The Complete Patient

Congress is about to tighten the rules for elderly individuals who use Medicaid to pay for their nursing home care. Medicaid is supposed to be a program to provide medical assistance to the poor, but over the years, middle class elderly have resorted to using the program to prevent themselves from being bled financially dry by nursing home bills that typically run $7,000-$10,000 a month. In order to qualify, these middle class elderly shift funds to their children and grandchildren in order to appear destitute. They often get help from eldercare attorneys so everything is neat and legal.

Now Congress is imposing rules that say, in effect: If you made financial transfers within five years of going into a nursing home, we reserve the right to refuse Medicaid coverage.

I can relate to what's going on because, some ten years ago, I sat in an eldercare lawyer's office with my mother, trying to figure out how to re-juggle my parents' finances so my father could qualify for Medicaid. He had Alzheimers disease, and it was only a matter of months before he would need to go into a nursing home. The idea behind the re-juggling was simple: We wanted to protect my mother from being thrown into poverty by the crushing nursing home expenses my father was about to run up.

In the view of the Congress, the approach we took, and which many thousands of other individuals take, is tantamount to fraud. One member of Congress, Nathan Deal of Georgia, was quoted as saying that wealthy elders are abusing the system by "buying two Mercedes, giving them to their children and...reducing themselves to poverty."

The way I felt sitting in that lawyer's office was quite the opposite. I saw my parents, who had both worked hard and paid taxes for more than 40 years, being abused by a government unwilling to extend a helping hand when one of them was sick and infirm. Moreover, that government was forcing us as a family to exploit loopholes in the system, all so that my mother could have some minimal financial protection after my father died.

As it turned out, my father died before any of the protections we had worked out actually went into effect. But I've always felt resentful about our government's efforts to avoid its obligations in the healthcare arena, by casting hardworking and honest taxpayers as frauds when they merely try to avoid being impoverished at a turning point in their lives...so they can die in dignity.

The concept of "functional food" is generating lots of excitement in the scientific community...and on Wall Street. There are various definitions of functional food, but generally it refers to food enhanced with vitamins and other types of nutrients. Thus, you might have fruit juice containing glucosmine and chondoitin to relieve arthritis. It's become a hot subject because the components of various plants, like soy, tomatoes, and broccoli, have been associated with health benefits.

Functional food has been around a long time, as in "Wonder Bread builds strong bodies in 12 ways." Not too many nutritional experts will advise eating Wonder Bread, and that's the potential problem here. Just as the corporate food giants (Kraft, Frito Lay, Coca Cola) have given us "natural" and "low-fat" foods (often high in sugar, trans fats), I fear what their marketing people will devise in the area of functional foods. "Energy" drinks, based on caffeine and sugar, are already in their arsenals. You can be sure they will come up with any number of "magic bullets" of questionable nutritional value.

The magazine, "Functional Foods and Nutraceuticals", contains an article in its current issue pointing out that an index of natural and organic food companies (i.e. Lifeway, Hansen, Whole Foods, The Hain Celestial Group and Spectrum Organic Products) has grown 229% over the last three years.  There's lots of money to be made appealing to health benefits, and the corporate food giants know it. Expect lots of claims, counter-claims, and in general the fog of confusion.

Here is a note of rationality to consider, from a recent report on functional foods from the Institute of Food Technologists:  "It should be stressed, however, that functional foods are not a magic bullet or universal panacea for poor health habits. There are no "good" or "bad" foods, but there are good or bad diets."

One of the major challenges facing every patient is dealing with the "ideologies" that permeate health care. Ideologies, of course, are supposed to explain all aspects of political, religious, or other major areas of life, and thus are all-encompassing and highly controversial. Wars are fought over ideology (i.e. World War II, The Cold War)  In health care, the major ideological struggle now taking place pits the conventional medicine of the hospitals and Big Pharma (i.e. surgery and drugs offer the best hope of cure) against the alternative medicine of the acupuncturists, chiropractors, nutritionists and others (traditional and natural approaches offer the best hope of staving off disease). (An emerging area of health care, known as "integrative medicine," is trying to stake out an in-between area.)

My article on BusinessWeek.com about Standard Process, the Wisconsin vitamin company that is attempting to prohibit health-care practitioners from selling its products via the Internet, highlights this ideological struggle. Standard Process wants the practitioners who dispense its products to believe that, thanks to organic foods and animal glands, the products have certain unique properties that help cure conditions and diseases out of the reach of both conventional medicine and other makers of nutritional supplements. I had chiropractors tell me about patients with everything from cancer to constipation had been "cured" by Standard Process products. Would other supplements have been able to accomplish the same things with these patients? Who knows?

It all hearkens back to a major problem facing alternative healthcare practitioners: the snake-oil syndrome. Back in the 1800s, hucksters used to go from town to town, selling their potions from a soap box with talk of miraculous cures, moving on before buyers realized the concoctions were useless. Makers of nutritional supplements rely on this same formula, though obviously in more sophisticated packaging, to move product today, and it is part of the ideology of the alternative health care movement.

I'm not saying Standard Process products are without value. I appreciate that nutritional supplements are extremely important to health care during an age when we are likely being deprived of important vitamins and minerals because foods are less wholesome than they used to be and because our bodies have requirements that aren't fully understood. I also believe that some supplements are of higher and more consistent quality than others.  I'm just skeptical of health-care approaches by makers of supplements that rely on special claims based more on anecdote than on  scientific assessment.  And I readily accept that in real-life cases, Standard Process supplements (along with those of other manufacturers) have helped patients recover from conditions that conventional medicine couldn't deal with.

One other trait I've noticed about ideologues is that they tend to be highly controlling. The Standard Process effort to prohibit its practitioners from selling over the Internet is about as controlling as you can get in this day and age. And its refusal to discuss the matter at all (in response to my requests for an interview with the president) is further indication of its control orientation. Ideologues don't like their constituents to be out there exploring and trying new things.

The traditional media have over the years tended to take a cynical approach to "alternative" health approaches and the nutritional supplements and emphasis on prevention that are often part of alternative treatments. Many seemed to take delight in scientific studies that questioned the benefits of vitamin E or echinachea (and failing to point out possible weaknesses in the study methodologies).

But in just the last few weeks, we've seen signs of a 180-degree shift. Newsweek in its Jan. 16 issue devoted 41 pages to a special section entitled, "Health for Life: Vitamins and Your Diet". (Never mind that the special section's major advertisers were Big Pharma, touting various drugs to reduce cholesterol and relieve asthma.) The New York Times, on its front page Jan. 11, had an article, "In the Treatment of Diabetes, Success Often Does Not Pay", in which it chronicled how a hospital center offering preventive treatment was forced to shut down because it couldn't make money; the profits come to the hospitals that perform amputations and other serious procedures to deal with the complications of diabetes. The most surprising evidence came in the Jan. 21-27 issue of The Economist, the staid chronicler of international business and economic developments. Its cover pointed readers to, not one, but two, pieces under the heading, "Eat More Fish Oil". The articles both related to a new study suggesting that mothers of children who consumed more of the omega-3 contained in fish oil had higher IQs and better sociability than under-consumers. One of the articles was an editorial that concluded, "...environmental damage wrought in the womb is as irreversible as the effects of bad genes. It is surely cheaper to make interventions that have an impact early on than to react later." Ah, the compelling force of economic logic.

Surely more such media shifting is to come as evidence mounts that nutritional voids in our diets likely create huge long-term health risks.