Measles Outbreaks In The Pacific

Fever, rash, cough and congestion. These are the hallmarks of measles. Before the beginning of the measles vaccination program in the 1960s, there were 3-4 million cases of measles annually in the United States, almost 40,000 people were hospitalized, over 1000 people developed permanent disability from measles encephalopathy, and almost 500 people died. Every year. Most of these cases happened in children.

Now with vaccination rates falling, we are again seeing outbreaks of measles. Right now, there are measles outbreaks occurring in the South Pacific. It’s estimated that only 30% of the population of Samoa, for instance, have been vaccinated against measles, and they are in the midst of a terrible outbreak right now. Other countries are sending medical supplies, doses of vaccine and health care personnel to help deal with this outbreak.

Samoa is a country with about 200,000 people. 3,149 cases of measles have been reported, 197 people are hospitalized and 42 have died. To give some idea of the magnitude of this outbreak, we can compare to the United States, which has a population of 327.2 million people. This size of an outbreak in the US would result in 5.2 million cases, 322,000 people hospitalized, and 68,712 deaths. Most of Samoa’s deaths have been in children under 4 years of age.

Think about that. Imagine a United States in which almost 70,000 infants, toddlers and preschoolers were killed within a month’s time. Bearing in mind that those deaths are preventable, this outbreak in Samoa is a heartbreaking tragedy.

The good news for the USA is that vaccine coverage overall is still above 90%. However, there are 11 states in which coverage is under 90% and there are pockets where vaccine coverage is much, much lower. Amish people reject most modern medical innovations (including vaccines). Many California communities have vaccine coverage rates at about 50%. This is much lower than what is required to prevent outbreaks of measles.

Measles is the most contagious illness we know. It is a serious illness and potentially fatal. The vaccine is safe, so safe that in 1.5 million people vaccinated in Finland from 1982-1992 no deaths or serious permanent adverse reactions were reported.

If you are not immune to measles and are exposed, you have a 90% chance of getting sick. This is in comparison to influenza, which has about a 50% transmission rate. Parents who choose not to vaccinate their children are making a choice to leave them unprotected against a serious, possibly fatal, horribly contagious illness that is still endemic in parts of the world.

No vaccine is perfectly effective, but the MMR vaccine is pretty close. It eradicated measles, mumps and rubella in Finland in the 1980s with a 12-year, 2-dose vaccination schedule.

Measles is still present in the world. The MMR vaccine is the most effective weapon we have against this illness. Please be sure to vaccinate your children.

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Mental Health Professional Shortage

Tiffany came to see me as a new patient this week. She is a very nice young woman with a number of very big problems. She is a single mother to two daughters, one of whom is autistic. As a working mom, she has to juggle childcare and all the other household tasks. Her ex-husband is behind on child support and only rarely takes the girls for weekends. He has trouble managing their autistic child’s behaviors.

It probably won’t surprise you that Tiffany is REALLY stressed. She isn’t sleeping, and her anxiety is becoming harder to manage. She came in this week asking for a referral to a psychiatrist.

If you’ve been following me for a while, you probably know part of me started to do a quiet little happy dance on the inside as I was listening to my new friend. She was in the absolute perfect place because I have so many tools to help her. The one that I DON’T use often (and just sits dusty on the shelf almost all the time) is a psychiatry referral. I don’t need it except in rare cases.

It’s a good thing, too, because psychiatrists aren’t exactly thick on the ground in northern Ohio. In fact, most of the country has a severe mental health professional shortage.

Researchers found that this shortage is impacting how people get care for mental health problems in a big way. They looked at claims for mental health vs. physical health problems. The researchers found that people chose to go out of network and pay a larger share of the cost of treatment for their mental health problems.

While the researchers didn’t speak to patients directly and didn’t ask why they went out of network, it’s pretty obvious to me. Those of us in primary care know it takes months to get an appointment with a psychiatrist. Insurance companies often have only a handful of choices for in-network care, and many psychiatrists don’t take insurance at all because reimbursement is very low. If someone is severely sick or a danger to themselves or others, they are directed to the ER where they may be hospitalized. Otherwise they wait.

