Thursday, November 26, 2015         

Health and Money

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During a recent medical mission to Asia, I held several clinics for a small, extremely remote village of ethnic Tibetans living at high altitude.

Keen awareness of environmental challenges faced by our blue planet must be combined with creative and practical solutions that bring prosperity. The greatest obstacle to sustainability is immediate self-interest.

In conjunction with rapidly growing epidemics in obesity and insulin-resistant diabetes, obstructive sleep apnea, or OSA, is also very much on the rise.

During a recent trip to New Zealand, I had the opportunity to interact with the indigenous Maori culture. The people call their country Aotearoa.

By the time a person begins to feel ill from high blood pressure, blood sugar or cholesterol, often, the damage has already been done. Even if we feel great, to ensure good health, it is essential that we receive preventive screening.

Not many years ago, patients could expect their primary care doctor to care for them at the doctor's office and, when necessary, admit them to the hospital.

The collective conscience of our nation determined that together we must find a way to provide health care for the tens of millions of Americans who suffer without it.

In the pursuit of good economic health, the majority of us first do our best in school, and then look for a good job and, if our health and luck hold up, work hard until retirement age. Along the way we purchase a home if we can.

When thinking about pharmaceuticals, modern society tends to focus on the front end. We seek out the best medications to manage our health conditions. We concern ourselves with how much the co-pay will cost us and wonder whether the side effects are worth the therapeutic benefit.

A professor of mine once announced that some of the lowest vaccination rates were for children whose parents are busy executives in New York City. These families had good insurance and great access to care, but the parents had no time to take their kids to the doctor.

Integrative medicine is about bringing together the best of modern medicine, traditional healing arts and manual therapies.

During my medical training, a trauma patient came in by air ambulance from the island of Hawaii. A successful businessman, he had been riding his motorcycle to the office. An oncoming truck crossed the center line and hit him head-on.

Some years ago a director of one of the largest auto insurance carriers, a graduate of our executive M.B.A. program at the University of Hawaii, gave a lecture about successful business practices.

After working 17 years as a stock clerk in a warehouse on Dillingham Boulevard, Keoni felt a sharp, shooting pain in his back as he lifted a 50-pound box. Not wanting to let down his co-workers, he kept working.

This month, HMSA launched the Patient Centered Medical Home (PCMH), a new initiative affecting health care delivery for Hawaii's clients and providers. HMSA's health maintenance organization patients are now being assigned to clinics that have agreed to participate.

My father once called from his clinic at the state Department of Mental Health in California and complained, "I'm a physician, and I can't make any sense out of the three choices I'm given for health insurance." We laughed.

Among the most underserved people in Hawaii are the aged, blind and disabled with low or no income. Historically, the Department of Human Services has reimbursed health providers to care for these patients on a direct, fee-for-service basis, albeit at a very low rate.

Now that I'm training as a candidate medical officer for the proposed worldwide voyage aboard the Polynesian Voyaging Society's canoe Hoku­le‘a, the dark starry nights, brisk winds and rough seas have begun to feel like home.

With a renewed sense of urgency, President Barack Obama and Republicans proposed competing plans this week to cut the budget deficit. Both agree on the need to cut Medicare spending.

Primary care clinics throughout Hawaii are filled with people complaining of itchy, stuffy noses, red and watery eyes, scratchy throats, chronic coughs from post-nasal drip and asthma. Meanwhile, annual sales of allergy medications have skyrocketed.

Libya threatens to become a failed state regardless of how long Moammar Ga­dhafi remains in power. Western allies are in disarray about their objectives.

The hearts and minds of people in Hawaii empathize with the profound suffering of our neighbors in Japan.

As a teenager, I recall my father's passion for his work as a psychiatrist. He was deeply intrigued by the complexity of the human mind and body and pondered the relationship between mood and medication.

As my grandmother drew her final breath last Sunday, her face was peaceful and her body so relaxed. I had never witnessed someone die of nothing. She had no terminal illness.

While sailing on the Hokulea as a candidate medical officer for the worldwide voyage, I have observed that seasickness among crewmembers is the greatest cause of missed watches.

I had an opportunity to experience old India during the late '70s while conducting research and fieldwork in medical anthropology. The culture seemed timeless and colorfully diverse but a world apart from modern society.

The tears of an Egyptian man went viral this week, ushering in a new era in the global community. Wael Ghonim, a Google executive who had been held and blindfolded by Egyptian security for 12 days, cried out for his nation's freedom.

