ADHD: Proximate vs. Ultimate

Ram across this Psychology Today article in my Internet travels.  All of us, I am sure, have some connection to a kid who has behavioral issues, and who has been formally diagnosed or is thought to have ADHD.

Turns out that there seems to be a strong cultural component:

In the United States, at least 9 percent of school-aged children have been diagnosed with ADHD, and are taking pharmaceutical medications. In France, the percentage of kids diagnosed and medicated for ADHD is less than .5 percent. How has the epidemic of ADHD—firmly established in the U.S.—almost completely passed over children in France?

Is ADHD a biological-neurological disorder? Surprisingly, the answer to this question depends on whether you live in France or in the U.S. In the United States, child psychiatrists consider ADHD to be a biological disorder with biological causes. The preferred treatment is also biological—psycho stimulant medications such as Ritalin and Adderall.

French child psychiatrists, on the other hand, view ADHD as a medical condition that has psycho-social and situational causes. Instead of treating children's focusing and behavioral problems with drugs, French doctors prefer to look for the underlying issue that is causing the child distress—not in the child's brain but in the child's social context. They then choose to treat the underlying social context problem with psychotherapy or family counseling. This is a very different way of seeing things from the American tendency to attribute all symptoms to a biological dysfunction such as a chemical imbalance in the child's brain.

As in all things, we need to look for the ultimate cause, not the proximate cause.  In other words, my father, for example, died of congestive heart failure.  That's what his death certificate says.  But that was just the proximate cause...the ultimate cause was a lifetime of poor habits and poor choices.

I'm not a doctor, so the situation is obviously complex and multi-layered.  But it sure seems that with ADHD, drug treatments would deal only with suppressing the proximate undesirable behaviors, while ignoring the ultimate psycho-social causes.

This is Why the Nation Needs Universal Health Care

Somehow the simple laws of cause and effect get lost in all the rhetoric.

This from Kurt Eichenwald a couple weeks back at Vanity Fair magazine:

The first thing to understand is that when people don’t have insurance, it hurts other people with insurance. In fact, the uninsured affect the finances, quality of care, and availability of medical assistance to every person in a community, regardless of their insurance status.

This is the fundamental issue that too many people do not understand. There seems to be this belief among some that those who are uninsured simply go off and die somewhere, thus having no impact on the medical-care-delivery system in the United States. But the opposite is true—the uninsured have some of the most dramatic effects of any group on our nation’s health-care system.

Here’s why: they seek out care, but usually when their once easily treated conditions have blossomed into a serious illness. Because private doctors do not take them, and because free clinics are not readily available, the uninsured seek their care in emergency rooms.

The rest of the article is full of great analysis and discussion of medical economics and is well worth a read.  But I wanted to highlight this fact specifically.

 

Also ran across another blog post, this one relating a personal experience with cancer, that deals with this issue:

 

Obamacare requires insurance companies for the first time to cover everyone, regardless of any preexisting conditions. There's no more disqualifying condition than cancer; without Obamacare, I would now almost certainly be uninsurable if someday in the future I try to get insurance on the individual market. And we know what happens to people without health insurance in the United States: they die.

 

 

  

On the Health Care Front...and Ultrarunning

Via Rising Hegemon, I see where the National Academy of Sciences has kinda dissed the notion that Americans have the best health care that money can buy:

America Is Number One (At Obesity, STDs and Dying Young)...among wealthy, developed countries, that is. According to a study from the National Academy of Sciences, Americans are "far" unhealthier than their counterparts in Canada, Australia, Japan, Britain, France, Portugal, Italy and Germany and eight other countries. But just how bad is it?

Well, Americans ranked last (or first, depending on how you look at it) in infant mortality, injury and homicide rates, teen pregnancy and sexually transmitted diseases, AIDS, drug abuse, obesity and diabetes, heart disease, lung disease, and disabilities. But don't worry, we managed all this while spending $8,600 a year per person on healthcare, which is more than twice as much Britain, France and Sweden, "even with their universal healthcare systems."
 

