Can We Afford High Cost Pharmaceuticals?

I'm in New Orleans, to meet tomorrow with a group of union leaders who oversee union health plans. They will have read, or at least - I hope - glanced at "Setting Limits Fairly," the book in which Norman Daniels and I presented the "accountability for reasonableness" framework for curbing unsustainable health care costs.

I'm excited at the prospect of working with union leaders. For them the constituency in the health plans they oversee are fellow union members, not impersonal "covered lives," the unfortunate insurance jargon term for you and me. And they know where the health plan funds come from - their own contributions and, perhaps, contributions from their employers, which could otherwise go into wages.

In advance I proposed four premises for the discussion:

1. Resources are finite.
   


2. There are more potentially valuable things that health care can offer than we can pay for.
   


3. Organizations like unions that provide health insurance will have to learn to work with questions like "how much is life worth?" in a thoughtful and constructive manner.
   


4. High cost pharmacy is a prime area where tough decisions will have to be made.

We'll use two drugs as examples that ultimately require us to acknowledge "how much is life worth?" as a real question. Provenge is a new immunotherapy for minimally symptomatic metastatic prostate cancer not responsive to hormone therapy. It extends median survival for 4.1 months at a cost of $93K. Cerezume is a biologically engineered form of the deficient enzyme in Gaucher's disease. It can produce significant improvements in quality of life for $150K - $250K per year.

In emotional terms, life is priceless. But in economic terms, it isn't.

I'll make the point that avoiding questions about the value of health interventions is a major reason we're in the mess we're in now. We won't solve the cost dilemma until we learn to think in terms of both numerator (my needs and desires) and denominator (the insured population's needs and desires). I'll make the further point that this kind of learning is more emotional than cognitive. And it takes time, so a long term strategy is necessary.

Union health plans, which are likely to have a high degree of solidarity among the insured population, are a promising venue for thinking this way. I hope we'll be able to probe health care costs as "our problem" rather than as something "they" are forcing on us.

I'll write more after I meet with the union leaders.

myPennMedicine: Giving Patients Access to their Online Medical Records

Penn Medicine patients now have access to their online medical records through myPennMedicine. Currently, Penn Medicine is the only health system in the region to offer patients this online health management tool. It gives patients the ability to submit routine requests for prescription refills, referrals or appointments as well as view lab results, medication lists and health summaries without having to pick up the phone.

Learn more about myPennMedicine and register to win a free iPad

Penn Medicine Wants You to Stay Healthy: Get Your Flu Shot Today!

Vaccination is the best protection against contracting the flu. The Centers for Disease Control and Prevention (CDC) recommend that everyone six months of age and older get vaccinated against the flu as soon the 2011-2012 vaccine becomes available.

“Every flu season, different flu viruses develop and spread,” says Charles Schwartz, MD, PennCare® for Kids. “The flu can affect people differently based on their body’s ability to fight infection.”

That is why yearly vaccination is critically important for protection against the flu. Penn Medicine has received its supply of flu vaccine and mist and the staff urges you to make an appointment today.

Read the full article

What Will Employees Accept to Lower Their Health Care Costs?

I recently looked at a Kaiser Family Foundation Public Opinion Survey that asked a random sample of people with employer insurance a number of questions about cost. The survey shows how far we have to go to come to grips with out-of-control health care costs.

The good news is that half have a reasonably accurate idea of the total cost of their health insurance. Their estimates were somewhat low, but in the ball park of reality.

The bad news is that the other half had no idea about a cost that was constraining their wages and cramping the employer they work for.

What dismayed me most were the responses to a list of possible changes to current insurance that would lower the cost of coverage. The only suggestion that received majority support (68%) was to "participate in a wellness program that promotes healthy behaviors such as losing weight or controlling your blood pressure or cholesterol." Only 30% were willing to accept paying more for brand name drugs, paying a higher deductible before the insurance kicks in, or accepting a more restricted list of participating doctors and hospitals.

So how are we going to keep health care costs from undermining public health more than is already happening?

Public education is important, but it won't do the heavy lifting. Despite lots of educational effort, something as obvious as constraining access to brand name drugs when alternatives are available still only gets 30% support.

Learning through experience is likelier to move our outlook. In the world of employer based insurance, employers and insurers should design multi-year approaches to helping us learn. We're starting to see employers offer "value-based" networks that emphasize primary care and community hospitals, with tertiary hospital care covered for services that aren't otherwise available. And as I've written about in previous posts, employers are putting more pressure on us to manage our health better (see here, here, and here).

