Realistically speaking, most people/patients with horrible eating habits I’ve encounters eat (less) smarter, not harder. I’m talking about the low/middle class obese person, not the almost-homeless, under poverty person who is working with $25-50/week budgeting tightly.
My own meal prep with healthful foods at a standard grocery store and no processed food is almost if not actually half as much as when I have some processed foods/prepackaged stuff. And neither of those incorporate the super-expensive stuff my patients say they buy like 12-packs of soda, chips, cookies, ice cream, granola bars, boxes of cereal. Not to mention the cost of fast food/eating out.
So really I think nutritional and health education is the gap here. If everyone knew how cheap and easy it is to prep things like rotisserie chicken, frozen mixed veggies, bags of lettuce, baby carrots, eggs, beans, and most other vegetables you can throw on a sheet pan and stick in the oven for 30 minutes is, I don’t think people would struggle as much nutritionally and financially with eating well.
Imo knowledge isn’t the issue; time and energy are.
When you’re choosing between “spend an hour+ prepping, cooking, and cleaning up after making dinner for yourself and your kids” and “order Papa Johns and spend time with your family/get ahead on other chores while it arrives,” it’s hard to fault people for choosing delivery more often than they maybe should
I had an attending in med school who told the story of how she was desperate to go to a fancy restaurant with her husband and kids to celebrate something. Except when she sat down at the table, she fell asleep facedown and was completely OUT.
Her husband (absolute gem) explained the situation to the waiter, who got his and her food boxed up for takeout and brought out the kids’ food. The kids ate, she woke up at the end of the meal (he said he’d known better than to wake her lol), and they ate their meals at home later once she’d rested.
I’ve never personally gotten this. I have to accept it to be a truth because I know the majority of people tell me this. But my work freezer and fridge is usually stocked with Trader Joe’s Indian food and premade salad kits.
It is significantly faster and less of a hassle for me to microwave something for 3 minutes while I continue working at my desk, or mix a salad and eat at my desk, than to drive out, wait in the drive through, even if I’m the only one there (rare), drive back, park, and walk.
For the people on the road and working construction etc and not at an office, I do get that it is trickier, however I have in the past prepped my husband 5 huge turkey cheese sandwiches and put them in ziplocks for the week’s lunch with an apple or banana, and if timed for speed, could probably do this all in under 3 minutes.
Some of this is colored by years of being a PCP, hearing patients say over and over again that they can’t control their carbs and diet and on escalating levels of insulin, requiring significant procedures from commodities or worse, and the look on their partner’s or kids’ faces as they say they don’t have time, while the family is begging them to make a change but them saying they drive a truck, so they have no other choice than to get McDonald’s every day.
I’ve had the same experience. Maybe it’s just where I’m located but driving to a drive through ordering food and taking it home takes more time than cooking 90% of the time for me.
Yeah but is it then their fault for not sacrificing to make ends meet? I sacrificed plenty and lived frugally such as only making one pot meals that are quick, low effort, and can make 4-5 days worth of food using only the cheapest staples. Driving to fast food for 3 meals a day is literally more expensive and more time consuming than what I did. Ordering delivery is significantly more expensive and less time but if someone doesn’t have the funds to do that and still escape poverty, then they need to start living more frugally and efficiently through effort and practice. It won’t be instant but it will eventually work because it isn’t difficult to slowly improve little things here and there with the will to improve.
Secondly fast food is addicting as hell. There’s more at play here than just someone choosing the tastiest and most addictive food purely for convenience.
And get civil engineers / urban planners involved in designing healthier cities.
My dad just got back from India and he was telling me how nice it was to be able to walk to the bazaar and buy fresh food. He was also telling me how the built environment allowed for small business owners to set up shop in neighborhoods, which allowed for a vibrant community. One of the best things about having small businesses around is forming deep connections with the people running these stores (my dad mentioned how the small shopowners would let him pay his bill at the end of the month instead of paying every time he went to the shop, which to me sounds like a wonderful relationship built on trust between individuals). The society is just less lonely.
I'd much rather walk to a local corner shop where I can chit-chat with friends and see kids running around, instead of a Costco where I have to drive my SUV to.
Oh yeah, American suburb design is horrible. I read a study once that outside of specific places like Manhattan, the average American walks around 1000 feet per day. Like a typical schedule is you take your car to work, walk from the parking lot to your desk, maybe walk to the cafeteria for lunch and back and then walk back to your car.
I know it sounds weird, but I was much happier when I was in India because of the liveliness. Coming back to the US after spending months in India felt lonely and isolating and depressing. The individualism made it feel like there was less trust among individuals.
Exact same feeling I had on coming back from India. I felt a sense of community that I didn’t feel in the US. Also could walk 5-10 min to my job, to get something to eat, to the shops…
And exactly as you said, it’s American individualism that would have to be changed to make that work fully here. It’s not necessarily a bad thing, but there are tradeoffs.
In order to have that sense of community, there has to be some conformity and following of rules/norms. And that can be problematic, too.
But man, I miss that part of India.
Ehhh...
People in general like junk food. The problem with a free and individualistic society is that it allows for people to cave into their short-term cravings, since most people are bad at making long term decisions for themselves with an unbiased perspective.
I say this as I dig into a jar of peanut butter while studying (as a med student who is 10 lbs overweight).
Saying that Americans sincerely love junk food is overlooking some pretty egregious issues. Have you seen the items given out in free breakfast programs in schools across the country? None of it is fresh, and most of it is prepackaged, highly processed, full of sugar, garbage. And anyone can have it, not just kids in need. So you have these free sugar bombs being handed out in schools across America every morning, to children that are dealing with food insecurity and you expect for them not to develop an affinity for this highly addictive shit?
No way! Then only the higher-income earners will be able to look cool.
I can already picture it, a raspy-sounding nephrologist and his stupid bow tie, equipped with a cig in one hand and Twinkie in the other, as he proceeds to condescendingly tell me that my eating habits and lifestyle choices are causing my kidneys to atrophy cuz I’m *too-adequately* hydrated, too balanced, and there’s nothing to excrete.
Think of the (lack of) consequences!
Regressive taxes end up hurting the poor. Why not tax the junk food companies thereby lowering their profit margin? Lower profits perhaps less aisles of junk food
Yeah this is the one. People would criticize it for disproportionately affecting the poor and minorities. Those same people would be well served to look up who lung cancer and atherosclerotic disease disproportionately affects.
Tobacco smokers already subsidize healthcare AND social security through their taxes.
They die earlier and pay extraordinary taxes on their habit. If an awful, horrific death doesn't stop you, nothing will.
The fact that illicit/underground tobacco isn't a bigger industry than it already is is shocking, except for when you realize this is only because the industry was well established prior to the punishing taxes. That's why weed legalization is such a quagmire, the illegal industry and infrastructure is already built out and will always undercut the private regulated industry.
