Prevention is the way out...The Swedish healthcare system gives everyone who lives or works in Sweden equal access to heavily subsidized healthcare. The system is taxpayer-funded and largely decentralized, and performs well in comparison with other countries at a similar level of development. Medical results are good relative to investments and despite funding restrictions.

Prevention is the way out...The Swedish healthcare system gives everyone who lives or works in Sweden equal access to heavily subsidized healthcare. The system is taxpayer-funded and largely decentralized, and performs well in comparison with other countries at a similar level of development. Medical results are good relative to investments and despite funding restrictions.

In any society , the private sector takes care of the upper class & upper middle class of society , while the public ( govt. ) sector takes care of the lower middle class & poorer sections of society .These sectors participate in preventive health & primary , secondary & tertiary health care . In a developing country , the public sector has a very important role to play in preventive health . The health indices of any country is measured by IMR , MMR & Life expectancy .Non communicable diseases & Infectious diseases are important causes of morbidity & mortality , which need different strategies to prevent & manage these diseases & they can be unique to each country . The health indices of the rich is always better than the poor in any country & therefore both private & public sector have an important role to play in improving the health indices in both preventive health & health care .Medical research is the only way to assess the impact on health indices & preventive health & primary care are most important tools to improve the health of any society .

I agree with Arun. Prevention is the key factor of developing a healthcare system that it will be equal to all citizens in a country. Prevention, not only by screen tests and vaccinations in a healthcare unit, but also by advertisements on the TV, public transport and so forth. There are many "bad" habits that cost a huge amount of money every year to the healthcare systems that can be "treated" before the actual patient arrives at a hospital and needs medical help. Sexual habits, smoking, drugs, alcohol and diet are the main categories that need to become the "target" of the advertisements. Most of rich or even poor have access to a TV.

The primary obstacles today in health promotion are several-fold:

1) Changes in the mass produced food supply lack the micronutrients and trace minerals that are absolutely essential for optimal function of repair and maintenance of human health.

2) Next, the cooking method of microwaving destroys the nucleus of the cells of food, and therefore, the protein building blocks of food itself. In the US, and nations that emulate the US diet, all categories of chronic disease have increased manifold and are still growing exponentially faster than the population. Diabetes and pre-diabetes, now affecting at least a third of the nation, is slated to rise to 50% by the year 2020. DMII is an umbrella condition that sets the stage for increased CVD and cancer, hence, those conditions are growing even faster than DMII. The key here is cellular acidosis, ignoring the principles of nutrtion that support the Kreb's cycle (also known as the Citric Acid Cycle) of the human body. See attachment of lecture notes for some detail on this. We advocate just about all cooking methods EXCEPT microwaving. The research on microwaving food was stopped by government edict in the late 1980s, so, yes, this may come across as 1980s to our critics. But decades of observation tell us that abandoning this form of cooking improves human health.

3) Coupled with this is an education system built around the nutrition, dietition field that does not make the distinction, or downplays it if it does recognize the distinction. Overall, that field tends to treat synthetic as equal to organic. Muddying the waters a bit here is a commercial nutrition field that does the same with natural crystalline compared to organic. While studies show natural crystalline nutrition, overall, about 44% more healthful than synthetic, it is not optimal by a long shot. Only organic has the universe of what the body percieves as complete nutrtiion. When it is missing, borrowed enzymes and uncountable co-factors must be given up somewhere else in the body for the food to digest properly.

4) High Fructose Corn Syrup (HFCS) dominates the US food supply as the primary sweetener, as my colleagues from Princeton have noted at http://www.princeton.edu/main/newsarchive/S26/91/22K07/, such is a root cause of the obesity and CVD epidemics in all age groups today in the US. Contrary to vested interests have promoted in advertising to consumers, the body DOES know the difference (between GMO high fructose and cane sugar).

5) We have developed a medical system that is in denial over what causes disease. Very few chronic diseases, in our view, occur without a nutritional/hydration/ environmental/food additive basis as primary or contributive causes. Immune systems weakened from poor diet catch every virus that comes down their way; healthy bodies resist the same bacteria. We can argue over this forever, but healthy consumers are walking away from the for-profit system of polypharmacy, endless clinical tests, and myriad unnecessary surgeries in droves. The patient with hypertension needs to resolve what is causing the hypertension, not put on a band-aid with 2, 3, or 4 anti-hypertensive medicines that lead to diabetes, weight gain, and worsened CVD. The US medical field, head to toe, is disincentivized to address underlying causes and start the populations back on a solid pathway of prevention.

6) The Orthomolecular Medicine approach, as espoused by Gonzales and others under the moniker "Metabolic Correction" and other similar approaches need to be incorporated in medical training and practice. For a review of the critical principles undergirding this approach go to http://wakeupsense.com/Gonzalez-Metabolic-Correction.pdf. There are other effective models, also, but nearly all of the ones to which we subscribe follow a similar tact at this one.

When medicine, nutrition, commercial delivery of food, and consumer lifestyle coalesce, we will see a much healthier population that is more productive, one that is more resistant to disease and viruses, and far fewer learning and mental health disorders. Resolving underlying causes, whether they be accumulated heavy metals and other environmental toxicities, nutrition, hydration, exercise, proper sleep, and judicial use of medications, etc., should be our united quest worldwide.

