Is shock therapy the answer to “cure” obesity?

10. August 2014 Lisa G (0)
The next obesity “fix” may be hitting the market known as "VBLOC therapy”.  This implanted device delivers intermittent electrical "blocking signals" to the intra-abdominal vagus nerve.  According to the manufacturer, the device "reduces sensations of hunger and produces satiety leading to weight loss.”

Seems to me like another classic case of conventional healthcare proposing surgery or medications to address the obesity epidemic. Pharmacologic treatment and bariatric surgery have been offered for years to win the battle of the bulge.  As a registered dietitian, who years ago begrudgingly counseled patients prior to undergoing bariatric surgery, I have seen countless people re-gaining all (if not more) of the weight lost after the first year of surgery. Same goes for pharmalogical interventions, such as Phentermine.  Sure it worked in the short-term.  But in every single case, when the medication was stopped, as it is not FDA approved for long-term use, the weight came creeping back.

My take on the releasing a significant amount of weight does not require going under the knife.  How about this instead? Address the cause of increase hunger and appetite.  This is a crucial missing link for many undergoing surgery or using medication(s) as a “solution”.  Not addressing the cause of increased hunger and ravenous eating behaviors precipitously results in rebound weight gain.  Rather than sending an electrical pulse to a nerve in the stomach, maybe the FDA should consider a Cureality-based nutrition program that is wildly successful stimulating a “side effect” of weight loss.  Wheat elimination offers a surgery-free option that reduces hunger and insistent drive to eat every few hours, thanks to freedom from gliadin driven appetite stimulation.  Weight loss is common experience due to reduced hunger and subsequent intake. Give it a try.  What else do you have to lose, but some love handles?

--Lisa Grudzielanek, MS,RDN,CD CDE
Cureality Nutrition & Health Coach

Are Your Beauty Products Toxic?

10. August 2014 Lisa G (0)
As a nutritionist and self-care advocate, I am very careful about what I put in my body.  Health benefits experienced through proper nutrition are well understood.  We avoid highly processed foods, wheat-based products, and sugary snacks because we know that are “unhealthy” for us.  But what about what we put on our skin?

An important piece of the health and wellness puzzle is not only what is on the end of our fork but on our toothbrush, slapped on our bodies and rubbed into our hair.  Skin is the largest organ and what we place on it on a daily basis penetrates the skin, enters the fat stores and contributes to the toxicity and adiposity of our bodies.  According to the Environmental Working Group, the average woman uses 12 beauty products per day, containing about 168 ingredients.  Yikes!

I’ve often held a high suspicious that endocrine disruptors such as parabens, triclosan, fragrance, and other punitive chemicals are a key suspect in the root cause of my endocrine disruption.  Interestingly, scientific evidence is now emerging to support this suspicion.

A few months back, I took a look at my hair, skin, and cosmetic products. I was shocked and horrified.  Parabens, an estrogen-mimicking preservative linked with endocrine disruption, was in dozens of products.  It reminded me of how I felt on that day years ago when I threw out all the products in my kitchen that contained wheat.  What are parabens not in?  Why was it in so many products?

In our next episode of Cureality Connections we will discuss key skin and beauty product chemicals to avoid along with other steps to take to attain beauty from within.

--Lisa Grudzielanek MS, RDN, CD, CDE

Top 3 Strength Training Exercises for Runners

28. July 2014 Amber B (0)
First and foremost, if you’re a runner and you’re not strength training you need to start.  This in and of itself could be an entire blog article.  But here I go with the synopsis. 

Strength training will indirectly help you run longer and faster.  Strength training exercises can improve your running mechanics, so that you run more efficiently.  Efficient running mechanics will lead to less wasted energy with each step and less injuries. 

Think about it.  You will take 80 to 90 steps per foot each minute you run.  If you have muscular imbalances that lead to joint mobility or stability issues you will move through an improper range of motion with each step. 

When you run for 30 minutes you take 2700 steps with each foot for a combined 5400 steps.  That could be 5400 steps of feet rolling in, rounded shoulders, wasted side to side movement or just pure pain.  Needless to say, when you are an endurance athlete it’s important that each step and every workout is adding to improved performance not to injury or fatigue.

The key to becoming a better runner is consistency.  For most runners, injuries are the biggest disrupter of consistent training.  Runners get a few good weeks or months of training, and then they are injured.   That means time off, loss of motivation, and a decrease in fitness. 

Strength training with proper form 2 to 3 times a week will reduce the onset of injuries and improve your running form.  Here are my top 3 strength training exercises for runners. 

Bulgarian Split Squat

You will need a bench, chair or stepper to perform this exercise.  Start by doing this exercise with just body weight and then progress.  The progression could include holding dumbbells, kettlebells or a barbell.  You can also make this exercise explosive. 




 
  • Place the to top of your back foot on.  If you are having a hard time with balance, flex your back toes and place them on the bench.   
  • Stand in a staggered stance about 2 to 3 feet wide.  This should allow your knee to bend while keeping your knees behind your front toes. 
  • Inhale as you begin to bend both knees. 
  • Focus on your back knee pointing straight down toward the ground and your body weight in your front heel.   
  • Keep your front kneecap inline with the 3rd toe of the front foot. 
  • Exhale as you straighten both knees to come back up to standing.  
Start with 10 repetitions on each leg and progress to 15. 

Calf Lowers

Use a stair or a stepper to perform this exercise.  Start by doing this exercise with just body weight.  The progression would include holding a dumbbell in one hand. 


 


  • Place the ball of your foot on the stair while holding on to the wall or railing.   
  • Rise up on the ball of your foot as high as your heel will go.  Make sure you have weight evenly distributed on all of your toes and that you are not rolling onto one side of your foot. 
  • Slowly, lower you heel back to the starting position.  Try counting 3 to 5 slow counts to ensure you really focus on lowering part of the movement.   
Do 10 reputations on each foot to start.  Work up to doing 20 reputations on each foot. 

