Inulin: A fiber for weight loss

Here's an interesting product that seems to be gaining some popularity for weight loss: Inulin.

Not to be confused with "insulin", with which it is completely unrelated, inulin is a naturally-occurring plant fiber. It's found in broccoli, asparagus, celery, etc. Like beta-glucan from oats or pectin, inulin is a so-called soluble fiber, a fiber that assumes a gel-like consistency when exposed to water.

Inulin has the effect of increasing satiety, or the sensation of fullness. This cuts your craving for foods. I've tried it recently and I prefer it over glucomannan, another soluble fiber for satiety.

The people at Stonyfield Farms have been adding inulin to their yogurts from some time. The nutritionist at the company tells me that there's 2-3 grams of inulin per 6 ounce container of their yogurt.

You can also find inulin as a supplement that you can add to foods, available from some health food stores and online supplement companies. I came across a neat product called Fiber Choice that's now being distributed widely throughout the U.S. I tried their Weight Management version. It was a delicous strawberry taste. The label says take two chewable tablets twice a day, but I found that two tablets three times a day somewhat better. It's best taken around 30-60 minutes prior to each meal and it causes you to be fuller with less food. One caution: It'll cause loads of gas, especially in the beginning. For that reason, you might try starting with a smaller dose, or start on the weekends when you have the option of some privacy!

More info on the Fiber Choice product can be found at their website, http://www.fiberchoice.com.

Disclaimer: I have no relationship with the manufacturer of this product. I'm simply passing on some thoughts on my experience with this interesting possibility for weight loss.

Comments (10) -

  • Anonymous

    5/24/2006 1:12:00 PM |

    Another excellent option is a new product from the manufacturers of Metamucil called Fiber-Sure. It's been on the store shelves for about 2 weeks. 100% Inulin fiber, flavor free, grit free, non-thickening. A heaping teaspoon = 5 grams of soluble fiber. It is designed to be mixed in to food or beverages.

  • Anonymous

    8/17/2007 1:16:00 PM |

    Just wanted to note the presumed typo in the third "paragraph" above -- you wrote "Insulin has the effect of increasing satiety, or the sensation of fullness." I believe you meant INULIN rather than INSULIN...

  • Dr. Davis

    8/17/2007 11:45:00 PM |

    Thanks for catching the typo. Now corrected.

  • Anonymous

    9/21/2008 1:00:00 PM |

    Inulin is a tasteless fiber and is reported to have less than half the calories of sugar/ ( 1.5 kcal gram compared to 4 kcal/gram for sugar) .
    It is used in many reduced sugar yogurts.
    The latest nutrition studies do show effects on satiety, weight loss .

  • Anonymous

    9/21/2008 1:04:00 PM |

    Regarding heart health :  Inulin has proven effects on lowering blood triglycerides.  
    Metamucil ( Psyllium fiber) is better for lowering cholesterol.

  • Anonymous

    5/15/2009 6:51:00 PM |

    Does anyone know what the potassium content of Inulin is?  I have a high potassium blood count and am trying to lower it, but I also need a high-fiber diet.  It seems that some of the best high-fiber foods are also high in potassium.  Thanks for any feedback you can provide.

  • Anonymous

    5/15/2009 6:55:00 PM |

    Can you tell me the potassium content of Inulin?  I have a high potassium blood count and am trying to lower it with diet changes before it reaches the danger zone.  But I also need a high-fiber diet.  It seems that some of the best high-fiber foods are also high in potassium.  Thanks for any feedback you can provide.

  • Anonymous

    5/15/2009 6:57:00 PM |

    Is Inulin safe for dogs?  My little Pomeranium needs an increase in fiber in his diet, and my vet doesn't know anything about inulin.  My dog is a picky eater, so something like inulin would be a perfect choice -- if it's indeed safe for canines.

  • Anonymous

    10/24/2009 6:32:33 PM |

    You need to update your info on Stoneyfield Farms Yogurt. They no longer include the inulin in their yogurt since their products are now all organic.  I guess they could not find an organic source for inulin.

  • buy jeans

    11/3/2010 4:53:50 PM |

    You can also find inulin as a supplement that you can add to foods, available from some health food stores and online supplement companies.