In the current U.S. system, the majority of non-elderly with insurance get their health insurance through their employer. Employers and insurers should collaborate to make health insurance a "learning opportunity," not just a "fringe benefit." It takes us time to learn about financial responsibility in our growing up. It's going to take time and a similar concerted effort for us to learn health responsibility as adults!

Shanghai Rice Bowl - From Brendan Brazier's Book 'Thrive Foods'

I have enjoyed making a lot of the recipes from Brendan Brazier's 'Thrive Foods' lately.  What an awesome book! Brendan is one of the world's foremost authorities on plant-based nutrition.  On page 230 you will find this recipe for Shanghai Rice Bowl. The Shanghai is one of the daily special items on rotation at 'Fresh'  in Toronto, Ontario.  This is a very tasty rice bowl that definitely hits the spot and was so easy to prepare.  I made my super Perfect Brown Rice to pile everything on.  Part of the recipe called for Mixed Herbs, which there is a recipe for on page 233. The Temple Rice Bowl, on page 232, also calls for the Mixed Herbs. I wasn't able to find any sunflower sprouts at the store and I didn't have time to sprout my own, so I used spinach instead (which was absolutely yummy).  The lemon squeezed on top is a definite must to bring out all the delicious flavors of this recipe.  This is a very satisfying, delicious meal and full of nutritional benefits that your body will love you for:)



Beautiful Baby Bok Choy



Mixed Herbs  (Page 230)



Shanghai Rice Bowl

Printable Recipe

Serves 2

1/3 cup water

4 baby bok choy, cut in half lengthwise

6 tbsp olive oil  (I used less than this)

6 tbsp tamari

3 cups shitake mushrooms, stems removed and halved if large

4 cups cooked brown basmati rice

1/2 cup Tahini Sauce (see recipe below)

2 tsp Mixed Herbs (see recipe below)

2 cups sunflower sprouts

2 tbsp hulled hemp seeds

1 cup cooked or canned chickpeas

2 lemon wedges, for garnish

• Put the water in a wok or skillet over high heat.  Add the bok choy halves and cover.  Steam 5 minutes until bok choy is almost tender.  When water evaporates, add 2 tbsp olive oil, 2 tbsp tamari, and the shitake mushrooms.  Saute 5 minutes until bok choy and mushrooms are tender.  Set aside.
• Divide the cooked rice between 2 large rice bowls, and drizzle both with Tahini Sauce, olive oil and 4 tbsp tamari .  Sprinkle with Mixed Herbs.
• Place the sauteed bok choy and shitake mushrooms on the rice, and to with sunflower sprouts, hemp seeds, and chickpeas.
• Garnish with lemon wedges and serve.

Tahini Sauce

Page 231

2 cloves garlic, minced

1/2 cup chopped parsley

1/2 tsp sea salt

2 tbsp lemon juice

2/3 cup filtered water

1/2 cup tahini

In a blender, process the garlic, parsley, salt, and lemon juice until smooth.

• Add the water and tahini, and process until smooth.  You may need to add a bit more water if your raw tahini is especially thick.  Add water a tablespoon at a time until you get a pourable consistency.
• Store in a sealed container in the fridge for up to 4 days.

Mixed Herbs

Page 233

Makes 6 tablespoons

1 tbsp dried oregano

1 tbsp dried basil

1 tbsp dried marjoram

1 tbsp dried dill

1 tbsp dried thyme

1 1/2 tsp dried rosemary

1 1/2 tsp dried sage

• Combine all ingredients in a bowl.  Mix well.

Perfect Brown Rice (The Health Seeker's Kitchen Recipe)

Serves 4

1 cup uncooked brown rice
1 tsp. olive oil
2 cups filtered water
2 fresh basil leaves (Optional)

1. Fix brown rice by cooking in 1 tsp. olive oil until lightly browned. You will hear it start to snap, crackle and pop. Add basil leaves and 2 cups water all at once. Quickly put on lid and bring to boil. Turn down heat to simmer until all water has evaporated (around 40 minutes).

Wise Traditions Conference

Hey buckaroos.  Just a reminder that I will be one of the featured speakers at this year's Wise Traditions Conference - the annual conference of the Weston A. Price Foundation.  I have been asked to speak about metabolism, and I will also have a booth set up where you can do everything from quiz me on 80's movie lines (last night I was told to "watch out for potholes" and knew that one right away) to test your whiz.  Anyway, several of you are coming and I'm really psyched to meet you.  If you do come to the conference and I find out that you didn't come up to me and harass me in some way you're in BIG trouble.  Hope to see you nerds there. 


