Beauty Health for Life

Taking a survey...

Read these headlines assembled by Kaiser Health News and its easy to get the impression that Americas physicians believe everyone else is to blame for health care costs.  A cursory read of the underlying original research suggests otherwise.  Regardless of the interpretation, the results should give pause to anyone who thinks health care orm is a slam dunk.

The Disease Management Care Blog explains.

3900 practicing physicians were randomly selected from the AMA Physician Masterfile. Three physicians were outside the U.S., leaving 3897 docs who were mailed an 8-page survey. $20 was used to increase the response rate. Non-respondents were mailed a second and then a third follow-up. The ultimate response rate was 65% and, aside from a one year age difference, the respondents were quite similar to the original 3897. The survey that was used can be found here.

The results are nicely summarized in Table 3 (go to this link, click the "Tables" tab).

99%, 97%, 94% and 86% of the respondents felt hospitals/health systems, health insurers, pharma and trial lawyers had "potential" major or some responsibility, respectively, to lower health care costs.  95% and 98% also felt the same was true for physicians and patients, respectively.

The DMCB take: None of the answers were mutually exclusive. The physician-respondents thought everyone was responsible.  That being said, if you look at Table 3, youll see a spread of "major" vs. "some" responsibility.  Physicians were less likely to assign "major" responsibility to themselves (prompting the headlines above) but thats because docs believe their job is to advocate for their patients regardless of cost.

Similarly high percentages of respondents generally felt that continuity of care (98%), chronic disease care coordination (98%) and reducing fraud (93%) were important means of reducing costs. What was interesting that fewer felt the same about the electronic health records (74%), penalizing docs for readmissions (41%) or bundling payments (35%). They were also less sanguine about increasing patient "skin in the game" with higher co-pays (61%) or high deductibles (58%).

The DMCB take: More physicians believed in the cost-reducing potential of disease management/care coordination than the EHR.  While part of the respondents skepticism about the economic incentives that underlie much of health care orm is arguably motivated by self-interest, the DMCB suspects physicians also genuinely believe patient needs trump economic penalties. Regardless of the underlying thinking, the results should give pause to policymakers and politicians who believe that readmission penalties and bundled payments are a no-brainer and that docs have bought-in.

The DMCB will close with the following scenario:

Pretend you are a Vice President for Medical Affairs, or a Chief of Staff, or a health system CEO about to announce a major collaboration with a major health insurer like CMS or a Blues Plan. Youve done your homework, read the journals, listened to the experts and anticipated the future. You havent been a regular reader of the DMCB.

Youve called a meeting of the physician staff - the professionals you are counting on, caring for all those patients - and your job is go to the front of the auditorium and convince them that the success of your new venture relies on lowering health care costs with new payment arrangements that align incentives, in tandem with the launch of an electronic health record.

If the survey outlined above is even partially true, would you want to be that VP, Chief or CEO?

Once upon a time, cereal bowls and takeout menus were the most-used items in my kitchen. Then came a voluntary downsizing, followed by a layoff, followed by four months of unemployment. It is amazing how motivating a drastically-reduced income can be!

From Flickrs procsilas

Man, and woman, cannot live on bread alone. And for some of us, a pot of beans or lentils is not the protein we want to dish out after a hard days work. There are some completely vegetarian dishes in rotation chez nous, but the go-to for me and my hardworking DH is a piece of meat, a side of vegetables, and a glass of wine.

Now: how to do that in the half-hour that is my self-imposed weeknight dinner prep time? Because lets face it, I dont want to spend more time than that in the kitchen after a full days work plus commute.

When it became clear that our $1200/mo food expenditure needed to be more like $400, I got in the kitchen. I scorched a few things. I learned not to use "soup mix" in any preparation except dip. And over time, I gradually accrued some actual cooking skills and lost my fear of spices. Here are three of my big winners for the carnivore who needs some meat fast, healthy, good - and relatively cheap.

Pan-grilled Chicken Breast

Generally speaking, I consider chicken one small step up from tofu. I have never had the opportunity to try a heritage bird, so its just not very exciting for me. However, its a good source of lean protein and in my area, organic cuts are readily available, so it does come into the house occasionally.

Years ago I discovered a recipe that produced a tolerable breast. (It was from a magazine, I think, so apologies to whoever wrote it, but I just dont remember.) I ended up changing it anyway, because it was a baked recipe and it just took too long. My oven is 30+ years old and takes twenty minutes to heat; baking for another 40 on top of that was not working for me.

