A Personal Perspective on Running A Prevention Based Clinic

[JeffN]

This is an important article as it puts things about our current culture and health care system in perspective as well as the challenges we face. The company I work for in NYC, had a similar experience. While we have run a very successful prevention-based, executive health company for over 100 years, we instituted a special VIP Concierge Medical service a few years ago and after about 2 years, we had to close it, also.

Considering that the perspective taken in the MDPrevent Clinic and the one I worked with in NYC are not as "extreme" as we are promoting here, and that they still couldn't make it, it helps us to better understand the long road ahead that exists for us and the challenges we face if this system we promote here is ever going to make it in the current culture, environment and society. As we can see from the article, the problems are many and varied and are not just "them," but also "us."

Changing this is going to take way more than a few intellectual, emotional and psychological arguments no matter how passionate, sound, credible, common sense and accurate they are.

This is why we should not be surprised at all when we see butter on the cover of Time magazine.

In Health
Jeff


Why I Had to Close My Preventive Healthcare Clinic
by Steven Charlap
(Steven Charlap is a medical doctor based in Delray Beach, Florida. He was the founder of HealthDrive, a medical and dental practice, and MDPrevent, a preventative-healthcare clinic)

Our system was predicated on integrated health, including cooking, exercise, nutritional therapy, and mindfulness meditation. Care models in the U.S. still reward treatment, though; not prevention.

http://theatlantic.com/health/archive/2 ... nt=3624240


"The final contributors to our demise were the patients themselves. Primary prevention requires work: making better food choices, adding more physical activity, engaging in meaningful activities, and developing tools to better manage stress."

"Based on our review of the credible research, our model mostly excluded dietary supplements and multivitamins because the science mostly did not support their use. When it came to pharmaceuticals, we didn’t rush to prescribe if there were a non-drug alternative. This approach was a turn-off to many patients who expected a prescription or emphatically clung to beliefs in supplements. And the no-cost, no-deductible, no co-payment provisions in Medicare’s preventive benefits may have had an adverse effect on people’s sense of its value. How much would you appreciate something that has no cost to you? For many patients, it seemed easier to take supplements than to be more attentive to food labels and exercise habits."

[f1jim]

When things like this happen it makes us realize that changing the eating habits and lifestyle of a culture is a long process interrupted by fits and starts of progress. Every time a celebrity or high visibility person jumps on board we see it as a major step forward. The real progress is measured by the boring numbers we see published regarding consumption of certain foods and the amount of movement we get in our lives. Those numbers appear to change rather slowly.
The push goes on and when one of these clinics folds a piece of me feels like it died. But I keep in mind the trend is in our favor over the long haul. Overall I am quite positive that changes are afoot beneath the surface.
If you extend your view backward in time you must see this too.
f1jim

[JeffN]

When things like this happen it makes us realize that changing the eating habits and lifestyle of a culture is a long process interrupted by fits and starts of progress.

Agreed. If we look at N Karelia Finland, it took over 25 years of a concerted effort and that was only to make some of the changes we would recommend.

Every time a celebrity or high visibility person jumps on board we see it as a major step forward.

We will agree to disagree on this one but when I see a celebrity get on board, I cringe.

I cringe because you live and die by them and it is appealing to the worst form of a logical fallacy.

http://www.skepticsfieldguide.net/2013/ ... brity.html

Clinton is a perfect example as is Orpah and all the others who have come and gone.

The real progress is measured by the boring numbers we see published regarding consumption of certain foods and the amount of movement we get in our lives. Those numbers appear to change rather slowly.

Agreed.

But I keep in mind the trend is in our favor over the long haul. Overall I am quite positive that changes are afoot beneath the surface.

Agreed.

I posted this today on FB (for some personal reasons) but thought it had some relevance to this issue.

http://nypost.com/2014/06/19/revel-casi ... out-buyer/

Atlantic city is hurting especially in the area of gambling. A few years ago, they opened the Revel, a 100% non-smoking casino. The hopes of the community was that this would not only survive, but thrive and help revive the troubled city.

I have in-laws who live there and I said it is crazy and will fail. I am all for a non-smoking society, and want to do what ever I can to help make one happen but this just defies all sense of logic, common sense and business acumen I know. How can a 100% non-smoking casino make it, let alone thrive, let alone revive a troubled gambling city, where smoking is allowed in all the other casinos there, is beyond me. Smoking is a powerful addiction and gambling is a behavior that often goes hand in hand with drinking and smoking.

I think a casino could have had success in this area over time, as we have had in reducing smoking in the society, but not like the way they went about it. The risked everything on it going 100%.

In many ways we are fighting similar forces.

The American diet is like an addiction for many and we live in a toxic society where this diet is *so* ingrained in *so* many aspects of this culture. How can a low fat,plant based, whole food, low/no SOS person, let alone such a business like a restaurant, survive, let alone thrive right now in the current culture unless it somehow compromises its position (which we often see)? Oh I know, the Wynn casino's have to have vegan options. Well, first, that is not making them all 100% vegan but just offering some options, and, as you and I know, I can't eat in most vegan restaurants as the food may be vegan, but it is not healthy. I think if he made them all 100% vegan menu's, they would not have succeeded.

