Dagger Thrust into the Heart Of the Affordable Care Act: Health Cometh Not From Healthcare
May 2, 2016
A dagger has been thrust into the heart of American medicine and The Affordable Care Act. But none dare call it death.
In
a complete denunciation of modern medicine, the profit-making schemes
of health plans and political efforts to make healthcare available to
all came to a dead end with a policy-bending report published in the
Journal of the American Medical Association that shows access to
healthcare does not deliver health. The Affordable Care Act does
deliver treatment. It does pay doctors and hospitals. But access to
health care fails miserably at delivering health.
“Health
cometh not from healthcare,” says preventive cardiologist John Mandrola
who summarizes this report by saying: “the key determinant of a
population’s health is not gleaming new medical centers, but individual
behavior.” [MedScape April 2016]
According
to an editorial in the Journal of the American Medical Association, only
about 10-20% of positive health outcomes are accounted for by delivery
of health care. [Journal American Medical Association April 10, 2016]
Another
recent authoritative report says only 3% of Americans live a healthy
lifestyle, defined as being physically active, eating a healthy diet,
avoidance of tobacco (which takes 10 years off a person’s life), and
having a lean body shape. [Mayo Clinic Proceedings April 2016]
The key
marker of health was found to be a zip code. Maps show almost a 15-year
disparity in longevity between the most healthy and least healthy zip
codes and this figure had nothing to do how much doctoring was going
on. Income is the predominant factor. [Journal American Medical Assn. 2016]
While more
Americans are now covered by health insurance this must be viewed in
the health and financial context of stagnant incomes. [US News Sept 16, 2015] It’s not insurance coverage but incomes that determine health status.
As Dr.
Mandrola says: “It’s about time Americans wake up to the fact that the
medical profession does not determine a population’s health.” Skip
building new medical centers and buying screening vans and build more
parks and bike paths, says Dr. Mandrola.
It is
individual behaviors that determine the health of a population, largely a
lack of exercise, obesity and tobacco use. Most of the credit modern
medicine takes for improved health numbers emanates from a steep decline
in smoking rates, not an increase in the availability of new medicines
or other treatments.
U.S. ranks 32nd in health
Butting up
against the so-called triumph of the Affordable Care Act that has
increased the number of insured, a harsh reality is that Americans live
shorter and less healthy lives than people who live in other high-income
countries.
In 2012, life expectancy in the US ranked 32nd
worldwide. Strikingly, when poor immigrants come to the United States
their health declines and they live shorter lives. One immigrant
succinctly said: “In Mexico, we ate healthily and didn’t even know it.
Here, we know the food we eat is bad for us. But we eat it anyway.” [Knowledge of Health]
Among
explanations for differences in life expectancy and health between the
US and other high-income countries are tobacco use, obesity, diet,
physical inactivity, alcohol and other substance abuse. Of interest,
both insured and uninsured Americans experience poorer health than their
European counterparts.
The fact
remains that the overwhelming contributors to the incidence of disease
(e.g. poor health behaviors) operate largely outside the influence of
medical care. “Why do Americans more often than adults in other
countries make behavioral choices that are detrimental to their
health?” [Annual Review Public Health 2014]
Uninsured
Americans actually report fewer health problems than those who are
insured privately and publicly. They use less health care services,
maybe because they have had to learn how to stay healthy without
doctoring.
Affordable Care Act said to address preventive care
It is said
the Affordable Care Act (ACA) addresses preventive care. “The
Affordable Care Act aims to increase coverage options and access
to treatment and preventive health care services for the majority of
the uninsured US population. However, the ACA may not play a
significant role in health improvement among the uninsured.” [BMC Health Services Research 2016] Preventive health care programs need to be effective, not just well attended.
It didn’t
help that government, which fashioned the Affordable Care Act, also
produced the Food Pyramid that misled Americans to consume refined
carbohydrates that convert to sugar in the body at the expense of fats
that quell appetite. Nina Teicholz tells the whole story in her
best-selling book THE BIG FAT SURPRISE (Amazon.com).
