Jonathan Mendick interviewed me earlier this week about Game Plan Academy (GPA).
His article made the Front Page today:
He did a nice job.
Wednesday, February 25, 2009
Tuesday, February 24, 2009
Maximizing ROI on Heart Health Prevention & Intervention
If I were a physicist studying the fluid dynamics of vessels in the heart, I would think twice about blaming fat as the culprit for heart disease. Instead, I would probably entertain a thought experiment like this: First, upon every other surface that I encounter, within every other mechanical system that I study, lipids and fat-like substances lubricate vessels, joints, and junctions. Fats, at some level, must support fluid flow, not oppose it, would be the tentative conclusion I would draw. Wouldn't high sugar content in the blood increase the viscosity of the fluid flowing through the coronary arteries? If I were a physicist studying fluid flow, most everything I had heard in the mainstream sects about heart health would not make much sense.
If I were a physicist, I would be confused.
If only Richard Feynman were still here to lead the contrarian investigations needed ...
Interestingly, a few years ago, my cardiovascular physiology professor repeatedly joked: "Every time I go to my cardiologist, I tell him that I have been eating plenty of high-fat foods so that I can make sure my arteries are nice and slippery in order to prevent a heart attack!" Of course, in response, the cardiologist, trained in the low-fat, high-carbohydrate 'Food Pyramid' platonic nutrition model mold, simply laughed at my insightful cardiovascular physiology professor (and then prescribed him statins ... most likely).
My recent search through the literature for studies on the interactions of lipids, sugars, and insulin on blood flow fluid dynamics in the heart proved fruitless, but I did stumble upon a nice study that helps illuminate how best to maximize ROI on heart health prevention and intervention given our strained financial circumstances throughout our healthcare system; here is the abstract (Circulation. 2004;109:1371-1378):
Background— Regular exercise in patients with stable coronary artery disease has been shown to improve myocardial perfusion and to retard disease progression. We therefore conducted a randomized study to compare the effects of exercise training versus standard percutaneous coronary intervention (PCI) with stenting on clinical symptoms, angina-free exercise capacity, myocardial perfusion, cost-effectiveness, and frequency of a combined clinical end point (death of cardiac cause, stroke, CABG, angioplasty, acute myocardial infarction, and worsening angina with objective evidence resulting in hospitalization).
Methods and Results— A total of 101 male patients aged 70 years were recruited after routine coronary angiography and randomized to 12 months of exercise training (20 minutes of bicycle ergometry per day) or to PCI. Cost efficiency was calculated as the average expense (in US dollars) needed to improve the Canadian Cardiovascular Society class by 1 class. Exercise training was associated with a higher event-free survival (88% versus 70% in the PCI group, P=0.023) and increased maximal oxygen uptake (+16%, from 22.7±0.7 to 26.2±0.8 mL O2/kg, P<0.001> versus PCI group after 12 months). To gain 1 Canadian Cardiovascular Society class, $6956 was spent in the PCI group versus $3429 in the training group (P<0.001).>Conclusions— Compared with PCI, a 12-month program of regular physical exercise in selected patients with stable coronary artery disease resulted in superior event-free survival and exercise capacity at lower costs, notably owing to reduced rehospitalizations and repeat revascularizations.Key Words: coronary disease • exercise • angina • angioplasty • cost-benefit analysis
Clearly, the cost-benefit analysis here enlightens the notable cost-savings and effectiveness of a 'less scientific' intervention - exercise - versus a 'more scientific' intervention - Percutaneous Coronary Intervention (PCI) - in treating a specific patient population, which, given the resource constraints of our healthcare system, provides the empirical evidence needed to drive medical decision making to best maximize the Return on Investment (ROI) of our precious, limited healthcare dollars.
Ultimately, my intuition tells me that nutrition is one of the most important components of maximizing ROI on heart health prevention and intervention. Another simple thought experiment enlightens the importance of nutrition: Human hearts and bodies are composed of atoms. Those atoms came from somewhere. In fact, the atoms that make up our bodies come from the foods that we eat. Really, "we are what we eat," my friends. From this basic materialistic perspective, then, healthcare leaders and Obama's team should elevate nutrition on the healthcare totem pole.