Thank you all

Education of the citizens at the grass-route level regarding the importance of health is a primary requisite for health promotion. This requires volunteering by educated citizens, incorporation of health-related subjects in the educational course-curriculum etc Furthermore making primary health necessities available to the economically backward people by varied government initiatives will aid in making health available to both the rich and poor.

I think that our aspiration for the health promotion should bear on renewed studies of the problems: «What is the life?», «Positive and negative influences of intracellular proteins and their intermediates on the DNA replication activity and cell division», «The optimal protein content in a living organism in whole», «The energy amount in food that is actually necessary for each organism», «The amount, composition, and valence forms of chemical elements that are necessary for introduction into the organism», etc. I foresee objections that, at present, almost all these problems underlie already the science on the optimal nutrition. However, we propose to consider them on a new basis, which is given, e.g., in: V.E. Ostrovskii, E.A. Kadyshevich, Life Origination Hydrate Hypothesis (LOH-Hypothesis): Original Approach to Solution of the Problem, Global Journal of Science Frontier Research (A), Physics and Space Science”, 12 (2012) (6), 1-36; V.E. Ostrovskii, E.A. Kadyshevich, Mitosis and DNA replication and life origination hydrate hypotheses: common physical and chemical grounds. In: DNA Replication – Current Advances, (Seligmann, H., еd.); InTech: Rijeka, Croatia (2011) 75-114; etc. (see ResearchGate). We develop the available notion that just DNAs rather than proteins represent the basis of life and, therefore, the optimal elemental composition of the products that should be introduced into the organism for life maintenance and development should be close to the DNA elemental composition and should be introduced in such valence forms and in the form of such chemical aggregates that can be used by the organism for replication of the DNAs that are inherent in it. In our opinion, just chemical and physical laws, synthesis and destruction of the so-called gas-hydrate structures, decomposition of introduced substances, and synthesis from them of the DNAs inherent in organisms rather than lock-key constructions and other «perfections» provide the maintenance and development of life processes. In our opinion, just accumulation of proteins in cells from one cell division to another leads to increasing in the protoplasm viscosity, decreasing in the diffusion-processes rates, depressing in the replication process, and, thus, promote aging of organisms.

Excellent contribution, Elena.

I suspect that you are right on the most important theories. In my comments above, I brought in some of the practical points that we are lacking in the US system, where we have the most medicated, chronically ill, and surgically altered of people on the planet. It is driven by economics that are disincentivized to improve the nutrient quality of the food supply, consumer education to something more than Pablum (analogy to a baby food brand), and a medical system so overwrought with overmedicalization of symptoms that we've come to call it "renting your health" (vs owning one's health. On the scientific side of the equation we have marvelous advancements that point to effectively alleviating chronic disease (and, by extension, many of the acute ones) on a grand scale, yet allopathic medicine keeps creating more disease through polypharmacy etc. and big business providing the food supply that is lacking in essential nutrients and micronutrients, and an unsuspecting public that, though highly educated by world standards, overall lack the will to resist the falacies of both assaults on the public health. It is ever my goal to see enlightenment illuminate the issues and that, as we are seeing more and more, people walk away from the system that is keeping them unwell and toward that which fosters true health. But, alas, the effort ever steps on the economic toes of heavily investments, and thus the conflict. In spite of it, work like yours marches on and hopefully the truth of it all will trump the current conditions of ill health promotion. Thank you, again!

I already participated to a similar discussion with the difference that the first one based on more practical than scientific considerations. It is obvious that researchers and scientists should debate based on scientific principles, and their conclusions can be the correct base to suggest a correct nutrition Bu the core of the problem is that even people perfectly could grasp the conclusions of scientific principles, possibly elementary explained, any correct suggestion would remain not applied by a lot of persons because fully inapplicable due to insufficiency of money or time or both to have foods appropriate for quality and for correct cooking. It is suitable to remind the millions of persons having their lunch or dinner eating industrial pre-cooked foods or a fast meal in a snack bar : coming back home after an heavy work day , already thinking to the next working day it's the worse base to decide on the remaining strengths to prepare a meal based on fresh foods that need to be prepared, and after accurately cooked. Based on these concrete considerations , I think that it is suitable and right to promote the principles for a correct nutrition , but that the most useful , sure and practical mean to obtain better results should be to obtain laws stating exactly the nutrient components allowed in the industrial prepared foods and drinks,

Dear Giancarlo Ruggieri,

You are right when you write about the necessity of "practical mean to obtain better results ...to obtain laws stating exactly the nutrient components allowed in the industrial prepared foods and drinks". But who is capable of revealing these laws if "researchers and scientists" do not reveal them; then who can do it, the politicians, manufacturer, or, maybe, cooks? The scientific works that are the subject of your remark are just aimed at revealing these laws.

