Health for life

With atypically little fanfare, the Disease Management Care Blog gazes into the crystal ball and offers ten health care predictions for 2012:

1.  After Mitt Romney secures the Republican nomination for President, he and Mr. Obama will mutually try to find ways to avoid debating the issue of health care orm.  Both will calculate that there’s little advantage to reminding voters of the messes they’ve made.

2.  As a result of 1 above, the election will not hinge on health care orm, which, thanks to an improving economy, will otherwise be very close and not be a erendum on Obamacare.

3. Yet, the U.S. Supreme Court will stir things up with a ruling that the Affordable Care Act mandate is unconstitutional because, among other reasons, Congress should have used its power to tax, not impose a penalty.

4.  There will be no generalizable and published peer reviewed studies on the Patient Centered Medical Home or the electronic health record that conclusively demonstrate that either reduces health care costs.

5.  Even though CMS will have trouble providing timely claims data feeds to its newly established ACOs, we’ll hear little about it in the public domain.  ACOs have every incentive to not cross CMS.

6. Speaking of ACOs, the least recognized Achilles heel as they start up will be a pervasive physician culture that trumps patient perence over shared savings.

7.  We will learn that, thanks to their complexity, the deadlines for implementation of health information exchanges will need to be pushed back.

8.  Congress will "kick the can" of the Sustainable Growth Rate conundrum down the road and past the 2012 election with another temporary patch.

9.  More academic medical center faculty will find that it’s far more professionally rewarding to post on line than to publish in paper-based journals.  Department Chairs will reluctantly find ways to use web statistics in promotion and tenure.

10. Piqued by Mr. Obamas recent recess appointments, the Republicans will respond by holding the up the appointment of Ms. Tavenner as CMS Administrator.

While the Disease Management Care Blog is pretty good at spotting current health policy silliness, its track record at predicting the future has been rather spotty.  Regular readers have undoubtedly forgotten this brazen attempt at 2012 health care augury, but the transparent DMCB uses to bury its mistakes.

So how did it do with its Ten 2012 Predictions?

1. Mitt Romney will win the Republican nomination and avoid discussing health care.  The DMCB got some of this right, but who would have predicted that the President would cleverly upend his opponents by embracing the term "Obamacare?"

2. A close election will hinge on an improving economy, not on Obamacare. In the end it wasnt really that close, but the DMCB was correct in foreseeing that Mr. Romneys candidacy would be undermined by dropping unemployment levels and the bottoming out of the comatose housing market.

3. The Supreme Court will rule Obamacare unconstitutional: Boy, the DMCB got that wrong.  But in its defense, few foresaw that SCOTUS would ignore the Affordable Care Acts statutory language and rule that a penalty was really a tax all along.

4. There will be no generalizable and published peer-review studies on the electronic record of the medical home that conclusively show that either saves reduces health care costs.  "Bingo!" says the DMCB.  It hopes 2013 is different and that a p value is < 0.05.

5. ACOs will not criticize CMS about the tardy delivery of claims data necessary to manage its assigned populations. The DMCB says the silence over this issue is deafening, which means either a) CMS has overcome its dismal track record on providing timely information or b) the ACOs are reluctant to go public with any concerns.  The DMCB has heard rumors that the latter is true.

6. Speaking of ACOs, their physicians will trump patient perences over savings.  The DMCB says the jury is still out on this, but time will tell if its call about this ACO Achilles heel is as important as it thinks it is.

7.  Health exchange deadlines will be pushed back. To the DMCBs knowledge, CMS is holding firm on the fall 2013 implementation date.  The DMCB takes some credit, however, for being among the first to spot this issue and bring it to its readers attention.

8. CMS will kick the Sustainable Growth Rate (SGR) down the road. "Bingo again!" says the DMCB.  It got his one right and looks forward to how Congress will deal with this in 2013.

9. Medical academics will increasingly turn to social media instead of print to make their mark on the scientific world. The DMCB believes this trend is continuing but has yet to reach a tipping point.

10. CMS Interim Administrator Tavenners status will remain in recess limbo.  OK, it wasnt all that hard to bank on continued partisan bickering, but the DMCB got this one right too.

Will the DMCB offer up predictions for 2013?  Stay tuned!

