The providers, MDs and hospitals had no incentive to reduce unnecessary or redundant procedures. Additionally, healthcare consumers were not motivated to question the volume of care or its expense, as they did not pay the bill.

Medicine was treated more as an art with an individual perspective, which often led to expensive variations in treatment. As a result of treatment inconsistencies and expanding costs, healthcare in America came to an annual cost of more than $1 trillion.

In the progression of healthcare reimbursement, managed care was developed to attempt to control escalating costs. Managed care is a means of restricting care to usual and customary services by taking the physician out of the care decision. Care is based on predetermined contractual coverage, often dictated by a clerk.

Managed care limits the amount paid to the healthcare provider, often with the goal of maximizing the managed care organization’s profits. In essence, managed care created the environment of managing cost — not care!

While managed care was successful in managing costs, there were numerous consumer complaints regarding quality and limits on care. It is this disenchantment that is creating an opportunity for health clubs.

Shii Ann and Clay got further instructions to go to Chuay Gahn camp while Ken and Helen got a note to go to Sook Jai camp. Shii Ann learned about the monkey, Magilla, and thought their camp was just a wonderful thing.

Helen was quite impressed with Sook Jai’s shelter. “Wow! You guys built this?” And then she noticed the chicken, “You’ve got to be kidding me!” She also really liked how close the water hole was.

Ken stated to the cameras that he “listened. I didn’t tell her much because, let’s face it, this is my enemy.” Helen was also cautious in her responses. She didn’t want to give out any secrets to the “New York City cop.”

Meanwhile, Shii Ann makes a do-or-die strategic decision: she lays it all out on the table for Clay. “Well, you know what? Our tribe hasn’t got along since day one. I’ll tell you what. I’ll tell you the truth here.”

I’m not sure if this was strategy or just Shii Ann needing a release. She said to the camera, “because I’ve been so pent up for 18 days, I just spilled my guts.”

She blabs to Clay, “I’ll tell you right now what they’re saying. We keep our five and start voting out you guys. And if Ken wasn’t around, I wouldn’t be here.

Ken is the person who’s like, ‘You know what, that’s not fair. Why are you booting her out? She works hard.’ And Penny, by the way, is as sweet as she looks. I’ll tell you, she is the most manipulative player on our team.”

Clay shares their obvious strategy, “Well we’ve already said if we could get Jake on the older side and get one more person that he likes…”

The study authors, led by Thomas A. Pearson, M.D., from the University of Rochester School of Medicine, used data obtained from the multicenter Lipid Treatment Assessment Project, or L-TAP, to determine what percentage of patients who were receiving lipid-lowering therapy for elevated “bad” cholesterol (LDL-C) actually achieved treatment goals.

These goals were last outlined in 1997 by the National Cholesterol Education Program, which was established by the federal National Institutes of Health in 1983. The NCEP periodically issues revised cholesterol guidelines.

The almost 5,000 study patients were divided into three groups:
Low risk of heart disease, having less than two known risk factors for coronary artery disease, or CAD, and no history of the disease;
High risk of heart disease, having two or more risk factors, but no apparent CAD; and
Those with known CAD. CAD was diagnosed in those who had a history of heart attack, or had bypass surgery or angioplasty.

CAD risk factors include smoking, high blood pressure, diabetes, age, low “good cholesterol” (HDL-C), and family history of premature CAD. The study evaluated equal numbers of men and women, and the patients’ average age was 60.

The NCEP-recommended treatment goals for group-1 patients was less than 160 milligrams of LDL-C per deciliter; for group 2, it was less than 130 milligrams per deciliter; and for group 3, less than 100 milligrams per deciliter.

Surprisingly, only 18 percent of those with known CAD (group 3) were being treated with enough medication without a prescription to lower their LDL-C to the NCEP-recommended level. In group 2, only 37 percent of these high-risk patients had levels of 130 milligrams per deciliter or less, while in the low-risk group 1, the level of 160 milligrams per deciliter was attained in 68 percent. Overall, the success rate was 38 percent.