Dear Dr Victor Ostrovskii, In my past intervention I wrote " It is obvious that researchers and scientists should debate based on scientific principles, and their conclusions can be the correct base to suggest a correct nutrition" and later " I think that it is suitable and right to promote the principles for a correct nutrition " that is to say that It is an obvious and implicit condition that the correct nutrition has to be defined on the base of the scientific acquisitions and researches in this matter : the cooks which you quoted have simply to know these suggestions an apply them. But my assumptions was not to deny that nutrition and other human behaviors concerning the human physic wellbeing have to base on the scientific knowledge and research, but more simply that too much often 1) the industries dealing in foods preparation and sale seem to ignore the base of the best nutrition 2) the people even aware of the base principles of a correct nutrition too much often does not have adequate time or money or both to apply and to follow his nutritional knowledge and these persons must to use pre- cooked or similar kind of trash foods. The local or national governments should be aware of these conditions and consequently they would have to prefer to avoid the occurrence of a diffuse malnutrition by appropriate laws rather than spending a lot of money to attend the diseases and the disabilities due to an inevitable malnutrition.

Dear Dr. Giancario Ruggieri,

OK! Each person should do his own work, and, the better he do it, the more useful is his activity for the common good.

Regards.

So true, Giancarlo! Thank you for your fine observations. The knowledge base on nutrition and immunology is deep and accessible, but because of varying levels of vested interests in the status quo, is often not consulted. But I think forums like this can help shine light on the knowledge base and hopefully consumers will walk away from that which is inferior and demand the application of the best knowledge in terms of what the body needs. Then, providers of food will race to get to the top of the quality side of the equation so that they can satisfy the market. Likewise with medicine, only that which addresses underlying disease processes, eschewing the false and problematic band-aids of assembly line medicine. That is when costs of healthcare will plummet--for it is very low cost to get and stay healthy and extremely costly to not do so. Thank you, again.

This is just to highlight on my previous comments . The life expectancy in the early 20th century was 25 - 30 years . This low expectancy was due to life threatening pandemic Infectious diseases such as small pox , cholera , plague & Influenza . The advent of antibiotics & vaccines transformed the scenario & many Infectious diseases became treatable & improved life expectancy . But , the HIV epidemic & development of antibiotic resistance reveal the threat of Infectious diseases in the present scenario . After the improvement in survival due to management Infectious diseases , Non communicable diseases such as Coronary artery diseases , Strokes , Cancer , COPD & Chronic Kidney Disease due to risk factors such as Diabetes mellitus , Hypertension , Dyslipidemia , Obesity & Smoking have emerged as important causes of mortality . These are due to lifestyle changes which are detrimental to health . Preventive health is bringing about life style changes in society , which is due to complex factors & primary care is diagnosis & treatment of risk factors in individual patients . I hope the valuable comments of other experts would definitely make an impact on management of life style diseases & improve life expectancy further .

I agree with much of what is said about the problem. Let me offer other views about ways to resolve it.

1- Elena, I agree that proteins are not all that matters, and your LOH-Hypothesis and "life origination hydrate hypotheses" are quite interesting. But the 'big diseases' are not the only thing afffecting people's health.

There is a simpler, more basic approach - the 'Water Stress hypothesis'

http://waterstress.blogspot.com.au/?zx=78dd1d0b01f3be5b (for links and connecting dots).

It traces many syndromes back to a difuse impairment of basic cellular functions induced by problems of water distribution (dehydration-congestion, or experienced mostly by women as being dry or swollen), which can lead to diseases, including but not only DNA problems (also for example epigenetic malfunctions that are reversible in syndromes).

I would like to warn about some assumptions made in this discussion, because you do not seem to be among the victims, so your solutions are biased. I propose other approaches, simpler and cheaper.

2-Several other responses mentioned solutions related to the 'change in lifestyle, diet, exercise'. You advocate costly adaptive solutions: educate, and seek funds for 'programs'. ... When one is busy every single day just trying to survive, there is no time to learn about nutrition, and no motivation either: one needs just "energy food" just to get through the day, each and every day. TV beautiful fresh meals are not on the menu ever, too expensive too. Sugary wheat product do the job, and one does not have the luxury of preparing nice ageing! Worse if all the doctors tell you that your pain is all in your head, and everyone around says you "Should" be "happy living like everyone else" locked in a house and office.

There is a simpler way : Just allow - and enable - common mortals to realise a very common wish (which we stop voicing after teenage years - a 'dream' impossible): live slower, less complicated, in nature, get better food, but also reduce human pressures. See on y profile the description of an Experimental Foraging Station I am working to set up: in the file

This one is an option that would cost very little and contains most of the best 'treatments' for syndromes, just not formal.

Food is not the only culprit, but it and other pressures affect hydration, which in turns affects everything in the body-brain (and alters mind too).

3-It is true that institutions do not focus on these (including medicine), that money and time are often obstacles. I would like to add that for 'little people', this option is not only made difficult, but a practical impossibility. I did field work and found many thrown onto travel roads, living in vehicles, because they neither can stand the dominant lifestyle nor can find access to land to make proper shelter, and some reasons for this. See in my profile:

Conference Proceeding: Modes of Thinking- bouchon Abstract & Images

Would new laws and regulations solve the problem? To a small degree, a little. Overall, no.

What a lot of people need in order to operate these changes is access to (1) 'green hands' jobs that are outdoors (2) or access to land, which is now impossible if one has no money to pay rent or buy land. Here, in Australia, all the official texts and brochures say "All land belongs to someone" ,,, so you are not legally allowed to be there more than a day or two! Humans are the only animal with no right to pick a spot on the planet, make shelter, take care of food... without having to pay "dues" to other humans, in hard labour or in money.

