#778
Date: Wed, 24 Jul 2002 09:28:07 -0400
From: Don Ardell <donardel@TAMPABAY.RR.COM>
Subject: =?iso-8859-1?Q?-_More_Doctors_Are_Not_As_Good_As_More_Wellness_Promoters!?=
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Don
--------------------------------
More Doctors Are Not As Good As More Wellness Promoters!
Don Ardell
"Cosmologists are often wrong but never in doubt." Russian physicist Lev
Landau
Evidence is mounting to support an idea seen as amazing to some but long
suspected by others, namely, that more medical care does not always equate
to better health. On the contrary, at some point—one often reached in this
country, more doctors make people sicker than they already are! “How can
this be,” you might ask. Let me tell you about it.
Ever heard of a glut of doctors? In some affluent communities, there is
an excess of medical specialists. Such an oversupply begins the explanation
of why more is not always better. It all goes back to supply and demand.
When there is an oversupply of doctors, consumers receive excessive
medications and medical attentions (i.e., surgeries and other procedures)
and have longer hospital stays (and higher bills).
While a doctor glut is much better than a doctor scarcity, there is no
need to choose from such a false dichotomy. The need is to develop a system
that more effectively spreads the medical talent to areas where the supply
of caregivers is low in relation to need. A part of the solution might also
entail figuring out ways to get our medical schools to turn out fewer
specialists and more general practitioners.
On a personal level, the solution is two-fold: 1) demand less care from
the super specialists; and 2) take fantastic good care of yourself so you
reduce the chances of needing doctors in the first place!
The most recent evidence to come along for this perspective is found in
the medical journal Health Affairs. An article in this publication
describes how a typical (can anyone be “typical?”) senior patient in one
city (Miami) spends significantly more than a similar patient living in
another city (Minneapolis). The difference? An abundance of medical
services in Miami. The older folks in Miami visited doctors and hospitals
more often and, in their final months, saw more than six times more medical
specialists and spent twice as much time in hospitals. They lived no
longer, enjoyed life no more (as far as any researchers could tell) and
probably endured more painful procedures than their cohorts in Minneapolis.
Similar differences were shown to appear even within regions, and were
explained as due to the differential clustering of physician specialists. In
other words, the more doctors, the more doctoring and attendant
costs--without any improvements in health. One doctor involved in the study
concluded, "What increased spending buys you is generally unpleasant
interventions like intensive care units and feeding tubes." The physician
head of the Boston-based Institute for Healthcare Improvement, a nonprofit
group in Boston added, "The evidence to my mind is so strong. More is not
better, and it often is very, very much worse." Yet another doctor wrote,
“The accumulating data makes you question what we're getting for this
phenomenal investment in health care." (Source: Gina Kolata, New York
Times, July 21, 2002, “Research Suggests More Health Care May Not Be
Better.”)
The same inverse relationship between doctor supply and health outcomes
has been noted at the other end of the life scale, in studies of clusters of
newborn intensive-care specialists and infant death rates. A tripling of
specialists resulted in no gains in infant mortality rates. All of this
leads me to wonder: Would we see an inverse relationship between wellness
promoters and wellness lifestyles? I don't think so. My guess, and I would
appreciate a large federal grant to check this out, is that more wellness
promoters, unlike more expensive medical specialists, would lead to better
health status, more responsible populations, happier people and increased
interest in life purposes and meanings. Don't you agree? What’s more, I
think you could be pretty sure that more wellness promoters would not be
associated with more hospital admissions, longer hospital stays or higher
hospital costs!
Maybe medical schools should produce fewer physicians and more wellness
promoters.
Be well, and always look on the bright side of life.
------------------------------
#779
Date: Wed, 24 Jul 2002 06:26:59 -0700
From: "Stephaine C. Mitchell" <stephie1605@YAHOO.COM>
Subject: Unsubcribe
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------------------------------
#780
Date: Wed, 24 Jul 2002 17:30:27 -0400
From: nfb <nfb@GWU.EDU>
Subject: CHHCS News Alerts: Congress Passes Nurse Reinvestment Act/Public
Comment Sought on Mental Health
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Congress Passes Nurse Reinvestment Act:
The House and Senate approved legislation July 22 intended to help
alleviate the shortage of nurses in this country.
http://www.healthinschools.org/2002/july23_alerts.asp
Public Comment Sought on Mental Health:
A new Commission on Mental Health named by President Bush is asking for
comment from stakeholders in the mental health community to assist the
commission in formulating a plan to improve the mental health delivery
system.
http://www.healthinschools.org/2002/july21_alerts.asp
Web Manager
The Center for Health and Health Care in Schools (CHHCS)
http://www.healthinschools.org
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#781
Date: Wed, 24 Jul 2002 20:28:57 -0400
From: "Cain, Richard" <RCain@RIC.EDU>
Subject: Determining Required Sample Sizes
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Can anyone refer me to any references (either paper or electronic) about how
to determine a sample size for a known population, using a specific test of
significance (ANOVA).
Thank you,
Rick Cain
Rhode Island College
rcain@ric.edu
------------------------------