The giant disconnect
There is a
giant disconnect in modern medicine. We have a massive diabesity
epidemic going on in America spawned by the food industry that spikes
foods with high fructose corn sugar (even ketchup, bacon, peanut butter)
that induces sugar-craving yeast overgrowth, and other chemicals that
cause consumers to lose control of their appetite. The medical
profession then treats diabesity as if it is a lack of exercise and lack
of self-control when leanness in other nations like Japan and France is
not attributed to frequent attendance at gymnasiums or the reading of
diet books. [American Family Physician 2001]
There is a
disconnect between the food industry that is fashioning prepared foods
that are spiked with corn syrup and other pleasure-center stimulants
that encourage overeating against the backdrop of modern medicine that
pretends to treat this behavior as a drug deficiency. [American Diabetes Association]
Executives
from the largest American food companies walked out on a 1999 conclave
that explored why half of the nation is diabetic or pre-diabetic and is
addicted to food. They protected their financial bottom line. [New York TimesFeb 20, 2013] The diabesity epidemic is good for business.
A
larger portion of the population is now covered by health insurance due
to The Affordable Care Act though the nation is far from achieving
universal coverage for all. But the drive for equality in health care
has only assured doctor and hospital get paid. It hasn’t made Americans
any healthier. It has resulted in many lower-income Americans feel
they can now see a doctor, but as underscored here, doctoring does not
equate with health.
For example, simple advice to cease smoking, delivered by physicians, motivates only 5% of smokers to give up tobacco. [Archives Internal Medicine1995; Cochrane Database 2000]
Doctors
consider programs that achieve very modest weight loss (~10 lbs. among
patients whose mean weight is ~230 lbs.) to be successful. [New England Journal Medicine 2011]
Greater access to care may be meaningless. Hospital closures have had no measurable impact on local mortality rates. [Health Affairs 2016]
Screening
and preventive services for obesity and diabetes are available under the
benefits provided by the Affordable Care Act. But that doesn’t mean
the diabesity epidemic would be over if everybody had access to
doctors.
Doctors
appear to be all too pleased with an epidemic that has brought them
endless patients in need of prescription drugs and even weight-loss
surgery. Real prevention is not screening and treatment, real
prevention is keeping the disease from occurring altogether.
Doctors
are trained to detect and treat disease. Hence, we now have treatment
for pre-diabetes, drugs and other therapies to address markers of
disease rather than the disease itself.
An
estimated 90% of people who have pre-diabetes are unaware of the
problem. Imagine the healthcare bill to treat all of these millions of
individuals. However, some doctors may be reluctant to treat numbers as
only a quarter of pre-diabetic subjects actually receive counseling or
drug therapy. [Science Daily March 8, 2016]
Many
physicians are steeped in calorie counting approaches to weight control
that are belatedly recognized as ineffective. “A calorie is a calorie
regardless of its source” has been a misdirection. [Public Health Nutrition 2016]
The paradox of healthy overweight Americans
The
recently discovered fact there are metabolically healthy overweight
Americans perplexes modern medicine’s low-fat dietary model. [PLoS One2013]
Historically
a similar phenomenon comes to mind, where hard-working rotund
immigrants from Italy who resided in Rosetto, Pennsylvania in the 1950s
and 1960s exhibited unusual health. The mortality rate from heart
attack was almost zero in that town when compared to surrounding
communities. [American Journal Public Health 1992] These immigrants were fat but healthy.
The
“Rosetto Effect” was not completely understood by health authorities
then, who for want of an explanation mistakenly guessed it was the close
family ties in Rosetto that produced this effect.
But these
Italian immigrants, male and female alike, who imported their
traditional wine from Italy, which they “drank with seeming abandon” and
preferred over soft drinks and even milk, may have achieved unusual
health from fermented grapes! [Huffington Post 2011]
This
wasn’t understood until the French Paradox was reported in 1991 on the
CBS Sixty Minutes television show. Dr. Serge Renaud of French reported
the wine-drinking French who also consumed a diet laden with fat and
calories exhibited a very low rate of coronary artery heart disease
mortality (90 per 100,000) compared to North Americans (240 per
100,000). [Lancet 1992]
A new revelation
There is a
new revelation involving the red wine story that provides a whole new
understanding about obesity, diabetes and really all disease. An animal experiment reveals this U-turn in humanity’s pursuit of health.