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Optimal medical therapy

Optimal medical therapy

I was re-reading some of the details behind the recently announced COURAGE Trial comparing angioplasty/stent in 1100 people compared to "optimal" medical therapy in another 1100. You'll recall that no difference was found.

In particular, over approximately 5 years, 20% of participants in each group died, experienced heart attacks, or strokes. Of those treated with "timal" medical therapy, 32% ended up getting a procedure like stents or bypass anyway due to deteriorating symptoms.

What is "optimal" medical therapy? I bring this up again because the study investigators in COURAGE, as well as in similar trials, say this with a straight face. Optimal medical therapy means aspirin and/or Plavix (the anti-platelet, aspirin-like blood thinner); "aggressive" statin drug therapy to reduce LDL cholesterol to 60-85 mg/dl; and "anti-ischemic" therapy (that reduces angina and the phenomena of poor coronary blood flow) using nitroglycerin preparations, beta blockers, and other drugs.

I do give credit to the investigators for having the courage to perform this trial in a world hell bent on doing procedures and still reporting the neutral outcome. But the notion of "optimal" medical therapy begs for comment.

Indeed, this is regarded as optimal by most practitioners. Some would even argue excessive, based on the low LDL target achieved. Would you be satisfied with a 20% likelihood of heart attack, stroke, or death or 5 years, a 1 in 5 roll of the dice? I would not. Recall that we aim for near-total elimination of risk.

What could have been further "optimized"? Plenty. For instance:

--What is the real LDL, not the fabricated, calculated LDL? The two can be commonly 100 mg/dl different.

--How about raising HDL to 60 mgd/?

--What about reducing the proportion of small LDL particles? After all, small LDL is the number one cause of heart disease in the U.S., not high LDL.

--What is Lp(a)? If you treat LDL with a statin drug, Lp(a) is unaffected and continues to trigger huge plaque growth. You will fail if this is not identified and corrected.

--What is vitamin D3? One of the most powerful facilitators of plaque reversal I know of.

--What are triglycerides? Triglycerides create hidden particles in the blood like intermediate-density lipoprotein, potent triggers for coronary plaque growth. Speaking of intermediate-density lipoprotein, that's another very important pattern to identify, the after-eating persistence of dietary fats.

--Why aren't they taking fish oil? With a 28% reduction in heart attack and 45% reduction in sudden death from heart attack, this alone would have halved the number of "events" in the "optimal" medical treatment group.

Of course, there's more. But the idea that aspirin, statins, and anti-ischemic therapy is somehow optimal is silly and sad at the same time. But that's the bias. The COURAGE Trial does represent a step forward, a step away from the "stent everyone and everything" mentality that motivates my colleagues, aided and abetted by their co-conspirators, the hospitals. But you and I know better. "Optimal" medical therapy, in truth, can mean a far better approach that can dramatically reduce, perhaps eliminate, risks for events like heart attack. The conventional "optimal" medical therapy will suffice only if you're content with a 20% likelihood of heart attack, death or stroke, or a 32% likelihood of an urgent procedure in your future.

Comments (6) -

  • David

    4/9/2007 8:54:00 PM |

    A year ago I had what was termed  a "minor cardiac incident". An angioplasty procedure identified 95% blockage in one coronary artery (at the back of the heart), and another 35% blockage in another coronary artery. A stent was implanted in the back artery.
    Your observations on the COURAGE Trial has caused me to question my treatment decision. Does 95% blockage in one coronary artery represent a necessary condition for stenting, as opposed to say, following clogging prevention therapy and a diet regimen that includes fish oil and D3?
    There must be a certain point in plaque conditions beyond which intrusive treatment (ie a stent) is considered essential to survival.

    I appreciate your blog. It's provided lots of valuable informtion.

  • Dr. Davis

    4/10/2007 12:57:00 AM |

    David--

    The fact that you had what you called "a minor cardiac incident" might suggest that you did not fit into the criteria of the people who were entered in the COURAGE Trial, who had stable symptoms. I suspect that your "incident" means that you released "cardiac enzymes" into the blood, meaning that your artery may have closed momentarily. This is an entirely different situation, a blood clot driven event that is different than the disease we focus on with heart scanning (and reversal) and the COURAGE Trial.

