Monday, August 01, 2011

Crash Courses

I'm proud of what I came up for my title today, as this post is about more than one crash course. One, as in the seminar I attended last week. And Two, as in our crashing credit rating and economy-sinking debt (see cartoon above).

I am finally posting about the 2 days of the Health Care Costs Containment seminar with my friend Vanny.
I am really supposed to avoid doing anything stressful 2 or more days in a row as an all-day activity, so attending it did have me limited as to my activities. Anyway, this is it!
I'd planned to blog more in a lot more detail about the seminar, mostly to avoid writing about the congressional debt ceiling crap, but also because I think what I learned was very surprising. Now that I'm getting a later start on it, let me just summarize it as best I can.

Did you know that there are companies called risk analysis firms, that take our health care info and create statistics out of them? Yup. Because of privacy laws, insurance companies, private employers and doctor practices cannot send them our names or social security numbers, but they can assign each of us code numbers, scrub the records of privates and then share them with these kinds of companies. The risk analyzers take this info (which also includes what we each cost the system) and make all kinds of statistical conclusions out of it, sending reports and recommendations back to the sender companies.

They've been around for a few decades now. So far, they've just mostly been able to advise about tweaking benefit packages -- increasing co-pays on this plan or that, this procedure or that. But recently, as health care costs have increased even more, they are being asked to go further and deeper with their data analysis. It's predicted that risk analysis will soon dramatically change health care as we know it, no matter who provides it, and in surprising ways.

After recovering from the shock, it becomes apparent that this is enormous. For good and ill. I'd read an article in The New Yorker earlier in the year about some do-good doctors who used this kind of data analysis done by Verisk Analytics to actually help a few patients reverse damaging longterm trends and become cheaper to the system as well as healthier. At the time, I considered it noble, but I also wrote it off to anecdoctal insignificance. After last week seeing its power spotlighted, it's gotten me to taking it more seriously.

We attended a few talks and panels that attempted to show this analytical power in more specific (and surprising) settings. The one which stood out most in my mind was the panel discussion that dealt with the longterm health care cost liabilities of marathon runners. Not the professional ones. I'm talking the ones among us. The guy or gal down the block, the coworker, the boss...there are tons of folks who do this and/or train to do this. If you read crafters and artists' blogs, you read about plenty of them. It seems to be the in-thing, especially among Generation X women, as far as I can tell.

As the panel explained, at first people usually begin running as exercise to lose weight or get fit. But for many it soon becomes an obsession linked with higher risk taking, similar to those who get hooked on drag racing or bungee jumping or even four-wheeling. The runners don't often see it this way, though. Many see it as some sort of ultimate character-building. And they tell themselves it is the healthiest thing they can do for themselves and that it's all-good with no health downside. Many doctors agree.

But the more sophisticated emerging risk analysis statistics are beginning to tell a bit different tale.

Short-term damage to the heart after extended running (basically triggering a flight-or-fight response that lasts way longer than it ever was meant to in humans) is also being suspected now of causing long term damage as well, because of statistics being analyzed patient history by patient history over longer time by fresh third-party eyes.

Then, there is also the long term damage to skeleto-muscular frames. This was actually one of the high cost items that first caused health care providers to marry up with risk analyzers, because of the increase in surgeries on joints and ligaments. One panel presenter said he's learned they are alarmed at the huge increase in arthritises, wondering if this is solely a degeneration thing, or whether the aggravated state of joint distress may actually trigger the disease.

It does not help that researchers cannot help answer this yet. While they have made strides in identifying congenital / hereditary dna markers for it, there is still a big internal debate about it being a virus and how it strikes. Hereditary cases only account for perhaps 20% of all forms of arthritis as far as we know now, so that's alot of cases out there being triggered by stuff that's still mysterious.

Yikes! As someone who owns 5 of those arthritis babies through my genes (I never was a runner...aka jogger in my day...although I did try once, my boobs were always too big for comfort), I can honestly say that mine were not triggered by running, but I cannot think of any kind of high worth the pain and crippling that I now endure. So, my empathy is with someone who does something for years they think is healthful, only to find out, not completely.

Heart and joint damage are one thing, but another panel added addiction to the list, and frankly this surprised me most of all. I really wanted to scoff, but I did google once I got home, looking for something to confirm or deny. And geez, I landed in more than a few online running forum discussions about this! Wow. Comments like, have you ever known a dedicated runner who wasn't grouchy and demanding? And what if they cannot run due to injury or environment? I really only spent less than an hour on it, but just in that small timeframe I found more than a few runners who were quite candid about their concerns about having OCD or Narcissistic Personality or being an addict to the endomorphins and the self-discipline, the sacrifice, the uber-human effort.

Another presenter talked about how it's really tough to tell the addict that what they are doing has good effects for one part of the body (lungs and circulation), but they are playing with russian roulette fire when it comes to other body systems. He talked about all the teenage school sports deaths where the kid just drops dead, and that the majority of them are on the basketball court after a prolonged period of constant running.

Plus, remember when it came out a few years back that you could receive similar aerobic results with less work or time? He said that also buried in that were study finding recommends to walk and swim over running/jogging. That was the beginning of what these analyses were showing, but as often happens, never got fully explained, because the media does not always interpret properly. The panel said there should have been more emphasis placed on the dangers of marathon running.

The next panel day dealt with future trends possibly resulting from findings like these. IOW, a health care system that uses risk analysis to determine care, pre-existing conditions, coverage of procedures...would it end up treating a marathon runner as suspiciously as an obese smoker? Quite possibly, was the panel's consensus, because it is all about the numbers and cost is a big number. Someone noted at that point that, thanks to risk analysis, they are also discovering there are a shockingly big number of older and elderly people still among us who are obese and/or who smoke. Hehe, you know I heard that, for sure.

I learned other things at the seminar, but I've shared what was to me the most surprising thing, about the marathon running. I frankly hesitated at first about sharing this, because I do not want to turn off readers who do run. So just know that I am only the messenger here! So if you think it's all bunk, then go right ahead. But at least I've shared it.

I just hope that my friends who choose this form of exercise know all the risks in order to make an informed decision, and that many doctors are not the ones to inform them, as they are not privy to all of the risk analysis and many of them run themselves so they think it's wonderful. But, really, we live in a time where research findings and associated advice change all the time, so how would we know what is right or wrong long term anymore? Sigh. So, I'd say, take this with a grain of salt, but file it away as well, in case later you see corroboration to add to it later.