Band or Cable Row

How many runners do you see hunched over logging long miles.  This exercise is for improved running posture, which can lead to improved respiration. 

To perform this exercise, use a band or a cable.  This exercise can be done with both arms or with just one arm. 





  • Stand in a staggered stance with relaxed knees.  Make sure your ribs on stacked on top of your hips to ensure good posture. 
  • Grab the handles of the band or the cable in the thumbs up position. 
  • Start the movement by protracting the shoulder blades.
  • Then bend the elbows straight back so that your biceps are close to your rib care.  Keep  your knuckles forward. 
  • To release, begin to straighten your elbows and bring your shoulders back to the starting position. 
Start with 10 repitions and work up to 20.  To increase difficulty, use a more difficult band or more weight on the cable system. 

Here’s to improving your running mechanics so that you can train more consistently.  Can’t wait to hear about the PR at your next race. 

How did Cureality get its start?

27. July 2014 William Davis (0)



In the Cureality program, we embrace information and strategies that empower you in health without drugs, without hospitals, without procedures. We convert your doctor from director of healthcare to your assistant in health. He or she is there when you need help, but you largely direct your own health future.

How did we gain the know-how, information, tools, even chutzpah to take on such an ambitious project?

It started around 10 years ago with the awkwardly named Track Your Plaque program. In fact, some of the current followers of the Cureality program are former Track Your Plaque members, having learned of the wonderful list of strategies that can be adopted to gain better control over, even reverse, coronary atherosclerotic plaque and risk for heart attack. They also learned that something special happens when you engage with other people with similar interests, all sharing ideas, insights, and resources to get the self-directed health job done. Over time, what started out as simply a source of better information for coronary health evolved into a self-directed coronary disease management program. We never set out to create something as wildly ambitious as a do-it-yourself-at-home coronary disease risk management program, but that is how it inadvertently turned out.

How we went from Information Provider to Health Empowerment Program

So we never intended to take on something so seemingly impossible as managing coronary risk on your own. But, because we armed people with such empowering, profound insights into better ways to manage their heart disease risk beyond “don’t smoke, cut saturated fat, be active, and take a statin drug”—the typical advice offered by doctors—they returned after an interaction with their doctors disappointed: doctors often declared such strategies unnecessary, or the doctor didn’t understand them—even when there were clear-cut clinical data already available to support their use. In other words, the patients—everyday people, not experts—knew more than their doctors. 

This flip-flop in the balance of knowledge made for some very interesting stories, like “Harold” (not his real name) who, having survived a heart attack and received a stent, was told by his doctor to cut his fat intake, eat more whole grains, exercise, take aspirin and a beta blocker drug, and reduce his cholesterol values with a statin drug. Upon learning all the additional information from the Track Your Plaque program, Harold returned to his doctor and asked “I’m not so ready to just go along with this idea of ‘reducing cholesterol’ to address heart disease risk. Because my goal is to gain as much control over coronary disease as possible, maybe even reverse it, I’d like to address some additional issues that I believe may be important. I’d like to have my advanced lipoproteins drawn to measure the proportion of small LDL particles I have, whether I have lipoprotein(a), an omega-3 fatty acid index and 25-hydroxy vitamin D level, and a thyroid assessment. Oh, and I believe I should also have an assessment of my inflammation status, perhaps a c-reactive protein and phospholipase A2, and my blood sugar status measured with a fasting glucose, insulin, and hemoglobin A1c.” Harold’s doctor was dumbfounded and speechless. Rather than reveal his ignorance, his doctor advised Harold that none of that was necessary, sending him on his way and telling him that he was fine.

But this left Harold with a sour taste in his mouth, having engaged in many online discussions with people who had followed conventional advice that resulted in more heart attack, more heart procedures—the conventional answers simply did not work. He also discussed his situation with people who had successfully obtained the additional information he sought, added it to their program and enjoyed dramatically improved health, including freedom from more heart attacks, heart symptoms, and heart procedures, as well as improved overall health. So Harold found an easy way to obtain the testing on his own. Within a couple of weeks, he returned to his online community and shared all his information. Within moments, he was provided useful discussion to help him understand the values, all leading to changes in nutrition, nutritional supplement choices, how and where to get the simple tools necessary, such as iodine and vitamin D supplements. He even entered his data, choosing which values he was willing to share with others, which remained private, allowing him to compare his own follow-up values several months later. Engaged in this process, self-directed but collaborative, he witnessed marked transformations in his health. Not only did he never again—over several years—ever re-develop heart symptoms nor require any more trips back to the cath lab, he lost weight, reversed a pre-diabetic sugar profile, improved his cholesterol values without drugs, got rid of the acid reflux symptoms he endured for many years, dropped his blood pressure to normal, enjoyed better mood, energy, and sleep. Slender, healthier, all accomplished without his doctor. 

Harold returned to his doctor for a routine follow-up. Slender, energetic, without complaints, on no drugs except the aspirin for his stent, the basic laboratory assessment his doctor ordered in front of him, his doctor admitted,” Well, I don’t know how you’re doing it, but these values look like a 20-year old substituted his blood for yours. They’re unbelievable. What drugs are you taking to do this?” “No drugs,” Harold replied, “I’m following a program to reverse heart disease, but it means doing some things that are different from conventional solutions.” His doctor closed their meeting with the signature response of doctors nationwide: “Well, I don’t understand what you are doing, but just keep doing it.”

Yes, Harold knew more about how to control heart disease than his doctor, more than his cardiologist. The cardiologist knew how to insert a stent or defibrillator. But deliver information that empowered Harold in all aspects of health from head to toe, while also dramatically reducing, perhaps eliminating, his coronary disease risk? As you now know, that is not what conventional healthcare does, nor is it interested in doing so, as it would relinquish control and threaten to cut off this hugely profitable revenue stream that drives “healthcare.”