In
a series of experiments, researchers raised genetically identical mice
in a germ-free environment and then installed their digestive tract with
intestinal bacteria collected from obese women and their lean twin
sisters. The mice ate the same amount of food but the animals that
received bacteria from obese humans grew heavier and had more body fat
than mice with implanted microbes from a lean twin sister. The
overweight mice also exhibited a less diverse community of gut
bacteria. [Scientific American 2014; Science 2013]
From this
point forward it should be understood weight control has little to do
with calorie counting and everything to do with gut bacteria.
Tim
Spector, a geneticist at King’s College in London, says modern medicine
has been on the wrong track for decades and that the key is to (get
this) eat cocoa and drink coffee and red wine, components of the
Mediterranean diet. [Daily Mail UK] But not for the reasons you might think.
Yes, these
foods provide polyphenols, strong anti-oxidants that are three times
more abundant in the Mediterranean than the American diet. But they
aren’t working directly to improve health. Come to find out polyphenols
in olives, wine, coffee, tea, and cocoa, are prebiotics, that is, they
foster the growth of beneficial bacteria in the digestive tract.
Come to
find humans have about four pounds of bacteria totaling trillions in
numbers that exceed the number of cells in the entire body. However,
increased consumption of supplemental “good” bacteria Acidophilus and
Bifidus as provided in yogurt or dietary supplements are not the full
answer either.
Polyphenols,
provided in berries, pomegranate, turmeric spice, cranberry and grapes
(and 1000-fold more concentrated in fermented grape juice, aka wine),
will do more to raise the ratio of good to bad bacteria than any
probiotic dietary supplement.
Ninety percent of the bacteria in the digestive tract is composed of two families: the Firmicutes (pronunciation) and the Bacteroidetes (pronunciation).
When the latter predominates over the former, there is less
inflammation, less plaque that clogs our arteries and greater burning of
calories instead of energy storage.
Obese
individuals not only exhibit a composition of gut bacteria that favors
Firmicutes over Bacteroidetes but also exhibit a reduction in gut
bacteria diversity. [Digestive Diseases 2016]
Does this explain why the wine-drinking French consume a high-calorie, high-fat diet and don’t pay the price for it?
Recently
researchers fed laboratory mice choline, a nutrient richly provided in
eggs, which generated a toxic molecule known as TMAO (trimethylamine
N-oxide) that in turn fosters clumping of blood platelets and blood
clots. [Cell2016]
In another
similar study, laboratory mice were given choline and resveratrol, the
most studied polyphenol in red wine. Resveratrol favored the growth of
Bacteroidetes over Firmicutes (Bacteroidetes increased from 20.6% to
34.0% at the expense of Firmicutes 60.1% to 50.1%) and abolished a
noxious chemical (trimethylamine N-oxide or TMAO) to improve the
production and flow of bile in the liver, which in turn retards
accumulation of fats (cholesterol) in artery walls.
Researchers
said (paraphrased): “This study demonstrates resveratrol improves the
dysregulation of the gut microbiota induced by a high-fat diet,
increases Bacteroides-to-Firmicutes ratios, and increases the growth of
Lactobacillus acidophilus and Bifidobacterium in mice.” [mBio April 2016]
The beneficial effect of polyphenols on gut bacteria and health is not confined to laboratory animals.
When
9-10 ounces (272 milliliters) of red wine, or about two 5-ounce
glasses, was given to 10 obese and 10 healthy adult males for 30 days,
both wine and dealcoholized wine produced a significant increase in
beneficial intestinal bacteria and favorably altered markers of heart
health. This study suggests red wine solids rather than alcohol are
responsible for the gut bacteria-altering effects of red wine and a red
wine pill would suffice to mimic the effects of wine. [Food & Function 2015]
To lean more about gut bacteria and health read my 23-page report on this topic at KnowledgofHealth.com.
Bill Sardi [send him mail] is a frequent writer on health and political topics. His health writings can be found at www.naturalhealthlibrarian.com. His latest book is Downsizing Your Body.
Copyright © 2016 Bill Sardi Word of Knowledge Agency, San Dimas, California. This article has been written exclusively for www.LewRockwell.com and other parties who wish to refer to it should link rather than post at other URLs.
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