The most fundamental change that would reduce ill health and correlate costs would be to allow people to meet their animal-body needs:

(1) Get medical science back on track studiyng the basic needs of life (not those of SurVival and extreme diseases, abandoning the 'non-urgent' patients to not even a visit to a specialist - too far 'wait-listed').

see my petition: https://secure.avaaz.org/en/petition/Save_women_form_the_syndromes_Ask_for_research_on_the_Hypothalamic_Osmostat_that_initiates_fatigue_pain_stressetc/?copy

Sign it if you feel that something is deeply wrong now with medicine and socio-profressional exclusion of women.

(2) share land, get the corporations and political institutions to give back access to it (instead of making luxury 'retreats' for the rich in national parks that start charging for seeing just nature!) ... Create the 'green hands-on' jobs, not 'green jobs' in resource hungry 'green energy' industries. This one is the least 'politically correct' option and most 'unacceptable' to the entire structure of the World of Human Organisation - society. But it happened in the middle ages after the plague, and would reduce greatly the 'economic load of disease & ageing', reduce the needs for giving out pensions (and making ill people feel 'Useless') Can you open up enough to contemplate it?

Dear Max, thank you for your appreciations. I want to add something on your last considerations: You wrote " hopefully consumers will walk away from that which is inferior and demand the application of the best knowledge in terms of what the body needs. Then, providers of food will race to get to the top of the quality side of the equation so that they can satisfy the market." This is an indubitable truth and a fundamental law of the market. But it has to take into account that in the market of the foods there already a lot of products of first quality at disposal of persons aware of the bases for a correct nutrition and in full conditions to buy according to a selection of suitable nutrients. But the market law that the best product will have the best market is certainly the base of the high sales in the field of many products, but all products outside the staple commodities as the foods undoubtedly are : everyone must eat if he wants to survive , and the persons do not having , I am sorry to repeat; money or time or both to correctly choice the correct foods, have to eat the foods needing the lowest spent money and time, willingly or not. The industries producers of the trash foods are perfectly aware of this situation , that is concerning a number of consumers very probably strongly higher than the number of the first group of consumers, and this is their power in the field of the alimentary market ; these producer certainly fully know the limit of the costs tolerable for their customers, by market researches, an on this knowledge they can state their prices and consequently the wanted gains. So , according to my personal opinion, the only way to obtain the lowest possible damages to these consumers is to state by law well defined levels of quality of the nutritional products to the alimentary industrial products , being certainly much more difficult to improve the economic situation and the working time burden of all these consumers.,

Thank you all

Maree, the answer is in your answer, so you did have it, afterall (smile). You said in many cases exercise, not medicalization of a symptom, is the answer if I recall correctly, that we have a pill for everything. There is lots of money (and perpetuated disease in most cases) in pharmacology, but practically no money in exercise. Add in a nutritious diet, sleep, hydration, and avoidance of all those things that we are bad for us, and presto! That individual will require very little medical care during their lifetime--that is the best answer of all! The question is, will societies built on the money model of disease, adopt it?

And I agree with you, Giancarlo. Standards in the regulations are needed. I wish we could promulgate a regulation regarding the use of GMO high fructose corn syrup, which now replaces cane sugar in nearly everything in the US, contributing mightily to liver disease, heart disease, obesity, and diabetes--all rampant and growing in the US. But, alas, the vested industry association was successful in running a series of million dollar advertisements claiming that the body didn't know the difference. But, after a number of excellent research projects, we know differently now. The only part of the body that doesn't know the difference is the consumer's brain. But the body is having to grapple with having concentrated fructose infused into the bloodstream in one step and the liver having to convert glucose into triglycerides in elevated quantities everytime the HFCS is ingested. The economic politics of it all are so powerful that it will take a major education program throughout the world to change it. I still think the answer is in the hands of consumers over here at least, because the chances of getting the regulators to regulate it or at least put warning labels on it are slim to nothing. But, in uncountable lectures by me and many others over here we are revealing the truth of it to consumers everywhere and in droves they are reading the labels and avoiding HFCS and other dangerous dietary elements. The whole foods stores, though more costly, are springing up everywhere, while the conventional food market is fighting over a gradually shrinking market, and having to raise their standards to compete. So, education appears to be the key. Thank you again for your excellent comments.

Marika, you hit a lot of nails on the head with one blow! Excercise, hydration, communal gardening, higher food standards (which you say probably won't change the total outcome much). Undoubtedly, getting the knowledge base that we have today to the consumer is the key. We are doing it somewhat now albeit too slowly. In the meantime, we stay the course!

I am a little late in the discussion. I believe that the best place to develop health promotion (HP) activities in primary health care services. The HP activities allied to intersectoral actions can potentially improve health treatments, preventing diseases and reduce health costs. As it was said before, the actual market of “junk food” has an increased influence in promote unhealthy behaviors and increase the risks for diseases. The notion to eat well, for example is currently associated to economic status. Eating organic; non-processed food seems to be expensive. However, there are a lot of affordable alternatives to eat well without spend expensive amount. There is a need for guidelines in best practices of healthy and affordable way to eat more organics and non-processed food without leave all your money in organic and /or healthy stores.

The association of wealth status and good food is not recent.

Rules of best practice won't matter to those scraping a living (what matters is cheap - junk is cheap). The easiest way to eat well and stay healthy, without much work or thinking about it is to live on land, not crowded in survival urban boxes buying food in boxes packaging.