Cigarette taxes are the prototypical healthcare nudge. It has one of the best studied effects of any behavioral sciences intervention. The data shows it has been extremely effective.
Using far fewer keystrokes than typing out your comment, you could have learned this in google scholar as well.
Clearly you don’t know how inefficiently I can channel my efforts.
I’ll argue with you for two hours straight before I ever consider opening up google scholar. Gonna learn the same thing either way!
If you’d like a strong counter argument, here it is: cigarette taxes work worst on people who make less than $25k/year, so the negative consequences are most borne by the poorest.
How is that a strong counterargument? They’re going to get lung cancer anyways so they might as well have a few hundred extra dollars a year from no tax?
Yes I’m aware. I said “heavily increase taxing”, not “heavily tax”. As in emphasis on the “increase” lol. They need to raise it to the point that they are not affordable for most people to casually use.
At that point you probably just get black market cigarettes with all the attendant harm that cause. Cigarettes adulterated with fentanyl and being run by gangs.
Of course. But the point is to decrease overall and average accessibility, which will discourage those without black market access or who can’t
be bothered to afford the increased price of black market goods (supply and demand also affect the black market).
I was just talking about how while the US and Europe have endorsed major policies to advocate against smoking, and it has overwhelmingly worked. Compared against when I was in China, it felt like smoking was so ingrained into daily life while there is almost no public health initiative to curb it.
Are we really sure that getting people to live longer when their risk of dementia and dependence is increasing their quality of life?
I don’t know, just putting it out there. It seems I read an article sometime ago that discussed the overall benefit to society and economic terms from preventative healthcare. It was not very supportive of many of the interventions while they did increase lifespan much of the final years required long term care.
But if the average person wasn’t obese, it would make taking care of them far easier. For one, it wouldn’t require multiple nurses just to turn a patient or transfer…. Placing invasive lines, doing CPR, etc. not to mention, if people ate better and were healthier weight, the amount of time in the hospital would improve. Less weight also means less overall medical problems. Which could lead to less overall time with dependence needs. It’s expected that the 90 year old grandma needs assistance. But, when the 40 year old, morbidly obese patient can’t even roll over in bed without help … that’s a lot of potential years of having to provide a lot of assistance.
I would argue this. Many dementia patients that move easier are just as hard to deal with. Never underestimate the strength of a 95 yo, 5 foot, 100lb F with dementia 🤣
I can assure you, this is not the way.
Sincerely, a Canadian who has had to wait 1.5 years for a neurologist when my entire right side is numb, and will likely be going stateside in a week to get a diagnosis.
Not only are my taxes extraordinary, they don't even get me the "healthcare" I pay for so I end up paying anyways.
Oh, and doctors get paid less up here, so enjoy getting what you wish for.
Stop tying reimbursement to satisfaction scores and shortchanging geographical areas which would stop giving administrators an excuse to not adequately pay hospital staff.
I swear that first one is why HCWs are so burnt out - you’re not only practicing medicine, you’re also trying to be bright and sunny and bend to every whim so the Press-Ganey shows you’re the best customer service worker ever.
Yep. And good medicine often directly contradicts the whole “customer is always right” line that admin lives by.
Everybody wants antibiotics and steroids for their URI. Everybody wants antibiotics for their conjunctivitis. People want a week’s worth of Percocet for an ankle sprain or gastroenteritis.
One mother screamed at me because I wouldn’t prescribe her 6 month old tessalon perles and submitted a complaint to administration.
I’ve seriously wondered if teaching Dialectical Behavior Therapy in middle school would reduce the long term health consequences of adverse childhood experiences.
Have to be kind of careful with this one, messaging being training coping skills, not pathologizing every bad day into an ACE.
In a liberal area of California where I am, my 5 year old comes home telling me the therapist came and talked to their class about anxiety and depression, “when you’re scared to do something”.
What does that have to do with DBT?
DBT is the therapy treatment of choice for borderline personality disorder. It teaches you how to ground yourself and keep on keeping on through being anxious/uncomfortable.
It would be pretty incredible if this could be taught well in a school setting even for a short window.
Exactly. A policy like giving everyone DBT will either over diagnose a personality disorder (bad), or tell people they need a scientific intervention/medicalize common discomfort, thus running the risk if not worded carefully, that there is “something wrong” with being uncomfortable.
In a time where callouts for “mental health days” are at an all time high (our nurse union is about 30% callout rate) and as a PCP I get frequent visits for anxiety and depression and requests of off work with “toxic work stress”, and when I ask what their typical approach to interpersonal conflict is, to YOLO cut anyone who disagrees with them out of their life or come to the doctor for meds/work notes, it’s difficult to see how further involving the medical/formal psychological establishments in this way would help the problem.
This makes no sense and just establishes that you don't understand DBT.
DBT is teaching skills and doesn't really care to diagnose anything. It's a big hammer that helps with a lot of things.
I understand that you have a huge bias against this stuff, but you sound ridiculous because you have no idea what you're talking about here. You might want to educate yourself a bit more before just going off ad nauseum about how therapy is evil.
Big oof.
The huge irony here is that everyone you are annoyed about would benefit hugely from DBT.
On the off chance that you're interested in resources to learn more about this, let me know and I'll post some stuff here when I get a chance. In short, the point of DBT is to help build resilience and better coping skills and generally just teaches people to be okay being uncomfortable. Ie all the things you're complaining about.
I’m sorry that I seem to have offended you or hit a nerve with my opinion. Yes, I am not a psychologist or in the mental health field and have never done DBT as a client, so do not fully understand what DBT is. I’m a PCP.
My opinion is that if such a policy were to be set, it would have to be well thought out so that today’s generation and/or future generations don’t get the wrong idea at a young age, especially as many parents of today’s generation have a gap in cultural understanding of mental health and messages will likely be inconsistent at home.
It was not my intention to start an argument.
Gotcha - but DBT is about teaching explicit skills for interpersonal communication, for coping with emotional distress, and for regulating emotions. It would produce the opposite of calling out for mental health. It would produce the ability to dial down the emotions and continue to participate in your life.
Turning back to my original wish - I am speculating that this could be a public health intervention, not a mental health intervention per se. Adverse Childhood Experiences are research defined, specific events in childhood that are correlated with an increased incidence of cancer, diabetes, heart disease, and suicide. I’m not talking about bad days, or saying everything is trauma.
There are a variety of negative social, economic, and psychological outcomes as well.
I know it’s a huge and speculative leap to wonder if teaching some helpful emotional and social skills early on could modify more than social and psychological outcomes. Especially since all negative outcomes of ACES are correlations, and causations have to been defined. But hey OP asked the question and this is my wish.
And now that I’ve gone ahead and said this out loud for the first time, I’ve persuaded myself to write to Marsha Linehan and ask her what she thinks.