    Nonethleless, now is the time to 1) identify your causes, and 2) correct them, so that it doesn't happen again. With conventional therapy, it will.

  • warren

    4/11/2007 1:46:00 AM |

    I have often wondered the same thing as david - I had what was described as a 95% blockage in the right coronary artery.  For me, what got me in to the doctor was shortness of breath while playing my regular racquetball partner or hiking uphill strenuously.  The rest of the time, I had no symptoms.  If I am correct, these were stable symptoms, right?  But in my case, the symptoms were interfering with my ability to exercise the way I want to exercise.  That was a few months ago, and I am back to my routine and symptom-free for now (and also following the Track Your Plaque program).

    I was given the choice, but the momentum of the system's bias pushed me forward toward having the stent put in.  Before going in for the angioplasty, I asked a lot of questions.  I never really asked if the procedure was necessary or would save my life - that was just assumed.  The questions and answers all revolved around what would happen if I needed a stent or an operation, the different types of stents, the concerns about re-clogging, and references to treating any blockages that were not stented afterward with medication.  

    Everything happened in one day - from the stress test to the angioplasty to the stent.  It was all quite dramatic and all the professionals were very concerned, and the sense I got was that this procedure was necessary to save my life and prevent the artery from closing up completely.  But when I look back, I realize that nobody ever really came right out and said so.  It was just assumed and implied.

    Dr. Davis, how do you feel about implanting stents in cases like mine, where the primary benefit is relief of stable symptoms?

  • Dr. Davis

    4/11/2007 12:08:00 PM |

    Hi, Warren--

    There are some issues here which allow me to comment only superficially on your situation, e.g., the actual appearance of your "blockage," over what period of time your symptoms developed, its pattern, etc.

    However, I will say that stenting is a superior way to obtain immediate relief of symptoms. That is probably the only substantial difference.

    As COURAGE showed and many of us suspected, stenting only prevents heart attacks as they occur, or are about to occur. Stable plaques without blood clot-promoting activity can usually be managed "medically." I have to give credit to the investigators in COURAGE for using the lame tools they did in the "optimal medical therapy" arm and sticking to it. Personally, their brand of optimal medical therapy really makes me nervous because of its obvious and glaring inadequacies.

    Look on the bright side: Following the Track Your Plaque program makes another stent highly unlikely.

  • David

    4/16/2007 10:59:00 AM |

    In your reply to warren, you say "Stable plaques without blood clot-promoting activity ....". I'd appreciate your elaborating on what activity this refers to? From your blog, you've clearly provided valuable information on activity that promotes unhealthy plaque buildup, but "clog-promoting activity" is less clear (at least to me). TIA

  • Dr. Davis

    4/16/2007 12:53:00 PM |

    David-
    As lame as it seems, the decision about how actively a specific plaque is triggering blood clots is usually made by 1) the pattern of symptoms, with increasing or easy to provoke symptoms more likely to mean more blood clot-prone, and 2) the appearance of the plaque surface at time of angiogram. Occasionally, it can be made with examination of the plaque with intracoronary ultrasound.

    Unfortunately, these are observations that generally require your cardiologist's judgement. I am a big fan of providing people with tools for self-empowerment, but this is not something you can decide for yourself. Hopefully, you do it with the assistance of a trustworthy cardiologist.

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Niacin makes NY Times

Niacin makes NY Times

In the wake of the crash and burn of Pfizer's torcetrapib, media attention has turned up the miracles of . . .good old niacin. The NY Times carried a well-written report on niacin in its recent report, An Old Cholesterol Remedy Is New Again.


(Read the entire report at http://www.nytimes.com/2007/01/23/health/23consume.html?em&ex=1169701200&en=670fa84ae2ea648c&ei=5087%0A)

Among their comments:

...torcetrapib worked primarily by increasing HDL, or good cholesterol. Among other functions, HDL carries dangerous forms of cholesterol from artery walls to the liver for excretion. The process, called reverse cholesterol transport, is thought to be crucial to preventing clogged arteries.

Many scientists still believe that a statin combined with a drug that raises HDL would mark a significant advance in the treatment of heart disease. But for patients now at high risk of heart attack or stroke, the news is better than it sounds. An effective HDL booster already exists.

