Why Traditional Physicians Will Trump Walmarts Primary Care Service Offering

A big box with plenty of
room for primary care?

Several years ago, while the Disease Management Care Blog was supervising a medical resident clinic  (an example of how they work can be found here), an elderly patient came in for an appointment.  According to the resident, Mr. Jones (not his real name) would unexpectedly lose consciousness while walking. He also complained of feeling shaky and unsteady on his feet.  Prior to entering the clinic room to see Mr. Jones, the DMCB already suspected the patient had Shy-Drager Syndrome.  One look at the his staring and unblinking face confirmed it, all in the space of about five seconds.

Which is why the physician DMCB confidently thinks its profession ultimately has little to fear from Walmarts apparent interest in establishing a national network of primary care clinics in its big box stores. 

Caul scrutiny of the Walmart Request For Information (RFI) reveals that potential partner companies are welcome to showcase their health care "solutions," "applications" and "offerings" that are "convenient, accessible, affordable, consistent, scalable and integrated."  Walmart wants these companies to leverage its retail and multi-channel clout to to reduce costs and increase access while maintaining or improving outcomes in clinical care, diagnostic services, prevention and wellness. Care services can include a host of general medical services, management of chronic as well as acute conditions, laboratory testing and "other."  Ownership, financial arrangements, data sharing, integration, technology, logistics, back office functions and the level of customization are negotiable.  To be taken seriously by Walmart, candidate companies need to have a track record of success at a national level, a credible leadership team, a business plan, timeline, access to secondary partners as necessary and familiarity with quality assurance.  There is an notable absence of any erence to the "medical home."

While the similarity of "Big Box medicine" to retail clinics could be criticized at many levels, the DMCB has heard two two major concerns from its colleagues about Walmart:

1) Walmart and the like will further "Balkanize" the system, leading to more, not less, fragmentation and

2) it will commoditize health care, leading to narrow and regimented treatment protocols that dont take the "big picture" into account.

The DMCB disagrees with the first assertion because Walmarts RFI seems to envision a highly integrated system backed up by informatics, connectivity and quality metrics that - on paper - should lead to more coordination not less.  Thats good.

Yet, the DMCB thinks that there may be something to the second  assertion. It is Walmarts style to relentlessly attack costs at every part of its service cycle and the company probably believes the strategy can be applied to health care.  If thats Walmarts intention, itll almost certainly choose a vendor that industrializes guidelines like this in a one size-fits all "protocolized" fashion all the time every time.

Thats not necessarily bad, but that means therell be little room for the kind of smart heuristics that helped the DMCB get to a quick diagnosis.  The DMCB doesnt deny being "smart," but the the point is that the best primary care intelligently combines guidelines and heuristics.  The DMCBs physician colleagues have that special skill.  Thanks to competition from Walmart (and retail clinics), theyll hone that expertise and respond with a higher, more efficient and better quality standard of care for many patients for a long time to come.

Image from Wikipedia

Will Taxation Fix the Obesity Problem

As the obesity epidemic continues to spread throughout the western civilization, the health of many millions are placed in severe jeopardy. With rates projected to hit a saturation level of 43% in the US by 2050, incidence of heart disease, diabetes, cancer and dementia will escalate and threaten to collapse our already failing health care system.

The current trend will only be broken by making some drastic changes to the driving forces behind overweight and obesity. One possible solution that has been proposed is to tax the type of foods most commonly linked to overeating and poor health. Is this enough to influence the eating habits of those most susceptible to obesity?

Understanding the Real Cause of Obesity

Part of the problem with obesity is that it is the result of many compounding factors. In addition to consuming excess calories and insufficient physical activity, stress is known to be an important contributor to body fat placed round the abdomen and declining health. Working in harmony with your appetite hormones, leptin and ghrelin can have a significant impact on how fat is metabolized in our body.

Meal timing, meal size and macronutrient ratios determine our metabolic rate and the quality and amount of sleep have also been shown to impact how we burn fat. There are many physical and psychological elements that must be mastered to achieve successful and permanent weight loss.

Study Examines the Role of Taxation on Obesity

Information compiled by the Organization for Economic Co-operation and Development and published in The Lancet Series on Chronic Diseases and Development examined the potential impact of placing a tax on unhealthy foods, restricting food advertising and improving food labeling. Researchers determined that these three measures would add nearly 7 million good health life years over the next 20 years if implemented in western cultures around the world. The annual cost would be less than $1 per person each year. Are these measures really necessary?

Natural Steps to Weight Loss and Controlling Obesity

The importance of losing weight and preventing obesity on our health cannot be underscored. Individuals who are more than 30 pounds over their ideal weight place an immense burden on their vascular system that leads to increased blood pressure, dysfunction of the delicate inner lining of the arteries and blood sugar surges resulting in metabolic syndrome. 

Placing a tax on fast foods, processed foods and sweetened beverages would likely be effective, as these types of measures have worked in the past to curb cigarette smoking and alcohol consumption. A better idea may be to rely on self control. Once you have determined that weight loss is the correct goal for you, avoiding processed food will become second nature.

Purge Unhealthy Foods for Two Weeks

You must be strong for a period of two weeks as you flush the unhealthy sugar, hydrogenated fats and refined carbs from your diet. Slowly increase natural food sources including fresh vegetables, nuts, seeds, fish, chicken, and olive oil. After this period you won’t miss the foods that encourage excess fat storage and natural weight loss will be the result.

Every man, woman and child should adopt a goal of healthy eating. Whether the scale indicates you need to lose weight or not, excess unhealthy calories will cause fat to be stored in critical organs such as the liver, pancreas and heart. Over the course of years this fat accumulation will trigger disease. While taxation may be a short term fix to large problem, the only way to achieve permanent weight loss is to take control of your dietary destiny.

Obesity Will Persist If not Treated

Like a disease, the more quickly dealt with faster and greater the chance of recovery, as well as obesity. The longer the excess fat deposited in the body, the more difficult it is back to normal weight. Similarly, the findings of recent research.This seems to be the answer to why people are often frustrated when undergoing a diet program. Weight loss is always back quickly despite being able to remove excess weight before. The scientists found that being overweight can change a persons normal body weight standards.A study published in the Journal of Clinical Investigation shows that the longer the mice were overweight, the more difficult it is to change his tendency to be obese. Obesity change the point of normal weight to obese rats permanently, making it difficult to back down despite a previous successful.
The research team used mice that were manipulated genes controlling hunger. Enabling this gene right after weaning would prevent mice eating too much and become obese. Mice that maintaining a healthy weight by eating a healthy diet to maintain normal body weight without dieting after the gene is activated.But in overfed rats, weight who already ride can never go back to normal after the gene is activated. Though the mice had greatly reduced food intake and increased physical activity. 

Therefore, the researchers then be doubts whether calorie restriction program and intensive exercise can help obese people lose weight for the long term in the future.If obesity is allowed to continue, will reprogram your body weight becomes heavier. Exact mechanism is still unknown and require much more research.