Here is my prescription for fixing our mental health care shortage:

  • Every single person needs to have an established relationship with a primary care doctor. This means a family doctor, general internal medicine doctor (NOT A SPECIALIST) or pediatrician for little kids. If you are reading this and don’t have a primary doctor, GET ONE. See him or her annually for your physical at a minimum. If you don’t like your primary doctor, get a new one!
  • Be aware of your lifestyle and its impact on your mood. Sleep, exercise, your spiritual practice, diet, ALL will impact your mood. Take small steps to improve your lifestyle before your mood starts to suffer!
  • If you start to feel stress is getting to you, see your primary doctor before things get bad. Don’t wait until you’re so sick you can’t function at all!
  • Consider seeing a counselor. Cognitive behavior therapy (CBT) is as effective as medication for mild-to-moderate depression and anxiety symptoms. It’s hard work, and requires a special kind of courage to unpack what’s going on in your life, but so worth it!
  • Psychiatrists need to send patients with depression and anxiety who are improved and in remission BACK TO THEIR PRIMARY DOCTOR for management. There is no excuse for psychiatrists to continue seeing patients who don’t need them. This will free up space in their schedule for patients who are truly in need of specialty care.

So what did I do for Tiffany? First I asked her to make an appointment with a counselor. I also asked her to start some nutrition therapy with a good multivitamin, B complex and magnesium supplements. Because she was really struggling I started her also on a low dose of an antidepressant and a gentle non-habit-forming sleeping pill.

As food for thought, we discussed the recent research showing diet’s impact on depression and anxiety and I gave her some suggestions. We’ll continue to discuss this in the future. I’m sure when I see her back in a few weeks she will be feeling better and much more in control.

I can’t fix the things going on in Tiffany’s life that are difficult for her. Divorce, single motherhood, working motherhood, and a child with a chronic illness are real stressors. However, depression and anxiety make hard things just that much harder. Treatment is effective, and doesn’t require a visit to a psychiatrist.

QUESTION: Did you know there is a mental health professional shortage?

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Go Green: Greens Are Good For You!

How many servings of leafy green vegetables did you eat today?  There are so many to choose from, it’s easy to get some every day.  They are soooo good for you and tasty too!  At the end of the post I’ll share my favorite kale recipe 🙂

Why are green vegetables so good for you?  Pound for pound they have the most nutrition of any food on our planet.  They are low-carb, low-calorie and full of good stuff!

1.  Vitamins and minerals:  Vitamins K, E, C, and many of the B vitamins, as well as potassium, magnesium, calcium and iron.

2.  Powerful plant pigments that function as precursors to other vitamins and as antioxidants.  Beta-carotene, chlorophyll, zeaxanthin and lutein are some of the phytonutrients found in dark leafy green veggies.  The brightly-colored pigments in plants help fight cancer by acting as antioxidants.

3.  Green veggies don’t contain as much fiber as, say, beans or lentils or whole grains but they have SOME.  Kale, for instance, has 2.6 grams fiber per 1-cup serving.  They also have a small amount of omega-3 fatty acids.

Nutrition experts estimate that our ancestors ate five pounds of green leaves every day!  They were hunter-gatherers and hunting green leaves was a lot easier than hunting animals.  They didn’t get up and run away, after all!  When game was scarce they simply ate the plants all around them.

So what is the best way to eat your greens?  The same way our ancestors did!  Raw 🙂  You can also lightly steam or saute them.  DON’T boil them (it leaches away the cancer-fighting phytonutrients) and don’t overcook them because that begins to destroy the nutrition.

Try adding a big salad of leafy greens every day.  Mix up your leaves or combine them to take advantage of different flavors.  Use just a little dressing and it’s best to make your own dressings fresh.  If you have a food processor it’s easy to whip up a small amount of fresh dressing for your salad.  Combining different oils (like olive, sesame or walnut) with different vinegars (such as balsamic, red wine, rice wine, or apple cider) and different spices is much healthier than using mass-produced bottled dressings.

