Dec 282013
 

Close up of young couple fighting

I’d like to discuss a new concept to be put forth toward marriage, that is, a social union and legal contract between two spouses.  Though there are many different motives for marriage, including legal, social, sexual, emotional, financial, spiritual, and religious; my focus is based on a new model to improve the likelihood of a marriage being ‘successful’ and life-lasting.

Let’s begin by looking at some important statistics about marriage and America’s middle class, which make up a large portion of our population.  Such numbers provide a strong backdrop toward understanding the far-reaching and devastating social effects of poor marriages, as well as those ending in divorce.

Back in the 1980’s, thirteen percent of children born to moderately-educated mothers were born out of wedlock.   Today, that number has risen to 44 percent – a massive increase of 338 percent!  Moreover, a recent analysis of data from the National Center for Health Statistics, revealed that in the U.S., among women less than thirty years of age, more than half of childbirths— 53 percent—now occur outside of marriage. 

If you believe that it makes no real difference whether children are raised with unmarried or married parents, take a read at an insight granted by Paul Amato, a Penn State sociologist:

“Increasing marital stability to its 1980 level would result in nearly half a million fewer children suspended from school, about 200,000 fewer children engaging in delinquency or violence, a quarter of a million fewer children receiving therapy, about a quarter of a million fewer smokers, about 80,000 fewer children thinking about suicide, and about 28,000 fewer children attempting suicide.”

Marriage and Relationship Education (MRE) programs have been in place since the mid-1970’s, having received public funding at the state and federal level.  The average “dosage” of the past typical MRE program was twelve hours, with most programs having targeted young married couples or engaged couples.

In review of the many studies referencing nearly thirty years of these programs, individuals who had MRE classes or training saw their relationship quality improve by forty to fifty percent. Along with that, communication skills with their spouse or future spouse were seen improving by fifty to sixty percent.  Hence, MRE programs appear to positively affect the first two to three years of marriage, which also happen to be high risk years for divorce.

So why haven’t these programs become more widespread in use? 

The simple fact is that people who are about to enter marriage only think the best thoughts and do not believe that they will be one of the divorce “statistics” down the road. Plus, there are no immediate benefits afforded.

Separately, many religious organizations and churches offer pre-marital classes for their members, emphasizing the moral underpinnings of marriage and the importance of God as a part of it.  However, several important studies on religion and divorce rates were made by George Barna, founder of The Barna Group, a market research firm looking specifically at “the intersection of faith and culture”.  

Barna’s group interviewed nearly 3,800 faith-based couples, including agnostics and atheists.  The results showed that the divorce rates for Christians were not much lower than the national average – and, in many cases, were equal to those of atheists and agnostics!

All of this led me to what I believe could be a new solution – The Marital ‘Rewards’ Program.  

The Rewards Program would start with the understanding that not all people are meant to be married, nor at the time they believe they should be.  The primary purpose of the program would be in discovering potential conflicts, and that couples could see these problems as true deterrents.  From there, the couples would either work through and solve them, set them aside and continue into the marriage with the real possibility of future marital difficulties, or hold off marriage altogether.  

The program would be a 30-day course, non-religious in nature, and consist of questions, group meetings, homework, consulting and tests.  Topics would include some of the most common reasons for divorce, such as:

  • Infidelity
  • Finances
  • Addiction (Smoking, drinking, drugs)
  • Risk-taking
  • Sexual preferences
  • Communication
  • Abuse
  • Child-rearing
  • Cultural differences
  • Boredom/Lack of Interest

All participants who complete the Rewards Program would receive an initial individual benefit of a $1,500 tax credit, for the first taxable year after completion.  If the participants do not pay taxes because of lower or no income, they would receive the money as a yearly payment by the government, to use as they see fit.  For each year they remain married and cohabitate, the benefit would be a $500 tax credit, with an additional $500 tax credit if they would take a yearly 12-hour course.

The prospective couple would also need to receive a minimum of two hours education on divorce, including statistics, state law, what happens during a divorce, child custody, and alimony payments.  Both participants would sign a form stipulating that they understand the nature, possibility, and legal ramifications of divorce.

This program would by no means be mandatory.  However, it would set the precedent for establishing a strong marital and family foundation.  That in itself could help to begin a cycle where strong nuclear families create more successful future generations.  

I welcome your thoughts here.

Dec 212013
 

4385086822_18f837c167_zPerhaps I’m not the only person to think of this.  Such a shame that the idea can’t be patented.  

Perhaps if it ever comes to be, I can look forward to yearly Christmas gifts from radiologists, orthopedists and MRI manufacturers.  (Hint…if you’re ever in Richmond, feel free to take me out for a nice steak dinner!)

In the area of bone and joint health, I have always found it astounding that our health care system has never adopted a proactive view of screening for joint problems. To evaluate joints, especially weights bearing joints such as the spine, knees and hips, regardless of whether an individual has pain or not.

