The
information in this column is intended for informational
purposes only, and does not constitute medical advice or
recommendations by the author. Please consult with your
physician before making any lifestyle or medication changes, or if you
have any other concerns regarding your health.
UNIVERSAL
HEALTHCARE INSURANCE
STUDY
As we continue to
struggle with the explosive increase in healthcare-associated costs
here in the
United States, all the while more than an estimated 43 million
Americans have
no health insurance overage at all (and many millions more have grossly
inadequate coverage), there is a growing consensus that some sort of
universal
healthcare insurance system needs to be implemented.
As I have discussed in previous columns, the
two enormous governmental healthcare entitlement programs (Medicare and
Medicaid) currently in place simply cannot be sustained indefinitely if
the
costs of these programs continue to rise at projected rates. But there continues to be
intense debate,
among healthcare policy experts and politicians, regarding the best
approach to
implementing a universal healthcare insurance system in the United States.
A
new report in
the Annals of Internal Medicine
provides a very useful glimpse of the results obtained, in Taiwan,
after the
1995 implementation of a national universal health insurance system in
that
island nation (or, if you adhere to the Beijing’s perspective, a
province of
China). Healthcare
coverage in Taiwan
increased dramatically, from 57 percent prior to the introduction of
this
national healthcare insurance system, to 98 percent of the population
after its
implementation. Looking
at a decade’s
worth of public health statistics following the activation of this
national
insurance system, financed by payroll taxes, government subsidies and
individual
premiums, this research study specifically evaluated the impact of
universal
healthcare insurance on life expectancy and preexisting healthcare
disparities
throughout Taiwan.
The
death rates
for all 358 townships in Taiwan,
with a total population of approximately 23 million, were analyzed,
both before
implementation of universal healthcare insurance and 10 years after
implementation. Modest
decreases in
deaths due to cardiovascular disease, infectious diseases, accidents
and other
illnesses were observed after implementation of universal healthcare
coverage. Significantly,
the townships
where death rates were highest, historically, appeared to benefit the
most
after universal healthcare coverage became available.
(Unfortunately, and unexpectedly, death rates
due to cancer actually increased
somewhat in these same townships following the introduction of
universal
healthcare coverage.) Although
overall
utilization of healthcare services increased after the implementation
of
universal healthcare insurance, the overall cost of healthcare,
measured as a
fraction of gross domestic product, remained essentially the same,
suggesting
that increased healthcare services were delivered with, perhaps,
greater
efficiency after universal coverage became available.
The
authors note
that while improvements in preexisting healthcare disparities among
poorer
regions of the country were observed after universal healthcare
coverage was
introduced in Taiwan,
the magnitude of this improvement was relatively small.
They conclude their analysis by recommending
that greater resources and efforts be invested in disease prevention
programs,
with more emphasis on lifestyle modification in particular, as a means
of
achieving more meaningful reductions in chronic illness and death
rates,
especially in regions where the rates of chronic disease and death are
still very
high.
I
believe that
the findings of this research contain some cautionary findings for us
here in
the United States as we struggle to find elusive answers to some very
difficult
healthcare questions and challenges that should have been addressed by
policymakers long ago. In
my forthcoming
book, A Cancer Prevention & Survival
Guide for the Human Race, the overarching theme is our
capability, today,
to eliminate more than two-thirds of all cancer deaths (as well as
deaths due
to major non-cancer diseases as well), simply through prudent lifestyle
modifications. As
the saying goes, an
ounce of prevention is worth [at least] a pound of cure. As our country searches
for the right
combination of improved access to affordable healthcare and a stronger
preventive medicine culture, we should keep in mind that a more
aggressive
promotion of healthy lifestyles are likely to provide the greatest
pay-off in
terms of disease and death reduction, on the one hand, and reduced
healthcare
costs on the other hand.
GLUCOSAMINE
&
ARTHRITIS
As we age, the
cartilage in our joints becomes progressively thinner and more
desiccated,
reducing the ability of our cartilage to absorb shocks and to resist
injury. Cumulative
repetitive injuries
to these natural cushions in our joints also results in progressive
deterioration of the cartilage in our joints, leading to joint
stiffness, pain
and, sometimes, joint swelling.
Virtually all of us will develop these classic signs and
symptoms of
osteoarthritis as we grow older, which makes this condition a very
common
source of discomfort and disability in our aging population.
Glucosamine
is a carbohydrate
(sugar) molecule that plays an important role in the structure and
function of
the cartilage which lines and protects our joints.
For years, glucosamine supplements have been
touted as an effective treatment for osteoarthritis.
Indeed,
there have been many clinical studies
that have purported to prove that glucosamine supplements reduce the
symptoms
of arthritis, especially in the hip and knee joints.
Unfortunately, most of these studies have
been based on small numbers of patients; and on patient questionnaires,
which
are notoriously subjective in terms of the quality of the data
collected. However,
a tiny handful of recent
double-blinded prospective randomized trials (the most scientifically
valid way
of performing clinical research), using placebo pills versus
glucosamine, have
increasingly called into question the benefit, if any, of glucosamine
sulfate
supplements in patients suffering from osteoarthritis, including a new
study
just published in the Annals of Internal
Medicine.
In
this Dutch
study, a total of 222 patients with osteoarthritis of the hip were
randomized
into two groups. One
group received
1,500 milligrams of glucosamine sulfate per day, while the other group
received
placebo pills (sugar pills that appeared identical to the glucosamine
pills). The
patients in this study received these
pills for a period of 2 years, and were repeatedly evaluated during
this period
with x-rays of their affected joints, and with previously validated
pain and
function survey tests. In
addition to
looking for x-ray evidence of improvement in joint narrowing (as the
protective
cushion of cartilage in the joint is lost, the gap between adjacent
bones, as
seen on x-ray, becomes smaller), the researchers assessed these study
volunteers for evidence of decreased joint pain and stiffness, and for
improved
function.
As
was the case
with another recent prospective randomized clinical trial, the results
for this
trial were very disappointing for those who had hoped to find some
benefit from
glucosamine supplementation. In
a nutshell,
no differences in any of the outcomes studied were found between the
two groups
of patients. Except
for a possible and
very modest benefit in a tiny sub-group of patients who had already
undergone
hip replacement surgery, absolutely no improvements in joint symptoms
or functions
were detected in the group of patients that had been randomized to
receive
glucosamine, and no improvements in joint space narrowing were seen on
x-rays,
even after 2 years of glucosamine supplementation.
This
is the
second recent randomized prospective study of glucosamine that has
found no
clinically apparent benefit in patients with osteoarthritis who take
this
over-the-counter dietary supplement.
Indeed, for many years, I myself took glucosamine
supplements for
painful joints, based upon the early, and admittedly weak, clinical
data
available. As I
struggled to swallow the
huge, gritty “triple strength” glucosamine and chondroitin tablets
twice a day,
I wanted to believe that my aching joints were somehow benefiting from
this
supplement. However,
after the recent
publication of another prospective randomized trial which, like this
one,
revealed no apparent benefit from glucosamine, I finally stopped taking
these
expensive supplements altogether.
Honestly, I have not noticed any difference in my joint
pain and
stiffness in the 12 months or so since I stopped taking these
supplements. (Which
reminds me, when I find the time, a
new book project of mine will be an evidence-based review of so-called
“nutritional” or “dietary” supplements, a multi-billion dollar industry
that
is, essentially, almost completely unregulated by the FDA and other
consumer
safety government agencies….)
Disclaimer:
As always, my advice to readers is to seek the advice of your physician
before making any significant changes in
medications, diet, or level of physical activity.