One of the most nutritious leafy green vegetables is kale.  Kale is bitter and many people don’t like eating it raw (including me).  I much prefer it sauteed.  Here’s my recipe!

Dr. Jen’s Sauteed Kale

Ingredients

  • 1 tablespoon extra-virgin olive oil or sesame oil
  • 1/2 onion, peeled and chopped
  • 2 cloves garlic, minced
  • 1 large bunch kale, washed, stems removed, and coarsely chopped
  • golden raisins soaked in hot water to plump them
  • Handful of pecans, chopped

Directions

  1. Drizzle a large shallow pan with oil and heat over medium heat. Add the onion and garlic and saute about 5 minutes, until starting to soften.
  2. Add a little water to the pan (for steam) then add the kale.  Cover and steam for about 5 minutes, then drain the oily water out.  Transfer the kale to a bowl and top with plumped golden raisins and pecans.  Enjoy!

Please feel free to play with this recipe.  There are so many fruits that you could use to add a little sweet to balance the bitter kale.  Toasted almonds, walnuts or sesame seeds could also be used for variety.

Want another easy way to get your greens?  Shaklee’s Organic Greens Booster has kale, spinach and broccoli in a form that’s easy to add to soups and smoothies.

For more information, check out 13 easy ways to eat more greens and Fitness Magazine’s guide to leafy greens.

QUESTION:  What is your favorite leafy green vegetable, and how do you like to eat it?

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Soy and Breast Cancer

I have a lovely patient who suffers terribly with menopausal hot flushes.  It’s been years and they show no signs of stopping.  The problem is, she also has a condition that increases her risk of breast cancer.  Hormone replacement with estrogen, while it would help her hot flushes, would be dangerous for her.  Some time ago her oncologist told her she also should avoid soy because it has estrogen effects and may increase her breast cancer risk as well.

You probably know I hate to see anyone suffer.  I hate it even more when the reason for the suffering is based on faulty or outdated logic.  I know newer research has shown that soy foods and soy isoflavone supplements do not increase the risk of breast cancer, but I didn’t have the research to back that claim up.  Off to the research database!

First, some background info.  The reason so many doctors and scientists assumed soy was dangerous for breast cancer patients is because soy contains substances, called isoflavones, that are structured like estrogens.  There’s evidence they can bind to estrogen receptors in cells.

It was assumed that, since most breast cancer tumors are responsive to estrogen, that any estrogen activity would stimulate the cells to grow.  In fact, highly successful treatments for breast cancer like Tamoxifen and Arimidex act by blocking ALL estrogen activity.  As you can imagine, these medications cause a lot of side effects like hot flushes, vaginal dryness and other symptoms that mimic menopause.

You know what happens when we assume, right?  More recently, scientists have decided to question that assumption and look to see if soy intake (both soy foods and soy supplements) actually does increase the risk of breast cancer.

What did they find?  LOTS of studies are out there, but I just want to mention a few.  There was a review article published in late 2013 that looked at 131 different studies on soy foods and soy and red clover isoflavones.  There was evidence that eating soy foods was protective against breast cancer.  Even stronger evidence is that breast cancer patients taking Tamoxifen had no increased risk of recurrence when they used soy.

Another study published in February of 2014 analyzed 35 studies looking at associations between breast cancer risk and soy intake.  The study concluded that in Asia, soy intake reduced the risk of breast cancer in women both before and after menopause.  However, there was no change in breast cancer risk demonstrated in women in Western countries with soy intake.  There was certainly no evidence of an INCREASED risk of breast cancer in women using soy.

A very large study published in 2013 asked over 3800 women about their dietary patterns, including soy intake, when they enrolled in the study.  Over 14 years the authors tracked several variables in study participants, particularly breast cancer diagnosis, breast cancer mortality and all-cause mortality.  There was no difference in breast cancer risk or mortality (from breast cancer or other causes) in women with the highest soy intake vs. those with the lowest soy intake.

A review article published in Germany in 2016 also concluded that soy did not increase the risk of breast cancer and increases survival after breast cancer diagnosis.

