A portrait of the failing U.S. health system | #28
Plus: sleeping in on weekends, benefits of coffee, cutting sugar for IBS, and more.
Greetings—
The Commonwealth Fund has been analyzing the health systems of selected developed countries since 2004—and no surprise on their most recent report from a few days ago: the U.S. system comes in dead last compared to 10 industrialized countries.
The Commonwealth Fund’s report measures 70 performance metrics in five areas: access to care, care process, administrative efficiency, equity, and health outcomes. The graphs in the report are shocking concerning the wide gap between the US and other countries in quality of care (lowest) and cost of care (highest)
The U.S. continues to be in a class by itself in the underperformance of its healthcare sector. While the other nine countries differ in the details of their systems and in their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic healthcare needs, including universal coverage. I strongly encourage each person to read this report and the suggestions on how to improve our failing healthcare system.
Now, let's dive into this month's recommendations:
#1: Catch up on sleep on the weekends—it may lower heart disease risk
There’s an interesting analysis of the UK Biobank data looking at the concept of ‘catch-up sleep’. A common practice for people who do not get enough sleep on the weekdays (defined as less than 7 hours a night) is to ‘sleep in’ on the weekends.
Teenagers perfect this strategy.
In this analysis, there is a 20% reduction in cardiovascular events when followed over a 14 year period. While I strongly support targeting 8 hours in bed time the data on trying to recover some of this lost sleep is interesting. A large caveat is that this is not yet peer-reviewed and was presented at the European Society of Cardiology meeting.
#2: An accurate blood test for Alzheimer’s disease
The diagnosis of dementia, especially early on, is difficult and often missed. It is one of the reasons I perform a cognitive screening on all patients over 40.
This new study from JAMA looked at 1,200 patients being evaluated for cognitive symptoms. It was compared to PET scan and cerebrospinal fluid (the current standard) and was 91% accurate in predicting Alzheimer’s Disease. While this blood test is not widely available it holds out hope on early detection.
Prevention of dementia is possible with a standard lifestyle focus and remains more powerful than any current drug regimen.
#3: Drinking coffee can lower cardiometabolic risk
Drink that coffee!
Moderate caffeine intake may lower your long term risk of cardiometabolic disease- CM- (Type 2 diabetes, coronary artery disease and stroke). This study looked at over 350,000 people from the UK Biobank database. The study found that compared with non-consumers or consumers of less than 100mg caffeine per day, consumers of a moderate amount of coffee (3 drinks per day) or caffeine (200-300 mg per day) had a 48.1% or 40.7% reduced risk for new-onset CM.
Studies have found that coffee polyphenols, such as chlorogenic acids, have many health-promoting properties, such as antioxidant, anti-inflammatory, anti-cancer, anti-diabetes, and antihypertensive properties.
#4: Cutting out sugar and starch is as effective for IBS as current recommendations
What diet is the right one to treat IBS, a common condition? According to this study, a starch- and sucrose-reduced diet (SSRD) has shown similar promising effects to the more restrictive FODMAP diet, which is an established treatment for irritable bowel syndrome.
The results from 105 patients with diagnosed IBS were presented in a new study from Lund University in Sweden, which also shows that weight loss is greater and sugar cravings are reduced among those who follow the starch and sucrose-reduced diet.
As the researcher states, ‘We wouldn't really even call SSRD a diet. It's how everyone should eat, not just those with IBS. And unlike Low FODMAP, SSRD is easy to understand and easier to follow’.
#5: Huge progress in treating advanced melanoma
In this remarkable landmark study on how immunotherapy has changed the course of metastatic melanoma, almost 50% of the 945 patients followed for 10 years survived a condition that was previously universally fatal.
"This was a practice-changing trial," said first author Dr. Jedd Wolchok, the Meyer Director of the Sandra and Edward Meyer Cancer Center and professor of medicine at Weill Cornell Medicine and an oncologist at NewYork-Presbyterian/Weill Cornell Medical Center. "The median survival for this population is now a little over six years, and people who are free from cancer progression at three years have a high likelihood of remaining alive and disease-free at the 10-year time point."