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Nutrition and Lifestyle

Health System Reform: What Works and What Doesn’t

Posted by John McDonough October 17, 2012 11:05 PM

For folks who pay attention to fixing the U.S. medical care system, it's got to be a confusing time. So many developments trending is so many directions. How does one make sense of it, and what does it all mean? Let's dive in for a bit.

First, an important shift in how we pay for health care in the U.S. began this month as the federal government started financially penalizing hospitals with excessively high rates of hospital readmissions and hospital acquired infections for Medicare patients. New Jersey is a state with among the highest proportion of hospitals facing these penalties, and here's a story about how hospitals there are addressing the challenge.

This shift is important. We are moving beyond fee-for-service by which we pay providers for how much they do. We are also moving beyond "pay for performance" where we reward providers for doing process steps such as screenings and other tests. We are moving, slowly and surely, toward "paying for outcomes," a potentially game-changing stage if the current efforts aimed at readmissions and infections are seen as just the first steps.

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Let food by thy medicine...

Posted by John McDonough July 9, 2012 10:49 PM

Time for some relief from ACA-mania.

This Mark Bittman column from yesterday's New York Times caught my eye: "Got Milk? You Don't Need It." Bittman confronts the "perfect food" mythology of milk -- and goes after it where it really hurts, namely the 50 million or so lactose intolerant Americans. I didn't realize it -- those 50 million include 90% of all Asian Americans and 75% of all African Americans, Mexican Americans, and Jews.

For Bittman, though, it's also personal, because he is one of the 50 million, so much so that:

"When I was growing up, drinking milk at every meal, I had a chronic upset stomach. (Channeling my inner Woody Allen, I'll note that I was therefore treated as a neurotic, which, in fairness, I was anyway.) In adolescence, this became chronic heartburn, trendily known as GERD or acid reflux, and that led to a lifelong Tums habit (favorite flavor: wintergreen) and an adult dependence on Prevacid, a proton-pump inhibitor."

Then:

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MA business leaders call to end tax break on soda and candy

Posted by John McDonough May 17, 2012 11:20 PM

Here's something worthy of notice: 30 Massachusetts business leaders this week urged House and Senate leaders to include in their health care cost control legislation a provision to eliminate the exemption from food taxes for soda and candy. Here are the 30 names and their companies who were organized by the Alliance for Business Leadership.

  • Andrew Tarsy, President & Executive Director, The Alliance for Business Leadership
  • J.J. Bartlett, President, Fishing Partnership*
  • Robert Beal, Partner and President, The Beal Companies
  • Josh Boger, Founder & CEO (retired), Vertex Pharmaceuticals
  • Nicolas Boillot, CEO, HB Agency
  • Howard Brick, CEO & Director, MedPanel, LLC
  • Jeff Bussgang, General Partner, Flybridge Capital Partners
  • Geoff Chasin, President, New England Retail Express
  • Tom Clay, CEO, Xtalic Corporation
  • Bob Crowe, Partner, Nelson Mullins
  • Betsey Dalbeck, Owner/President, Fresh Tracks
  • Jeff Dorigan, Global Head, Professional Development Program, State Street Corporation
  • Phil Edmundson, Chairman & CEO, William Gallagher Associates
  • Israel Ganot, President, Co-Founder & CEO, Gazelle
  • Norm Gorin, Chairman & President, Instinct Health Sciences, Inc
  • Mark Herman, Vice President, Goldman Sachs
  • Diane Hessan, President & CEO, Communispace Corporation
  • Kip Hollister, Founder & CEO, Hollister Staffing
  • Trish Karter, Founder & Chief Deer, Dancing Deer Baking Company
  • Ed Krapels, CEO, Anbaric Transmission
  • Janet Kraus, Senior Lecturer, Harvard Business School
  • Charles Lord, Senior Project Manager, CQuest Capital LLC
  • Jack Manning, President & CEO, Boston Capital
  • George Matouk, President & CEO, John Matouk & Co., Inc
  • Linda Moulton, CEO , Ceralta Technologies
  • Mari Ryan, Founder & CEO, Advancing Wellness
  • Tedd Saunders, President, EcoLogical Solutions, Inc
  • David Schechter, Managing Partner, Perspective Global Management, LLC
  • Ron Shaich, Founder, Chairman & Co- CEO, Panera Bread Company
  • Bill Sullivan, CEO, Hub Healthcare Management Services
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Statins, Chronic Disease -- and the Definition of Insanity