It is always amazing to me that the health care debate came from such ignorance, I suppose it shouldn't. But all those folks under 65 complaining about their taxes, don't seem to have any desire to notice that their health insurance premiums are disgusting. Maybe, just maybe, in return for paying say $3,000 a year more in taxes, you pay $5,000 less a year in health insurance premiums AND get better care.
 

The problem, of course, is that our health care model is flawed.  See, first off we have a for-profit model, in which the profits of the providers are higher if they provide customers less (= poorer) service.  Their "natural" inclination for their shareholders is to keep costs down, maximize profits, etc. 

Part of that cost control necessarily involves deny, deny, deny.  The bride and I have 5 college degrees between us, yet whenever we read from our health care plan coverage manual, we come away with a glazed look in our eyes of incomprehension.  It literally boggles the mind.

Then we have this vast middleman layer--the Blue Crosses of the world--that shuffle the papers associated with this admin support. To the tune of 20% overhead, while the admin costs of Medicare are amazingly low--around 2%.

Which is why many folks like me think Obamacare should just have said "Medicare for All" and we'd all be SO much better off.

And the mandatory connection to Ultrarunning?  I tend to think that my active lifestyle tends to confer immunity to cardiovascular disease.  Truth be told, I also suspect I'm less likely to to die of cancer.

But guess what?  My probability of dying is still 100%.  As is yours.

So even if my heart pumps well and faithfully, another malady will stop me dead in my tracks, if you'll excuse the phrase.  My only hope is that my Ultra lifestyle will add years to my life...and not "junk" years added to the end, but quality years added NOW to the middle.

Note to self: do some investigation of life expectancy for runners to try to get a handle on this important question.  So many questions, so little time....

 

 

Health Care, In Simple Terms...and Ultrarunning

From a great post by Paul Waldman, on 4 April 2012:

One day, we'll realize who the villains are in today's debate about health care.

Someday, all Americans will have access to health care, just as all people in Germany and France and Japan and Sweden and every other advanced industrialized democracy do today. It may take a decade or two after the implementation of the Affordable Care Act in 2014 (if it survives the whims of Anthony Kennedy) to fill in the gaps the law leaves behind, or it may take decades beyond that. But it will surely happen eventually. And at some point after it does, we'll come to a consensus as a society that it was a collective moral failure that we allowed things to be otherwise for so long.

--SNIP--

And today, there are upstanding Republicans, including somewhere between three and five of the members of the Supreme Court, who believe it is unconscionable for the government to try to get everyone health insurance. Just as the defenders of child labor would never have dreamed of putting their own little children to work in a factory, all those crying about the tyranny of the individual mandate already have their own insurance, and so will have their "freedom" infringed not a whit by the requirement. What they find so abhorrent, in truth, is the very idea of universal health security. What offends them so is the idea that everyone, even those who have proven their defective character by not being rich, could have full access to health care.

What we have here is a clash of perspectives. One says that getting help when you're sick or injured is a right that should belong to all, like an education. There are countries where there are no public schools, and if you can't afford the tuition you'll remain illiterate and bereft of any opportunity to improve your lot. But here in America as in most places, we don't demand payment at the schoolhouse door, because education is so essential to human flourishing that we believe it should be denied to no one. Everyone may not be able to go to the fanciest prep school, but everyone gets to go to school. The other perspective says that health care is completely a privilege of wealth. If you can afford it you can get it, and if you can't then that's too damn bad. And should the government try to make a basic level of health coverage a universal right then it must be fought with unimaginable fury and resourcefulness.

If you are an Ultrarunner--or just an ordinary human being--I just don't see how universal health care is analogous to Satan's spawn.  It's just what's right.