REGISTER FOR WISE TRADITIONS HERE

Cauli-Bean Tacos with Homemade Tortillas

I posted the recipe for these super delicious Cauli-Bean Tacos a year ago, but due to their popularity I wanted to post them again and encourage you to try them for both their delicious taste, as well as the health benefits. Last October I had a big beautiful bunch of cauliflower and wanted to create something new & different with it. Tacos sounded yummy, so Cauli-Bean Tacos were born and they turned out amazing.  In one of my cooking/nutrition classes we made these and everyone loved them.  First, I started my project by making the cauliflower/black bean taco mixture.  Then I created my tortillas. They were so simple and delicious. This recipe makes 8 servings.  I added lettuce, tomato, cilantro, hot sauce or salsa, almond jalapeno cheese and a squeeze of lime to garnish.  I know everyone in your family will absolutely love these.
     The health benefits of cauliflower are huge!! Even though this white delight looks like a vegetable, you're really eating the flower of the plant, hence the name. Cauliflower is a member of the 'white' family in terms of fruits and vegetables. Included in this group are other natural foods such as bananas, mushrooms, onions, and garlic. Cauliflower contains allicin, which can improve heart health and reduce the risk of strokes, and selenium, a chemical that works well with Vitamin C to strengthen the immune system. Cauliflower can also help to maintain a healthy cholesterol level.
     Folate is also found in cauliflower, which is a B vitamin that is needed for cell growth and replication. For this reason, it is often recommended that women who are pregnant or may become pregnant eat significant amounts of cauliflower in order to help their unborn children develop properly.
     Of course, cauliflower is an excellent source of fiber, which helps to improve colon health and can even help prevent cancer. And, most recently, it has been discovered that cauliflower, as well as other cruciferous vegetables, such as brussel sprouts and cabbage, contain indole-3-carbinol, a substance that can affect the metabolism of estrogen in the body, and prevent breast and other female cancers.

CAULI-BEAN TACOS
Printable Recipe

1 tbsp. olive oil
1 large bunch cauliflower (processed until small ground pieces)
1/2 yellow onion (sliced)
1 Serrano pepper (sliced)
1 1/2 tsp. chili powder
1 1/2 tsp. cumin powder
2 tbsp. tomato ketchup
1/2 tsp. sea salt
1 15 oz. low sodium black beans (drained & processed until smooth)
pepper

Garnish with:
Romaine lettuce, tomatoes, cilantro, lime & Almond Jalapeno Jack Cheese, salsa.

1.  Cut up cauliflower and put in food processor until ground into small pieces.
Add cauliflower, onion and pepper to olive oil and cook on medium high for about 5 minutes. Add seasonings and continue to cook on low for a few minutes. 

2.  Process beans until smooth.  Add to cauliflower mixture and salt & pepper to taste. Use 1/4 cup mixture for each tortilla. Garnish with items of your choice.

Homemade Wheat Tortillas
Printable Recipe
8 Servings

1 cup white whole-wheat flour
1/4 tsp. sea salt
1/2 cup lukewarm water

You will also need 2 tsp. Earth Balance Butter (melted) and 1/4 cup additional flour.

1. Mix flour, salt and water together to make a soft dough.
2. Spray ball of dough and surface with olive oil and knead until smooth. You want to have dough a little sticky, but not too sticy.
3.  Set the dough aside and cover with a warm damp cloth.  Let the dough rest for at least 10 minutes or more.
4.  Divide the dough into 8 equal parts.
5.  Make smooth balls and press flat.  Roll balls in flour and roll out until you have a 6 inch circle.  If the dough sticks to the rolling pin or surface, dust very lightly with flour.  (use just enough to help you roll out circle~too much flour will make your tortilla dry.
6.  Heat griddle while rolling out first two balls.
7.  Brush tortilla lightly with Earth Balance Butter on side that will touch griddle.
8.  When tortilla starts changing color and start puffing, flip over. 
9.  Flip again after a few seconds. Take a flat spatula and press lightly on the puffed parts of the tortilla.  This will help the tortilla to puff more.
10. Flip again.  The tortilla should have light golden-brown spots on both sides.  Do not cook very long because it will become hard.  You need it to be soft and pliable.
11. Keep tortillas stacked together on and under a cloth to keep from drying out.
12. Tortillas can be kept in container on counter for 2 days or refrigerated for 5-6 days.
13. ENJOY!!