It is pretty clear that soy intake does not increase the risk of breast cancer and may actually be protective in some populations.  Why is this?  There is a theory that soy isoflavones, while mimicking estrogens in structure, do not actually behave like estrogens.  Therefore, when they bind to estrogen receptors in cells, they block the actions of the person’s own estrogen molecules.  This theory could explain why soy isoflavones do not increase breast cancer recurrence in patients taking Tamoxifen for estrogen-sensitive breast cancer.  The soy actually behaves a bit LIKE Tamoxifen without the side effects.

If you have considered trying soy isoflavones to reduce hot flashes or using soy as a good source of complete dietary protein, there is plenty of good evidence that it won’t hurt you.  Even if you have a higher-than-normal risk of breast cancer, or have actually developed breast cancer, there’s no evidence that soy is harmful.  As always, you should always discuss supplementation with your doctor to make sure any supplements won’t interfere with your treatment plan.

QUESTION:  Do you have menopausal hot flashes?  Have you considered trying soy?  Have you been told it could be harmful?

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Diet Change And Depression

Depression and anxiety are incredibly common symptoms that we see in primary care. It is estimated that 75-90% of visits to doctors are related to problems caused or made worse by stress. I was so excited to see a new study published showing a link between diet change and depression symptoms!

We all have to eat. Most people recognize that our diet has a huge impact on our health. Heart attacks, strokes, cancers, obesity and many other illnesses are impacted by what we eat. Doctors spend a lot of time advising people to eat less sugar, less saturated fat, and more fresh fruits and vegetables.

Many people don’t realize what you eat affects your mood, too! I’ve had great success with nutritional supplements in helping people with depression and anxiety feel better. A new research study has shown a very clear association between diet change and depression as well.

Researchers in Australia studied 76 young adults with depression and anxiety symptoms. They were randomly assigned to two groups – one group got no intervention, and one group got instructions to improve their diet via a 13-minute video they could re-watch whenever they wanted to.

They were instructed to increase their intake of

  • vegetables to 5 servings per day
  • fruits to 2-3 servings per day
  • whole grains to 3 servings per day
  • lean protein (lean meat, poultry, eggs, tofu, legumes) to 3 servings per day (Remember, plant sources are healthier than animal)
  • unsweetened dairy to 3 servings per day
  • fish to 3 servings per week
  • nuts and seeds to 3 tablespoons per day
  • olive oil to 2 tablespoons per day

They were also instructed to take 1 teaspoon of turmeric and 1 teaspoon of cinnamon most days. They were to DECREASE their intake of refined carbohydrates, sugar, fatty or processed meats and soft drinks. They were given sample menus and handouts answering common questions as well.

After 3 weeks the average depression questionnaire scores had not changed in the control group, not surprisingly. However, in the diet-change group the scores had returned to normal! And the improvement was maintained when they were rechecked after 3 months.

This study supports what I’ve said for a long time. Depression and anxiety are not just related to stress or genetics. Our nutrition strongly impacts our brains’ ability to manage and cope with stress. A crappy diet predisposes us to depression and anxiety, and we can improve our mood by improving our diet.

If you struggle with stress, depression and/or anxiety, improving your diet is something you can do TODAY. Improving your diet is as effective as medication, and works just as quickly. It also has no side effects! What are you waiting for?!

QUESTION: Do you see a link between how you eat and how you feel?

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Gout Risk And Lifestyle Factors

Do you know anyone with gout? I do, unfortunately, quite a few people. It is one of the few illnesses I am willing to treat sight-unseen. It is on my top-five list of illnesses I NEVER want to have, right up there with kidney stones and cluster headaches.

We’ve known for a long time that gout risk is tied to lifestyle factors. It used to be known as the “disease of kings” and was associated with a rich diet, obesity, and alcohol intake. Recent research suggests that a huge percentage of gout risk is related to four risk factors: overweight and obesity, not eating a heart-healthy diet, alcohol intake and taking a diuretic medication.