The success rate was higher in those patients who were treated with prescription drugs as opposed to diet alone, but was highest in those treated with both diet and drugs. Those who were treated with “statin” drugs had a greater rate of achieving NCEP goal levels of LDL-C than those who were treated solely with other drugs. The majority of physicians responsible for prescribing treatment for the study patients said they were aware of the NCEP guidelines, and they knew that lowering LDL-C was an important treatment approach to CAD prevention.

Why then is there such a low level of successful treatment for this very treatable condition? The drugs used most commonly and effectively, the statins, are generally quite safe and easily tolerated. It has been clearly established that cholesterol-lowering therapy reduces the occurrence of both initial and recurrent coronary events. Several studies over the past few years have yielded similar results: not enough is being done to lower elevated cholesterol levels.

The study authors have no easy answer, but theorize that one or more of the following factors may explain this situation: too low a dosage of drug, low drug efficacy, wrong choice of drug, and noncompliance with the prescribed regimen.

Maximal oxygen consumption training (VO2max).The goal of a VO2max workoutis to increase the supply of oxygen at the level of the working muscle, which is an absolutely necessary component of performance for endurance events. The work period is three to eight minutes, at 80 to90 percent of maximumheart rate. The work-to-rest ratio is 2 to 1, or 1 to 1 (i.e., four minutes ofwork totwo minutes of rest, or four minutes ofwork tofour minutes ofrest).

Anaerobic threshold training (AnT).The goal of AnTis to produce lactic acid at such a rate that the body cannot dispose of it. This forces the body to adapt to the effects of lactic acid, buffer its effects, increase lactate removal, and increase tolerance physiologically and psychologically to the pain of training and competition. The work period is two to six minutes at 60 to85 percent of maximumheart rate. The work-to-rest interval is 1 to1 (i.e., five minutes ofwork tofive minutes ofrest).

Phosphate training system (Pts).The goal of Ptsis to increase the ability to be fast and efficient with less effort,while improving recovery. The work period is four to 15 seconds at 95 to100 percent of heart rate maximum. The work-to-rest interval is 1 to2 or3 (i.e., 10 seconds of work to 20 or30 seconds of rest).

Aerobic threshold training (ATT).The goal of ATTis to improve high aerobic capacity, which is a decisive factor for all events of medium and long duration, including daily living activities. This is important in lifestyle training when the oxygen supply represents a primary limiting factor. The work period includes a high volume of work performedat a uniform pace (20 minutes to two hours). This can also be accomplished with intervals using repetitions longer than five minutes. The recovery periodtypically equals the work interval.

Your students need to learn about appropriate exercise intensity, caloric expenditure, perceived exertion, duration, warm-up, cool-down, exercise safety, myths and misconceptions, injury prevention, nutrition and the latest in fitness research. Instructors can pass out informational handouts and offer “fit tips” at the beginning of class or during the cool down.

You can also use bulletin boards, posters and newsletters as information sources, as well as invite guest lecturers to speak in classes. Give a weekly quiz pertaining to health and fitness information, then post the answers the following week.

Ask the instructors to summarize what everyone has achieved at the end of the workout, review which muscles have been worked and go over the learning points. Besides educating your students, you will help them feel a stronger sense of accomplishment by having taken your classes.

Youth. Incredibly, organizations that focus on children — including the National 4-H Council and the Children and Youth At-Risk Program of the University of Pennsylvania School of Social Work — were supported by tobacco funds.

What nice people those cigarette manufacturers are!

They manufacture a product that kills over 400,000 Americans each year, and they they give away hundreds of millions of dollars to good causes.

While Dr. Siegel’s new report does not go beyond documenting the extent of philanthropy from cigarette manufacturers, a 1990 report by Larry White, published by the American Council on Science and Health, did look at the dilemma, “The Ethics of Accepting Tobacco Money.” Mr. White acknowledges that the recipients of tobacco money customarily engage in “good works.” And it might be argued that the value of those good works outweighs any ethical considerations about taking tobacco money.