And Im back for part 2 of my AHS 2012 review.  Read part 1 if you missed it.  And no, this blog is not about AHS, the leader among home warranty providers.  Its the Ancestral Health Symposium.  Only the biggest event in the paleo nutrition world, everyone knows that.  Now read......

Can you believe Mark Sisson is 60?  I guess this paleo thing works.

Mark Sisson and Robb Wolf Q&A
This was another highlight of the weekend, in which Mark and Robb took questions from the audience.  It was only a 40 minute session, but I could have listened to this for hours.  I honestly dont remember what any of the questions were, so I guess I dont have much to talk about here, but they were very engaging and hilarious.  Great stuff.  I would love to spend a night socializing with these guys over NorCal margaritas.



Gut Health and Obesity
Stephan Guyenets talk on gut health and obesity was just fascinating.  Hes been one of my favorite people in the paleo community for a while now, Ive learned so much valuable information from his blog.  The gist of his talk, from what I can remember, was on how your intestinal health affects your propensity to gain weight.  And he made a major distinction between visceral fat and subcutaneous fat (visceral being the fat gained within the abdominal cavity, and subcutaneous fat being fat located under the skin).  Theres a big difference.  A person with more visceral fat will be at much higher risk for metabolic abnormalities and chronic disease, while someone with mostly subcutaneous fat is likely to be metabolically healthy, regardless of the fact that theyre obese.

Ill certainly need to go back and watch Stephans presentation again to really take in the information (once they get the lectures online, that is).  But as I recall, the most interesting part to me was about gut bacteria and obesity.  He talked about a few studies in rats, in which they performed fecal transplants to transfer gut bacteria from one rat to another.  Yes, that means taking the poop from one rat and sticking it up the butt of another rat.  We do it in humans too.  But the basic idea was that the gut flora differed between lean and obese mice.  But when the gut bacteria from the obese rat was transferred to a lean rat, that lean rat then became obese.  There was much more to it than this, but as I said, I need to go back and watch it again and take notes.  But its very intriguing to me that simply changing the gut flora of an animal could make them become obese.  It sounds like this area has a lot of potential for future study, and its definitely something Ill be following.

On another note, on the last night of the conference I was able to meet Stephan and chat a little bit.  He was super nice and down-to-earth.  We talked about beer and other manly things, apparently he brews beer.  But I also talked with him about probiotics.  Probiotics can be found in either food or in supplement form, but they are essentially healthy bacteria for your gut.  The idea is that they make it to your large intestine, set up shop there, and do good things for your digestion and your body.  But according to Stephan, and I suspected this to be true, probiotics dont significantly change your gut bacteria, and they dont really have any effect at all.  Most of the bacteria get killed on the way to the large intestine, and the few that are left just dont make a dent in the billions of bacteria that are already there.  Ill be sure to look into this more in the future as well.

Maybe the best part of Stephans talk though... the opening.  "Hi, Im Stephan Guyenet, and Im not going to talk about carbs."  Loved it.


Lustig and His New Research
Dr. Robert Lustig gave one of the better talks at AHS as well, about sugar (as if he ever talks about anything else).  It was really great though.  Even though Ive seen his lecture Sugar: The Bitter Truth, and Ive seen his 60 Minutes special on sugar, I still learned something.  He discussed the danger of fructose overconsumption, per the usual, but one thing he stressed this time was that fructose is only toxic if it is consumed in the context of a hypercaloric diet.  Translation:  if youre in caloric balance, or caloric deficit, fructose doesnt exhibit the same dangerous effects on insulin sensitivity, weight gain, etc.  Only if you are overconsuming calories will it exhibit these toxic effects.  I had read this on Stephans blog as a criticism of Lustigs work, so I was happy to see Lustig evolve his information.  In a real life situation though, it seems as though many people who consume a lot of sugar would be in caloric excess, especially those who consume a lot of sugar-sweetened beverages.  High-sugar foods typically arent satiating and can lead to overconsumption.


Dr. Lustig also revealed some data on a new sugar/fructose/metabolic syndrome study that hes working on getting published.  He asked the audience not to take any pictures of his slides since this study isnt published yet, and as a result, I have no way of remembering any of the details.  However, he was very pleased with the results, and as you can guess, it made sugar look pretty shitty.  Cant wait for that one to be published.


Okay, thats it for this edition of my AHS review.  Ive still got much more to talk about, so come on back for part 3 tomorrow!