Friday, May 2, 2008

Longevity - Controlling Longevity in a Polyglot Nation

These days physicians are being judged on outcomes. The ultimate outcome, of course, is how long patients live. But where you live may not depend on health care, but where you live, your race, and what your income is. If you live in Appalachia, the Deep South, the Southern Plains, or Texas, you’re likely to live less long than if you reside in the upper Midwest, New England, or the West.

In many ways, judging doctors indiviudally or the health system as a whole on longevity data is silly, even irrelevant One can judge physicians on process - whether a doctor orders beta-blockers or aspirin on hospital discharge after a heart attack or whether a doctor checks a diabetic’s eye grounds or glycosylated hemoglobin during an office visit– but to judge doctors on final outcomes, e.g., deaths after myocardial infarction, other chronic disease, or obesity , is absurd because longevity depends heavily on such interacting variables as genetics, race, lifestyle, socioeconomic status, and geography what doctors say or do.

A recent Harvard study in the journal PLoS found significant declines for longevity of women in 180 of 3,141 counties in the U.S. The rising mortality was mainly due to smoking, COPD, lung cancer, obesity, and diabetes. The declines, in turn, were due to economic gaps between the “least deprived” and “most deprived,” the gap growingfrom 2.0 years to 3.3 years in women from 1983 to 1999. The gap for men rose to 5.4 years from 1.6 years over the same period.

These gaps, of course, are matters for public health experts to consider. What can be done in an increasingly polyglot society to prolong life? The answer would seem to be to increase the general level of prosperity and narrow the gap between least and most deprived.

Lengthening longevity is a tricky general proposition, but let's give ourselves a little credit, we’re trying to help people live longer on multiple fronts,

• More physicians are encouraging patients to get preventive tests and to eat right, exercise more, and stop smoking (Codes to pay physicians for these activities would help).

• A number of entrepreneurial health appraisal organizations across the U.S. have sprung up to evaluate health and to recommend programs for wellness and prevention.

• Employers are initiating wellness and preventive programs, providing onsite facilities to aid wellness, and rewarding patients for wellness (the reward for employers are healthier, more productive employees, and lower benefit costs)

• Certain doctors, such as Michael Roizen, MD, chief wellness officer of the Cleveland Clinic, have spent their life promoting wellness among the public at large. Roizen created the RealAge ® concept, wrote a #1New York Times bestseller, RealAge, started an executive health center at Northwestern Memorial in Chicago, and has written or co-authored 10 books for RealAge, Inc, a media corporation providing health information for consumers.

There's only so much doctors can do.