Yet, there is broad agreement that money from certain sources should not be deemed acceptable for funding even good work. For example, few if any charitable institutions would knowingly accept money from the mafia. Why? Because accepting it would make them an accomplice to the immoral actions of the donor. A recipient of such funds also might feel obligated not to offend the donor for fear of losing future funding.

Further, it is evident that in receiving money, an organization or researcher or a performing artist is bestowing something on the giver — in this case, the cigarette company. When Philip Morris sponsors an event at the Metropolitan Museum of Art, some of the museum’s legitimacy rubs off on the cigarette maker. As Mr. White noted, “When Harvard University accepts an R.J. Reynolds grant, RJR acquires a little chunk of Harvard’s credibility.”

There is a particular cruel irony in Big Tobacco’s support of organizations that serve youth, minorities and women — three groups the cigarette manufacturers are targeting for cigarette sales, thus imperiling their health and life.

As Mr. White concluded, “Whatever good tobacco industry philanthropy does is more than offset by the vast toll in human suffering caused by smoking their products. Tobacco industry giving is not politically neutral. It is intended to promote an industry whose product kills hundreds of thousands of Americans each year.”

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In a new and comprehensive report entitled “Tobacco Industry Sponsorship in the United States, l995-l999,” Dr. Michael Siegel of the Boston University School of Public Health documents — in a systematic and comprehensive way — corporate sponsorship by tobacco companies during that five-year period. Specifically, Siegel identified 304 tobacco company sponsorships of events, programs or organizations in the following areas:

AIDS. Tobacco companies provided funding to at least 42 different AIDS service organizations. The centerpiece of tobacco industry support for AIDS patients is Philip Morris with its sponsorship of the Positive Helpings program — support which provides money to aid the nutritional needs of people living with HIV.

Charities/Causes. Tobacco companies have supported a wide variety of general charities including: humanitarian organizations (Christian Relief Services), health and human services (including the American Red Cross of Louisville and Hospice groups) and disaster relief (Hurricane Floyd) — as well as legal services (Association of the Bar of the City of New York Fund).

Domestic Violence. Through the Doors of Hope initiative, Philip Morris provided grants totaling $2 million to 180 organizations across the country to support food and meals, emergency shelter, counseling and other aid to victims of domestic violence.

Education. The industry supported programs at colleges and universities across the country, including the Universities of Central Florida, Louisville, Kentucky, Rochester and Virginia, as well as Duke, MIT and North Carolina State University among others. The largest contribution identified was $3 million to the University of Louisville in 1996 for completion of a football stadium.

Environment. The industry supported organizations that promote the protection and restoration of water and land resources — and supported many environmental conferences, including the Drinking Water/Pollution Prevention Forum and the Keep America Beautiful national conference.

Festivals. The industry supported a multitude of festivals including the Kentucky Derby Festival and the Wisconsin Sesquicentennial.

Hunger. Tobacco companies made contributions to the efforts to fight hunger in the United States with donations to more than l00 local organizations, including the Helping the Helpers program, which provides donations under emergency circumstances to food pantry programs, soup kitchens and the elderly.

Minorities. The industry is a major giver to minority groups, particularly African-American groups, including the National Convention of the National Black Chamber of Commerce and art exhibits featuring African-American artists.

Performing Arts. Tobacco donations went to the John F. Kennedy Center for Performing Arts and the New York City Opera among many others.

Politics and Government. Dr. Siegel identified 12 events or organizations in this category, including sponsorship of trips to conferences and seminars paid for by tobacco companies. The tobacco companies also sponsored the Presidential and Vice-Presidential debates in 1996 and the annual meetings of the U.S. Conference of Mayors in l998 and 1999.

Sports. Tobacco companies sponsored a variety of sports events, including the Senior PGA Tour Vantage Championship.

Visual Arts. Among the most notable sponsorships here were the Brooklyn Museum of Art and the Cincinnati Art Museum.