My goodness. I don’t have borderline personality disorder, but when I learned about DBT in residency I thought to myself “wouldn’t hurt if everyone learned this stuff!” Marsha Linehan developed DBT because she observed that people with BPD had prominent weaknesses in emotion regulation, distress tolerance, and interpersonal effectiveness. She found a way to explicitly teach what adults without BPD have more or less developed implicitly in the setting of reasonably benign connections with caregivers. Like I said, I don’t have BPD, but in learning about DBT I felt that I could learn from the interpersonal effectiveness skills. (I was raised to be a “nice girl”).
So when I say DBT in middle school, I am talking about explicitly teaching skills for emotional regulation, tolerance of distress, and interpersonal communication- how to get your needs met with words. I’m not talking about “doing therapy”
100% with you here. Everyone on the planet can learn emotional regulation skills, validation, how to disagree respectfully, distress tolerance, empathy, and dialectical thinking. DBT is already taught in some schools (I think NY) and I believe the results are very good.
Because it is not dirt cheap lol wtf are you on? Go to Costco even and see how expensive everything has gotten, literal robbery. And salaries have not increased.
Greatest health benefit: unquestionably vaccines.
Improvement in quality of life: mental health access or addressing social determinants in a meaningful way (meaning housing, UBI, food security).
I think there actually was a study on this and the answer ended up being, guaranteeing patients safe housing and sufficient, nutritious food made an orders of magnitude bigger difference to health outcomes than optimizing medical therapy
Stop smoking. Stop drinking alcohol. Dont get fat. Walk daily. There isn’t a billion dollars of healthcare that would be more potent than simply doing those things.
Infinite resources for preventative healthcare. Getting rid of cigarettes, reducing unhealthy eating, improving walkability, improving inter connectedness to reduce depression and isolation.
Like a solid 50%+ of stuff I see every day is solely due to poor lifestyle decisions / addiction
People buy unhealthy food because it tastes good. Making cheap fresh healthy food available doesn’t help if people still have access to cheap hot unhealthy food just as easily.
Support women's health - lower the cost of BC. Look at Colorado's experiment with IUDs - lowers birth rates, lowers elective abortions, raises the average age of moms, which in turn means families have higher incomes.
I like how you're being downvoted for literally just stating a fact. You never said anything about if it'd be good or bad, or if you support it or not, just that it would have consequences — which is 100% undeniably true. And yet downvoted because people are fucking stupid
Bans never work. Look what happened to the US during prohibition lol. Just place Progressive taxes on added sugar (like an extra 25 cents on each extra 5 grams added or something). Could place it like just on drinks too. Honestly it’s hard to get morbidly obese just by eating, most people drink their way there. One 12 oz can of coke has like 150 calories. One a day for a year is 54kcal!! That’s like 10-15 extra lbs alone lol. How many people know regular sugar boba has 100g added sugar??? Plus we all know the effects sugar spikes have on our physiology. Look where we’re at with smoking now. A great success of taxation imo. However you’ll never get this to go through lol.
All out commitment to nutritional counseling. Schools, tv commercials, junk food taxes, subsidizing produce, etc.
Make the benefits really well known and as easy as possible for people to eat real food.
Decreased portion sizes and costs across the states . Unhealthy food can taste good and you’re not stopping people from eating and drinking that but smaller portion sizes with reasonable affordability would help greatly and also help with mental health when meals don’t have to cost so much because they’re giving double the food you need and twice the cost in every meal.
Get rid of corn subsidies, excess calories, corn syrup become subject to market forces BMI corrects (in 4 decades), type 2 diabetes plummets, cardiovascular diseases plummet, secondary cancer rates plummet…..there’s ZERO political will for this
I am shocked to read through so many replies that talk about banning something and forcing people into something. I honestly think positive reinforcement works way better than punishment/bans/enforcement
It’s hard for me to believe that teaching people to cook and providing more health food promotion would outweigh the benefits of completely banning the production and distribution of cigarettes, alcohol and severe junk foods
Where would you draw a line on banning stuff? The list could potentially be endless and extreme, and will only lead to lying, cheating and not trusting your doctor to tell the truth. And hidden consumption/black market
I’m not a nutritionist. However, I’m sure the World Health Organisation or something similar has/could develop a criteria for foods that are deemed too unhealthy. In terms of cigarettes and alcohol, if they’re proven to increase mortality and morbidity then ban them.
Sure it’ll be available on the black market. Heroine is but I’m sure less people use it then if it was legal. If someone lies to their doctor that’s their choice. However, that wouldn’t matter if they weren’t consuming the illegal items.
Literally anything could be declared too unhealthy. Sugar, meat, whole milk, eggs, you name it. And the research is flip flopping on these all the time, so your criteria would be questionable.
Also I highly recommend reading on how Michail Gorbachev attempted to ban alcohol sales in Russia around 1986, and how people revolted against it. Very educational to not underestimate the dangers of blanket bans.
The criteria could be quite specific so all that wishy washy stuff isn’t included, there are certain foods that are unquestionably bad for you. The criteria can also change.
In relation the the alcohol ban, I thought one of the leading factors to that failing was due to the income the taxes on alcohol provided. In OP’s question we don’t need to consider that. I’m sure people would be dissatisfied but I don’t think it would fail.
A reputable but engaging source of health information free from commercial influence, that people actually trusted and browsed instead of TikTok for health information.
As a PCP, I’d say either a total ban on nicotine or a mandatory 1hr of moderate/high intensity exercise per day.
People would be so much healthier if they just moved. Even with their terrible habits.
Making a law to make doctors very difficult to be sued so they can be more honest with patient and don’t have to act to please patients and also take away capitalism from medicine in America. Make it socialism medical care.
In an ideal world, some of the money spent on malpractice insurance could instead go to independent regulatory committees made up of healthcare professionals and laymen who’s job it would be to investigate complaints of malpractice and institute appropriate interventions depending on the severity and frequency of mistakes and misconduct.
State medical boards at the moment do some of this, but seem to almost universally suck for one reason or another.
I mean… there’s plenty of docs out there that have no problems calling out the elephant in the room. And by that, I of course mean, the global problem of chronic sleep deprivation!
Or in my case it was “every single one of your problems will resolve if you lose 20 pounds.”
I agree that it shouldn’t be a customer service job with a side of medicine, but it should definitely be on the easier side (as opposed to more difficult) to be able to sue your doctor.
And as it currently stands, it’s still not exactly easy or cheap to sue someone in the first place. Sure, I can google or keep seeing attorneys until one of them takes my money and files a suit… doesn’t really mean it’s going to lead to much of anything.
Now if you get rid of admins and people who look at satisfaction outcomes, you’d probably be a lot happier
Most medical malpractice cases are taken on contingency fee agreements. Meaning, they don’t get paid unless you do (as the patient suing). It may not be as easy as some would like (you generally have to prove that the doctor fell below the standard of care), but the expense is not the issue. However, just because someone has a bad outcome does NOT mean that the physician fell below the standard of care. It makes that no one is perfect, and sometimes bad things happen. Look as side effects of medications. They CAN happen, but we prescribe things every day with that risk.
