by Jeffry S. Life, M.D., Ph.D. and Alan P. Mintz, M.D.
The Decline of Medical Care in America
What Can We Do About It?
We have just ended a century of unprecedented advances in
medical knowledge and technology. Serious medical conditions
that were once considered disabling or a death sentence are
now curable. Most devastating disease conditions that exist
today are now manageable. In spite of all the amazing medical
advances in recent years, there exists a great paradox in health
care today—we simply cannot afford it! The economics of
today’s health care has made all of the advances in medical science
less and less available to just about everyone—including
even those who are willing to pay for them.
In an attempt to control increasing medical
costs, managed care organizations were
formed near the end of the last century. Under
the rubric of managed care, the practice of
medicine has radically shifted from physicians
dedicated to the patient’s best interest to individuals
and organizations bound primarily to
the best interests of corporations. Today the
benefits of our state of the art health care
Clearly, system are methodically and systematically limited or completely
denied to those who need them the most by organizations
that stand to benefit the most financially from withholding
these benefits—managed care companies.
As medical costs continue to soar, patients are increasingly
being denied coverage for crucial services by their insurance
companies. Managed care is condemned by the people it
covers, the professionals it employs and contracts with and
even the lawmakers who make the rules for it. Recently, managed
care systems have taken the financial control over their
patients to even greater heights by transferring the process of
authorization and denial of medical services from treating
physicians to administrators. Many doctors now find themselves
inadvertently forced by managed care administrators
(many of whom have had no medical training) into utilizing
their medical knowledge, expertise and experience for the benefit of the plan’s utilization and economic goals—not for what
is best for their patients. This, obviously, is a very dangerous
system of rationing.
Now physicians—not the plan’s administrators—have been
put in a position that can jeopardize the care they provide their
patients. Today your managed care physician has had the awesome
responsibility of controlling managed care costs added to his or her responsibilities. This manifests itself by influencing
what medications are prescribed for you, whether or not diagnostic
tests or blood work that may signal the onset of silent
disease are ordered for you, whether or not you are referred to
a specialist and whether or not you are admitted to a hospital.
These decisions directly impact your provider’s salary.
Economic rationales have now replaced clinical judgment.
Except for those rare cases in which a physician has completely
rejected managed care, virtually every medical decision made by a physician today is affected in some way or another by the
changes wrought by managed care.
Doctors no longer practice autonomously. It’s easy to see
how all of this could impact disastrously on the quality of your
health care. This form of rationing of medical services is
extremely dangerous and smacks directly in the face of the
Oath of Hippocrates, in which all physicians take a vow “to
follow that method of treatment which, according to my ability
and judgment, I consider for the benefit of my patients, and
abstain from whatever is deleterious and mischievous.”
Managed care has finally succeeded in redefining what is best
for their patients on their terms. No other health care system in
the entire world is like this.
Clearly, these are troubled times for the recipients and
providers of health care in America. Price pressures increasingly
leave doctors feeling rushed, harried and second-guessed.
According to a recent study, more than half the physicians in
the U.S. believe that their ability to provide quality health care
has deteriorated over the past five years. Medicare continues to
institute cutbacks for medical services. And as if all of this isn’t
bad enough, the number of primary care providers, understandably,
has continued to decline year after year. This is frightening
because the better a country’s system of primary medical care, the better is the health of its
citizens, according to a Johns
Hopkins School of Public Health
study involving 13 industrialized
nations with populations of 5 million
or more. Interestingly enough,
in this study the U.S., along with
Belgium, France and Germany, were
found to have the weakest primary
care infrastructures.
So what can we as patients do to
avoid all of these problems and
receive the best health care possible?