Having managed to inadvertently create a self-directed coronary risk management program with such spectacular results and in probably one of the most difficult areas of all—heart disease—it became clear that a similar approach could be even more easily applied to many other areas of health, such as weight loss, bone health, cholesterol and blood pressure issues, diabetes and pre-diabetes, hormonal health, autoimmune conditions, and others. You can do it when empowered by safe, effective information, and supported by a community of sharing and collaboration. We don’t fire our doctors; they are there when we need them when, for instance, we get injured or catch pneumonia, or as an occasional resource. But doctors should no longer be able to get away with neglect, misinformation, or blindly directing you to the next revenue-generating procedure because you are empowered by the information and support you receive in Cureality.

As we get more effective in delivering this information and new tools to you, just imagine what we can accomplish in this new age of information and self-empowerment. The future for us is bright with ambitions for better interactive tools with Cureality expert staff, better ways to crowd source health answers, provide more engaging community conversation, all while the health insights that help accomplish our self-directed health goals get better and better. Each person that joins Cureality helps make this service more effective because your wisdom, insights, and experience are added to the collective knowledge. We are more powerful together than we are as individuals.

If you are already a Cureality Member, please add your comments and questions to the growing conversation. If you are not a Member, consider joining our discussions, as each new voice gets us closer and closer to better answers to take back control over health.

Sit Less and Move More.

21. July 2014 Amber B (0)


We sit way too much. Many of us have desk jobs where we sit for 8 to 9 hours a day. After we leave the office, we sit in our car to run errands. We follow that by sitting down to eat dinner. Our day ends by sitting on the couch to unwind by watching some television.

Many of us will be sitting a good 12 to 15 hours each and every day. Unfortunately the research shows that long hours of sitting can lead to obesity, heart disease, diabetes, and even early death. Don’t be fooled that your workout is enough movement. You can still be active and sedentary.

How can you add more movement to your day? First, think about all the times you find yourself sitting during the day. Then come up with a creative way that you can get out of the seat and move your feet.

Here are a couple of examples:

Instead of driving everywhere, jump on your bike. The picture above is of the bike I use to go to work or run errands. Bike riding is great exercise, greener transportation and a great stress relief.

We spend a lot of time at work sitting in front of the computer or the phone. Prop your laptop on a bookshelf to create a standing workstation. You can also purchase a sit-stand workstation you can adjust throughout the day. Get a headset and stand during phone calls.

Walk during your lunch break. Walk to the coffee shop, the mailbox, and the dry cleaners. Get your errands done on foot or just enjoy a stroll outside.

Take a movement break every hour. Do some desk push-ups, squats or walk the stairs. Need to communicate with a coworker? Don't email, walk over and talk to them.

Human beings are meant to move, not sit in chairs all day. I want to challenge you to incorporate more movement into your day. I'd love to read your comments how you move more and sit less.

Have You Had Your Prebiotics Today?

11. July 2014 Lisa G (0)


Prebiotics and resistant starch may be the missing link to your digestive health. Indigestible fibers that allow healthy bowel flora to proliferate and thrive are often called prebiotics. They are also known as resistant starches, because they are resistant to human digestion. I recently had a client call the addition of resistance starch to her diet, “the missing link my body needed”.

A starch that resists digestion and reaches the large intestine becomes food for the healthy bacteria in the large intestine. These bacteria can break down and “feed on” the resistant starch thus providing the friendly bacteria with the fuel they need to survive.

Imbalance of the quantity and type of bacteria species present in the gut contributes to gastrointestinal illness, blood sugar imbalance, obesity, mood disorders, and immune system challenges.

Green unripe bananas and plantains are one of best sources for prebiotic fiber content with 27 to 30 grams of fiber in one medium banana. Green bananas are essentially inedible. They are most easily incorporated into diet by blending into a smoothie.

One mistake frequently made incorporating prebiotic fibers from bananas is consuming bananas that are too ripe. Once the banana ripens the resistant starch is degraded and become a digestible starch. Thus, no longer a good prebiotic fiber source. In fact, the riper the banana becomes the higher the glycemic (blood sugar) response.

It can be difficult to find bananas that are very green. I made several trips to my local grocery store to find these bowel flora champions. I find it helpful to ask the produce clerk to take a look at the shipment that just arrived, noting the day the shipment arrives, for the best chance to gobble up these green beauties.

In an effort to keep green bananas green I tried a few strategies. One that sounded promising was wrapping the end of the banana to prevent the ethylene gas, which ripens the fruit, from dissipating. You can see from the image this clearly did not work. After a mere two days the green bananas were no longer green. What I found works best is placing the green bananas in the fridge. This halts the ripening process. The skin of the banana will turn brown, which is normal, but the fruit inside is still good. I’ve kept bananas in my fridge for up to 8 days and they hold up well other than the brownish black discoloring that develops on the skin. The banana will be firm and require a knife to cut the skin off the banana.

If you’d like to learn more about prebiotics and strategies to support resolution of common gastrointestinal complaints read the recently release Cureality Guide to Healthy Bowel Flora by Dr. Davis. This guide is one of the many valuable resources available exclusively to Cureality.com members.
---Lisa Grudzielanek, MS, RDN,CD,CDE
Cureality Nutrition Specialist

Something is Better Than Nothing

2. July 2014 Amber B (0)


This past weekend I attended a fitness conference with an amazing lineup of presenters. Even after 11 years in the fitness industry, I love attending these events. I’m a lifetime student always learning more and honing my craft.

I went to a presentation by Al Vermeil about joint mobility, not knowing anything about him. To my surprise, Al was the strength and conditioning coach for the Chicago Bulls and the San Francisco 49ers the years these teams won championships in their respective sports. That’s a pretty impressive resume.

Al was a great presenter, full of fun and practical advice. During his presentation, Al said the following statement:

“Every time you miss a workout, the next one is easier to miss.”

This statement really hit home because I’ve seen this time and time again working in the fitness industry and in my own life. One workout is missed, then an entire week of workouts are missed, then it’s been an entire month of never setting foot back into the gym.