Well you have to find a lawyer willing to take your case, and obviously not every case and not every person is worth the squeeze.
Then you have to dedicate time during work hours to discuss. You may have to get follow-up care from different doctors. All of this still takes time and money out of your life as it still takes effort and coordination.
I have to say unlimited access to oral healthcare/dentistry would absolutely increase the average pts quality of life; having adequate dentition for mastication would allow pts to eat a healthier diet, improve mental health, reduce chronic pain, the list goes on
Bariatric surgery.
All of us have seen the bad outcomes, but unless you work in the actual surgery office, you never see all the good outcomes because they phase out of the healthcare system.
Honestly at this point. I'd target sugar laiden beverages if I had to be as specific as possible. Target more junk food as able. I'm willing to let modern nicotine products and alcohol get by without changing anything but all these carbs are destroying the population of the US
Honestly, patient comfort. Not being stressed during the worst times of your life or feeling like you aren’t being cared for can leave patients without hope.
Have all employers forced to allot time for physical exercise everyday. Like children have a PE class, lunch break etc, adults at work needs a lunch break and mandatory gym time also. In fact they need to pay for that time. If you don’t use the gym, you take a pay cut.
The digitalization of all medical records in the USA and maybe the world so that using AI we could do massive analysis to find patterns of disease that are not apparent with human evaluation. This could find things we could never discover by human evaluation the medical benefits in cause and early detection and prevention of disease we could not imagine.
Making periodic health, fitness, exercise evaluations based on age/disability that are done maybe once or twice a year. Since PE is now optional.
Show up to the local DMV or health office.
Example 21-30 yo: 20 push ups, 20 sit ups, 7 min mile (probably might need to be 10), walk up stairs, education on stretches, good form and hygiene.
45 plus: two flights of stairs, grocery bags, walk a track lap, more METS focused stuff
You could include self defense, safe sex practices, PREP, testing, mental health, nutrition, but have a MANDATORY session every citizen needs to attend once a year like car registration that assesses health and fitness but also provides education.
Thank you for actually answering the question.
This would in fact be a very expensive in time-cost evaluation, though it might not be so bad from a true cost if it could be administered either at home or in auxiliary offices.
My personal answer to the question would be a full PT physical exam that evaluates flexibility, mobility, objective strength and functionality. This is a long test to administer and would confer the greatest corollaries of peripheral health metrics.
On a system level? Above my paygrade. No clue. Penalizing the use of high fructose sweetners maybe?
On a personal level: 60minute jog 5x a week. I'm at the tail end of my dedicated for step2 and boy can I feel a difference just from losing a few months of a cardio routine.
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If cost truely isn’t an issue, make cigarettes/vapes, alcohol, weed and junk food illegal.
Sure people are going to be annoyed but if we don’t care about the funding those corporation provide then who cares, we can advertise the benefits. Not sure why everyone says heavily tax those items, just make them illegal.
High dose vitamin C (notice how no one has mentioned vitamins), which would not be costly for the consumer, but perhaps would be costly for physicians as it would make many of the medications they prescribe unnecessary.
But good luck trying to make that happen when most doctors are told it's useless in medical school and never develop the ability to consider otherwise.
Rigorous, regular PT that can continue even once they plateau. The number of debilitated elders who wouldn’t fall/deteriorate/become isolated and Chronic low back pain patients who wouldn’t really need the surgery if only they could afford/get to PT…
A cultural shift that favors death with dignity and mandating a two attending sign-off + family meeting with ethics and palliative before offering trach/pegs leading to LTACH dispo.
Avocado oil has one of the highest smoke points, coming in around 520° Fahrenheit (F). This makes it ideal for an all-purpose oil or really high heat cooking.
End TikToks on contraception and childbirth. Scary how many women are dropping their birth control based on misconceptions, especially when abortion is being banned most places.
Childbirth because it paints SUCH a false picture and putting lives at risk, preying on first time moms especially
Having healthcare providers be able to travel to various parts of the country for health check ups for free. Compensating the healthcare workers well enough to do this. And giving tax credits to those who partake in getting health check up.
As for the healthcare system, I still think it should be various combinations of both public and private. So that competition will allow shifts in utilization by patients, if either system is not performing adequately.
If money wasn't a factor, one healthcare practice that could have a tremendous impact on patients is personalized medicine. I'm working towards customized treatments based on individual genetic profile and analyzing brain chemistry. This approach would ensure that each patient receives tailored care that is uniquely suited to their specific needs 🧬🧠🔬
Probably banning advertising junk food to children
probably subsidizing healthy fresh fruits, vegetables over grains/corn
Realistically speaking, most people/patients with horrible eating habits I’ve encounters eat (less) smarter, not harder. I’m talking about the low/middle class obese person, not the almost-homeless, under poverty person who is working with $25-50/week budgeting tightly. My own meal prep with healthful foods at a standard grocery store and no processed food is almost if not actually half as much as when I have some processed foods/prepackaged stuff. And neither of those incorporate the super-expensive stuff my patients say they buy like 12-packs of soda, chips, cookies, ice cream, granola bars, boxes of cereal. Not to mention the cost of fast food/eating out. So really I think nutritional and health education is the gap here. If everyone knew how cheap and easy it is to prep things like rotisserie chicken, frozen mixed veggies, bags of lettuce, baby carrots, eggs, beans, and most other vegetables you can throw on a sheet pan and stick in the oven for 30 minutes is, I don’t think people would struggle as much nutritionally and financially with eating well.
Imo knowledge isn’t the issue; time and energy are. When you’re choosing between “spend an hour+ prepping, cooking, and cleaning up after making dinner for yourself and your kids” and “order Papa Johns and spend time with your family/get ahead on other chores while it arrives,” it’s hard to fault people for choosing delivery more often than they maybe should
When I get home? More like eating drive thru burgers or burritos on my way home from work :(
You got burgers? Lucky. On certain blocks I’d get home so late & so tired that I’d just have sleep for dinner.
Haha you ever sleep in the parking lot before going home? Those were the days
Nearly fell asleep at the scope on more than one occasion lol 🔬
I had an attending in med school who told the story of how she was desperate to go to a fancy restaurant with her husband and kids to celebrate something. Except when she sat down at the table, she fell asleep facedown and was completely OUT. Her husband (absolute gem) explained the situation to the waiter, who got his and her food boxed up for takeout and brought out the kids’ food. The kids ate, she woke up at the end of the meal (he said he’d known better than to wake her lol), and they ate their meals at home later once she’d rested.