@Marika Bouchon

I would not generally agree to the fact that living outside uf urban areas correlates with healthy life. This might hold true if the people there work physically and/or have a lot of exercise, as well as eat balanced and fresh due to availability. But there are more than enough rural regions with alarming numbers for obesity and health issues - even more so if the people are commuters as their workplace is in a nearby city. There are many studies showing a relation between high use of cars instead of public transportation/walking/bicycle use and obesity.

Malte is correct that indeed lifestyles have changed dramatically in the Western world so that even the rural areas also are succumbing albeit to a lesser extent with long hours of satellite TV, computer games, drug use less than optimal diets, and the same issues we see in urban areas. In the days when such families were supported primarily by farms and the physical labor was an important aspect, we rarely saw diabetes, heart disease, or cancer in significant numbers--those were the diseases of crowded urban areas where populations were packed in and children had nowhere but the streets to get their exercise. So, my observation on this point is that modern lifestyle components(microwaved genetically modified, irradiated, synthetically fortified, degerminated, caffeine and additive laced over-processed food coupled with an ubiquitious lack of exercise and adequate hydration) have coelesced into the "perfect storm" of exploding rates of chronic disease we see in the US today. This being the case, you would think we would be placing the lion's share of our public health resources into changing the food supply back in the organic direction, including food preparation and hydration, and campaigning against the high-caffeine drinks that dominate the landscape today.

In some regions, this actually makes the problem worse on the land, as the traditional cuisine, more prevalent in rural areas, tends to feature high fat, high cholesterol food once appropriate for the heavy work load in many cases. I highly agree with that analysis, @Max Chartrand.

The recent increase in life style related diseases has caused an interesting health paradox . There has been a tremendous increase in high tech health care technology in diagnosis & management with paradoxical increase in man made life style diseases . Lack of physical inactivity , consumption in high calorie junk food , smoking & alcohol consumption have led to dramatic increase in Non Communicable Diseases ( NCD ) . This has lead to enormous rise in health care budget due to tertiary care management of NCD complications . Coronary angiography / Coronary Artery Bypass Grafting for coronary artery disease , Maintenance Dialysis for Chronic Kidney Disease & Bariatric surgery for Obesity are some examples of high cost care , which at some stage is going to be unacceptable for any economy . This has to be compared to low cost preventive & primary care to manage NCD . The problem is that success in life is associated with economic prosperity , with neglect of personal health . The mindset of individual has to change towards better personal health & it should be emphasized that high tech care is not sustainable in the long run . Medical research comparing cost of preventive & primary care with high tech tertiary care for life style diseases is the only solution to highlight the significance of the former to both government & society .

It starts with education on young age (remember the dentist come to your school with an huge toothbrush..). What hygiene aspects and warnings on communicable diseases where in the '30 till '80 - preventive action focused on related lifestyle should be the topic these days.

I don't agree, Alexia. It starts with not inflicting on children rules at school such as: no running, no barefoot, no eating an apple when hungry, no time in the school garden when the brain is overwhelmed with the teaching and the body stressed with not breathing enough... etc. Just have to listen and observe both kids and (some) parents. Not all young ones are as twisted as adults.

The rules may "prepare them for the Real World" and certainly suit adults, but they lead to for example a stooped posture and chronic hunger by 6 years old in children with perfect posture and hydration prior to schooling... with lots of consequences and learned compensatory habits sanctioned by society, which you then come and "educate" about and try to "prevent" with other counter-habits (eg 3 meals a day).

Research in exercise has shown that children who receive praise for their physical activity are more likely to grow up to become active adults. For this effect, praise should not be dependent on performance but rather on participation in exercise.

Excellent contribution, Rita. Maria Montessori would be proud (smile). Our public schools today are heading the wrong way in regards to the necessity of exercise for developing immunological, metabolic, and neurological systems. That, and lack of organic diet and avoidance of high fructose and caffeine could completely change the health trends of the young, and by extension, adult health. Hoping they are listening to us.

Again, my approval to Max and Rita. Schools will often have to compensate a lack of role models, not only for exercise but general healthy living. Cooking, eating at predefined times and without interruptions, enjoying living in one's own body, exercise etc. are all fundamental to healthy life. But with more and more parent struggling to earn enough to support the family, especially single mothers/fathers, and other factors contributing to a lack of role models, this deficit has to be remedied by other sources, not only schools, but also early child care, Kindergarten, day-nurseries...

This has been widely discussed and researched in Germany in the last few years for the controversy about day-nurseries, but is often overlooked.

In my consumer lectures (I try to give a few here and there) I talk about "renting your health" where we don't address underlying causes of chronic disease, instead taking multiple medications (polypharmacy), invasive (unnecessary) surgeries, not exercising, not eating organically, loading on the caffeine, and alcohol, depending on tons of clinical tests to guide the system--VERSUS--"owning you health" where we change our diet, get the nutrients we need, exercise, better sleep habits, using the gentle modalities of deep cold laser, medical massage, hydration, abstinence from everything we know to be bad for our health, etc. The difference in terms of cost are about 20:1, in other words acheiving and maintaining health is about 1/20th the cost of one's lifetime healthcare costs than letting the clinical system guide and manage that health. Longevity and quality of life are immensely more robust, as well.