It’s easy to get thrown off your workout routine when life gets busy and days get long. So what do you do? Do you just trash your workout plan?

The all or nothing attitude is common when it comes to making health changes. Either you’re following your plan 100% or you not. I’m here to tell you that doing something is better than nothing. Doing part of your workout or a mini workout is better than missing an entire workout.

The other day I had the choice to do something or nothing. I had a full day of work meetings, video, and family commitments. Here is what happened. I did shorter variation of my joint mobility routine. I followed that with a quick kettlebell circuit of 25 kettlebell swings, 12 kettlebell overhead presses, and 12 kettlebell goblet squats. I did three rounds of this circuit. That’s it! The following day, I got back to my regular exercise routine.

Be consistent with movement and you’ll always see improvements. That’s the magic of exercise. You'll get better if you just do it.

What’s the Problem with My “Healthy” Bowl of Oatmeal?

26. June 2014 Lisa G Nutrition, Oatmeal (0)


Food manufacturers have clever ways to market foods to us. Unfortunately, many foods that have a reputation for being healthy are no more than junk food disguised as a healthy food choice. I commonly see people under the influence of a “health halo” effect. This is due to strategic marketing efforts. People overestimate the nutritional value of a food that is labeled “good for you” or they underestimate the negative impact of a food because it contains a healthful ingredient, like flaxseed or fiber. In fact, a recent study from the University of Houston found that terms on food labels such as antioxidants, all-natural, and gluten-free often are used to give an otherwise standard food a "healthy" halo, and influence consumption from the well- intended consumer.

Case in point-- oatmeal. We’ve all heard about the cholesterol lower benefits from soluble fiber contained in oatmeal. It’s blasted all over packages with a paid endorsement from The American Heart Association. However, that’s not the whole story. Most people enjoy a cup of oatmeal with one to two tablespoons of added sugar and fruit such as a ripe, yellow banana. In other words, let’s enjoy a bowl of “send my blood sugar through the roof” high glycemic oatmeal. The glycemic index of oatmeal is 55, and instant oatmeal is 83. Top that with more table sugar, glycemic index 58-65 and better yet top that with a high glycemic, ripe banana with a GI of 62.

Preparing one packet of regular instant oatmeal with one tablespoon of sugar and a medium ripe banana five days per week would result in the sugar equivalent of more than 5 1/2 cups of sugar per month!

Furthermore, the story many Americans are missing is all of that sugar intake, from their so-called “healthy” bowl of oatmeal, actually raises small-dense LDL cholesterol particles, increases blood sugar and contributes to insulin resistance, faulty gut flora, and belly fat.

How do we improve upon our bowl of oatmeal? Enjoy a bowl of hot coconut flaxseed cereal, eggs any variety of ways, or last night’s leftover salmon and vegetables.

The Cureality program provides tools, guidance, and support that does not follow the party line but rather offers nutrition solutions that address the underlying causes for proliferation of many chronic diseases.

Power in Numbers

25. June 2014 William Davis (0)


In his book, The Wisdom of Crowds, author James Surowiecki begins with the story of an ox judging competition in which 800 people—not ox experts nor breeders, just ordinary people attending a county fair—were asked to guess the weight of the ox. The competition was conducted by a scientist, Francis Galton, who held a low opinion of the intelligence of the average person, remarking that “the stupidity and wrong-headedness of many men and women being so great as to be scarcely credible.” He hoped to prove, by examining the various guesses, that the average person had no idea of how to judge the real answer. After all participants casted their written votes, Galton tallied up the total and averaged the result: 1,197 pounds—just one pound off from the real weight of 1,198 pounds. Few individuals actually guessed the correct weight themselves but, when the opinions of many were combined, the result was near-perfect.

Crowds can also be a source of irrational behavior, panic, and stampede. Witness any modern football or soccer game, for instance, in which fights break out over an issue as minor as a disputed call or a heckle. Or go back through history to the countless events when mass hysteria ruled, such as the Salem Witch Trials or Orson Welles’ War of the Worlds radio broadcast.

Let’s put aside examples of mass emotional chaos of the sort that causes crowds to stampede store doors on Black Friday. Let’s focus instead on conscious, considered, thoughtful opinions. We all accept that there are as many opinions on issues as there are people, not uncommonly with widely divergent views. But can we, as Galton’s famous experiment did, combine the opinions of many and come away with some fruitful insight—the correct answer? Just as the people participating in Galton’s experiment were not experts, so Cureality participants—a crowd-sourced collection of opinions—are not experts. If we were to poll everyone to identify their area of expertise or experience, it would likely include finance, the retail industry, raising children, or teaching—but not health. Yes, we have experts curating the direction of content, but we also crowd-source collective opinion.

Right now, Cureality is based on existing science, the philosophy of self-directed health, combined with guidance and community to help the participant along in the sometimes complex world of health questions. But as our processes and procedures improve, can we—like Galton’s ox weight guessers—come away with coalescent wisdom, answers to our health questions, near-perfect solutions to health conditions that have eluded the “experts” for centuries?

I think that we can. No, I know that we can. We enter a new age in information and harness the power of the crowd-sourcing of solutions, even when no single individual has the complete answer herself.

Use This Trick to Boost Exercise Motivation

23. June 2014 Amber B (0)


Are you been struggling to get your workouts in? 

Do you belong to a gym and find that you're not going?

Do you have exercise equipment sitting in your basement collecting dust because you find that you just can’t get yourself down there?

If you answered, “yes” to any of these questions you are not alone. Many people struggle with finding the motivation to exercise.

The problem here is that you have head trash going on. Head trash is that voice inside your head coming up with a million excuses that inhibit you from carving out a bit of time to take care of yourself.

Head trash will tell you that you’re too tired, even though a workout would give you a boost of energy.

Head trash will tell you that you’re too busy, even though you just spent a half hour on Facebook.