First of all, what is gout? Gout is the most common inflammatory joint disease in the US. It is related to high blood levels of a substance called uric acid. When levels of this substance get high, it creates crystals in the joints that look like tiny needles under the microscope. Just looking at the crystals hurts! No wonder this illness is so painful!

A patient’s gout risk is directly related to serum uric acid levels. What makes uric acid go up? You got it – overweight or obesity, alcohol, a diet rich in meat, saturated fat and sugar, and diuretic medications.

Researchers at Harvard Medical School analyzed NHANES survey data and found that the most important risk factor for high uric acid levels was weight. People with a body mass index (BMI) over 35 were 3.5 times more likely to have high uric acid levels (and therefore increased gout risk) compared to people with a BMI less than 25. The higher the BMI, the higher the risk.

The closer people stuck to the DASH diet (the standard heart-healthy diet rich in fruits and vegetables and low in sodium, sugar and saturated fat) the better, too. Alcohol use increased the risk, and so did taking diuretics (water pills) for blood pressure and water retention.

If you or someone you love has gout, there are real things you can start to do TODAY to lower your uric acid levels and reduce your risk of gout attacks. You DO NOT want gout attacks. Trust me, I’ve seen them, it’s not pretty, and it is VERY painful. It will destroy your joints.

  • Stop drinking alcohol
  • Download a guide to the DASH diet and start following it. Reduce your intake of soda, sugar, processed foods, meat, dairy, eggs and shellfish. Add more fruits, veggies, beans, whole grains, nuts, seeds and fatty fish.
  • Over time, work on bringing your weight down. It won’t happen overnight but you CAN do it!
  • Talk to your doctor if you take water pills. The risk of causing gout isn’t huge, but it is there.

QUESTION: Do you know someone who has gout?

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Measuring Biological Age In Humans

Have you ever heard the phrase “Age is just a number”? I have patients who are young at 80 years of age, and patients who are old at 59 years of age. What’s the difference? BIOLOGICAL age.

Diet, lifestyle, inflammation, disease and many other factors combine to influence someone’s biological age. Many of these factors actually influence the way our genes are expressed – the field of epigenetics studies this phenomenon.

There is a large group of researchers studying ways to measure biological age. One way is to study DNA methylation. Aging produces predictable changes in DNA structure. Measuring these changes can give ideas about an individual’s risk of developing age-related diseases like heart attacks, dementia.

Researchers at UCLA have found that there are a number of diet and lifestyle factors that influence biological age. A lot of it makes intuitive sense. Things like abdominal obesity, smoking, high rates of inflammation (measured by blood levels of C-Reactive Protein or CRP), high blood pressure, diabetes and prediabetes are associated with accelerated aging and a higher biological age than chronological age. High triglycerides and low HDL cholesterol, part of the metabolic syndrome (along with abdominal obesity, diabetes and high cholesterol) also are associated with more rapid aging.

Conversely, there are a number of factors that slow down biological aging. Exercise and eating fresh fruits and vegetables are protective. Fatty fish and light to moderate (NOT excessive) alcohol intake also seem to slow the aging process. Interestingly, higher levels of education and higher income also are associated with lower biological aging. I’m not sure why this is so, but it may be that more well-educated and well-off people choose healthier diets and lifestyle habits than those who are poorer and less educated.

So what conclusions can we draw from this research?

  • Exercise regularly! Choose something you enjoy and JUST DO IT!
  • Eat more fresh fruits and vegetables!
  • Maintain (or get to) a healthy weight. Your waist circumference should be less than 35 inches for women, and less than 40 inches for men. If you are very tall or very short, your waist should be less than half your height.
  • Stop smoking! See your doctor, there are treatments that will significantly increase your chances of success.
  • Choose fatty fish or take a fish oil supplement to increase your EPA and DHA intake.

If you have children, it is important to set up good habits now. Some interesting research has shown that in many respects health is more related to a person’s socioeconomic status and lifestyle in childhood than to what they achieve in adulthood. Setting a strong foundation of good lifestyle and diet habits now will help them be healthier their whole lives!