Patient concerns have not been quelled by the recent results from a broader sampling of Oahu's drinking water. The state Department of Health came out again to proclaim Oahu's drinking water safe but also promised to study levels of hexavalent chromium (chromium 6) at all 100 pumping stations islandwide.

"A chicken in every pot and a car in every garage." This was Herbert Hoover's campaign promise when he ran for president in 1928. He claimed that every American would be prosperous under a Hoover presidency.

Mark Twain once said that "no one's life, liberty or property is safe when the legislature is in session." At the opening ceremony of the state Senate this week, one had a greater sense of optimism. Present were a host of current and past governors, our two U.S. senators, the state attorney general and top entertainers including the delightful Kamehameha choir and our own Willie K. Those present were reminded that we do live in a functioning democracy, however imperfect.

Since Neanderthal times, families rejoiced in the birth of young, healthy children to support and perpetuate the tribe. Until the industrial age an extended family was the norm, and "social security" meant productive and faithful children and grandchildren.

Pundits are all over the board with the bears and bulls in a dead heat. The markets were up in 2010, and so far in 2011 they continue to stay up with positive economic news of the day. Still, consensus is that the fundamentals remain worrisome.

This year, make your New Year's resolutions enjoyable and doable. Too often, the goals we set are overly ambitious and the results are short-lived.

How often have you found yourself fighting to stay awake during an afternoon meeting or had your curiosity piqued by those ads for liquid energy supplements that promise to keep you awake? Americans are sleep-deprived.

Female hedge fund managers enjoyed nearly double the returns of their male counterparts during the past 10 years, according to Hedge Fund Research.

The top of the world seems a different world altogether. This week my son and I returned from the Himalayas where we provided medical services for seven days in the Nepalese village of Sama. To get there we had to take a kerosene-fueled helicopter from Katmandu.

In 1976, at an American Legion convention in Philadelphia, a particularly deadly strain of bacteria caused the tragic deaths of 29 participating veterans. It was later discovered that the bacteria, now named Legionella Pneumophila, had spread via the ducts in the hotel's air-conditioning system.

Hawaii still has a golden opportunity to become the global leader in sustainable, health and wellness tourism. To do so successfully, we must bridge the resources of our visitor industry with existing government and private efforts to make Hawaii a better place and develop its green economy.

My 13-year-old son goes to the living room, jumps on his Sony PlayStation and enjoys an interactive battle of "Modern Warfare" simultaneously with cousins both in Ireland and Southern California, and classmates here on Oahu.

The Tibetans of Sama village must trek five or six days to reach any modern health care. Nestled in the Himalayas, still in Nepal but near the Tibetan border, the village is so remote that mortality rates for appendicitis and childbirth are alarmingly high.

I first encountered a patient with breast cancer while working as a medical student in a free clinic in Los Angeles. She had never been screened. When I told her that we needed to schedule a biopsy, she protested, explaining that as a single mother of three, if she lost any work her children would go hungry.

After expanding by another $194 billion last quarter, China's foreign exchange reserves rose to a record $2.65 trillion. This reflects a recent influx of "hot money" with expectations of a stronger yuan and increased asset prices.

Apple pulled off the ultimate IT coup. On the heels of the iTunes revolution, which put iPods in our ears and a spring in our step, we got the iPhone, actually a mobile computer that gives us Face Time.

Traditional Chinese value food still teeming with life. In contrast, public health education has taught Americans that food is fuel and to consume specific amounts of recommended nutrients. Fast food changed all that.

This summer, my son and I flew to Alaska to fish for salmon. Alaskans are always welcoming to Hawaii watermen as both share a passion for the pristine beauty and bounty of Mother Earth's rivers and oceans. Salmon are incredible in the water, and the color of the flesh is amazing.

Several readers commented on last week's column. Many noted that although free-market forces can cause us to forget the environment and think "what's in it for me, now," all other systems pose greater problems. Agreed.

When my grandfather studied pharmacy at Columbia in the 1930s, pharmacists were still called "chemists" and the pharmaceutical industry was in its formative stages.

Ben Bernanke, chairman of the Federal Reserve Board and arguably the most powerful person in the monetary world, recently gave a speech at the University of South Carolina. He cautioned the student body to guard against choosing a career simply because it would be lucrative. Instead, he encouraged those in the audience to seek a livelihood that for each individual was the path of heart.

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