Head trash is barking at you to take care of others, even thought you know your health is important for you well being.

Head trash is a real conflict that can get in the way of our health and fitness goals. We start an exercise program with the intentions of a long-term commitment. But after the initial excitement wears off, we find our workouts occurring less frequently. Head trash begins to take over and soon we find ourselves not exercising at all.

Here is my secret for winning the battle over the head trash that keeps getting in way of your workouts. Tell yourself that you are only going to exercise for 10 minutes and evaluate if you want to continue. If you're truly too tired you can stop after 10 minutes. If you're truly too busy you can stop and move onto a task that needs your attention.

Making this deal with your mind that you are only going to exercise for 10 minutes seems reasonable. The head trash will become quite because your mind is convinced it has an out within 10 minutes.

I've used this 10-minute trick myself. I grind through the first few minutes, but then the magic happens. Once you hit the 10-minute mark your body takes over. Exercise feels amazing and your body is energized and enjoying the movement. You have tricked your mind to get over the hurdle of starting and now you’re in the exercise groove.

Try the 10-minute trick next time your head trash is getting in the way of your workout. You'll be amazed how your workout consistency improves.

The ultimate insurance company cost savings

The ultimate insurance company cost savings

29. September 2010 William Davis (48)
I had a very disturbing conversation with a physician who is employed by an insurance company last week.

I admitted a patient in the hospital for very clear-cut reasons. She is one of my few non-compliant patients, doing none of the strategies I advocate--no fish oil, no vitamin D, no correction of her substantial lipoprotein abnormalities, not even medication. Much of this was because of difficult finances, some of it is because she is from the generation (she is in her late 70s) that tends to ignore preventive health, some of it is because she is a kind of happy-go-lucky personality. So her disease has been progressive and, now, life-threatening, including an abdominal aneurysm near-bursting in size (well above the 5.5 cm cutoff). The patient is also a sweet, cuddly grandmother. I have a hard time bullying nice little old ladies.

While she was in the hospital, the social worker told me that her case was being reviewed by her insurer and would likely be denied. Their medical officer wanted to speak to me.

So the medical officer called me and started asking pointed questions. "Why did you do that test? You know that she's not been compliant. Are you sure you want to do that? I don't think that's a good idea." In other words, this was not just a review of the case. This was an opportunity for the insurance company to intervene in the actual care of the patient.

Then the kicker: "Have you considered not doing anything and . . . just letting nature take its course?"

At first, I was stunned. "You mean let the patient die?"

Expressed in such blatant terms, while he was trying to be diplomatic, made him back down. "Well, uh, no, but she is a high-risk patient."

Anyway, this was the first instance I've encountered in which the insurance company is not just in the business of reviewing a case, but actually trying to intervene during the hospital stay, to the point of making the ultimate healthcare cost savings: Letting the patient die.

Unfortunately, never having had an experience like this before, I did not think to record the conversation or take notes. I am wondering if this is an issue to be taken up by the Insurance Board . . . or is this a taste of things to come as the health insurers fall under increasing pressure with the legislative changes underway?
Tags :

Comments (48) -

  • Apra -- The Shaman

    9/29/2010 5:34:45 PM |

    There's no reason to blame this on health care legislation yet, it hasn't taken effect yet. It sounds like it is the usual coldhearted, profiteering insurance companies have engaged in.

  • Anonymous

    9/29/2010 5:50:58 PM |

    Who needs Death Panels -- the insurance industry has been doing this stuff for years and will continue under Obamacare.

  • Jon

    9/29/2010 5:53:16 PM |

    Wow. I'm stunned. I cannot believe they basically would come in to the hospital and ask you to let her die so they can save money...

    -Goes to show how out of wack peoples' values have become these days.

  • aek

    9/29/2010 6:02:09 PM |

    As stunning as that was, it does bring up an interesting point:  if this patient is essentially refusing interventions aimed at reversal/control of disease, is it appropriate to have an end of life discussion with her?  Is she opting for palliative care or hospice type care?  What are her goals?  Pain management? ADL function?  Some quality of life issue?

    I don't think that "bullying", scare tactics, coercive tactics, disease curative advocacy tactics  etc. are useful here.

    Having a frank discussion about her health aims and her knowledge in order to partner in achieving her health/quality of life goals may actually be where the utility will be.

    Great post.  Thanks for writing this.

  • Dawn

    9/29/2010 6:27:23 PM |

    I think the whole point of this episode is that Obamacare has nothing to do with "death panels" and that insurance companies have already been intervening (read: rationing) care for years.

  • David Csonka

    9/29/2010 7:19:44 PM |

    This is the kind of situation that got so many people riled up, when the topic of "death panels" arose during the health care reform debates.

  • Elenor

    9/29/2010 7:43:34 PM |

    No one is willing to point this out  -- but if she is NOT willing to do anything to try to ameliorate her health, then perhaps "society" should not have to pay for her hospitalization.  

    People are all up in arms about "oooohhh. Death panels!!" There is no human life that does not end in death. It is a REASONABLE economic consideration whether "society" (that is, you and I) owe anyone 'free' health care when they refuse to follow their medical practitioner's advice. (Yes, that means I pay for my own medical care, because I'm not insured, and I don't always agree with my doctor's advice.)  

    No one is "owed" full medical coverage when they're not willing to participate in their own health.  And society (you and I) CANNOT afford to pay for everyone's health care. Period. It's not possible.  There is not that much money on the planet!  

    I dislike the insurance companies -- but their attempt to protect their shareholders' money is a REASONSABLE financial decision based on rational grounds. Sorry that granny isn't able or willing to take care of herself, but we CANNOT afford to pay for everything for everyone.

  • Anonymous

    9/29/2010 8:05:20 PM |

    This is nothing new.  Insurance companies exist to make money.  They're neither good nor evil.  They're not interested in patient care.  They're interested in taking in more money than they give back out.

    Not sure what else you'd expect.