If there was a subtantial consumer movement away from the "renting option" and the public began taking responsibility for their health ("owning"), think of the tremendous burden that would be lifted from society in terms of healthcare costs, taxes, and an overwrought system that is only making them sicker as a population.

I fully agree with Max Chartrand views on ' renting your health ' vs ' owning your health ' debate . Unless lifestyle changes are made by individuals , it is not possible to make an impact on the non communicable diseases epidemic . A substantial consumer movement is probably the only solution to avoid a health care disaster in the near future & this is for both developed & developing countries . With the economic slowdown in most countries , there is no choice , but to rely on preventive health care .

There are evident associations between physical fitness and health, this has profound implications for health promotion in schools, suggesting a need for more aggressive strategies to promote physical fitness and weight control. For physical education and general education practitioners, the potential impact of physical fitness on health promotion should be encouraged.

HEATH PROMOTION INITIATIVES: THE GOOD, BAD AND THE UGLY

A Mini-Review

BENEFITS

Hundreds of methodologically sound studies have shown that well-designed workplace health promotion programs can be effective in improving health in the domains of smoking cessation, improvement of some eating habits, increased physical activity, reduced excess alcohol use, and improved management of blood pressure and lipids [1,2,5,6]. Furthermore, dozen studies have shown that programs can actually be cost-effective, saving money and sometimes in excess of the costs incurred [3,4].

LIMITATIONS: SMALL SUCCESSSES

(1) But despite the success of these programs, we cannot expect that just any health promotion intervention will either improve health or be cost-effective, since the quality of the delivery of the intervention is critical to success.

(2) And programs based solely on education are unlikely to have much impact: although it's commonplace to believe that if we just informed people about the risks of smoking, excess alcohol, obesity and poor diet on the one hand, and the benefits of exercise, weight control, a nutritious diet, stress management, etc., and then help them learn about their own personal health status, that would be all that was need since people would use their native intelligence reason to readapt to a healthier lifestyle. Unfortunately, as the evidence below suggests, such programs based on these assumptions have been failing for decades. In fact the CDC review [2] referenced below concluded there is “insufficient evidence of effectiveness to recommend” the approach of a health screening plus feedback with no skill building.

(3) It is also important to acknowledge that we have not been successful in developing programs that are predictably successful in helping people in three critical domains:

a. weight loss,

b. increase fitness level, or

c. increase in fruit and vegetable consumption.

These conclusions were also reported in the CDC review [note however that the recent Australian systematic review [7] and a just published RAND Report [8] have contradictory findings on fruit and vegetable consumption, showing efficacy as opposed to the CDC systematic review [2]].

(4) In addition, we must not expect very large efficacy effects from such health promotion initiatives: as the recent Dutch meta-analysis from Anne Rongen and colleagues [9] which reviewed RCTs of 21 interventions in workplace health promotion programs (WHPPs) found, the overall effect of a WHPP was small when considering robust RCTs, with larger effects suggested only in studies of poor/compromised methodology.

The CHALLENGES, AND THE WAY FORWARD

(1) We need to develop, refine and improve initiatives that are culturally, racially, ethnically and faith-sensitive [10]. As I show in my paper on these countervailing factors [11], culture, ethnic and religious beliefs can play a large adverse role to discouraging people from seeking effective interventions: (i) stigmas on body revealment by women in Arab/Muslim populations have engendered a consistently low involvement in breast cancer screening, clinical breast examinations by male professionals, and breast self-examination; (ii) while fatalistic culturally/religious beliefs (that once cancer develops, mortality is certain) disincentivize seeking treatment; and (3) low knowledge and education about the real facts of cancer and other chronic diseases often encourage some people to ineffective alternative modalities.

(2) We need more, and more effective, globally/cross-nationally coordinated and collaborative initiatives that pool and integrate knowledge and successes [12,13,14,15] so that the failures and limitations of already completed interventions are not simply and wastefully repeated in other countries.

(3) We need to recognize, and then develop strategies to overcome what is known as MESSAGE DISSONANCE in health promotion reporting: this phenomenon occurs when despite best efforts at education, subjects are exposed to disorientating mixed and inconsistent messages in the medical and popular media, as when for example, the New York Times Heath Section reports the benefits of coffee or omega-3 fatty acids or moderate drinking, followed in rapid succession but stories that say the opposite, followed again but other divergent results, leaving the consumer thoroughly confused. This happens also with medical reporting sources where the most recent results are reported without consideration or discussion of other existing conflicting results, and with no attempt at what the weight of the evidence shows, as opposed to what any individual study claims (an irrlevancy in evidence-base review and critical appraisal). People can be more influenced by what the assume, usually incorrectly, to be authoritative sources (print and online media) even above and against the messages of national health bodies or their own health professional. And regrettably health professionals themselves show the same patterns of confusions and dissonant reporting, gullibly accepting, say, the negative findings of the USPSTK on prostate cancer PSA testing or the benefits of pre-50 years-of-age mammography, where as I have shown through my own reviews, the USPSTK conclusions (and those, for example of the IOM (Institute of Medicine) on Vitamin D) are in fact in error and founded on severe methodological flaws in their analyses.