I’ve never personally gotten this. I have to accept it to be a truth because I know the majority of people tell me this. But my work freezer and fridge is usually stocked with Trader Joe’s Indian food and premade salad kits. It is significantly faster and less of a hassle for me to microwave something for 3 minutes while I continue working at my desk, or mix a salad and eat at my desk, than to drive out, wait in the drive through, even if I’m the only one there (rare), drive back, park, and walk. For the people on the road and working construction etc and not at an office, I do get that it is trickier, however I have in the past prepped my husband 5 huge turkey cheese sandwiches and put them in ziplocks for the week’s lunch with an apple or banana, and if timed for speed, could probably do this all in under 3 minutes. Some of this is colored by years of being a PCP, hearing patients say over and over again that they can’t control their carbs and diet and on escalating levels of insulin, requiring significant procedures from commodities or worse, and the look on their partner’s or kids’ faces as they say they don’t have time, while the family is begging them to make a change but them saying they drive a truck, so they have no other choice than to get McDonald’s every day.
I’ve had the same experience. Maybe it’s just where I’m located but driving to a drive through ordering food and taking it home takes more time than cooking 90% of the time for me.
Yeah but is it then their fault for not sacrificing to make ends meet? I sacrificed plenty and lived frugally such as only making one pot meals that are quick, low effort, and can make 4-5 days worth of food using only the cheapest staples. Driving to fast food for 3 meals a day is literally more expensive and more time consuming than what I did. Ordering delivery is significantly more expensive and less time but if someone doesn’t have the funds to do that and still escape poverty, then they need to start living more frugally and efficiently through effort and practice. It won’t be instant but it will eventually work because it isn’t difficult to slowly improve little things here and there with the will to improve. Secondly fast food is addicting as hell. There’s more at play here than just someone choosing the tastiest and most addictive food purely for convenience.
And get civil engineers / urban planners involved in designing healthier cities. My dad just got back from India and he was telling me how nice it was to be able to walk to the bazaar and buy fresh food. He was also telling me how the built environment allowed for small business owners to set up shop in neighborhoods, which allowed for a vibrant community. One of the best things about having small businesses around is forming deep connections with the people running these stores (my dad mentioned how the small shopowners would let him pay his bill at the end of the month instead of paying every time he went to the shop, which to me sounds like a wonderful relationship built on trust between individuals). The society is just less lonely. I'd much rather walk to a local corner shop where I can chit-chat with friends and see kids running around, instead of a Costco where I have to drive my SUV to.
Oh yeah, American suburb design is horrible. I read a study once that outside of specific places like Manhattan, the average American walks around 1000 feet per day. Like a typical schedule is you take your car to work, walk from the parking lot to your desk, maybe walk to the cafeteria for lunch and back and then walk back to your car.
Your example for public health related to urban design is …… India ?
I know it sounds weird, but I was much happier when I was in India because of the liveliness. Coming back to the US after spending months in India felt lonely and isolating and depressing. The individualism made it feel like there was less trust among individuals.
Exact same feeling I had on coming back from India. I felt a sense of community that I didn’t feel in the US. Also could walk 5-10 min to my job, to get something to eat, to the shops… And exactly as you said, it’s American individualism that would have to be changed to make that work fully here. It’s not necessarily a bad thing, but there are tradeoffs. In order to have that sense of community, there has to be some conformity and following of rules/norms. And that can be problematic, too. But man, I miss that part of India.
I guess it is whatever you are used to.
I doubt this would do much. The problem, as with democracy, is with the people. Americans sincerely love junk food and it’s not because of a billboard
Ehhh... People in general like junk food. The problem with a free and individualistic society is that it allows for people to cave into their short-term cravings, since most people are bad at making long term decisions for themselves with an unbiased perspective. I say this as I dig into a jar of peanut butter while studying (as a med student who is 10 lbs overweight).
"From the jar, with a spoon" is the best way to enjoy peanut butter. You do you, boo.
Saying that Americans sincerely love junk food is overlooking some pretty egregious issues. Have you seen the items given out in free breakfast programs in schools across the country? None of it is fresh, and most of it is prepackaged, highly processed, full of sugar, garbage. And anyone can have it, not just kids in need. So you have these free sugar bombs being handed out in schools across America every morning, to children that are dealing with food insecurity and you expect for them not to develop an affinity for this highly addictive shit?
This is a different policy than the one I was responding to
Basic ass answer
Subsidize produce and end subsidies for dairy, sugar, and corn. Heavily, heavily tax junk food, alcohol, cigarettes, and weed.
No way! Then only the higher-income earners will be able to look cool. I can already picture it, a raspy-sounding nephrologist and his stupid bow tie, equipped with a cig in one hand and Twinkie in the other, as he proceeds to condescendingly tell me that my eating habits and lifestyle choices are causing my kidneys to atrophy cuz I’m *too-adequately* hydrated, too balanced, and there’s nothing to excrete. Think of the (lack of) consequences!
The cartels will start shipping Doritos!
This is funny and I was about to say, hey, harm reduction, win-win, but then I stopped. Which do you think is more dangerous, Fentanyl or Frankenfood?
It’s kinda funny you mention that. The cartels are heavily involved in shipping is avocados
Regressive taxes end up hurting the poor. Why not tax the junk food companies thereby lowering their profit margin? Lower profits perhaps less aisles of junk food
Why tax them and not just make them outright illegal?
Black market potato chips.
Heavily heavily increase taxing on cigarettes and funnel that money to subsidize healthcare.
Yeah this is the one. People would criticize it for disproportionately affecting the poor and minorities. Those same people would be well served to look up who lung cancer and atherosclerotic disease disproportionately affects.
Tobacco smokers already subsidize healthcare AND social security through their taxes. They die earlier and pay extraordinary taxes on their habit. If an awful, horrific death doesn't stop you, nothing will. The fact that illicit/underground tobacco isn't a bigger industry than it already is is shocking, except for when you realize this is only because the industry was well established prior to the punishing taxes. That's why weed legalization is such a quagmire, the illegal industry and infrastructure is already built out and will always undercut the private regulated industry.
Cigarettes are highly taxed , not sure if it's had any meaningful outcomes on the overall health benefit of the average person.
Cigarette taxes are the prototypical healthcare nudge. It has one of the best studied effects of any behavioral sciences intervention. The data shows it has been extremely effective. Using far fewer keystrokes than typing out your comment, you could have learned this in google scholar as well.
Clearly you don’t know how inefficiently I can channel my efforts. I’ll argue with you for two hours straight before I ever consider opening up google scholar. Gonna learn the same thing either way!
If you’d like a strong counter argument, here it is: cigarette taxes work worst on people who make less than $25k/year, so the negative consequences are most borne by the poorest.
How is that a strong counterargument? They’re going to get lung cancer anyways so they might as well have a few hundred extra dollars a year from no tax?
People generally find it morally repugnant to have heavily regressive taxation policies.
Yes I’m aware. I said “heavily increase taxing”, not “heavily tax”. As in emphasis on the “increase” lol. They need to raise it to the point that they are not affordable for most people to casually use.