It is niacin, the ordinary B vitamin.

In its therapeutic form, nicotinic acid, niacin can increase HDL as much as 35 percent when taken in high doses, usually about 2,000 milligrams per day. It also lowers LDL, though not as sharply as statins do, and it has been shown to reduce serum levels of artery-clogging triglycerides as much as 50 percent. Its principal side effect is an irritating flush caused by the vitamin’s dilation of blood vessels.

Despite its effectiveness, niacin has been the ugly duckling of heart medications, an old remedy that few scientists cared to examine. But that seems likely to change.

“There’s a great unfilled need for something that raises HDL,” said Dr. Steven E. Nissen, a cardiologist at the Cleveland Clinic and president of the American College of Cardiology. “Right now, in the wake of the failure of torcetrapib, niacin is really it. Nothing else available is that effective.”

In 1975, long before statins, a landmark study of 8,341 men who had suffered heart attacks found that niacin was the only treatment among five tested that prevented second heart attacks. Compared with men on placebos, those on niacin had a 26 percent reduction in heart attacks and a 27 percent reduction in strokes. Fifteen years later, the mortality rate among the men on niacin was 11 percent lower than among those who had received placebos.

'Here you have a drug that was about as effective as the early statins, and it just never caught on,' said Dr. B. Greg Brown, professor of medicine at the University of Washington in Seattle. 'It’s a mystery to me. But if you’re a drug company, I guess you can’t make money on a vitamin.'



Of course, you and I don't have to wait for the media to endorse something. I'm nonetheless thrilled that this hugely helpful vitamin is gaining greater recognition. My preferred form nowadays is over-the-counter SloNiacin (Upsher Smith). Weve seen no liver side-effects and a minimal quantity of flushing. It's also reasonably priced, $13.99 for 100 tablets of 500 mg at Walgreen's. That's a lot cheaper than prescription Niaspan at $130 for 60 tablets.

Perhaps the notoriety will cut back on the silly responses from some physicians that I still hear about from patients: "My doctor said to stop the niacin because it's going to destroy my liver."
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The Myth of Prevention: Letter to the Wall Street Journal

The Myth of Prevention: Letter to the Wall Street Journal





The June 20-21, 2009 Wall Street Journal Weekend Journal featured a provocative front page article written by physician, Dr. Abraham Verghese:

The Myth of Prevention

While eloquently written, I took issue with a few crucial points. Here is the letter I sent to the Editor at Wall Street Journal:


Dear Wall Street Journal Editor,

Re: Dr. Abraham Verghese’s article, The Myth of Prevention in the June 20-21, 2009 Weekend Journal.


I believe a more suitable title for Dr. Verghese’s article would be: “The Myth of What Passes as Prevention.”

As a practicing cardiologist, I, too, have witnessed firsthand the systemic “corruption” described by Dr. Verghese, the doing things “to” people rather than “for” them. Heart care, in particular, is rife with this form of profit-driven health delivery.

There is a fundamental flaw in Dr. Verghese’s otherwise admirable analysis: He assumes that what is called “prevention” in mainstream medicine is truly preventive.

Dr. Verghese makes issue of the apparent minor differences between preventing a condition and just allowing a condition to run its course. Prostate cancer screening is one example: Men subjected to repeated screenings have little length-of-life advantage over men who just allow their prostate to suffer the expected course of disease.

What if, instead, “prevention” as practiced today is nothing more than a solution that has been adopted in mainstream practice to suit yet another doing “to” strategy than doing “for”? In the prostate cancer example, PSA and prostate exam screenings often serve as little more than a means of harvesting procedures for the local urologist.

That’s not prevention. It is a prototypical example of “prevention” being subverted into the cause of revenue-generating procedures.

I submit that Dr. Verghese has fallen victim to the very same system he criticizes. His views have unwittingly been corrupted by the corrupt profit-driven system he describes.

What if, instead, prevention were just that: prevention or elimination of the condition. What if “prevention” of prostate cancer eliminated prostate cancer? What if heart disease “prevention” prevented all heart disease? What if this all proceeded without regard for profit or revenue-generating procedures, but just on results?