Posted by John McDonough March 11, 2012 06:00 PM

Two recent developments -- an advisory from the U.S. Food and Drug Administration (FDA) and one new study -- caught my attention over the past week. This involves cardiovascular disease (CVD), statin drugs, type II diabetes, patient education and empowerment, and more. Neither seemed to get much attention, and to my knowledge, no one connected the dots between them. So let me give a try.

First, on Feb. 28, the FDA announced the development of new warning labels for cholesterol-lowering statin drugs, warning of the risk of type II diabetes and memory loss from taking the drugs. FDA pegged the risk as "small," but read a bit from this New York Times analysis by Eric J. Topol and judge for yourself:

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Dept. of Eating: Why Vegan?

Posted by John McDonough December 30, 2011 11:55 PM

Beyond Bill Clinton (America's #1 vegan) here is a short, selected list of other prominent Americans who have publicly embraced an exclusively whole grain/plant based diet:

Alec Baldwin (actor); Neal Barnard (physician); Ed Begley, Jr. (actor); Patrick O. Brown (biochemist); Molly Cameron (Cyclist); Robert Cheeke (Professional bodybuilder); Chelsea Clinton (daughter of Bill Clinton); James Cromwell (actor); Mac Danzig (professional mixed martial arts fighter); Ellen DeGeneres (actress, comedienne, Talk-show host); Michael C. Dorf (Cornell law professor, author); William Clay Ford, Jr. (executive chairman of Ford Motor Company); Gary Francione (law professor, author); Michael Franti (Reggae artist); Brian Greene (scientist); Michael Greger (physician); Tonya Kay (dancer); Coretta Scott King (civil rights leader); Carl Lewis (track and field star); John Mackey (CEO, Whole Foods); Tobey Maguire (actor); Mike Mahler (body-builder); Brad Pitt (actor, producer); John Salley (professional NBA player); Alicia Silverstone (actress); Russell Simmons (entrepreneur); Salim Stoudamire (Professional NBA Player); Ruben Studdard (2nd season winner of American Idol); Mike Tyson (boxer); Jaci Velasquez (Contemporary Christian and pop singer); Alice Walker (Pulitzer prize winning author and feminist); Betty White (actress); Steve Wynn (entrepreneur); Mortimer Zuckerman (entrepreneur). (In a subsequent post, I hope to assemble a list of prominent Bostonians who are publicly vegan -- email your suggestions at jmcdonough@hsph.harvard.edu)

So are they all kooks like me? Or do they know something worth knowing?

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Dept. of Eating: I, Vegan

Posted by John McDonough December 26, 2011 11:01 PM

Those of you who have been trying to figure out if I'm a kook -- here is your answer.

This coming Sunday, January 1, will be the third anniversary since my wife and I switched to fairly strict "whole grain/plant based" diet, also known as "vegan."  I am as surprised as anyone.

On the one hand, so what? It's just what we eat. Nobody's business but our own. And yet, as I have gotten more knowledgeable about this nutritional choice, the meaning and implications keep growing. In my first post here at boston.com, I disclosed my interest in the intersection of nutrition, food policy, and health policy. During this coming week or so, I will put up a few posts laying out my thinking in various ways. This first one presents a bit of my personal story.

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Health Stew? What's Up With That?

Posted by John McDonough November 7, 2011 02:00 AM

Gideon Gil, the Globe's earnest health editor with a melodic name, blew his trumpet and asked me to start this blog. He was a reader of a blog I started in 2005 when I was executive director of Health Care For All, Massachusetts' consumer health advocacy group. He liked it enough to think I might create some motion and emotion here at boston.com ...

Why Health Stew and what's this blog about? I like stew because lots of different ingredients get thrown in, often with delicious results. I'm interested in lots of things related to health care policy and politics, and how odd things can fit together. And I love soup.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »

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