   

Obama Care and Conservatives

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Health Care...and Ultrarunning

Via Canadian Ian Welsh on 12 Aug 2011, Hard and Complicated Aren't Synonyms, where he brings to bear something sorely needed in the health care discussion: empirical facts.

See, stopping smoking isn't complicated. All you have to do is. not smoke. But it's hard as dickens, which is why so many people fail to do it.

Now a lot of US problems are like this and health care is one of them. The US spends about 16% of its GDP on healthcare, clocking in at 2 trillion. Changing to a single payor universal system will slash about a third of that. Savings: about 650 billion dollars. Everyone knows this who isn't paid not to know it - every other country in the world that has universal health care pays about a 1/3 or less than the US and when Canada switched, its costs dropped by a third.

This isn't complicated. But it is hard. It's hard for the same reason that quitting smoking is hard, or that losing weight is hard - that 650 billion dollars extra is something the US is addicted to. That money pays for jobs and profits at insurers, drug companies and to hospitals and to some doctors.

That's a lot of money, and the people who are currently making a living, or a huge profit from it, don't want to lose it. So they'll fight tooth and nail to not end the gravy train. The 20% to 30% administrative margins in health insurance companies as opposed to the 2% to 3% margins in Medicare are money that someone is getting. The price is that 50% of bankruptcies are caused by medical costs; that 43 million Americans are unemployed and that American companies like Ford and GM have huge medical costs that companies like Toyota don't have.

Ian's entire post is worth a read.

Oh, and the link to Ultrarunning?  Well, yesterday I had my annual physical and was pronounced fit.  While I realize that could--literally--change in a heartbeat, I already knew I was fit.  And I have no doubt that my fitness is due to the vice of Ultrarunning.

 

More Health Care...Plus Political Tactics

This is an article about health care reform from the blog Balloon Juice, and how the Republicans want to repeal the Affordable Care Act (AKA Obamacare).  This goes along with my post of Wed on health care.

Coming at the end is a priceless quote about tactics. This is the Republican message:

American health care is the best in the world and doesn't need fixing. If it does need fixing, it just needs the power of the free market. If it needs something beyond the power of the free market, it needs something other than what Democrats are proposing. And if what Democrats are proposing gets passed, then it's unconstitutional.

There is no issue you can't do this with.

I'm speechless at how perfectly the writer nails it right on the head.  This tactic works, and we've all seen it in operation.  And during the "debate," it all sounds so reasonable, so practical, so sensible, that we almost lose sight of the original basis for the discussion.  Namely, that tens of millions of Americans are without health care (some 47 million, according to the U.S. Census, and that was in 2006).

We can do better than this.

Medicaid Belt Tightening

Time to get political again, I guess.

From Diane at Cab Drollery on 4 Feb 2011. As a government employee, I have good health care. But I shudder to think if I did not, and tens of millions of Americans are in that particular boat. Heading up that particular creek, and they just lost their paddles.


(Diane's post links to this LA Times article )

Helpful Advice

Yeah, right, this is going to help states out when it comes to Medicaid expenses.

On Thursday, in a move that reflected both the changing political landscape and the still-troubled economy, Health and Human Services Secretary Kathleen Sebelius sent a letter to governors suggesting a range of cuts, including removal of some people from the program. ...

The Obama administration is suggesting that governors could cut optional health benefits that many Medicaid programs offer, such as physical therapy, dental care, eyeglasses and even some prescription drugs.

States could also require beneficiaries to pay more for some of these services.

After all, the people using Medicaid (MediCal in California) are poor. They probably don't vote. And besides, they are entitled to the same things that rich people are, the best medical care money can buy. If they don't have the money, well, they get what they deserve, which ain't much.

Besides, glasses, fillings for cavities, physical therapy after injuries, medicine, these are just frills, luxuries, if you will. Surely they can eat cake without the icing.

It is to die for.

The richest country on the planet and we cannot take care of the least of our brethren.  This is not a priority for the Congress because--literally--they are all millionaires.