Dr. Verghese specifically targets heart scans or coronary calcium scoring, a test he likens to “miracle glow-in-the-dark minnow lures,” calling them “moneymakers.” Yes, when subverted into a corrupt algorithm of stress test, heart catheterization, stent, or bypass, heart scans are indeed a test used wrongly to “prevent” heart disease.

But what if the risk insights provided by heart scans prompt the start of a benign yet effective “prevention” program that inexpensively, safely, and assuredly prevents--in the true sense of the word--or eliminates heart disease? Then I believe the differences in mortality, quality of life, and costs would be substantial. Such strategies exist, yet do not necessarily include prescription drugs and certainly do not include the aftermath of heart catheterization and bypass surgery. Yet such programs fail to seize the limelight of media attention with no new high-tech lifesaving headline nor a big marketing budget to broadcast its message.

The problem in medicine is not prevention and its failure to yield cost- and life-saving results. It is the pervasively profit-driven mindset that keeps true preventive strategies from entering mainstream conversation. It is a repeat of Dr. Ignaz Semmelweis’ late 19th-century pleads for physicians to wash their hands before delivering babies to reduce puerperal sepsis, ignominious advice that earned him life and death in an asylum. We are essentially continuing to deliver children with unwashed hands because there is no revenue-generating procedure to clean them.

No, Dr. Verghese, the economic and medical failings of preventive strategies are not at fault. The failure of the medical system, in which everyone is bent on seizing a piece of the financial action for himself, has resulted in the failure to support the propagation of true preventive strategies that could genuinely save money and lives.

President Obama’s goal of cultivating preventive practices in medicine can work, but only if the profit-motive for “prevention” does not serve as the primary determinant of practice. Results-driven practices that are applied without regard to profit have the potential to yield the sorts of cost-saving and life-saving results that can reduce healthcare costs.


William Davis, MD
Milwaukee, Wisconsin
Medical Director, The Track Your Plaque Program (www.cureality.com)
Blog: http://heartscanblog.blogspot.com

Comments (20) -

  • Matt B.

    6/25/2009 1:28:37 PM |

    Dr. Davis,

    Well written.  I wish you were on President Obama's panel last night becuase this information needs to filter his way.

  • Anonymous

    6/25/2009 2:10:54 PM |

    The problem for government, the same one it now faces with the finance industry, is how to regulate away the profit motive in a capitalist system. How does the government force physicians to care about their patients and not their wallets? Maybe the only hope is to make these motivations the same thing through shifting incentives, but true prevention's payoff is people living longer, which is impractical to measure, so difficult to reward. It's easier to harness individual motivation to live longer and healthier, ironically, through government educating the public about physicians' and the food and drug industries' profit motives and as such the failures of the government's basic capitalist principles. -keith.

  • Dr. William Davis

    6/25/2009 2:45:48 PM |

    I believe one way to approach the outsized appeal of procedural "solutions" to health is to make reimbursement more on a par with non-procedural solutions.

    In other words, if I put in a stent, I get around $2000. If I coach a patient on how to avoid a stent, I might get between $59 and $178. (Remember that what physicians are paid is not personal payment, but payment to cover costs of operating an office, malpractice costs, etc., all the costs of doing "business.")

    That means that practicing prevention is a way to lose a bunch of money, not sustain a viable practice. Putting in plenty of stents, or putting in knee prostheses, defibrillators, or other procedures will buy you a vacation home in Aspen and a country club membership.

    So the root problem is the perverse excessive reimbursement for procedures, the poor reimbursement for "cerebral" functions like prevention.

  • Anonymous

    6/25/2009 3:06:08 PM |

    Dr. Davis,
    This is Billye once again. You said it all.  I watched the President last night being questioned on the tube about health care.  Not one question was asked relative to the curative power of a Low carb-high fat healthy diet.  As I mentioned before, in just a short nine months I reversed my obesity, diabetes type 2, and stopped most of my medications for heart disease including Staten's.  During a commercial a statistic was flashed on screen that said the following: Heart disease,   diabetes, and obesity was 50% of all health care costs.  I must be living in a parallel universe along with you and a few other brave doctors.  It's amazing how the propaganda job that has been perpetrated on the  American public, which as you know first started with Dr. Ancell Keys fifty years ago and has led to the healthy eating dogma, which continues today, has lemming like led us all over the cliff to bad health.  This has to be stopped and be reversed. Only then will health care become affordable.