(4) Finally, we need some strategies to assure quality control, accountability and consistency of the health promotion information being disseminated where too often school and workplace educators, and nursing, physician, public health, and other stakeholder professionals, may be providing different messages, with no system of review in place for quality assurance and consistency of imparted information; this is the problem of MESSAGE INCONSISTENCY across professionals, rather than MESSAGE DISSONANCE across popular reporting media (print, radio.TV, and online).

METHODOLOGY OF THIS REVIEW

A search of the PUBMED, Cochrane Library / Cochrane Register of Controlled Trials, MEDLINE, EMBASE, AMED (Allied and Complimentary Medicine Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycINFO, ISI Web of Science (WoS), BIOSIS, LILACS (Latin American and Caribbean Health Sciences Literature), ASSIA (Applied Social Sciences Index and Abstracts), SCEH (NHS Evidence Specialist Collection for Ethnicity and Health) and SCIRUS databases was conducted without language or date restrictions, and updated again current as of date of publication, with systematic reviews and meta-analyses extracted separately. Search was expanded in parallel to include just-in-time (JIT) medical feed sources as returned from Terkko (provided by the National Library of Health Sciences - Terkko at the University of Helsinki). A further "broad-spectrum" science search using Scirus (410+ million entry database) was then deployed for resources not otherwise included. Unpublished studies were located via contextual search, and relevant dissertations were located via NTLTD (Networked Digital Library of Theses and Dissertations) and OpenThesis. Sources in languages foreign to this reviewer were translated by language translation software.

References

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I also follow the idea of ""renting your health ', but I think it should be addressed in both ways: individual behavior and community/population interventions. Some policies related to food ( less tax for health food) and interventions to promote walkable neighborhoods can impact on health, environment and economic levels.

My 5% about food: :) Recently I checked the menu of several daycares in Ottawa and the entire menu are concentrate in carbohydrates. At least I notice that some daycares are given water instead of juice (which is mainly sugar, color and water). Changing food habits is very difficult, especially for kids that are dependent of the parent’s choice.

Great insights, Constantine, and superb review of the studies cited. Methodological soundness seems too often rarely regarded before interpretations pour out to the media when there are big dollars at stake in the outcome. Biases built into the time-frames, sample relevance, and generalizability of the data seem too often self-serving for those financing the studies. Hence, my long-standing contention that all objective research and its financial backer must somehow be separated.

In that vein, I've always tended to view the research community as the "watering hole" of the health sciences--that objective, friendly locus of ideas that can be looked at under qualitative and quantitative lenses--where none of us including our financial backers have a financial stake in the outcomes. Years ago my firm designed and manufactured hearing conservation diagnostic enclosures that we wanted tests done under conditions that might have disqualified it to meet the then very strict standards of ambient noise exclusion. We knew our work could go down the drain in fell swoop and the temptation was to get involved in the design of the study itself. To avoid even the appearance of improprietary involvement, we added a clause that we would abide by the outcomes. By a squeaker we missed the standard and had to make costly djustments to the materials and acoustic design before it could go to market. This is an aspect of ethics in research of drugs and especially in the studies on nutrition by those whose vested interest is to show negative outcomes so their synthetic product can be prevail.

For instance, I made mention to you that I thought there was not enough evidence in the research community supporting the efficacy of natural statins--not that I personally think they are not effective; just that those of us who would prefer the natural/organic route wherever possible feel that we have not had enough verifiable ammunition to make our case for the natural statins. You proceeded to show my assumption incorrect by citing a solid robust study where the natural statin in red yeast rice actually performed quite well. Faith restored, but then the danger for the commercial field would in generalizing the results of that study into ALL such statins, when such may not be the case. This brings us back to the "watering hole" for researchers where earnest discussion and analyses can occur without regard of vested interests. I, and I am sure you, too, looking toward the day that the watering hole returns to neutral and away from the pressures of financial/investment models that neccessarily introduce bias.

Thank you again for your most cogent comments.

Mirella, I like your comments on the Kool-Aid that at too many DayCare facilities pass off for "fruit juice". The GMO high fructose and "artifically sweetened" aspertame versions particularly are concerning in the way these industrial byproducts can negatively impact developing bodies and minds. Like Constantine said earlier, education is not enough (although we can never have enough of it), a major portion of the blame goes to the providers of the food supply. It goes without saying that to help the larger society reduce the risks and costs of health treatment, we need to start with the food supply itself and, by extension, the parents and daycare professionals that are the end-suers of that supply.

I read the very interesting views of Constantine Kaniklidis . It seems that given a choice between healthy life style & unhealthy life styles , humans chose the latter due to complex reasons . Max Chartrand view that providers of the food supply are to be blamed is relevant . Even if information is available to citizens on healthy food habits , the choice would be determined by availability . The legal pressures mounted on smoking have had a definite impact on the complications of smoking . Unless such pressures are applied on other aspects of unhealthy lifestyle causes , it would be difficult to make an impact on life style diseases . Inspite of excellent efforts made by various agencies to make an impact on good life style behaviour , evidence seems to be not very optimistic . I hope , in future , the only choice before individuals is good life style habits & other choices are slowly eliminated .

Anyways people need the government help to keep themselves healthy. Yesterday I was in a lunch meeting and we discussed about the contamination of arsenic in rice and rice products. Some population like Asian and Latin consume rice almost daily. Scientists argue that “arsenic became one of the great historical poisons in human history.” Where are we going? The way we're eating is killing us. There is a need of a public health intervention to address all food issues.