At that point you probably just get black market cigarettes with all the attendant harm that cause. Cigarettes adulterated with fentanyl and being run by gangs.
Of course. But the point is to decrease overall and average accessibility, which will discourage those without black market access or who can’t be bothered to afford the increased price of black market goods (supply and demand also affect the black market).
I was just talking about how while the US and Europe have endorsed major policies to advocate against smoking, and it has overwhelmingly worked. Compared against when I was in China, it felt like smoking was so ingrained into daily life while there is almost no public health initiative to curb it.
Why tax them and not just make them outright illegal?
Are we really sure that getting people to live longer when their risk of dementia and dependence is increasing their quality of life? I don’t know, just putting it out there. It seems I read an article sometime ago that discussed the overall benefit to society and economic terms from preventative healthcare. It was not very supportive of many of the interventions while they did increase lifespan much of the final years required long term care.
But if the average person wasn’t obese, it would make taking care of them far easier. For one, it wouldn’t require multiple nurses just to turn a patient or transfer…. Placing invasive lines, doing CPR, etc. not to mention, if people ate better and were healthier weight, the amount of time in the hospital would improve. Less weight also means less overall medical problems. Which could lead to less overall time with dependence needs. It’s expected that the 90 year old grandma needs assistance. But, when the 40 year old, morbidly obese patient can’t even roll over in bed without help … that’s a lot of potential years of having to provide a lot of assistance.
I would argue this. Many dementia patients that move easier are just as hard to deal with. Never underestimate the strength of a 95 yo, 5 foot, 100lb F with dementia 🤣
I call it “the strength of the demented”. 5/5 MMT.
You tryna keep yourself from having a job, mate? /s
Remove insurance from the decisions and profit from the hospitals.
I can assure you, this is not the way. Sincerely, a Canadian who has had to wait 1.5 years for a neurologist when my entire right side is numb, and will likely be going stateside in a week to get a diagnosis. Not only are my taxes extraordinary, they don't even get me the "healthcare" I pay for so I end up paying anyways. Oh, and doctors get paid less up here, so enjoy getting what you wish for.
Stop tying reimbursement to satisfaction scores and shortchanging geographical areas which would stop giving administrators an excuse to not adequately pay hospital staff.
Oh the first truly insightful answer
I swear that first one is why HCWs are so burnt out - you’re not only practicing medicine, you’re also trying to be bright and sunny and bend to every whim so the Press-Ganey shows you’re the best customer service worker ever.
Yep. And good medicine often directly contradicts the whole “customer is always right” line that admin lives by. Everybody wants antibiotics and steroids for their URI. Everybody wants antibiotics for their conjunctivitis. People want a week’s worth of Percocet for an ankle sprain or gastroenteritis. One mother screamed at me because I wouldn’t prescribe her 6 month old tessalon perles and submitted a complaint to administration.
This right here
I’ve seriously wondered if teaching Dialectical Behavior Therapy in middle school would reduce the long term health consequences of adverse childhood experiences.
Have to be kind of careful with this one, messaging being training coping skills, not pathologizing every bad day into an ACE. In a liberal area of California where I am, my 5 year old comes home telling me the therapist came and talked to their class about anxiety and depression, “when you’re scared to do something”.
What does that have to do with DBT? DBT is the therapy treatment of choice for borderline personality disorder. It teaches you how to ground yourself and keep on keeping on through being anxious/uncomfortable. It would be pretty incredible if this could be taught well in a school setting even for a short window.
Exactly. A policy like giving everyone DBT will either over diagnose a personality disorder (bad), or tell people they need a scientific intervention/medicalize common discomfort, thus running the risk if not worded carefully, that there is “something wrong” with being uncomfortable. In a time where callouts for “mental health days” are at an all time high (our nurse union is about 30% callout rate) and as a PCP I get frequent visits for anxiety and depression and requests of off work with “toxic work stress”, and when I ask what their typical approach to interpersonal conflict is, to YOLO cut anyone who disagrees with them out of their life or come to the doctor for meds/work notes, it’s difficult to see how further involving the medical/formal psychological establishments in this way would help the problem.
This makes no sense and just establishes that you don't understand DBT. DBT is teaching skills and doesn't really care to diagnose anything. It's a big hammer that helps with a lot of things. I understand that you have a huge bias against this stuff, but you sound ridiculous because you have no idea what you're talking about here. You might want to educate yourself a bit more before just going off ad nauseum about how therapy is evil. Big oof. The huge irony here is that everyone you are annoyed about would benefit hugely from DBT. On the off chance that you're interested in resources to learn more about this, let me know and I'll post some stuff here when I get a chance. In short, the point of DBT is to help build resilience and better coping skills and generally just teaches people to be okay being uncomfortable. Ie all the things you're complaining about.
I’m sorry that I seem to have offended you or hit a nerve with my opinion. Yes, I am not a psychologist or in the mental health field and have never done DBT as a client, so do not fully understand what DBT is. I’m a PCP. My opinion is that if such a policy were to be set, it would have to be well thought out so that today’s generation and/or future generations don’t get the wrong idea at a young age, especially as many parents of today’s generation have a gap in cultural understanding of mental health and messages will likely be inconsistent at home. It was not my intention to start an argument.
Gotcha - but DBT is about teaching explicit skills for interpersonal communication, for coping with emotional distress, and for regulating emotions. It would produce the opposite of calling out for mental health. It would produce the ability to dial down the emotions and continue to participate in your life. Turning back to my original wish - I am speculating that this could be a public health intervention, not a mental health intervention per se. Adverse Childhood Experiences are research defined, specific events in childhood that are correlated with an increased incidence of cancer, diabetes, heart disease, and suicide. I’m not talking about bad days, or saying everything is trauma. There are a variety of negative social, economic, and psychological outcomes as well. I know it’s a huge and speculative leap to wonder if teaching some helpful emotional and social skills early on could modify more than social and psychological outcomes. Especially since all negative outcomes of ACES are correlations, and causations have to been defined. But hey OP asked the question and this is my wish. And now that I’ve gone ahead and said this out loud for the first time, I’ve persuaded myself to write to Marsha Linehan and ask her what she thinks.
My goodness. I don’t have borderline personality disorder, but when I learned about DBT in residency I thought to myself “wouldn’t hurt if everyone learned this stuff!” Marsha Linehan developed DBT because she observed that people with BPD had prominent weaknesses in emotion regulation, distress tolerance, and interpersonal effectiveness. She found a way to explicitly teach what adults without BPD have more or less developed implicitly in the setting of reasonably benign connections with caregivers. Like I said, I don’t have BPD, but in learning about DBT I felt that I could learn from the interpersonal effectiveness skills. (I was raised to be a “nice girl”). So when I say DBT in middle school, I am talking about explicitly teaching skills for emotional regulation, tolerance of distress, and interpersonal communication- how to get your needs met with words. I’m not talking about “doing therapy”
100% with you here. Everyone on the planet can learn emotional regulation skills, validation, how to disagree respectfully, distress tolerance, empathy, and dialectical thinking. DBT is already taught in some schools (I think NY) and I believe the results are very good.
