By John Ballard
I had known and adored Jeremy's family for several years. So when the sandy-haired, good-natured 8-year-old came to see me in my clinic with abdominal pain, I bent over backward to find out why his tummy hurt. I poked and prodded; did tests of his urine, stool and blood; and took X-rays, over the course of several months. When those tests came back normal, I did more. I had trained at a top medical school and gone on to one of the best residencies in my specialty; in Jeremy, I thought I had identified a real clinical mystery. But in the end, the mystery was not a best-seller: It turned out that Jeremy's family couldn't afford to buy food.
It had never even occurred to me to ask his mother about how much food there was in the house.
In Jeremy's case, I had diagnosed "abdominal pain" when the real problem was hunger; I confused social issues with medical problems in other patients, too. I mislabeled the hopelessness of long-term unemployment as depression and the poverty that causes patients to miss pills or appointments as noncompliance. In one older patient, I mistook the inability to read for dementia. My medical training had not prepared me for this ambush of social circumstance.
Maggie Mahar opens a five-thousand-word tour de force by quoting from an op-ed by Dr. Laura Gottlieb in last year's SF Chronicle. She summarizes in her most compelling prose the many ways that diet and lifestyle impact health and outcomes, often sadly inappropriately or unrealistically diagnosed by medical professionals.
Those who take time to read this excellent commentary should let the language of Paul Ryan play in the background describing medical patients as consumers. Medical professionals addressing their problems, must be... hell, I don't know what he calls them -- medical marketers, I suppose, since the plan is to have them competing in a marketplace to see who among them can deliver the biggest medical bang for the buck. And this Walmart approach to medicine is what he advances as the answer to rising medical costs.
The reader will have to forgive me. The GOP plan is so savage and devoid of compassion I'm not able to describe it rationally. Gutting Medicare is not even the start.
The real "tip of the spear" [great term... I picked it up reading about military stuff] will be what happens when swollen state populations of Medicaid "beneficiaries" [Yes, scare quotes...as benefits shrink we need a better term... moochers, perhaps] start getting those benefits rationed by the various states.
Who knows? States might opt out of Medicaid altogether. That's one way to rid society of the problems of poverty. Make them vanish altogether.
Go read When Poverty and Unemployment Are Misdiagnosed . . . The Limits of �Medicine�
Here is a sample...
Many blame the poor for being obese, arguing that they foolishly squander money on expensive high calorie �junk food� when they could be preparing less expensive high quality foods. But as Professor Adam Drewnowski, Director of the NIH RoadMap Center for Obesity Research illustrates in the chart below �energy-dense foods cost less; nutrient-rich foods cost more.� Quite simply, high-carb, high-fat foods are much more affordable than fresh fruit, vegetables, fish and other foods that are rich in protein. And nutritious fresh food tends to be even more expensive in grocery stores in poor neighborhoods where pricey items turn over slowly and may spoil before they sell.
Meanwhile, finding a place to exercise in a ghetto can be difficult. �Gyms are too expensive for low-income families; exercising outdoors can be dangerous, and in inner cities, public schools often lack playgrounds and gymnasiums,� Schroeder observes. Public school lunches in poor neighborhoods also tend to be made of ingredients that are cheap and high in fat, carbs and calories.
Until we are willing to raise taxes to pay for school lunches that include lean, ground sirloin, fresh strawberries, and blueberry smoothies, safe outdoor playgrounds, school gymnasiums (and gym teachers), subsidized green markets, and well-lit, well-policed jogging paths�perhaps we should stop blaming the poor for being overweight.
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