Max:

Thanks for the many fine and penetrating points in your response, something anyone who knows you has come to expect. I will here had some comments on two issues raised, reinforcing the points you made:

THE INCREASING APPLICABILITY OF EVIDENCE-BASED CAM INTERVENTIONS

As I have said - and demonstrated before - for an impressively large distinguished class of CAM interventions - a couple of dozen in epithelial malignancies alone - not only have we been able to demonstrate efficacy and safety under the most rigorous evidence-based criteria, but for many at the highest level of evidentiary demonstration, Level I, complete with multiple cross-confirming RCTs, systematic reviews and meta-analyses. Those that are effective can be demonstrated so, and with no exemptions from the demands of evidentiary science. And we have still more extraordinary Level I evidentiary foundations when we move out of the oncology context:

- Red Yeast Rice (RYR) for cardiovascular and lipid control benefit;

- BLT (bright light therapy) for both seasonal and non-seasonal endogenous depression, matching by Level I RCT data the efficacy of two of the most powerful traditional antidepressants available, without any measurable side effects;

- mindfulness-based interventions for psychosocial adjustment and clinically significant reduction of emotional distress;

- standardized ginger for toxin-induced nausea/vomiting;

- harpagosides (from Devil's Claw) for osteoarthritis;

- ULD (ultra-low-dose) guarana for fatigue syndromes;

et cetera et cetera et cetera.

In systematic reviews and critical appraisals of CAM and its sister disciplines, eb-CAM (evidence-based CAM) and eb-IM (evidence-based integrative medicine), the weight of the evidence supports a finding of "probable efficacy" (Level I and Level II) for 100+ CAM interventions, supported by systematic review, meta-analysis, and critical appraisals, at the level of RCT (randomized controlled trial) [as, with melatonin, ginger, acupuncture, and numerous others evidenced within eb-CAM], As evidence-based CAM matures, it is to be expected that significant bodies of CAM modalities, interventions and agents will be winnowed out by critical appraisal and failure in human clinical RCTs, but that nonetheless a highly significant albeit smaller body will achieve probably efficacy and be ultimately integrated into conventional medicine, a progress we are already beginning to witness.

In addition, you are quite right that we cannot necessarily extrapolate from findings of one pharmaceutical-grade natural RYR (red yeast rice) statin to another (I note that since we last communicated, a few other RYR commercial products now achieve pharmaceutical grade, but except for one, only by ignoring the label recommendation and rather following dosing as determined in the authorizing RCT data, and we also have just published RCT data that the oral bioavailability of RYR is superior to that of the traditional statin itself, lovastatin, and with reduced incidence of myalgias.

Conclusion: It is clear that the "arc" of successful CAM inclusions at the highest levels of evidence continues to advance.

RESISTANCE AND HOSTILITY TOWARDS CAM MODALITIES

You also are astute in the observation of often intrinsic bias and hostility towards natural CAM modalities and interventions: I could cite hundreds of examples, but a few may suffice:

(1) traditional testing - reported in the New England Journal of Medicine - of the benefits of glucosamine found none, but the study use glucosamine hydrochloride, a form of glucosamine without the critical sulfur moiety, and moreover, a form virtually no one on this planet consumes (virtually all glucosamine is in the sulfate form);

(2) the efficacy of another vitamin was tested and found wanting in another study, but the schedule was every other day - and clearly no one rational is taking any vitamin every other day; and

(3) in still another study Vitamin E was found wanting against lung cancer in a widely acclaimed trial, but that trial - under what can only be described as methodological insanity - allowed smokers in the intervention group! And so on, for hundreds and hundreds of biased and/or methodologically crippled studies.

But, as a final reminder, studies of poor methodological quality - often also with significant conflicts of interests - abound in the evaluation of traditional medicines as well, not just CAM/natural agents. As my compatriot, the esteemed Dr. John Ioannidis showed, "Contradictory and potentially exaggerated findings are not uncommon in the most visible and most influential original clinical research”, as per his sobering and now legendary review entitled "Why Most Published Research Findings are False", of major studies published in three high-impact influential medical journals between 1990 and 2003 where of 45 highly publicized studies, approximately one third of the original results failed to hold up under scrutiny.

As Dr. Ioannidis concluded:

"… we all need to start thinking more critically.”

Excellent points, Constantine. Thank you for this excellent review and commentary.

I recall a few studies like you mentioned like the one on Vitamin E that did not control for or eliminate tobacco users, which pretty well disqualified any findings therefrom. Of course, the news releases failed to report these difficiencies and the public was led to believe that nutrient x was "not efficacious", after all. The same with a recent large population study on Alzheimer's in older adults that did not control for or at least first remove the auditory deficiencies from there data (unmitigated hearing loss can mimic AD to a high degree), while at least 66% of the population studied had comcomitant hearing loss.

Likewise, for years those of us in the communicative disorders field have had to suffer under flawed studies that confused central auditory disorders for cognitive dysfunction in older adults--even today, the clinical foundation of the two remain faulty because of that decades long oversight. Entire new drug therapies and diagnostic protocols are being and have recently determined and released to the market without a speck of consideration or differentiation of these factors.

But I digress; a fresh injection of critical thinking, as you say, is badly needed. Thanks again.