  • Tax Sale Property Jim

    9/29/2010 8:21:52 PM |

    Wow. Reading this chilled my blood to the point that I wondered for a split second if you made it up (nothing personal, was just that shocked).

    Shocking, and appalling.

  • Anonymous

    9/29/2010 8:26:58 PM |

    Given the complexity of the health care legislation, is it really possible to say that it will make the situation with insurers better or worse?  Some provisions aimed at limiting cost could make the situation worse, but the standardization of plans that the exchanges are likely to cause could make the situation better.  From my point of view, it seems to hard to answer without going into the details, and I have yet to see a detailed analysis.  Does anyone know of one?

    Even then, the full effects of the legislation is likely to be unpredictable due to the hybrid nature of our health care.  (See "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care" for a description of various health care systems and how ours compare).

  • Chuck

    9/29/2010 8:27:03 PM |

    I tend to agree that if she refuses to make attempts to improve her health that a real "end of life" discussion is warranted.  maybe that was had and that what precipitated the test requests.

  • Barkeater

    9/29/2010 8:31:36 PM |

    If she has insurance, it is not "society" that should determine her care, it is her individual contractual right.  The insurance company is stuck with her and needs to pay for her care in accordance with the contract.  Trying to persuade her doctor not to prescribe the care he ought to is dealing off of the bottom of the deck.  

    She should be compliant, of course, but I am certain she cannot be denied further care under the policy just because she made some poor choices in the past.

    I think the reason "death panels" is such a scary concept (and insurance companies rationing care too) is that as individuals we want the right to the best care, and we thought we were getting it and paying for it through insurance.  Sadly, the entire system (as is and as will be) is skewed toward top-down decision-making, rather than patient empowerment (and responsibility).

    If her regular doctor were someone other than Dr. Davis, the care she might have gotten might not have done any good anyway.  God sent her a rowboat as the flood waters lapped at her feet, and she did not get in.

  • Anonymous

    9/29/2010 9:57:30 PM |

    As long as health insurance is a "for profit" business, this situation is bound to happen. Why should this surprise anyone ? Like any for profit business, they are in it for the money. It unfortunately for us, the paying public, involves our lives. I don't see anything changing unless the insurance industry is changed over to a non-profit one. Not likely to happen in the US.

  • Ellen

    9/29/2010 10:06:29 PM |

    ". . or is this a taste of things to come as the health insurers fall under increasing pressure with the legislative changes underway?"


    Yes.

  • TJ

    9/29/2010 10:15:48 PM |

    >>>  No one is willing to point this out -- but if she is NOT willing to do anything to try to ameliorate her health, then perhaps "society" should not have to pay for her hospitalization

    -----

    Well the irony here is that the prescription of many docs for being "compliant" (ie. eating whole grains and takings statins etc) actually makes their health WORSE and costs society more money in the end (all the while lining the pockets of big pharma.)

    I agree in principle with your point about self-responsibility, but we have to be careful because few docs are as enlightened on this topic as Dr Davis are.

  • scall0way

    9/29/2010 10:41:33 PM |

    Hmm, well in many ways I *also* reuse to follow my medical practitioner's advice - by following a low carb diet, and refusing to take statins. So does that make me also "non-compliant" and ready for the death squad?

  • Anonymous

    9/30/2010 1:37:28 AM |

    I'm not sure how insurance works for the elderly, but remember for my father he didn't have a choice.  Once he reached the age of 65 he had to join the government plan.   I remember, he wasn't too happy about it.  Was the insurance firm for your patient Medicare?  Is there other insurance?  Scary tale regardless.

  • Anonymous

    9/30/2010 1:44:02 AM |

    Doesn't want to follow advice, change her diet, but likes to visit doctors a lot. Sounds like Elderly Munchausen syndrome.

  • rdyck

    9/30/2010 1:49:23 AM |

    No one has a right to health care and no one has a right to force care on another that refuses such care. Whether or not her decisions are "right" as judged by others is immaterial.

  • Anonymous

    9/30/2010 4:52:40 AM |

    Doesn't this woman have Medicare (i.e., govt health insurance for the elderly)?  

    Also, the health care law HAS taken effect as companies and insurance companies seek to adjust to its many diktats.  See today's news that McDonald's is thinking of dropping its (admittedly paltry) coverage and the "reform" has added much extra cost to many company bottom lines, not to mention additional tax reporting obligations.  Think what you will about the current system, but it will get worse with this reform.  Long lines, fewer specialists, no cutting-edge testing like the doctor advocates.  I know; I have lived in Canada.

  • Medical Insurance

    9/30/2010 5:31:35 AM |

    Group health insurance policies are always beneficial and the premiums for health insurance quotations are lowest when opted for a group health insurance policy, since it’s important to cover the health first.

  • Jack M.

    9/30/2010 9:21:31 AM |

    Thanks for being so transparent!  Do the drug companies offer you money to write prescriptions?  Have you heard about that from your colleagues?

  • Dr. William Davis

    9/30/2010 4:03:28 PM |

    Although I was frustrated by this (very nice) woman's inability or unwillingness to follow a preventive effort, my primary concern here is the aggressive effort to intervene by the insurance doctor.

    This is not the only instance of the clamp-down they have been exerting; we've been seeing it in many others ways. For instance, for most of the routine tests we run, including lab work, we have to get the okay of the insurer. Sounds fine, except my staff spends hours every day on the phone telling the insurance person things like "Their last HDL was 67," or nonsense that has nothing to do with justification of testing.

  • Anonymous

    9/30/2010 8:15:09 PM |

    Some of the comments here emphasize the problem of looking at health care of an individual as some sort of collective enterprise where society or some other collective claiming an interest should have its say in life or death decisions of the individual, rather than the individual, with the counsel of family and physician, retaining sole autonomy. For those of you advocating the right of the "collective," however viewed, to cast its vote on your treatment consider this: 1) by any objective standard, none of you took perfect care of your health, either, (glass houses & stones) 2) by even being on this website, you advertise your dissent from many prevailing opinions of "correct" medicine; maybe the collective would conclude that your suspect medical practices ought not to be rewarded with treatment in a crunch 3) e.g., maybe because you refused that statin & now you've had a CVA, nature ought to be allowed to take its course since you refused "best practice." I could say a lot more, but maybe you collectivists can figure it out from here.