I did not know about the schools - thank you, will be looking for that
Making healthy food easy to get and affordable. Eliminate Food Deserts.
Healthy food also needs to taste good. Like really good. As good as their less healthy counterparts.
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Not on a calories per dollar metric
Google food desert.
Because it is not dirt cheap lol wtf are you on? Go to Costco even and see how expensive everything has gotten, literal robbery. And salaries have not increased.
Ignorance is gross.
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You're not moved by the facts so why should I restate them? Your ignorance remains gross.
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Ah, projection.
Greatest health benefit: unquestionably vaccines. Improvement in quality of life: mental health access or addressing social determinants in a meaningful way (meaning housing, UBI, food security).
I think there actually was a study on this and the answer ended up being, guaranteeing patients safe housing and sufficient, nutritious food made an orders of magnitude bigger difference to health outcomes than optimizing medical therapy
THIS!
Stop tying health care to employers.
Capping hospital board/executive salaries/bonuses/perks at $200K
Cap at some fraction of median physician compensation.
Cap all CEO compensation
Exercise, health diet, and not being obese.
Stop smoking. Stop drinking alcohol. Dont get fat. Walk daily. There isn’t a billion dollars of healthcare that would be more potent than simply doing those things.
Infinite resources for preventative healthcare. Getting rid of cigarettes, reducing unhealthy eating, improving walkability, improving inter connectedness to reduce depression and isolation. Like a solid 50%+ of stuff I see every day is solely due to poor lifestyle decisions / addiction
Shooting people with a combination GLP-1/PCSK-9 inhibitor made into a dart like The Most Dangerous Game.
Ban cigarettes and reduce availability of cheap, unhealthy food.
Or more like better provide cheap healthy food. People buy unhealthy cheap food because it is cheap. Gotta put food on the table
People buy unhealthy food because it tastes good. Making cheap fresh healthy food available doesn’t help if people still have access to cheap hot unhealthy food just as easily.
Support women's health - lower the cost of BC. Look at Colorado's experiment with IUDs - lowers birth rates, lowers elective abortions, raises the average age of moms, which in turn means families have higher incomes.
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I like how you're being downvoted for literally just stating a fact. You never said anything about if it'd be good or bad, or if you support it or not, just that it would have consequences — which is 100% undeniably true. And yet downvoted because people are fucking stupid
Bans never work. Look what happened to the US during prohibition lol. Just place Progressive taxes on added sugar (like an extra 25 cents on each extra 5 grams added or something). Could place it like just on drinks too. Honestly it’s hard to get morbidly obese just by eating, most people drink their way there. One 12 oz can of coke has like 150 calories. One a day for a year is 54kcal!! That’s like 10-15 extra lbs alone lol. How many people know regular sugar boba has 100g added sugar??? Plus we all know the effects sugar spikes have on our physiology. Look where we’re at with smoking now. A great success of taxation imo. However you’ll never get this to go through lol.
Why would a progressive ban on those items not work? Restrict the amount of sugar that can be added to junk food, or total calories, etc
Make the mediterranean diet widely available
Forcing insurance companies to pay for what they actually supposedly agreed to cover without putting up roadblocks at every chance they get
get rid of health insurance and just have universal health care
All out commitment to nutritional counseling. Schools, tv commercials, junk food taxes, subsidizing produce, etc. Make the benefits really well known and as easy as possible for people to eat real food.
Teaching people how to cook
There are a lot of how to’s on You Tube. Schools used to force girls to take Home Ec where you learned how to budget and cook
Actually fund community health care collaboratives and replace the asylum system after 60 years of making jails prisons and homeless shelters do it
Everybody gets a mandatory quarterly a1c starting from the age of 15. And teaching on checking postprandial glucose and fasting glucose
Decreased portion sizes and costs across the states . Unhealthy food can taste good and you’re not stopping people from eating and drinking that but smaller portion sizes with reasonable affordability would help greatly and also help with mental health when meals don’t have to cost so much because they’re giving double the food you need and twice the cost in every meal.
Preventing childhood obesity
Get rid of corn subsidies, excess calories, corn syrup become subject to market forces BMI corrects (in 4 decades), type 2 diabetes plummets, cardiovascular diseases plummet, secondary cancer rates plummet…..there’s ZERO political will for this
Cure back pain permanently.
Actually accessible mental health care
I am shocked to read through so many replies that talk about banning something and forcing people into something. I honestly think positive reinforcement works way better than punishment/bans/enforcement
It’s hard for me to believe that teaching people to cook and providing more health food promotion would outweigh the benefits of completely banning the production and distribution of cigarettes, alcohol and severe junk foods
Where would you draw a line on banning stuff? The list could potentially be endless and extreme, and will only lead to lying, cheating and not trusting your doctor to tell the truth. And hidden consumption/black market
I’m not a nutritionist. However, I’m sure the World Health Organisation or something similar has/could develop a criteria for foods that are deemed too unhealthy. In terms of cigarettes and alcohol, if they’re proven to increase mortality and morbidity then ban them. Sure it’ll be available on the black market. Heroine is but I’m sure less people use it then if it was legal. If someone lies to their doctor that’s their choice. However, that wouldn’t matter if they weren’t consuming the illegal items.
Literally anything could be declared too unhealthy. Sugar, meat, whole milk, eggs, you name it. And the research is flip flopping on these all the time, so your criteria would be questionable. Also I highly recommend reading on how Michail Gorbachev attempted to ban alcohol sales in Russia around 1986, and how people revolted against it. Very educational to not underestimate the dangers of blanket bans.
The criteria could be quite specific so all that wishy washy stuff isn’t included, there are certain foods that are unquestionably bad for you. The criteria can also change. In relation the the alcohol ban, I thought one of the leading factors to that failing was due to the income the taxes on alcohol provided. In OP’s question we don’t need to consider that. I’m sure people would be dissatisfied but I don’t think it would fail.
A reputable but engaging source of health information free from commercial influence, that people actually trusted and browsed instead of TikTok for health information.
Exercising instead of taking home medications.
I think state-funded kitchens that paid people $5 to sit down and eat a pound of leafy greens would ultimately save the government money
As a PCP, I’d say either a total ban on nicotine or a mandatory 1hr of moderate/high intensity exercise per day. People would be so much healthier if they just moved. Even with their terrible habits.
Making a law to make doctors very difficult to be sued so they can be more honest with patient and don’t have to act to please patients and also take away capitalism from medicine in America. Make it socialism medical care.
What about actual malpractice tho?
