Stone, the director of cardiovascular research at Columbia

What’s a Pound of Prevention Really Worth

canada goose factory outlet vancouver Arthur Canada Goose Outlet Agatston, the South Beach diet doctor, came to town last week and, in between buy canada goose jacket cheap bites canada goose coats of filleted fish, he was trying to persuade me that his patients rarely have heart attacks anymore. canada goose factory outlet vancouver

canada goose outlet store new york As he is quick to tell almost anyone as he told me before we had even sat down for our Greek lunch he is an accidental diet doctor. By canada goose uk black friday training, he’s a cardiologist. He spent 20 years doing research and seeing patients in Miami before his little nutrition manifesto was published in 2003. It and its various spinoffs have since sold close to 20 million copies. canada goose outlet store new york

canada goose outlet in canada But Dr. Agatston still spends much of his time as a working cardiologist. After the first book came out, he opened a private practice where he treats everyone from locals who knew him when he was just another doctor canadian goose jacket to wealthy South Americans who fly in to see the famous South Beach doctor. canada goose outlet in canada

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canada goose outlet in usa But his larger point is a perfectly good one: we now know an enormous amount about how to prevent heart attacks, with powerful drugs like statins, smoking cessation, exercise and diet. With the right preventive care, people can cut their risk of a heart attack by up to 80 percent, cardiologists estimate. canada goose outlet in usa

canada goose outlet toronto “We have made major improvements in prevention,” Dr. Gregg W. Stone, the director of cardiovascular research at Columbia University, says. “But it’s difficult. It takes frequent visits, a close relationship between a physician and a patient and a very committed patient.” canada goose outlet toronto

canada goose outlet houston Which is exactly the atmosphere Dr. Agatston’s canada goose uk outlet practice tries to create. Nurses there give patients specific cholesterol goals to meet and help them deal with the side effects of the drugs they are taking. A nutritionist, Marie Almon, meets with patients frequently enough to discuss real life issues like how to stick to a high fiber Mediterranean Canada Goose Outlet diet even on a cruise or a business trip. canada goose outlet houston

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canada goose discount uk See, preventive canada goose uk shop medicine just doesn’t pay in the current American medical system. “The time we spend Canada Goose sale with patients we get rewarded almost zilch,” Dr. Agatston says. Or as Dr. Valentin Fuster, a former president of the American Heart Association, puts it: “There is no incentive at all. It’s a disaster.” canada goose discount uk

canada goose outlet uk This is obviously an exciting time for Canada Goose online health care reform. In California and Massachusetts, state officials have announced plans to provide universal health insurance. Last week, the head of the Business Roundtable, a major corporate lobbying group, and Andy Stern, a union leader, held uk canada goose a news conference together to call for universal coverage. President Bush devoted a big part of last night’s State of the Union address to his own health insurance ideas. The push to reduce the number of canada goose black friday sale uninsured, now approaching 50 million, is long overdue. canada goose outlet uk

canada goose outlet toronto location But a lack of insurance is only one of the two huge problems with health care. The other is the perverse system of incentives that nudges doctors and patients toward expensive tests and procedures when cheaper preventive measures might actually produce better results. Partly as a result, costs are rising rapidly for the 250 million people who do have insurance. canada goose outlet toronto location

canada goose outlet authentic In cardiac care, nuclear scans and invasive procedures like bypass surgery bring in the money. Medicare canada goose clearance sale alone paid almost $15 billion, or about 5 percent of its total budget, for bypasses, stents and other invasive cardiology in 2005, according to Jonathan Skinner of Dartmouth. Yet for many patients, there is no scientific evidence that stents or surgery prolong life. canada goose outlet authentic

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canada goose outlet price Absent a wealthy patron, many other clinics that focus on preventing heart disease are struggling to survive, Dr. Richard Pasternak, a Harvard Medical School cardiologist and Merck Company executive, says. Family doctors, doctors who treat back pain and doctors who treat diabetes all face similar canada goose coats on sale challenges. canada goose outlet price

canada goose outlet jackets It’s important to note that the economic gains from preventive care are sometimes exaggerated. Sadly, the cheapest patients are often the ones who receive no care whatsoever, because many die before they reach their medically expensive golden years. canada goose outlet jackets

canada goose outlet store uk But the political canada goose case the moral case for prevention is unassailable. And to the extent that drugs and lifestyle changes replace surgery, rather than merely supplement it, preventive care can help pay for itself. canada goose outlet store uk

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canada goose outlet online store review Humana, the insurer, and Dr. Fuster will soon begin studying 6,000 high risk patients, in part to get a better understanding of how they can be persuaded to take the preventive steps they should be taking. Medicare, meanwhile, is experimenting with some pay for performance stipends for doctors. canada goose outlet online store review

canada goose outlet seattle “We still pay more when patients have more complications and get more services than when they get canada goose store better results,” Dr. Mark McClellan, Medicare’s former director, told me recently. canada goose outlet seattle

canada goose outlet orlando The prevention push is still waiting for its Massachusetts moment a signature event to make it a topic of national conversation, as Massachusetts’s health insurance cheap Canada https://www.topcanadagoose.ca Goose plan did for Canada Goose Jackets universal coverage last year. Dr. Agatston, who does have a track record uk canada goose outlet of getting people’s attention, has one Canada Goose Parka idea. canada goose outlet orlando

canada goose outlet las vegas “My dream has been to go to a corporation and say, ‘Have all your executives and all your high risk employees come to our practice, and if they hit our goals and still have a heart attack, we’ll buy canada goose jacket give you a million canada goose factory sale dollars,’ ” Dr. Agatston said. “My wife and our lawyers say, ‘You can’t do that!’ But that’s frankly my dream.” canada goose outlet las vegas.