  • Anonymous

    10/1/2010 10:31:32 AM |

    Welcome to "Obama Care"....

  • eh

    10/1/2010 4:11:26 PM |

    Happens all the time, in one way or another. My mother was sent home from the hospital in hospice care with morphine prescribed for "shortness of breath" (she had lung cancer). Clearly they didn't think there was anything more they could (or TBH, probably wanted -- she was 84) to do for her, but I guess they couldn't quite conscience doing nothing for someone experiencing difficulty breathing.

  • Anonymous

    10/1/2010 6:40:38 PM |

    Adopting unconventional approaches to health do not imply unconventional political or philosophical views. Please take these sorts of debates elsewhere.

  • Anonymous

    10/1/2010 11:43:22 PM |

    Another Anonymous said:

    "welcome to Obamacare"

    This will be the outcry going forward even though it is patently false.

    I say welcome to the culture of greed.


    2007 Total CEO Compensation

    Aetna - Ronald A. Williams: $23,045,834

    Cigna - H. Edward Hanway: $25,839,777

    Coventry - Dale B. Wolf: $14,869,823

    Health Net - Jay M. Gellert: $3,686,230

    Humana - Michael McCallister: $10,312,557

    U.Health - Grp Stephen J. Hemsley: $13,164,529

    WellPoint - Angela Braly (2007): $9,094,271

    These people do not earn this money.  There is nothing about them that is that special or irreplaceable.
    A whole lot of healthcare could have been provided in place of these bloated compensation packages.

    Let's look at H. Edward Hanway at Cigna as the poster child of egregiousness.  He makes just under a half million dollars EVERY WEEK!!!!  Now a half million dollars would buy a nice house (since it's not buying healthcare).  Something that many people would like to be able to afford on a 15 or 30 year mortgage.  But not H. Edward Hanway, he can pay cash for his house and buy himself another one every week if he wants.  That granny has to die early so H. Edward Hanway can have a new house every week is a small price to pay don't you think?

    So Anonymous who blames this on Obamacare, do us a favor and stay home on election day.  We can't afford YOU!  Sheesh

  • Anonymous

    10/2/2010 12:59:44 AM |

    Welcome to a taste of the coming Obama-care health era. This case is an example of something that no one will even raises an eyebrow about. Ahhhhhhh, the people's paradise. The joys of socialism, right here in America.

    And Apra, you're mistaken about the legislation not haven taken effect yet.

  • Anonymous

    10/2/2010 11:40:53 AM |

    Socialism? What a laugh. The "Affordable Care Act" is corporate welfare in the same way Medicare Part D was corporate welfare. Big Pharma got theirs, and now the insurance industry will get theirs. (like they were suffering before)

    And let's not forget Big Agra who gets to design the food pyramid with all those "heart healthy grains" at the top.I'm really surprised the corn industry couldn't buy a place for HFCS in the corporate pyramid.

    It's not socialism, it's an oligarchy, get used to it.

  • Anonymous

    10/2/2010 2:16:18 PM |

    Why am I not surprized?  If more doctors spoke out when insurance companies do this kind of thing, I'd be willing to bet that the insurance companies would soon stop doing it.

  • helene edwards

    10/2/2010 10:59:32 PM |

    Why don't you draft up a declaration in highly detailed form, and submit it to your state's Trial Lawyers' Association for future use?  The hardest thing to do in law is prove that an insurer has a "pattern" of acting badly.  You  could provide the starting point.

  • Cheryl

    10/3/2010 2:08:09 AM |

    Dr. Davis,

    Aren't you "intervening" in the care of this patient?  Aren't you taking her (or her insurance company's money) for treatment that she rejects?

    Maybe this is a patient you should decline to treat. Sounds like if she is a lovable old lady there is a doctor who will assist her in the way she wants, clearing your schedule to accept patients who want your style of care.

    Sounds harsh, but why try to push someone into something they don't want?  She's heard you, and doesn't want to listen. she wants to live her life they way she wants.  that "living" includes her eventual death.

    That's the way it goes birth-life-death. We don't typically choose our birth, and we're sometimes asleep during our life and death.  Still though, choice is ours.

  • Principal Quattrano

    10/3/2010 4:20:32 AM |

    The real issue is that a great many Americans cling desperately to absolutely horrible diets. I'm not even talking about that vast gray area of controversy, but of those who only occasionally eat fruit or vegetables and consume mostly wheat or corn, truly a third world diet.

    How does one motivate someone who clings desperately (in a quasi-religious cultish fashion) to something that not only may hurt them in the distant future, but actually does hurt them right now? Many celiacs continue to eat wheat even though they experience immediate symptoms.

    It is as though Americans have confused the diet they may need to continue living healthy lives with an imposition on their freedom of expression.

  • Anonymous

    10/3/2010 4:56:21 AM |

    happens all the time in Neurosurgery my friend.  Welcome to our world.

  • Anonymous

    10/3/2010 1:08:05 PM |

    I'm Canadian. Like most of Europe, we have national health care. If you are ill, you get care. It is only primary care.  Each Province has its own flavor so in some cases drugs are covered across the board and in other cases, like Ontario, it is only in hospital and if you don't have a drug plan and need expensive drugs....you are no better off than in the US. Anyone with financial means can,and does, go out of country if they want.  The government will pay for private care out-of country if they have emergency needs where a patient is at risk.

    Friends of mine from Boston visited recently (I lived there for 5 years) and I was surprised to hear the question of economic value for treatment of an at-risk patient come up.