    Billye

  • Wil

    6/25/2009 3:26:18 PM |

    Excellent letter Dr. Davis.  I hope the WSJ will publish it.  Allow me to also suggest that you send a copy to the Obama administration and your congressional representatives in Wisconsin.  I plan to forward a copy of your letter to our congressional representatives in Delaware.  

    You have identified a most important issue that is a crucial aspect of the needed reform in our medical services / medical insurance system.  Thank you for that and for all the great info on your blog.

    DT

  • Scott Moore

    6/25/2009 6:02:46 PM |

    Your wonderful post gave me some incentive to write my own letter to the editor. I thoroughly enjoy reading every one of your posts; keep up the good work.

    Here's my letter; you may not agree with the details but I believe you would appreciate its spirit.

    Dear Wall Street Journal Editor,

    While I can see Dr. Verghese's point about the corruption of the system, I think he is missing the broader point about prevention because he is part of the system. Many of our most vexing medical problems can be prevented with non-medical, non-chargeable (or minimally-chargeable) practices:

    * What if the cold and flu season could be made a thing of the past by something as simple as people monitoring their blood level of vitamin D in order to keep it at least 65 ng/ml and took over-the-counter Vitamin D3 gelcaps as a supplement? And what if these gelcaps cost less than $5 per month?
    * What if type II diabetes could be "cured" without medicine but simply by eliminating (or drastically reducing) wheat (bread and pasta), sugar, and potatoes from our diet? This would have been investigated deeply except for the "problem" that the medical profession can't make money off it.
    * What if total cholesterol had very little to do with heart disease? Monitoring it would have very little preventative effect, statins (the world's most profitable drugs) would have their associated revenues cut by 90% or more, and the whole manufactured food industry would have to change their ways -- just as with the diabetes problem above, think of all of the "heart healthy" foods and advertising campaigns that would have to change. What if heart disease could be monitored and predicted better through coronary calcium scans, levels of HbA1c, and the ratio of triglycerides to HDL? What if heart disease could be prevented by lowering our sugar intake and taking inexpensive fish oil supplements? This would mean that doctors would have to retract much of what they have told us for the last 35 years, tell us that they have been wrong, and that they are now right. This is a difficult set of tasks, and one that would challenge their very credibility --- and would reduce their income and the income of the pharmaceutical industry.

    As you might guess, all of the above have been supported by research though the medical industry has been slow to share these findings with us. Prevention isn't a myth --- prevention according to profitable medical practices is the myth.

    Sincerely,

    Scott Moore

  • Anonymous

    6/25/2009 6:31:31 PM |

    Dr. Davis,

    Along the same lines, I think the biggest problem is that the government funds the pharmaceutical to perform ALL the research. As long as the drug industry does all the research, we will never see huge strides in preventative solutions.

    Like you said, most pharmaceutical corporations are more interested in houses in Aspen than they are in looking at things like fish oil and vitamin D, vitamin K and diet adjustments. I can just picture a CEO of a company thinking: "Mmmm...should we use millions of government funds to do research on a new drug, or should we use that money on clinical trial using vitamin D, K, iodine and diet adjustments?" So sad.

  • scall0way

    6/25/2009 7:48:04 PM |

    Interesting article and response. Some of the comments on the article are interesting too, and some make me want to scream, like the one saying:

    " Dairy and meat products do serious health harm... People who live a "raw vegan" eating lifestyle never get diabetes and almost never get cancer or heart disease. Of course people who have high cholesterol will be much more likely to have heart disease. Animal fats solidify on the walls of the bloodstream, clogging them. Plant fats don't do this. Animal protein turns on cancer growth like fertilizer."

  • Kent

    6/25/2009 8:23:13 PM |

    Dr Davis,

    In light of your thoughts that "prostate exam screenings often serve as little more than a means of harvesting procedures for the local urologist", I wanted to get your thoughts on possible similar motives for heart scans.