I think we all want to be the 85 year old with the health of an active 60 year old! I know I do 🙂 Epigenetic research is helping us understand how what we do today influences our biological age and how long we are able to maintain our good health.

QUESTION: Have you heard of epigenetics? Did you know your lifestyle choices influence your genes?

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Is Chiropractic Therapy Good For You?

A while back I noticed a recurrence of some mild neck and right shoulder pain, with less mobility in my neck than I’m used to.  I noticed it hurt to turn my neck all the way to the right and left (to check blind spots while driving, for instance).  There was some tightness of the muscles of my right upper back as well.

So…  Off I went to see my chiropractor.  I’m a bit of a slow learner about some things, you see.  I know in my head that regular treatments are helpful for keeping the body healthy, but actually making time in the schedule for it is a challenge sometimes.

As I was talking with Dr. Bobbi Taylor at Crossroads Chiropractic and Acupuncture, I was thinking about not much more than getting rid of this discomfort in my neck and upper back.  Then I started wondering why more people with neck and back pain don’t see chiropractors.

Unfortunately manual therapies like chiropractic therapy have a little bit of a bad rap in the USA.  Health care is dominated by western medicine and if a therapy doesn’t involve cutting the problem out or drugging it away, western medicine sometimes doesn’t have much use for it.

So what are manual therapies, and do they work?  Manual therapies involve a practitioner using parts of their bodies (usually the hands, but sometimes other parts such as elbows, knees, or feet) to treat, influence or change parts of the patient’s body.

Examples of manual therapy are massage, chiropractic therapy, osteopathic manipulation (OMT), and physical therapy.  The laying on of hands in manual therapy is a powerful treatment in its own right.  When a skilled therapist uses touch to soothe tight muscles, realign spinal vertebrae, or restore proper joint balance, the improvement can be startling.

What does the science say about manual therapy?  Since I am committed to advocating and promoting evidenced based treatments, I looked into the evidence.  Manual therapy is helpful for neck and back pain, headache, recurrent otitis media in children, colic in babies, preterm delivery, Parkinson’s disease, and even heart attack patients.

What can you expect if you decide to see a chiropractor or other manual therapist?  It depends on the problem you’re addressing.  As with other practitioners it’s important to be clear from the first visit about your goals for therapy.  What’s wrong?  What do you want done about it?  How often can you expect to see the practitioner?  What will you feel?  How long will it take to see results?

It is also important to remember that manual therapy practitioners are people just like anyone else.  Most of them are good.  Some are excellent and a few are quacks.  Get recommendations from friends or family or check with the practitioner’s regulating body before making an appointment.  If your condition isn’t improving like it should, don’t hesitate to get a second opinion.

Manual therapy is an excellent addition to a holistic approach to wellness.  Give it a try and experience the healing touch!

QUESTION:  Have you seen a chiropractor or received other manual therapies?  What was your experience?

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Cherry Extract Health Benefits

What if I told you there was a supplement that improves blood pressure, cholesterol and diabetes control, decreases inflammation, reduces muscle soreness after exercise and improves markers of oxidative stress?

No, I’m not channeling Morpheus from the Matrix. There is such a supplement. Cherry extract has all these benefits and is becoming a very popular supplement.

Higher intakes of fruits and vegetables are associated with lower inflammatory markers and lower overall disease burden in humans. We are meant to eat lots of fruits and vegetables. Most of us don’t get the number of servings we need.

Credit: https://heartsandmindspurehealth.com

Fruits that contain polyphenols (red and blue pigments that are powerful antioxidants) have incredible health benefits for our bodies. Besides cherries, red, blue and purple fruits like berries and pomegranates are rich in polyphenols. If it will stain a white shirt, it probably is good for you!

I was looking for scientific support for the cherry extract claims and found a great article published in 2018 that summarizes the current research.

  • Better control of blood pressure, blood sugar and cholesterol
  • Lower markers of inflammation and oxidative stress
  • Decreased uric acid and gout attacks
  • Less pain, muscle damage and recovery time after exercise
  • Better sleep
  • Decreased anxiety and improved memory and mood

Unfortunately I haven’t been able to find any third-party quality testing guidance on cherry extract supplements. If you’ve been following the blog for awhile you know I always recommend supplements from the Shaklee Corporation, and you can click this link to read about why.