    Insurance companies get no say in who gets health care, it is Universal and is part of who we are as a nation.  

    Having a profit layer in the middle does not sound like a good place to be. Sure people are covered, but the insurance company forced to take on "bad risk" will look to minimize the loss potential.

    Trev

  • John Townsend

    10/3/2010 3:40:23 PM |

    Noting here a number of comments about the pushing of “heart healthy grains" on an unwitting public, I was intrigued this morning by the host of the Rachael Ray show (CBS)devoting a whole program on this very topic. While demoEdit  John Townsend said...nstrating various grain-based dishes, Rachael quite unabashedly pronounces that grains in the diet are very healthy, reducing the risk of heart disease by 25%, followed by a gleeful applause endorsement by the TV audience.
    She provided no backup source, nor an explanation of how this is so. This sort of irresponsible
    “pushing” of what is clearly a doubtful contention by celebrities of this ilk on mainstream media is appallingly reprehensible.

  • John Townsend

    10/3/2010 3:44:19 PM |

    Noting here a number of comments about the pushing of “heart healthy grains" on an unwitting public, I was intrigued this morning by the host of the Rachael Ray show (CBS)devoting a whole program on this very topic. While demonstrating various grain-based dishes, Rachael quite unabashedly pronounces that grains in the diet are very healthy, reducing the risk of heart disease by 25%, followed by a gleeful applause endorsement by the TV audience.
    She provided no backup source, nor an explanation of how this is so. This sort of irresponsible
    “pushing” of what is clearly a doubtful contention by celebrities of this ilk on mainstream media is appallingly reprehensible.

  • Anne

    10/4/2010 11:40:32 AM |

    Thankgoodness I don't live in the USA - that's all I can say !

  • f0xpawz

    10/7/2010 4:35:03 PM |

    ". . or is this a taste of things to come as the health insurers fall under increasing pressure with the legislative changes underway?"

    You nailed it.

    The redeeming feature of the free market is when one company is being a jerk, customers can take their business elsewhere. If they are big enough jerks they get sued and have to change their policies or at least get bad publicity.

    When the government is in charge of insurance, there is no elsewhere, they can arrest you for not paying your permium, they cannot be sued, and no amount of bad publicity will make them clean up their act.

  • Anonymous

    10/8/2010 2:27:48 PM |

    It’s annoying how some people such as f0xpawz use an otherwise importantly informative
    web-site and discussion board as a bully pulpit for their unlettered views on subjects entirely
    irrelevant to what the site is all about. This kind of behavior is straight up unseemly and offensive.

  • Anonymous

    10/25/2010 5:38:05 AM |

    I this happened to my mother last year.  

    The hospital and then nursing home staff were clearly driving her into the ground with bad food and defective medicines.  The doctor was a social climbing medical deity, the head nurse a borderline psychotic.  

    I was able to find more knowledgeable, broad minded doctors, cut the meds, improved the food, aded supplements over the nursing home's many obstructions, and we eventually escaped without mortality.  Mom got better, after eliminating a number of drugs and their horrid side effects (including nausea and vomiting, Parkinsonism).

    All the nursing homes in the locale exhibited the (sub)standard American diet syndrome.  I have since come to view US nursing homes as death traps.

    Also my wife's cousin died in UK last year under NHS cost control.  Her sister, an American MD, on the phone, recognized her sister had a systemic infection that needed IV antibiotic, stat.  NHS guidelines delayed treatment.  Dead in 48 hrs.

  • Anonymous

    10/25/2010 5:38:29 AM |

    I this happened to my mother last year.  

    The hospital and then nursing home staff were clearly driving her into the ground with bad food and defective medicines.  The doctor was a social climbing medical deity, the head nurse a borderline psychotic.  

    I was able to find more knowledgeable, broad minded doctors, cut the meds, improved the food, aded supplements over the nursing home's many obstructions, and we eventually escaped without mortality.  Mom got better, after eliminating a number of drugs and their horrid side effects (including nausea and vomiting, Parkinsonism).

    All the nursing homes in the locale exhibited the (sub)standard American diet syndrome.  I have since come to view US nursing homes as death traps.

    Also my wife's cousin died in UK last year under NHS cost control.  Her sister, an American MD, on the phone, recognized her sister had a systemic infection that needed IV antibiotic, stat.  NHS guidelines delayed treatment.  Dead in 48 hrs.

  • ash17

    11/9/2010 4:01:24 PM |

    Well, it’s amazing. The miracle has been done. Hat’s off. Well done, as we know that “hard work always pays off”, after a long struggle with sincere effort it’s done.
    -----------
    marqgibs
    Savings

  • zeeshan ali

    12/3/2010 8:31:36 AM |

    I found your blog very informative about insurance policies and plans.

  • Dana Seilhan

    12/11/2010 9:50:02 AM |

    I get angry every time I hear a don't-wanna-be-a-socialist RED-stater griping and complaining about "Obamacare" and how they don't want to be forced to pay for other people's bad health choices.  Then they bleat about death panels.  Have these kind souls ever BEEN without insurance?  Boy, I sure have.  Nothing says "death panel" like "sorry, we require payment up front and by the way, you don't qualify for Medicaid."

    Paying for someone's dumb decision to leave their front door unlocked at night when they suffer a burglary and have to call the cops?  No problem.  Paying for someone's dumb decision when they fall asleep in bed with a lit cigarette and need the fire department?  No problem.  What's the difference then?

    I do not understand and I will never understand.  Yet they go on about "death panels" and "un-American" and so on and so forth.  What, are fat people and chronically ill people not alive or something?  Or not American?

  • commercial insurance quote

    1/27/2011 2:31:50 PM |

    I am really shocked to read the whole post. In my opinion the real cause is the increasing number of fraud that people are doing by showing false information so that they will get the claim. This just results into the poor people who are true, suffers a lot.

  • Anonymous

    3/10/2011 1:23:55 AM |

    To: Dana Seilhan

    VERY WELL said!

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