Our education system failed to teach people personal finance, and our entire financial system blew up as a result.
In parallel, the time-bomb is ticking in the healthcare industry: Our education system fails to teach people nutrition (real nutrition), and our entire healthcare system is sitting atop a pile of dynamite as a result ... far too many folks live in chronic illness states for most of their lives because the atoms they feed their bodies via their nutrition patterns fail to provide their physiologies with the right fuel for their metabolic engines.
This educational deficit similarity between personal finance and nutrition provides just one more reason why healthcare has the opportunity to learn by grace, instead of hard knocks, by heeding the lessons learned from our banking blunders (thanks to Dave Lull and Nassim Taleb).
To good (heart) health.
Monday, February 23, 2009
(Not So Intimate) Partner Violence and Abuse (IPVA): Out-of-Control Control
(*Book note: Before its publication, I reviewed manuscripts for and provided feedback on The Physician's Guide to Intimate Partner Violence and Abuse book, published by Volcano Press, Inc. It is a wonderful resource for healthcare professionals that I highly recommend.)
Intimate Partner Violence and Abuse (IPVA): Control. As the book title above suggests, the term "Intimate Partner Violence and Abuse" (IPVA) may one day phase out the still dominant "Domestic Violence" term, but there is nothing 'intimate' about intimate partner violence and abuse. At its core, IPVA is all about control (out-of-control control): an abuser/stalker attempts to control the victim's behavior, life, and environment. Whether it is a celebrity performer before the Grammy's, a successful orthopedic surgeon in the quite suburbs, or a day-laborer in a rural community abusing his wife, fiance, girlfriend, or other intimate partner, violence in human relationships is a universal phenomenon; it spans all socioeconomic, cultural, and other societal barriers and boundaries. Far, far too often, unfortunately, in relationships, males try to control females and females attempt to control males (and all the other combinations as well) - it occurs in both/all directions with unique manifestations depending on the polarity of the control (ie. males tend to escalate their control efforts to violence, while females elevate their controlling behaviors in other ways, typically). And, as much as I love power-law dynamics (ancestral fitness, for instance, is built on healthy power-law lifestyle patterns), I am afraid that the math of IPVA / domestic violence looks (roughly) like this:
IPVA Power-Law Distribution
Y-Axis = Level of AbuseX-Axis = Number of Controlling Behaviors
Intimate Partner Violence and Abuse (IPVA): Power-law mathematics. The distribution picture above shows that a few controlling behaviors have high levels of abuse (high impact = this is where murders occur), a medium number of controlling behaviors have medium levels of abuse (medium impact = minor physical altercations, such as shoving, for instance), and a large number of controlling behaviors have low levels of abuse (low impact = stalking behaviors, such as excessively texting a partner to find out what he is doing, for example). Usually, in intimate relationships the controlling behaviors amass in the right tail - one partner nitpicks the other or tries to dictate that person's friends and activities, to name a few, and, as a result, crosses numerous interpersonal boundaries that people respect in healthy human relationships. With these boundaries broken, the flood gates unleash in exponential fashion (as illustrated by the graph above), and a few number of controlling behaviors escalate the level of abuse quite quickly (grabbing turns to pushing, pushing turns to throwing, throwing turns to hitting, hitting turns to suffocating, suffocating turns to shooting, as one possible path up into the left tail). All the low level abuse (impact) controlling behaviors are dangerous because it only takes a few (or one) high level abuse controlling behavior to cause very serious damage to or end someone's life. However, while experiencing the long right tail, victims (we) tend to rationalize/narrate abusers' controlling behaviors; we give people the benefit of the doubt, we question whether the abusive behavior is isolated, we think the controlling behavior will stop, we make attribution errors and blame ourselves, we are embarrassed, etc. - simply, we are surprised, saddened, and shocked by the reality that a person would treat someone so poorly. It is in the right tail where prevention is so important and others (friends, family members, mentors, witnesses - avoid the 'bystander effect') must step in and advocate for victims of abuse early and often in order to clip exposure to the left part of the IPVA Power-Law Distribution. Relationships fracture quickly and make jumps unexpectedly (ie. "He lost it; he snapped."), and you cannot predict when an abuser is going to take the level of control/abuse to an exponentially higher level.