From Flickrs larryjh1234

So I decided to try and see if I could adapt the recipe to my trusty Calphalon grill pan. And lo, it worked. Here it is. Please note, in my home, life is too short to buy chicken breast bone-in. Your mileage may vary.

Ingredients: two boneless, skinless chicken breasts totaling about one pound (and about $7 max). Bread crumbs or panko. Olive oil. Spices.

Prep: Remove the chicken from packaging, rinse, and pat dry. Rinse off their styrofoam tray as well and dry it. (If the chicken did not come in a tray, just use a plate.) Put the chicken back on the tray, pour a little olive oil on top and rub it in; turn the breasts over and repeat the treatment. While doing this, preheat the pan to medium.

Cooking: right before adding the chicken to the pan, lightly coat both sides with bread crumbs and seasoning. I apply both straight from their containers, and my seasonings are typically garlic powder (not salt) and paprika. Then lay the breasts in the pan and cook for 7-8 minutes. (Use a paper towel to brush off your plate into the trash - crumbs and oil really shouldnt go down the drain.) Turn the breasts over, reduce the heat to medium-low, place a large lid loosely over the pan to hold some of the steam, and cook for another 7-8 minutes. Note: this is not about getting a crispy coating on the chicken, its about getting moist chicken fast without using a gallon of oil!

After 15-16 minutes total cooking time, I usually cut the breasts lengthwise to check for doneness, as medium-rare chicken is not too appetizing, and my goal with weeknight food is to get it on the table expeditiously, not prepare a magazine photo. (Which explains why I have no photos.) Cook a little longer, under the lid, if necessary.

After the turn, prepare your side - in my case, nearly always a salad or a package of frozen veg. This preparation makes four servings.

The pairing: I like a bright red wine with chicken, like Sangiovese or Garnacha (Grenache). On the white side of the spectrum, this holds up well to chardonnay, verdejo, or pinot grigio.

Pineapple Pork Pot Roast

From Fresh Direct

"Pot Roast" is traditionally beef in the U.S., but a lower-fat, less-expensive alternative is pork. The secret is to not try to make it 100% non-fat. If you go for very lean cuts of meat in the slow cooker, you will sacrifice flavor and mouth feel on the altar of "nutrition." However, its my firm belief, based on years of study, that a moderate amount of fat from animals is not only not going to kill you - its good for you. This stuff metabolizes usefully: the body can really put it to work. Obviously, Im not recommending sitting down to a tasty bowl of lard, but letting your meat cook with its fat is not necessarily a bad thing.

With that in mind, and with the memory of a rather dry pork loin haunting me, I went looking for a piece of nice fat pig. I took home a four-pound pork shoulder roast, with about a one-centimeter layer of fat on its base (well say, a strip about three inches by eight), at a cost of less than three dollars a pound. Pork shoulder does have the fat and it does have a chunk of bone in it. After slow cooking, the net serviceable result was about 2.5 lbs - easily enough to feed eight.

This preparation cooks during the day, and if you like "Hawaiian" pizza, you will Love. It. For quick and easy assembly, peel the onion and garlic the night before, wrap in a damp paper towel, and leave in the rigerator till morning.

Ingredients: 1 c. crushed pineapple, in juice. 1 6-oz can of tomato paste. 1 large onion, peeled and cut in eighths. 8 to 10 cloves of garlic, peeled, smashed, and roughly chopped (or not. Chopped, they will dissolve entirely, so if you like a bite of garlic, use more and dont chop them). Spices to taste: I used red curry, paprika, nutmeg, and chipotle - about 1/2 teaspoon of the first two, and 1/4 tsp. of nutmeg and chipotle. Plus, of course, the pig.

From Flickrs norwichnuts

How to prepare: first, get out the slow cooker and turn it to High. Combine pineapple, tomato paste, garlic, and spices in the bottom. Place the pork shoulder in the cooker and slowly roll it around in the sauce mixture. Then add the chunks of onion, put on the lid, and go get ready for work. Right before you leave, turn the cooker down to Low.

When you get home, roll the pig around a little to make sure the onions get thoroughly mixed into the sauce. The pork will probably fall apart at this point. Pick out the bone and let the pot roast continue to cook, with the lid off, until you are ready to eat. I served this with absolutely nothing else, but rice or quinoa or even couscous can be easily (and more or less negligently) prepared while you are decompressing.

The pairing: any chilled rose or sparkling wine, gewurtztraminer, or riesling.