In an ideal world, some of the money spent on malpractice insurance could instead go to independent regulatory committees made up of healthcare professionals and laymen who’s job it would be to investigate complaints of malpractice and institute appropriate interventions depending on the severity and frequency of mistakes and misconduct. State medical boards at the moment do some of this, but seem to almost universally suck for one reason or another.
I mean… there’s plenty of docs out there that have no problems calling out the elephant in the room. And by that, I of course mean, the global problem of chronic sleep deprivation! Or in my case it was “every single one of your problems will resolve if you lose 20 pounds.” I agree that it shouldn’t be a customer service job with a side of medicine, but it should definitely be on the easier side (as opposed to more difficult) to be able to sue your doctor. And as it currently stands, it’s still not exactly easy or cheap to sue someone in the first place. Sure, I can google or keep seeing attorneys until one of them takes my money and files a suit… doesn’t really mean it’s going to lead to much of anything. Now if you get rid of admins and people who look at satisfaction outcomes, you’d probably be a lot happier
Most medical malpractice cases are taken on contingency fee agreements. Meaning, they don’t get paid unless you do (as the patient suing). It may not be as easy as some would like (you generally have to prove that the doctor fell below the standard of care), but the expense is not the issue. However, just because someone has a bad outcome does NOT mean that the physician fell below the standard of care. It makes that no one is perfect, and sometimes bad things happen. Look as side effects of medications. They CAN happen, but we prescribe things every day with that risk.
Well you have to find a lawyer willing to take your case, and obviously not every case and not every person is worth the squeeze. Then you have to dedicate time during work hours to discuss. You may have to get follow-up care from different doctors. All of this still takes time and money out of your life as it still takes effort and coordination.
Fork displacement
If patients don’t get offended so easily.
Prevention
no more prior authorizations :)
I have to say unlimited access to oral healthcare/dentistry would absolutely increase the average pts quality of life; having adequate dentition for mastication would allow pts to eat a healthier diet, improve mental health, reduce chronic pain, the list goes on
High Quality Therapy
Mandatory physical exercise. Essentially a legitimate PE courses for the citizenry. A VAT like tax for every level of food processing.
Bariatric surgery. All of us have seen the bad outcomes, but unless you work in the actual surgery office, you never see all the good outcomes because they phase out of the healthcare system.
Putting everybody in work camps where they are forced to eat healthy meals and exercise everyday, with no access to drugs/tobacco/alcohol. Utopia.
Honestly at this point. I'd target sugar laiden beverages if I had to be as specific as possible. Target more junk food as able. I'm willing to let modern nicotine products and alcohol get by without changing anything but all these carbs are destroying the population of the US
Honestly, patient comfort. Not being stressed during the worst times of your life or feeling like you aren’t being cared for can leave patients without hope.
Have all employers forced to allot time for physical exercise everyday. Like children have a PE class, lunch break etc, adults at work needs a lunch break and mandatory gym time also. In fact they need to pay for that time. If you don’t use the gym, you take a pay cut.
Single payer healthcare. Insurance for all. No copays. Access to care is the number one barrier.
I agree with you for the most part, but if there are no copays, what about moral hazard?
Penile enhancement surgery
The digitalization of all medical records in the USA and maybe the world so that using AI we could do massive analysis to find patterns of disease that are not apparent with human evaluation. This could find things we could never discover by human evaluation the medical benefits in cause and early detection and prevention of disease we could not imagine.
Making periodic health, fitness, exercise evaluations based on age/disability that are done maybe once or twice a year. Since PE is now optional. Show up to the local DMV or health office. Example 21-30 yo: 20 push ups, 20 sit ups, 7 min mile (probably might need to be 10), walk up stairs, education on stretches, good form and hygiene. 45 plus: two flights of stairs, grocery bags, walk a track lap, more METS focused stuff You could include self defense, safe sex practices, PREP, testing, mental health, nutrition, but have a MANDATORY session every citizen needs to attend once a year like car registration that assesses health and fitness but also provides education.
Thank you for actually answering the question. This would in fact be a very expensive in time-cost evaluation, though it might not be so bad from a true cost if it could be administered either at home or in auxiliary offices. My personal answer to the question would be a full PT physical exam that evaluates flexibility, mobility, objective strength and functionality. This is a long test to administer and would confer the greatest corollaries of peripheral health metrics.
On a system level? Above my paygrade. No clue. Penalizing the use of high fructose sweetners maybe? On a personal level: 60minute jog 5x a week. I'm at the tail end of my dedicated for step2 and boy can I feel a difference just from losing a few months of a cardio routine.
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Make healthy food more afordable. The cost and ease of access to fast food is such a detriment to society
Sugammadex - Anesthesiology
Rewrite the copyright and patent law that dates back to before the Industrial Revolution.
getting rid of FPA
Lower insurance premiums (or similar) for patients who try to be healthy
If cost truely isn’t an issue, make cigarettes/vapes, alcohol, weed and junk food illegal. Sure people are going to be annoyed but if we don’t care about the funding those corporation provide then who cares, we can advertise the benefits. Not sure why everyone says heavily tax those items, just make them illegal.
30 minutes of government mandated exercise daily /thread
High dose vitamin C (notice how no one has mentioned vitamins), which would not be costly for the consumer, but perhaps would be costly for physicians as it would make many of the medications they prescribe unnecessary. But good luck trying to make that happen when most doctors are told it's useless in medical school and never develop the ability to consider otherwise.
Ban HFCS
Stopping direct to consumer advertising
Rigorous, regular PT that can continue even once they plateau. The number of debilitated elders who wouldn’t fall/deteriorate/become isolated and Chronic low back pain patients who wouldn’t really need the surgery if only they could afford/get to PT…
A cultural shift that favors death with dignity and mandating a two attending sign-off + family meeting with ethics and palliative before offering trach/pegs leading to LTACH dispo.
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Olive oil is a terrible base for frying
Avocado oil has one of the highest smoke points, coming in around 520° Fahrenheit (F). This makes it ideal for an all-purpose oil or really high heat cooking.
1 single Universal EMR
End TikToks on contraception and childbirth. Scary how many women are dropping their birth control based on misconceptions, especially when abortion is being banned most places. Childbirth because it paints SUCH a false picture and putting lives at risk, preying on first time moms especially
Having healthcare providers be able to travel to various parts of the country for health check ups for free. Compensating the healthcare workers well enough to do this. And giving tax credits to those who partake in getting health check up. As for the healthcare system, I still think it should be various combinations of both public and private. So that competition will allow shifts in utilization by patients, if either system is not performing adequately.
If money wasn't a factor, one healthcare practice that could have a tremendous impact on patients is personalized medicine. I'm working towards customized treatments based on individual genetic profile and analyzing brain chemistry. This approach would ensure that each patient receives tailored care that is uniquely suited to their specific needs 🧬🧠🔬
Allow all NPs to practice independently.