all citizens.  People who oppose the ACA ,aka Obama Care, dislike or even fear government involvement in medical care; they consider it interference, control, or even nationalization of the United States healthcare system.

a Veterans Administration clinic
a Veterans Administration clinic (photo by Dr. Aletha)

I think many people, even physicians, don’t realize or forget, how involved the government already is in healthcare. As far back as the American Revolution the fledgling government extended health care benefits to the soldiers and veterans of that war; that system evolved into the current military health care system which covers service members and the Veterans’ Administration system for veterans.

American soldiers serving in Afghanistan
American soldiers serving in Afghanistan

2015 marked the 50th anniversary of two other government healthcare programs- Medicare and Medicaid.

Medicaid provides insurance coverage for adults and children who are unemployed or low income.

Medicare covers disabled children and adults  and persons 65 years and older.

wheelchair-749985_1280
Disabled children and adults may qualify for Medicare.

The numbers are rather staggering.

  • Together these programs cover at least 30% of Americans.
  • Together they comprise 25% of all federal spending.
  • Together they pay 40% of total U.S. health care spending.

An infographic from the Kaiser Family Foundation and JAMA explains this further.

hospital-79605_1280
Children may be eligible for Medicaid if their families cannot obtain health insurance for them.

You may not be eligible for either of these programs now, but chances are eventually you or someone close to you will.

  • Anyone can become disabled from a serious illness or freak accident.
  • You or your spouse may lose your job and your employer sponsored health insurance.
  • Your child may have a disability that will prevent them from working when they grow up.
  • We may all live long enough to qualify for Medicare on the basis of age alone.  Your parents or grandparents are near or already at Medicare age.
Senior adults age 65 and older use Medicare.
Senior adults age 65 and older use Medicare.

It’s important to understand how Medicare works, since it’s not automatic; even if you qualify, you need to sign up to be covered (with a few exceptions). The rules are summarized here. Or consider an easy to understand book here. 

Several government agencies regulate, monitor, promote and/or support  both public and private healthcare through the Deparment of Health and Human Services and other agencies.

Food and Drug Administration- FDA

Centers for Disease Control and Prevention- CDC

National Institutes of Health- NIH

Occupational Safety and Health administration-OSHA

Drug Enforcement Agency-DEA

Congress has enacted several important laws that  concern health care such as

 The Affordable Care Act- ACA

Health Insurance Portability and Accountability Act-HIPPA

Emergency Medical Treatment and Labor Act- EMTALA

Health Information Technology  for Economic and Clinical Health- HITECH

Americans with Disabilities Act-ADA

Family Medical Leave Act-FMLA

LIFE, LIBERTY AND THE PURSUIT OF HEALTHCARE

Sharing the HEART of health

In the Declaration of Independence, the founders of the United States  created a nation based on the “self-evident truths”  of  “Life ,Liberty, and the pursuit of Happiness” as well as  to promote “Safety and Happiness” . 

In the Constitution they vowed to “promote the general Welfare” .

I wonder if they envisioned that would eventually include so much effort and money providing and regulating health care, most of which was not  even imagined at that time? 

Dr. Aletha

Update on weight management options

This post has been updated so please choose this link

approaches to weight loss.

First and always are lifestyle changes involving food choices, and eating habits.

Along with that, one needs to start or increase physical activity.

There are many different ways to achieve these, from books, videos, group activities, online programs, counselling and many combinations of these.

For those folks who still can’t reach goal, the next options are weight loss medications, and surgery.

someone standing on a scale
New weight loss options are good news.

Now there are FDA approved options which do not involve drugs or invasive surgery. These medical devices aid weight loss by affecting the amount of food that gets eaten and/or absorbed into the body.

The ReShape Integrated Dual Balloon System was approved by the U.S. Food and Drug Administration in July 2015. . Candidates for the device are

  • Adults
  • BMI 30-40
  • At least one obesity-related condition- hypertension, diabetes, elevated cholesterol

It is a device placed into the stomach by going through the mouth and down through the esophagus through a tube called an endoscope. It takes about 30 minutes and requires on a mild sedative, not general anesthesia. Once in the stomach the “balloons” are inflated; by taking up space in the stomach it can trigger a feeling of fullness.

Patients still continue to follow their eating and exercise plan and the device is removed in 6 months.

Like any medical procedure, there are potential adverse effects including headache, muscle pain, and nausea from the sedation and procedure; in rare cases, severe allergic reaction, heart attack, esophageal tear, infection, and breathing difficulties can occur. Once the device is placed in the stomach, patients may experience vomiting, nausea, abdominal pain, gastric (stomach) ulcers, and feelings of indigestion.

The Orbera Gastric Balloon works in a similar way, with a single silicone balloon. Potential adverse effects are similar to the ReShape.

The Maestro Rechargeable System is implanted under the skin; an intermittent pulse generator delivers an electrical signal to the vagus nerve in the abdomen. The vagus nerve controls stomach action; when slowed down, one feels full sooner and theoretically will eat less.

 

Another interesting device is AspireAssist.

This is a tube inserted into the stomach, from which a portion of the stomach contents can be “aspirated” (removed) after eating.

This device helped 10 out of 11 people loss 18% of total body weight in one year.

An application has been submitted to the FDA but it has not been approved for use in the United States.

People lost weight with all of these devices largely due to the intensive counseling and support they received along with use of the device.

tape-403591_1280
Obesity is defined using BMI, body mass index, but waist circumference is also important and may be more accurate.

A success story

After gaining weight with her pregnancies, one woman , J.T. ,successfully lost weight with gastric bypass surgery.

Read about the lifestyle changes she made at this article from American Family Physician journal. 

 

IN THE NEWS- BIG LOSSES, BIG GAINS

Many news sources have reported  a recently published study about contestants in “The Biggest Loser” weight loss contest. In this contest, severely obese people have lost huge amounts of weight with strict diets and vigorous exercise.

Unfortunately, the study found that most of them gained most of the weight back over time, due to what the scientists called “metabolic adaptation”, popularly called slowed metabolism. This is discouraging news.

However, they also point out that even though the contestants regained a “substantial” amount of weight in 6 years post competition,

“they overall were quite successful at long term weight loss compared with other lifestyle interventions.”

Even though they regained weight, they still weighed less than when they started.

If you want to read the full report with all the graphs and statistical analysis, here is the link

Persistent metabolic adaptation 6 years after “The Biggest Loser” competition

statues of athletes jumping
Contestants in the Biggest Loser competition exercised several hours daily but did not continue this after it ended.

Finf other posts about weight management at these links (info current as of the publication date)

Obesity and BMI defined

How we should view excess weight 

How effective are weight management programs? 

A success story; how a doctor helped her patient lose weight

When diet alone doesn’t work

How my friend lost weight and inspired others with her example

 

Dr. Aletha