Healthy Future US Blog

Why is it that so many "solutions" to chronic disease are good-news/bad-news? Take great news about the "miracle-drug" semaglutide.  Originally for people with type 2 diabetes, a  recent study  shows it can reduce weight by 10-20%+ for those with obesity--with minimal side-effects, and requiring only a weekly subcutaneous (just-under-the-skin) self-administered injection.  That amount of weight loss is also often enough to reverse prediabetes & even type 2 diabetes! So what's the bad news?   Semaglutide is a proprietary biologic pharmaceutical.  It costs close to  $1000/month  for the smaller dose needed to manage diabetes.  Extrapolating this, the larger dose used in the study to reduce obesity could cost $2000+/month!  R educing the cost substantially could be a challenge.  B iologics are typically more complex & expensive to manufacture than traditional pharmaceuticals. And BTW: if you stop taking semaglutide after l...

We want to reduce the stigma of obesity.  And we want to improve health.  So how about focusing on fitness not "fatness"?   As we head toward the majority of adults with obesity in the coming decades, it is increasingly self-harming for our society to stigmatize large bodies.  Yet as our health worsens, we need to take urgent sustained action to develop healthier habits.  How do we reconcile these two seemingly contradictory issues? I wouldn't be surprised if a large portion of anxiety & depression among Americans, especially teens, is due to weight & body shape.  The increase in child & adult obesity is spreading the stress, even as it becomes more normal to be obese.  At the same time, as obesity becomes more widespread, some of the stigma is receding--with the potential good-news/bad-news downside of less motivation for people to do something about dangerous extra weight causing metabolic syndrome, diabetes, heart disease, etc....

Can you have a better A-Team than this?   Amazon, Chase & Berkshire Hathaway joint venturing  via a new nonprofit, Haven, to finally solve our health care problems!   While I was hopeful when this joint venture was announced several years ago, I was also deeply skeptical.  Rather than addressing the root causes of health costs, such as inactivity and unhealthy nutrition, Haven tried  to "develop new ways to improve access to primary care, simplify insurance coverage and make prescription drugs more affordable"--including by throwing a lot of "big data" tech innovations at these issues. While this approach was pitched as a breakthrough, it was more of a Disease Management 2.0--focusing on more cost-efficient "care," rather than less chronic conditions to begin with.  The latter is the ultimate solution, but requires far more than blue-chip brands plus high-tech to resolve--and a lot more time.   2-3 years of effort just scratches the ...

The answer to this question should be a no-brainer: Is it better to pay trillions of dollars annually in preventable chronic health costs, or to pay a cumulative $500-600 billion or so one-time to cover all  student college loan defaults or Great Recession mortgage losses ? Hmmm.  And what's the connection? We got the massive Dodd-Frank Reform in 2010 to prevent future financial catastrophes, and hopefully Great Recession 2.0--after 1.0 cost private lenders $535B, plus much collateral damage to families & the economy.  We then got  Obama-era regulations, subsequently reversed under Trump ,  to help prevent student loan defaults.  Now Biden has proposed eliminating all  public college/university, historically black college and undergraduate student debt .   This would make a big dent in about $585B in expected student loan defaults.  So where are the massive federal proposals to head off chronic diseases before they start?   Wit...

One side insists that we must have affordable health care for all.   The other side insists that individuals must take personal responsibility for their own health. For the “affordability” advocates, they mean that individuals should all be able to pay an affordable amount for health care--even if that requires government-funded free or highly subsidized health care for many, such as Medicaid & the Affordable Care Act. For the “personal responsibility” advocates,  they mean that many people choose to do unhealthy things, so they become unhealthy.  Why should “responsible” healthy people with healthy habits pay for the "irresponsible" ones?  In fact, doesn't free and subsidized health care encourage unhealthy behavior, since unhealthy people pay little for the consequences of their choices? What the affordability proponents don’t discuss, is whether the country can afford to pay for widespread free or highly subsidized health care--especially when 60% of ...

Questions have been raised about whether education in America is patriotic enough.  But what is "patriotic education" and how can we make K-12 ed more patriotic? These questions get very deep very fast.  If we want to educate people to become more pro-American, what is it that we want them to say is great about America?  And in cases where our country falls short of our ideals, how is our patriotism supposed to react to that?   Some people would say that it is unpatriotic to complain about America.  "Love it or leave it!"  Yet probably the most broadly revered part of the Bill of Rights, which in turn is probably the most revered part of our Constitution, is the 1st Amendment--guaranteeing freedom of speech and religion, the right "peaceably to assemble"... and the right to "petition the Government for a redress of grievances."  So if everything is already perfect, why would we need to be able to speak up, get together and protest (peacefully), ...

By now, it should be clear that doctors' admonitions to lose weight and exercise more have little impact on our long-term, day-to-day behavior.  We all know this already from sad personal experience.  But we also know it from many studies, and from the multi-decade worsening in Americans' obesity and other chronic conditions.  The medical profession has been begging us for countless years to improve our health behavior--to almost no avail. Yet the fantastical headlines persist, even in publications like the Washington Post :  "Losing 13 percent of your weight could lead to big improvements in your health"    It is hard enough for adults to lose even 5 pounds and to keep it off--much less the 15-30+ pounds implied by "13%".  It is very rare to pull off sustained weight loss of this magnitude.   In fact, the only proven way currently to achieve this much permanent weight loss, on a whole-population scale, is the last resort, when all else has f...