The answer is really very simple—don’t get sick! We must do everything
possible to avoid disease and
maintain excellent health. Disease
prevention is definitely the key to
America’s health care crisis. The
question then, is how does one go
about obtaining top quality preventive
health care? Unfortunately,
today’s medical practice devotes
little, if any, time to teaching
patients about preventing disease,
maintaining quality of life as people
age, promoting the virtues of exercise
and proper nutrition and the
importance of hormonal balance
and optimal hormone levels in preserving
vitality. Most of today’s traditional
physicians do not know how
to incorporate these areas into their
own life style, let alone into their
medical practice. In addition, all
efforts to screen for silent disease
markers and to promote preventive
health measures are discouraged by
insurance carriers. They state that
these important medical tests are
“unnecessary.” This must change.
The medical system should serve
patient interests, instead of those of
the insurance companies.
Most Americans want much
more from their physicians than just
10-minute visits dealing mostly with
managing isolated problems and
writing prescriptions. Detailed and
ongoing counseling on how to
manage the aging process and prevent
disease must become an integral
part of each and every office
visit. We must all learn how to maintain
our quality of life and zest for
living, how to prevent the accumulation
of body fat and how to get rid of
it if we already have it, and how to
prevent or reverse the loss of bone and muscle tissue. This becomes critically
important as we age if we are to
avoid nursing home care, chronic pain,
immobilization, mental deterioration
and prescription drug dependency.
Everybody must become proactive in
managing his own health, preventing
disease and maximizing the quality of
their lives. Patients desperately want
and must be allowed to have a say in
their health care. I have provided a
chart that lists all of the tests each of us
should request on a routine basis to
help us take action early on to prevent
disease. These tests will provide valuable
baseline information that can be
used to stay vital as you age.
Remember, we don’t die of old age—we die from degenerative diseases, many of which have easily obtained “early warning” tests that
can prevent or delay their onset.
Physicians must start spending more time with their patients
so that all preventive health care issues can be adequately
addressed. A frequently asked question these days is why don’t
our physicians do more to help us understand the need for
establishing the baselines of aging as we approach 50 or 60?
Why don’t they counsel us on the imperatives of nutritional
supplementation, the value of exercise, the benefits of hormonal
modulation and the philosophical grounding to prevent
physical and emotional disease? The answer, I believe, is that
the vast majority of primary care physicians are not allowed the
time to do this well and, as I said before, most are not trained
in these areas. Fortunately, however, there is a new medical
specialty that deals specifically and exclusively with all of these
issues—Age Management Medicine.
Age Management Medicine (AMM) is an exciting new medical
specialty that is dedicated to the science of healthy aging.
AMM emphasizes the enhancement of health over the treatment
of illness. Traditional medical practices follow a “fix it
when it breaks” or “diagnose and treat” approach. AMM, on
the other hand, focuses on disease prevention, wellness and
quality of life. Its goal is to promote a more dynamic life
throughout middle age and beyond by utilizing scientifically
sound, 21st century strategies that enhance health, quality of
life and longevity. These strategies include the promotion of
optimal key hormone levels combined with specific exercise
and nutritional programs specifically designed to lower body
fat, increase muscle tissue and strength, reduce risk factors for
illness and improve overall cardiovascular fitness.
The concept of Age Management Medicine was born on July
7, 1990, when Dr. Daniel Rudman published a landmark article
in the New England Journal of Medicine. Dr. Rudman looked at
the effects of supplementing growth hormone in men between
the ages of 61 and 81 years who were basically healthy. In this
group of 21 men, Dr. Rudman managed to increase their lean
muscle by 8.8 percent, decrease their fat mass by 14.4 percent,
increase their skin thickness by 7 percent and increase lumbar
bone density by 1.6 percent, simply by giving injections of human growth hormone three times a
week over a six month period. The
results of Dr. Rudman’s study were
confirmed and even extended in a
study recently completed by the
National Institute on Aging and Johns
Hopkins University, headed by Doctors
Mark Blackman and Mitch Harmon.
Similar findings have been demonstrated
with several other studies as
well.
We must all change our thinking
about aging. Older does not mean
sicker. The majority of us have a strong
enough genetic makeup to live beyond
85. The key is to make the best of the
genes we have. By incorporating AMM
practices into our daily lives we can
compress the time we are sick to the very end of our lives. We can’t stop the aging process, but we
can definitely manage it much better than previous generations
have. We can avoid premature disability and death. After
all, what are the benefits of living longer if we end up in a
nursing home, locked into a body or brain that doesn’t work
during the last 20 to 30 years of our life?