Broiled Beef Tri-Tip

Tri-tip is most often seen at barbecues and in a mushroom sauce at Sizzler. But it is also a great steak substitute. I picked up a pound of tri-tip roast at my grocery store, on a night when they had no acceptable tenderloin, for less than ten dollars with my loyalty card - the same price as a pair of wimpy ribeyes that weighed in at a mere .6 pounds. This particular cut was about two inches thick at its deepest point, which dictated the cooking time. Less thick = less time.

From Flickrs arnold | inuyaki

How to cook it: remove your pound of tri-tip from grocers packaging and place it on your broiler pan. Give it a generous dose of your seasoning of choice, on both sides. (This seasoning should not include salt! Try a mix of black pepper, paprika, and garlic powder. If you want salt after you taste it, go ahead.) Heat broiler for five to ten minutes. Put the whole tri-tip under the broiler for ten minutes. Then turn it over, and give it another eight to ten minutes (for medium-rare. If you require your steak well-done, you shouldnt bother eating steak).

Now take a look at it. If the edges are slightly carbonized, the top is lightly browned, and the meat springs back under your finger (presuming a silicone glove, here), its done. If it looks mostly gray and feels spongy, give it two or three more minutes. When its done, place the hot broiler pan on your stovetop and let the meat rest for at least five minutes. Then move it to a board and carve it into centimeter-thick slices. Because a tri-tip roast doesnt contain much fat or any bones, this will provide four servings of just under four ounces each.

A note on the nutritional value of meat. The oft-recommended four-ounce serving contains between 28 and 32 grams of protein. It just so happens that 30 grams of protein is the maximum that the average person can metabolize at one sitting. Anything more than that is excreted, or converted to glycogen (carbohydrate) and stored in the muscles for future short-term energy demands. So this is really all the meat you need in a given meal.

But this is a small amount of food, so you will want some additional ... something ... on your plate. I recommend a separate bowl, actually, with a nice big green salad in it. Or you could put the slices of tri-tip right on top of that salad. Or throw a package of frozen veg in the microwave after turning the roast.

The pairing: your hearty red wine of choice. I am fond of blended reds under $8.

If you are cooking for two, these three low-salt preparations will see you through 6-7 days with cooking only necessary on three days, for a meat cost of less than $30. If you try em and like em, Id love to hear about it!

~~~

If you like this post, youll love:

• Angus Anguish: Is Angus Beef Worth the Money?
• Newsflash! Scientists Getting Closer to Lab-Grown Meat
• Vegetarian Meal Planning for Meat Eaters

Vitamin D-deficient older individuals are more likely to struggle with everyday tasks such as dressing or climbing stairs, according to a recent study accepted for publication in The Endocrine Societys Journal of Clinical Endocrinology & Metabolism (JCEM).

Scientists estimate many as 90 percent of older individuals are vitamin D deficient. The vitamin – typically absorbed from sunlight or on a supplementary basis through diet – plays a key role in bone and muscle health. Vitamin D deficiency can lead to a decline in bone density, muscle weakness, osteoporosis or broken bones.

"Seniors who have low levels of vitamin D are more likely to have mobility limitations and to see their physical functioning decline over time," said the studys lead author, Evelien Sohl, MSc, of VU University Medical Center in Amsterdam, the Netherlands. "Older individuals with these limitations are more likely to be admitted to nursing homes and face a higher risk of mortality."

Using data from an ongoing Dutch cohort study (The Longitudinal Aging Study Amsterdam), the researchers examined among two groups – 762 people between the ages of 65 and 88, and 597 people between the ages of 55 and 65 – over the course of six years. Using blood test results, the subjects were split into groups with the highest, moderate and lowest vitamin D levels. To assess mobility limitations, participants were asked about their ability to perform routine tasks, including sitting down and standing up from a chair or walking outside for 5 minutes without resting.

Among the older group of participants, people with the lowest vitamin D levels were 1.7 times more likely to have at least one functional limitation compared to those with the highest vitamin D levels. In the younger cohort, individuals with low vitamin D levels were twice as likely to have at least one physical limitation.

While the majority of the people in the older cohorts top two vitamin D groups did not report any physical limitations, 70 percent of the people with the lowest vitamin D levels had at least one limitation.

In addition, the study found vitamin D-deficient individuals were more likely to develop additional limitations over time. The older cohort reported more mobility issues after three years, while the younger cohort developed additional limitations over the course of six years.

"The findings indicate low vitamin D levels in older individuals may contribute to the declining ability to perform daily activities and live independently," Sohl said. "Vitamin D supplementation could provide a way to prevent physical decline, but the idea needs to be explored further with additional studies."