Shaklee’s PM Recovery Complex is part of the Performance line of sports products and was developed to reduce muscle damage and pain after exercise. From now until the end of July this product is on sale for a 15% reduced price. Even better, from now until 7/21 Shaklee is offering free membership with any purchase!

Shaklee membership is forever and provides a 15% discount on product purchases AND you get me! Your distributor is there to provide personalized guidance based on your health goals and preferences and help handle any problems. We get to know our Shaklee family members so as to take care of them and help them live their best and healthiest life 🙂

If you have any concerns about your blood pressure, blood sugar or cholesterol, have joint pain or other inflammatory conditions, or struggle with mood and sleep problems, you might want to give cherry extract a try. If you try it with Shaklee you’re not taking any risk – it’s guaranteed to help you!

QUESTION: Have you heard of cherry extract supplements? Have you tried them?

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Primary Care Pay For Primary Care Work

At our medical staff mid-year meeting we discussed in depth how primary care is so necessary to manage chronic illness, provide preventive services and keep health care costs down. One study showed that the more primary care doctors are available in an area, the lower the disease burden and mortality in that area.

The major barrier to providing good primary care to a group of people is that there just aren’t enough of us. Let’s face it, doctors are really smart people. If we’re smart enough to get into medical school, we’re definitely smart enough to figure out that going $300,000 into debt to pay for our education requires careful thought about our specialty choice after school.

Primary care compensation is at the bottom of the barrel as far as medical specialties go. The three medical specialties with the lowest compensation are, in order, family medicine, general pediatrics and general internal medicine. (Yes! I’m number one!!)

I’m an assistant professor in Case Western Reserve University School of Medicine’s Department of Family Medicine and Community Health. I work with students regularly and one of my goals is to show them why they should consider primary care. It’s definitely never boring!

I also tell them I completely understand why primary care is hard to sell to students who are paying $46,000 per year for their education. So how can we get more medical students to choose primary care?

The bottom line is that we need to pay primary care doctors more. We need to pay primary care doctors more, and specialty doctors less. And we need to insist that primary care level of care is provided by primary care doctors, NOT specialists.

What do I mean by that? I mean that care that CAN be provided by primary care doctors SHOULD be provided by primary care doctors. There is absolutely no reason for a patient to see a gynecologist for a routine Pap tests. I can’t get my patients in to see a gynecologist when they have an abnormal Pap test, fertility concern, excessive bleeding or pelvic pain because they are too busy doing routine Pap tests.

Endocrinologists are not needed to manage routine hypothyroidism. Patients think if they have high cholesterol they need a cardiologist, if they have migraines they need a neurologist, and if they’re depressed they need a psychiatrist.

These people ONLY need a primary care doctor. We manage ALL of this, quickly and in many cases better and in a more cost-efficient manner than the specialists.

So this is my suggestion for controlling health care costs and incentivizing medical students to see primary care as a more desirable option. First we need to increase payments to primary care doctors for the work they do. Then we can offset that spending by either refusing to pay specialists to do primary care work, or by paying them what primary care doctors make to do the same work.

If an endocrinologist gets paid what a family doctor receives to manage routine hypothyroidism, that will save money because, believe me, the endocrinologist gets paid more than I do to do that same job. If that causes endocrinologists to tell patients their family doctor can manage their thyroid, so much the better. Maybe then it won’t take me 3 months to get someone who needs a hormone workup for an unusual problem in to see the doctor they need.

With the current furor about the pay gap between women and men and between white workers and minorities, I would suggest the pay gap between primary care doctors and specialists is just as shameful. It is time for Medicare, Medicaid and private insurers to pay primary care doctors properly for the work we do. And if specialists choose to provide primary care services, they should get paid what we get paid for that.

QUESTION: Did you know there is a pay gap between primary care and specialty doctors?

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