Alan P. Mintz, M.D., is chief medical officer chief executive officer and
cofounder of Cenegenics Medical Institute. He is a diplomate for the
American Board of Radiology, including Nuclear Medicine and
Radiation Therapy, and is certi.ed in Age Management Medicine. For
further information contact Dr. Mintz or Dr. Life at 1.866.953.1530 or
e-mail at doctor@cenegenicsficom.
Jeffry S. Life, M.D., Ph.D., is a diplomate of the American Board of
Family Practice, the American Board of Anti-Aging Medicine,
a fellow of the American Academy of Family Physicians and is certi.ed
in Age Management Medicine. He is a Cenegenics Institute physician
and lives a lifestyle that promotes health and fitness. He writes a
column on performance nutrition for Muscle Media Magazine and was the
grand champion of the Body-for-LIFE Contest in 1998.
About Cenegenics
Cenegenics Medical Institute is the largest and most experienced Age
Management Medicine practice in the world with patients from every
state in the United States and several countries, 25 percent of whom
are physicians and their families. Cenegenics consistently receives
regional, national and international media exposure and has been the
featured expert in the media, including USA Today, Wall Street Journal,
ABC’s “20/20,” and CBS’s “48 Hours.”
Cenegenics Physician Training Programs
Through the joint sponsorship of The Cenegenics Medical Institute and
the Foundation for Care Management, Cenegenics provides American
Medical Association PRA Level 4 Classification Tutorial Training in Age
Management Medicine for physicians with a maximum of 50 Category 1
Continuing Medical Education (CME) credits. Cenegenics also sponsors
an Institutional Review Board (IRB) Research Protocol for Age
Management Medicine with university affiliation. In addition,
Cenegenics has the highest rating for a privately held entity with Dun &
Bradstreet, Inc. because of their business ethics. For further
background information, including biographies of their physicians,
management team and medical advisory board, please visit
www.cenegenicsficom.
Important Tests That Empower People
to Maintain Optimal Health and
Lower Disease Risk |
| Test | Optimal Result |
| Bone Density of Skeleton, LS Spine and Hips (Men and Women) | T Score > 0 |
| Complete Eye Exam (Glaucoma Testing and Amsler Grid) | Negative |
| Cancer Screening |
| Colonoscopy | Negative |
| Mammogram (Women) | Negative |
| PAP/Pelvic/Breast Exam (Women) | Negative |
| Digital Rectal Exam of Prostate (Men) | Negative |
| PSA (Men) | 0-3 ng/mL |
| Blood Sugar Control |
| Hemoglobin A1c | < 5 % |
| Insulin (Fasting) | < 5 miu/mL |
| Glucose (Fasting) | 65–95 mg/dL |
| Cardiac |
| Cardiac Stress Testing | Negative |
| Homocysteine | < 9 umol/L |
| C-Reactive Protein | < 1.0 mg/L |
| Lp(a)-C | 0–10 mg/dL |
| LDL | < 70 mg/dL |
| HDL | > 50 mg/dL |
| Triglycerides | < 100 mg/dL |
| Hormones |
| Thyroid |
| TSH | 0.4–3.0 mu/L |
| Free T3 | 230–420 pg/dL |
| Free T4 | 0.8–1.8 ng/dL |
| Gonadal |
| Total Testosterone | Men 700–900 ng/dL
Women 50–70 ng/dL |
| Free Testosterone | Men 130–190 pg/mL
Women 6–8.5 pg/mL |
| Dihydrotesterone (Men) | 25–75 ng/dL |
| Estradiol, High-Sensitivity (Men) | 10–40 pg/mL |
| Adrenal |
| DHEA (Men and Women) | 350–500 mcg/dL |
| Cortisol (AM) | < 18 mcg/dL |
| Pituitary |
| IGF-1 (indirect assay of growth hormone) | 250–320 ng/mL |
|