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Take 5 For Fitness is a comprehensive pre-work stretch and health education program for the approximately 200 line workers and 100 office personnel at the company’s manufacturing building. The program was developed by SmithKline Beecham’s fitness center staff and an onsite occupational health nurse. Five-minute stretching sessions facilitated by 15 “team trainers” are now held at the beginning of both shifts. Employees have pocket-sized stretching books that are easily updated as new exercises are added. Follow-up sessions are held to introduce new stretches and to evaluate progress.

The fitness team also implemented a health education plan that includes a series of “lunch and learn” seminars to teach employees how they can improve their lifestyle practices. Topics include back injury prevention, weight management and nutrition. There is also a bulletin board that provides updated information on wellness topics.

This proactive approach to wellness has been well received. Unlike fitness center programs that only appeal to currently active individuals, Take 5 For Fitness offers all onsite employees the opportunity to practice healthy behavior and learn more about wellness concepts.

Employees have been embracing the opportunity to participate in the health education sessions and have requested additional classes on fitness principles, workplace ergonomics and back health. In addition, the program has encouraged employees to join the fitness center at the manufacturing facility.

SmithKline Beecham has benefited in other ways as well. There have been no workplace injuries since the start of the program, showing that the stretching sessions have improved flexibility, and reduced muscular stress and strain. This has reduced claims for worker’s compensation and disability benefits while improving the company’s safety record. Team leaders also report that the program has motivated employees and improved morale. In fact, participants have requested that the stretching sessions be scheduled before and after each shift. Take 5 For Fitness has been a win-win situation, providing benefits for everyone involved.

Many of these women will be treated with angioplasty, one of the most common non-surgical approaches to heart disease treatment available today.

Nearly 1 million angioplasties are performed each year and are becoming more common, according to the American Heart Association. They’re performed by interventional cardiologists and involve inserting a small catheter into an artery in the groin or arm and guiding it to the blocked artery. A little balloon on the catheter is then inflated, flattening obstructive, built-up plaque against the artery wall. It also is common for the physician to insert a stent, a tiny mesh coil that stays in the artery and props it open to prevent reclosure.

Prior to angioplasty, the only treatment for blocked arteries was bypass surgery — a major surgical procedure. Angioplasty is performed under light sedation, and the patient typically goes home the same day.

The risks of angioplasty are small, but real nevertheless. There is less than a 5 percent chance of heart attack or emergency bypass surgery, and the risk of fatal complications is less than 2 percent.

Other, less common ways of treating arterial blockages without surgery include directional atherectomy and rotational atherectomy, in which small instruments cut out, or pulverize, blockages. Lasers can also be used to destroy plaque buildup.

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In addition to providing free transportation to senior members who are unable to drive to the fitness center, Health On Wheels offers transportation from local senior organizations and retirement communities to health lectures scheduled throughout the year. According to Wendy Oakes, director of senior and recreational programs, the service reaches far beyond just transporting members to the club. “It is well known that the age wave is upon us and Americans are living longer,” Oakes says. “The senior citizen segment of the U.S. today is growing at twice the rate of any other segment. As this segment grows, health care remains a major concern. Programs such as Health On Wheels offer a new beginning and may ultimately help reduce one’s dependence on a long-term care facility.”

Currently, more than a dozen members use the transportation service on a weekly basis, and according to Oakes, several other senior members have expressed gratitude knowing the service is available should they need it. To cover the cost of the free service, the Cooper Fitness Center sells sponsorships to area businesses. The annual cost of the program ranges from $10,000 to $12,000, Oakes says.

To ensure member safety, those who utilize the van service are required to complete an extensive health form and be screened for health status and medication information. This information is then shared with the van driver, who is certified in CPR and first aid. In case of emergency, the vehicle is equipped with a phone.

Although the club has yet to track membership statistics in relation to Health on Wheels, Oakes predicts a definite boost in membership. “We’ve got members who are in their 50s and 60s who now want their parents to join because of the service,” she says. “It’s turning out to be a great service for everyone.”