Intimate Partner Violence and Abuse (IPVA): Respond to red flags. The best we can do is identify for ourselves and help others identify within their relationships (we need to advocate for ourselves and for others) the controlling 'red flag' behaviors in the right tail of the IPVA Power-Law Distribution. Red flag signals represent any acts or behaviors that breach the respect boundaries of healthy relationships. As these red flags accumulate early on, we cannot become desensitized and adapt to them (screen for narration and rationalization: "It's not that bad; he only acts that way under stress ...", for instance); instead, we have to protect ourselves and others and escape controlling relationships right away: an abusive/controlling person does not deserve the joyful gifts of a relationship with respectful person.
So, let the IPVA Power-Law Distribution empower your efforts to help others escape controlling relationships early and often, before these relationships 'fracture' and jump to highly abusive, out-of-control levels.
Personally, at Game Plan Academy, I look forward to working with students within the Coaches Corner framework to discuss and reflect openly each week on ways that teenagers can recognize 'red flags' in both their own relationships and in others' and respond in creative, supportive, and practical ways to mitigate risk exposure to the escalating violence spiral that controlling behaviors fuel. Coaches Corner is an exceptional Family Violence Prevention Fund campaign that I encourage folks to peruse.
In the end, the power of the IPVA Power-Law Distribution is that it demonstrates the power of prevention and early intervention in abusive relationships: be careful out there - let's make stands for RESPECT along the way.
Sunday, February 15, 2009
Innovative localism: Mentor-based ventures in Sacramento
Innovation in healthcare is difficult; there are numerous barriers to entry. In fact, unfortunately, the Healthcare Innovation Challenge co-sponsored by Arizona State University and Idea Crossing has been postponed to Spring 2010 in lieu of the current economic downturn. Carlos Rizo and I were looking forward to this innovation competition and implementing some of the concepts and ideas we have been tinkering with in the background.
In the meantime, innovation in healthcare should start here: Theory to Practice (or here: Mark's Daily Apple). Lifestyle innovation for the patient of one during these challenging financial times seems like a worthwhile space to expend healthcare energy and thought leadership.
However, innovation in youth development is both needed and slightly more accessible. So, in response, my friends from high school and I have done our best to innovate locally, in Sacramento and Northern California, in the youth development space.
As seen above, Academic Impact represents our best effort to provide youth with mentor-based educational experiences. Throughout our lives, mentors of all types and walks of life play key roles in our personal developments. By linking up young, dynamic graduates from top universities like Stanford, UCLA, and UC Davis with high-school and K-8th grade students, Academic Impact pairs youth with mentors who can provide academically rigorous tutorial assistance while also building bonds with students to help them develop emotionally and interpersonally through relationship-based learning. People respond well to people they look up to as role models, and our tutors provide youth with these responsible response agents.
However, not all youth have full access to high-quality, professional mentors. Thus, Academic Impact has partnered with two former NFL players to launch its first GoDoGood project: Game Plan Academy. Game Plan Academy provides Sacramento student-athletes with a free, community supported, fractal development program that combines sports, academics, and mentorship over multiple weeks, founded on the mentor-based learning and personal growth model. The first Game Plan Academy starts on March 15 and runs eight weeks, finishing in May. Sacramento Mayor Kevin Johnson supports our program and will speak to students at Game Plan Academy as well. This initial camp will work with high-school football players, but we would love to expand the model into other sports, such as baseball. If anyone is interested in helping support the Game Plan Academy in any way, please let me know.
Localism in action: Human development is a local, longitudinal process, based in local, longitudinal relationships. Transformation in personal development is a non-linear process that requires a local, consistent presence from responsible and reliable mentors. Whether through the ancestral process of mimicry or through the relationship-based action of close conversation and open communication, mentor-based development is an important component of human development. Remember, we are local animals living in an increasingly global world: thinking and acting locally, I suspect, will prove ever more critical as our cultures evolve in this Information Age.
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