About 4 years ago, I was working with someone in this movement and we were discussing this issue. They were convinced that given the right information and support, this is a "no-brainer" and any intelligent person would get it,. I said, it is not that easy. In fact, do the experiment. Pick 30 of your friends or people you know who you consider smart/intelligent. Give them a copy of the China Study (or your favorite WFPB Book) and a copy of FOK (or your favorite DVD). Or invite them all over for a showing of it and give them all their own copies of both. Then do the experiment, let them all know, you are willing to help them in anyway possible to incorporate what they have learned for the next 30 days. Be willing to do anything to help them, cook, shop, go out to eat, etc. 100% support. Out of the 30, how many do you think would even try to do it? Of those, how many would finish the 30 days? Of those, how many would be doing it in 6 months, let alone a year (even with your help)?

He agreed and thought it was a "no-brainer."

We all know what happened. Most were not even interested and of those who were, none of them finished the 30 days.

I am not arguing against succeeding, I am arguing that in order to succeed, we have to understand the map to get there, the process it will take and the challenges we face, otherwise, it will fail.

In Health
Jeff

[f1jim]

We most certainly agree on celebrity joiners. The large majority of people see it as part of a landslide in popularity for the diet. I think in most cases they jump from one popular movement to another. I do welcome their involvement but it's rarely rewarded with a long term commitment. I don't cringe but I do take it in stride.
f1jim

[JeffN]

We most certainly agree on celebrity joiners. The large majority of people see it as part of a landslide in popularity for the diet. I think in most cases they jump from one popular movement to another. I do welcome their involvement but it's rarely rewarded with a long term commitment. I don't cringe but I do take it in stride.
f1jim

Thanks

In Health
Jeff

[JeffN]

This is from Kim Willams, MD, former President of the American College of Cardiology and a self proclaimed vegan.

Pearls From: Kim Williams, MD
Preventive care focus loses $$; pay-for-performance may change that
https://www.medpagetoday.com/cardiology ... sion/69661

He says

"For those of us who are doing a lot of prevention, it actually is a financial burden, because if we are successful, particularly with plant-based nutrition, decreasing the number of heart attacks, strokes, and the amount of heart failure in our patients we end up generating less revenue. We're doing less echocardiograms for heart failure and less stress tests for chest pain and this actually translates to a, hopefully, temporary decrease in revenue that will be made up for when we start talking about wellness and doing real healthcare instead of doing sick care, which is what our model has been about.”

I take my hat off to Dr Kim for all he is doing to help get this message out but it is just not this simple.

This is why the I posted the original article in the original post. That is why there are so few doing this.

There is no simple (or hopeful) temporary decrease in revenue that will be made up by talking about wellness and "doing real healthcare." Where is the revenue to support these incomes supposed to come from?

The average physician is making around 200K in primary care and 300K in speciality care with cardiologists coming in at 400K.

https://www.medscape.com/slideshow/comp ... -6008547#2

https://www.medscape.com/slideshow/comp ... -6008547#4

True primary prevention is about education. The majority of our results come from a change in diet, moving more and behavior change.

Right now, we have Exercise Physiologists, Registered Dietitians and Psychologists educating the public on the messages of eating right, move more and changing our behavior.

The average salary for a RD is 56K and for an Exercise Physiologist is 54K and for a Licensed Clinical Therapist of Psychologist is 60- 70K. That is the value we put on this. Yes, we need to fine tune their message and perhaps add some value to it but this is 1/6 to 1/3 what the MD's are getting.

I do think the RD and Ex Phys should average a little more in our society but how do we bridge the gap be tween 54-56K to 200K when we all become mostly educators, which is what true primary prevention is.

Are MD's going to be happy just teaching prevention and making 70K? Or are we going to continue to pay them 200K to do what we already have people doing for 50-70K?

Where does the cash flow come from?

Insurance?

Paid out of pocket?

The Government?

Or should there even be this much cash flow into the system?

The estimate is that we can prevent 80-90% of lifestyle related diseases (70% for cancer) which account for about 75% of Health Care costs.

If we do eliminate all those health care costs, we need a new model that may take generations to implement. It will also need a change in the food industry, farming, food production, etc

As the article above shows, most have not been able to make it work.

This is why many who do try to do this, thinking there is a simple shift in money flow and then not being able to monetize it, end up dropping out, or switching their message and/or adding in selling high priced proprietary supplements, meal plans, and unnecessary gadgets and expensive tests.

Just food for thought

In Health
Jeff

[JeffN]

Cardiovascular Guideline Skepticism vs Lifestyle Realism?
JAMA, December 14, 2017
doi:10.1001/jama.2017.19675

Philip Greenland, MD
Department of Preventive Medicine,
Northwestern University Feinberg School of Medicine,
Chicago, Illinois;
and Senior Editor, JAMA.

https://jamanetwork.com/journals/jama/f ... le/2666625

"The US way of life is the problem, not the guidelines... "

So, is the problem fundamentally with the guidelines or with the US lifestyle? Both the cholesterol and blood pressure guidelines prominently emphasize prevention and lifestyle habits.1,3 Some who have raised concern about the guidelines have often overlooked this emphasis and have focused on overmedicating patients. However, the data and the guidelines are clear: too many individuals in the United States and around the world are overweight or obese, eat unhealthy diets, fail to get recommended amounts of weekly exer- cise, or smoke. As a consequence, too many patients have high blood pressure: above the ideal level of 120/80 mm Hg. Too many have unhealthy blood glucose levels: above the ideal level of 100 mg/dL fasting. Too many have high blood cholesterol level: above the ideal of 200 mg/dL. The problem is not the result of rigorously developed guidelines, but rather is inherent in the high prevalence of unfavorable cardiovascular risk factors. Patients and clinicians need to focus attention where it belongs: on promotion of healthy lifestyles; prevention of the risk factors in the first place; and only when needed, use drugs to reduce cardiovascular risk, following evidence- based recommendations.