    I don't have an ebt scan location in my city, however, there is a "hospital" in Oklahoma http://www.integris-health.com/INTEGRIS/en-US/Specialties/HeartCare/HeartHospital/Prevention/EBT+Heart+Scans/ that offers them for $50. Should there be concerns over the extreme low price? Obviously, they are not making their money from the scans. With these scans being offered at a hospital who is well known for "heart procedures", would you feel comfortable with them doing heart scans? Is there a reasonable chance that they could "over read" or alter a scan in order to suggest other procedures?

    Thanks,
    Kent

  • kris

    6/25/2009 9:12:22 PM |

    Dr. David,
    I think the root of the problem starts much early. The amount of time that it takes to complete medical studies and earn degree to become a doctor is lot more than most of the other professions. The whole process kind of justifies a doctor to feel better than the “others”, hence deserve to make more money than the “others””.

    Even the selection process and courses are design only to give favor to the person with great memorization skills not the person who can put two and two together. Even though that there is always a luck of the draw that some individuals are good at both but the ratio suffers. With today’s changing technology, with computers and all that should be able to change the path to the doctor’s degree with open book exams and let the best of the best graduate, not the memorization and nothing else.
    The real “deserving doctors” who really care about humanity, have slim chances to get through the current system. Nor does the current financial commitment is helping them in any ways.

    My older son always good in studies good at memorization always over 95% in biology and it looks like that he can make it all the way to the medicine. But when it comes to the common sense, he has to be explained in a written book fashion. The younger son, not good at the memorization but when it comes to the common sense he is better by miles. He can see and look at the things at the same time but I do know that he can never be a doctor under the current system and he doesn’t have the patience to go through it.
    Older one is already discussing about what the doctors make and how secure the profession is in here in Canada. I may have an idea that when and if he becomes one, what kind of doctor he will be.
    It is hard to change one’s nature. The current system attracts certain kind of nature to get selected as a doctor. Therefore we are seeing the results.

  • homebray

    6/26/2009 3:39:14 AM |

    How to create a virtuous cycle in health care will be a difficult task.

    I'm trying to think of an example on which we could a model --- not easy.  At first I thought dentistry, they are big on preventions with 6 month cleanings and all.  But in the end they are treating the mechanics of your teeth, in a way similar to maintaining a car extends it's life.  They don't (or at least I've never seen one) address underlying issues that lead to problems with the teeth.

    Maybe the closest I can come up with is obstetrics where the prevention is practiced in the form of pre-natal care. Of course the pay day for the doc comes on the big day.

    Can insurance reward doctors for positive outcomes? The heart patient who avoids the need for emergency procedures for examples? I can't see a way for this to work, you don't want doctors who refuse to treat unhealthy patients because there won't be a big pay day.

    Taking the money out of profession would also seem to work against the end goal. You loose the incentive to innovate.

    it's a quandary.

    Dr Davis, perhaps you are leading the way in your practice?

  • Anonymous

    6/26/2009 9:29:23 AM |

    Your letter was excellent.

    And you are right -- what passes for "prevention" in medicine today is nothing but lead-generation.

  • Dr. William Davis

    6/26/2009 2:34:36 PM |

    Great suggestions.

    I don't have the answer to how the system should be changed. But I think that the inequities of outsized procedural payoffs that persists is a source of much of the overuse. It fuels a system of hospitals growing beyond their needs, abuse of procedures, and excessive costs.

    That much at least needs to change.

  • homebray

    6/26/2009 3:43:09 PM |

    Maybe Docs could get paid for positive outcomes or procedures but not both -- -kind of like a wash sale in the stock market.

    That way you can't put off a procedure until after pay day and then do the procedure and collect twice.

    I don't know, Obama needs to do some clever thinking.

  • kris

    6/26/2009 6:14:48 PM |

    I think most of the things that we talk here on the heart scan blog should be a part of the high school curriculum. after all education builds nations. no education is more important than taking care of one's own health. it doesn't have to be unnecessary, no reason, medicine school language. it can be done in an easy make sense beginners language. first prevention is the people themselves should be educated enough to take care of their own bodies. doctors should only be in necessary extreme cases.

