LIVING HEALTHY

1
LIVING HEALTHY

• Without Spending a Fortune
• Richard P. Sargent, MD
• St. Peters Community Hospital
• Helena, Montana

2
AMERICAN HEALTHCARE SYSTEM A FINANCIAL DISASTER

• Its somebody elses fault
• Insurance and Drug companies
• Greedy doctors
• Durable Medical Equipment, Oxygen
• Tobacco companies
• Pogo

3
NOT MANY GUARANTEES IN LIFE

• TAXES

• DEATH

4
EVIDENCE BASED MEDICINE

• POEMS v. DOEs
• Patient Oriented Evidence that MatterS
• Disease Oriented Evidence

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Disease Oriented Evidence

• measurable endpoints, fixed timelines, easy
  graphs, slick marketing brochures and increased
  drug, equipment and procedure sales.
• It is easy to remember and helps sell.
• Who pays for the basic research?
• 'Surrogate' measures for which drug is best?
• Don't focus on the patient.

6
Playing Whack a Mole in Health Care

• Stomping Disease rather than Health Promotion
• Nobody gets off the world alive.
• Heart disease is a very effective way to die.
• Stroke is not.
• HTN, Chol, Diabetes
  family Hx, age, tobacco
  alcohol, exercise,
  teeth
• Prevention is easier and
  cheaper than early
  detection.

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POEMS

• What doctors say
• mortality but also other outcomes that affect
  patients lives and well-being,
• sexual function, family and social roles, work,
• activities of daily living

8
AARP

• People want to live
• 1. independently,
• 2. in their own homes,
• 3. with out being a burden to others
• 4. As long as they can
• People wont argue with this list.
• Realign Your Goals

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Evidence Based Information

• Levels of evidence
• Reliability of the information
• YPLL or YPLG
• Cost/Benefit equation
• If you are paying the bill
• And you are paying the bill.
• What is worth doing?

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Seven Lifestyle Interventions Have the Biggest
Impact on Extending Life

• Tobacco 14 years
• Seat belts 10 years
• Exercise 3 years
• Diet to reduce cholesterol (maybe 15
  less calories than would consume in an
  unrestricted eating environment) 2.5 years

• Brush and Floss teeth daily 1.5 years
• limit alcohol to two drinks per day or less
• Take 800-1000 IU of Vitamin D daily.

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More Lifestyle Interventions That Extend or
Improve Life

• 7 to 9 hours of sleep daily
• Relax, unplug, go low tech
• Teach yourself to relax
• Regular exercise and diet
• Resting Heart Rate lt 75
• Waistline lt 40 inches (women lt35 inches)
• Stretch your muscles.
• Vaccines
• (flu, pneumonia, shingles)

• Drink (tap) water
• Volunteer for a Cause
• Make friends with bacteria
• Dont keep bedroom troubles to yourself
• Stay married
• Go to church
• Keep a health history
• Allergies, meds, family history

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WAIT A MINUTE!

• This is supposed to be a talk on Health Care
• Please bring your money and body to me.
• After we remove enough money from your wallet we
  will tell you if you are allowed to live another
  year.
• What is the value of all of the recommended
  screenings?

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Statistics The So What-O-Meter

• Incidence of hypertension increases with age
• Incidence of death increases with blood pressure
  for any given age
• Incidence of death from heart disease increases
  with age for any given blood pressure.
• Incidence of death increases with age.

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MORE STATISTICS

• Get our test to prevent death
• How much disease in the population (Prevalence)
• False positive rate and cost (Oops)
• False Negative rate and frequency of testing
• Likelihood that a true positive will make a
  difference.
• True positive but disease wasnt deadly
• Treatment is worse than the disease

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IT ALL WORKS

• How to lie with statistics
• Not lying
• Not focused on the correct goal.
• AARP goals
• Do we have the personnel to handle the
  recommendation?
• Annual (Really Complete) Physical

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ANNUAL (REALLY COMPLETE) PHYSICAL

• 2000-2500 Patients/doctor
• 200 working days per year
• 10 physicals per day, 23 minutes, 116
• value for mostly healthy people-low
• Emphasis on lifestyle changes.
• How Many times do I have to tell you before you
  will change?
• Health Conditions require more frequent visits
• And opportunities for health screening.

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ANNUAL (REALLY COMPLETE) PHYSICAL

• In the August 22nd issue of The Army Times, there
  was an article titled "White House opposes more
  exams for Reservists. Annual physicals said too
  costly."
• The Officer October 01, 2005 Bockel, David R.

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EFFECT OF BP CONTROL
Figure 3. Percentage decline in age-adjusted
mortality rates for CHD by gender and race
United States, 1970 to 2000. Source Prepared by
T. Thom, National Heart, Lung, and Blood
Institute from Vital Statistics of the United
States, National Center for Health Statistics.
Death rates are age-adjusted to the 2000 US
census population.
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MULTIPLE RISK FACTORS

• Family History
• Tobacco
• Blood Pressure
• Obesity
• Diabetes
• Cholesterol
• Physical Activity
• Diet

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COLON CANCER SCREENING

• Get our test to prevent death
• How much disease in the population (Prevalence)
• 2 of General Population between 50 and 80 (no
  family Hx)
• False positive rate and cost (Oops)
• False Negative rate and frequency of testing
• Likelihood that a true positive will make a
  difference.
• True positive but disease wasnt deadly
• Treatment is worse than the disease
• We could hurt you
• serious harms occur in 2.8 per 1000 screening
  colonoscopies

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COLON CANCER SCREENING

• Options
• Yearly test for blood in the stool
• Flexible sigmoidoscopy every five years
• Colonoscopy every ten years
• Barium enema every ten years
• Colonography (CT Scan)
• Expenses
• Dollars (400,000 per year of life saved)
• Dolor (Pain)
• Death
• It is important to know your family history.

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PROSTATE CANCER SCREENING

• PSA is all the rage
• No clear cutoff
• Not endorsed by USPHSTF or ACP
• Many cancers are not aggressive
• Well meaning doctors can hurt you.
• Incontinence, impotence, proctitis
• It is important to know your family history.
• Risk factors
• Age, genetics, Race, high fat diet, nsaids

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PROSTATE CANCER SCREENING

• Options
• Yearly Finger
• Yearly PSA
• Trans Rectal Ultrasound
• Expenses
• Dollars
• Dolor (Pain)
• Death
• It is important to know your family history.

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AARP MEMBERS WANT

• TO LIVE
• Independently
• In their own homes
• without being a burden to others
• As long as they can

• You prevent this by preventing
• Stroke
• Congestive heart failure
• Multi-infarct Dementia
• Renal Failure
• Blindness

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Seven Lifestyle Interventions Have the Biggest
Impact on Extending Independent Living

• Tobacco 14 years
• Seat belts 10 years
• Exercise 3 years
• Diet to reduce cholesterol (maybe 15
  less calories than would consume in an
  unrestricted eating environment) 2.5 years

• Brush and Floss teeth daily 1.5 years
• limit alcohol to two drinks per day or less
• Take 800-1000 IU of Vitamin D daily.
• Mammograms 12 days

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THANK YOU

• QUESTIONS