  • Wil

    6/26/2009 9:58:31 PM |

    Dr. Davis, your WSJ letter inspired us to write to our congressional reps today.  We included the full text of your letter to the WSJ editor in our own letter, copied below.  Best regards.

    "TO:

    Michael Castle
    Thomas Carper
    Ted Kaufman

    June 26, 2009

    Re:  Medical Care / Medical Insurance Reform

    Gentlemen:

    We will try to keep this message as brief and straightforward as possible.  Very simply, our country badly needs a publicly sponsored medical insurance plan available to all of our fellow citizens at a reasonable cost.  Otherwise we will continue to have the situation where too many families either have no insurance or inadequate coverage.  Our country cannot allow this state of affairs to continue.  We need the public plan feature as part of any “health care” reform so as to provide competition with the private medical insurance industry; an industry which is driven solely by profit for its executives and stockholders.  Clearly, the industry with all its “unhealthy” Wall Street influences cannot be trusted to act in the public interest and, in truth, their business model guarantees they will not.   In fact, the whole idea of profit-driven medical care / medical insurance monopolized by shareholder-owned corporations such as pharmaceutical, medical device and insurance companies is just plain wrong, in our opinion.  

    Our country’s present system for the financing and delivery of medical care has not made American citizens healthier and has given rise to perverse incentives that have made the system outrageously costly and unsustainable.  This must be stopped and Congress must act now in the interests of American citizens and not on behalf of the above-mentioned vested interests that, over time, through lobbying and large campaign contributions, have corrupted public policy and the legislative process.  We hope that any senator or congressman who in the past (or presently) has been accepting campaign contributions from any of these industry “players” will return those contributions and publicly announce that they will no longer accept such contributions.  

    It is our view that each member of Congress needs to begin to think very differently about the way medical services are provided.  As part of the overall reform process we all must ask what it is that will lead to better incentives and more efficient methods for improving the health and well-being of our fellow citizens.  To that end we draw to your attention a recent letter from Dr. William Davis, a practicing cardiologist from Milwaukee, Wisconsin, to the Wall Street Journal.  Dr. Davis has raised a crucial issue that all policymakers should be thinking about as they address medical care reform.  His letter reads as follows:

    [Dr. Davis, here we inserted the text of your WSJ letter]

    Mike, Tom and Ted:  We hope each of you will think seriously about these matters after severing whatever ties you may have to the vested interests that will spend millions on their lobbyists and on stealth advertising to prevent meaningful reform from being enacted by Congress.

    Sincerely,
    etc.

  • Dr. William Davis

    6/27/2009 12:41:23 AM |

    Hi, Wil--

    Well said.

    If enough of us stand up and shout, perhaps we can eventually out-shout the voices of Big Pharma, the hospital lobbies, and preservers of the status quo.

    I believe that we need to continue to fight, including opposing this crazed notion that prevention is a waste. Unintentionally (?), Dr. Varghese has performed the country a grave disservice.

  • Tanya

    6/27/2009 7:37:15 PM |

    Dr. Davis,

    Did the WSJ publish your letter?  I took a look at their site and it looks as though it wasn't picked up.

    Can I humbly make a suggestion?  I've spent a lot of time in politics and therefore know the value of getting into the Letters page.  It is very important to keep letters fairly short.  Long letters are not often published.  Your perspective is so important and you write very well, that it would be a shame if your letters are not published simply because newspapers need to include a number of letters and to do so on no more than one page.

  • Dr. William Davis

    6/27/2009 7:39:14 PM |

    Hi, Tanya--

    No, it looks like they didn't.

    Thanks for the helpful suggestion. Next time!

  • Trinkwasser

    7/14/2009 4:09:37 PM |

    Be careful what you wish for, here's our (UK) Government's view of prevention

    http://www.nhs.uk/Change4Life/Pages/default.aspx

    sponsored by Kelloggs and Tescos

    http://www.satfatnav.com/

    sponsored by Unilever

    http://www.diabetes.org.uk/Guide-to-diabetes/Food_and_recipes/Eating-well-with-Type-2-diabetes/A-healthy-balance/

    our only Diabetes Charity's opinion

    sponsored by

    http://www.diabetes.org.uk/Get_involved/Corporate/Acknowledgements/

    money doesn't talk, it SHOUTS

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