According to researchers, osteoarthritis (OA) is a condition which annually increases health care expenditures by $186 billion. Let’s put this into perspective.  Though there are more than one hundred different types of arthritis, the cost of diagnosing and treating OA and its effects exceeds the combined yearly revenues of Microsoft, McDonald’s, Amazon, Visa, Nike, and EBay.  

The Centers for Disease Control and Prevention (CDC) states that today, 27 million Americans suffer just with OA. To make matters worse, estimates are that by the year 2030 there will be a 248% increase in the number of adults in the U.S. diagnosed with this condition.  

Medical experts concur with the CDC, stating that the increase in OA is due to obesity and longer-living adults.  The latest research forecasts that the demand for knee replacements will increase 674% by year 2030, with hip replacement demand increasing nearly 200% for that same target year.  That will keep a lot of orthopedists well-paid and orthopedic hospitals well-staffed.

Osteoarthritis is a degenerative type of arthritis and a major debilitating disease that causes gradual loss of cartilage, mostly affecting the knees, hips, hands, feet, and spine. It is also known as degenerative joint disease.  If you’ve seen the malformed knuckles of an elderly person or ever had people tell you about their ‘bone spurs’, you know of it. 

The operative (pardon the pun) word here is ‘disease’. Osteoarthritis is not merely an ache and pain condition. Rather, it’s a disease process where the cartilage or spinal discs between bones wears away.  Over time, bone spurs grow in and around the affected joint, much like a weathered door hinge becoming rusted. Beside the pain of arthritis, it affects mobility too.   Primary OA is due to aging and heredity.  Secondary OA is due to prior injuries, surgeries, congenital abnormalities and carrying excess weight.

If you didn’t know about osteoarthritis and its prevalence, now you do.  Let’s move on.

 

THE PROBLEM

The crux of this blog topic centers on a commonly-held notion, shared both by patients and many front-line family doctors.  The same logic that proves true for many common health issues does not stay consistent for joint-related maladies such as OA.  To be more clear…

Organic problems such as diabetes, osteoporosis, cancer, heart disease and high cholesterol often exist when people have no symptoms.  That is to say, one can FEEL GOOD and be diseased and dying.  However, when it comes to joint-related conditions, the understanding is that until one FEELS BAD, they really don’t have a problem.  

Organic conditions are handled proactively through the use of objective, screening tests such as pap smears, blood and urine tests, mammograms, blood pressure checks, bone density tests, and prostate/OBGYN exams. Doctors, patients and health payers buy into the value of these tests.   

In contrast, joint-related conditions, such as OA, are identified when patients come to their doctor complaining of pain and symptoms.  Hence, these patients and their joint conditions are handled reactively through the use of medication, pain management, therapy and surgery.  There is no screening to identify loss of joint health before the pain comes.  

Yet any rheumatologist, orthopedist or chiropractor worth their salt will tell you that the onset of any stiffness or pain will typically occur long after the beginning of the degenerative arthritic process in a joint. Osteoarthritis comes either as a result of either normal aging or from past injury to a joint.

Would one wait until his or her first heart attack to get their blood pressure checked?

Let’s take Mary Smith, a 42-year old saleswoman and mother of two.  She visits her family doctor’s office complaining of neck stiffness and some intermittent tingling in her right hand that she’d had for the last six months. Ms. Smith had not suffered any recent falls, accidents, or lifting injuries.  However, she has had what she felt was ‘stress-related’ upper back stiffness for the last 7-8 years.  For this, she has taken over-the-counter pain medication several times a week to help her feel better.  

On a visit to her family doctor, she is examined and has x-rays taken of her neck.  The x-rays reveal osteoarthritis in the two lowest bones of her neck.  The rest of the neck appears normal.  The doctor tells Mrs. Smith that a little bit of OA is “normal for her age” and provides her with some pain medication. In time her neck pain feels better, so long as she continues her medication, but she still has tingling in the right hand.

Mrs. Smith is referred to an orthopedist.  There, a more extensive history is taken, where she recalls being in a single, severe auto accident when she was 20 years old.  She had been stopped at a streetlight and was subsequently rear-ended by a car going 50 mph.  She was taken to the emergency room and being given pain medication.  Her recollection is that a few weeks later, she felt better and all was seemingly well.  

Upon performing some orthopedic tests, the patient demonstrated increased right hand tingling.  With more specific imaging done for her neck, it was determined that even though she was only 42 years old, Mrs. Smith had the lower neck joints of a ‘normal’ 70-year old woman. This included the diagnosis of two moderately degenerated discs in her lower neck, as well as two bone spurs rubbing against nearby nerve root tissue.  This was determined to be causing both the tingling in her hand, as well as what she always thought to be stress-related neck and upper back pain.

For Mrs. Smith, the auto accident most likely injured the joints of her lower neck to the point where although she felt better, the beginning of OA commenced in those damaged areas.  The time for Mrs. Smith to start making changes in her life would have been perhaps when she was in her mid-twenties, or even when she had her first consistent period of aching in the upper back.  

How many Mary Smiths do we know?  How many times are people diagnosed with OA, after having many years of light pain and stiffness?  How many times do people and doctors dismiss low-level pain as ‘just muscular’ or stress?  Can OA be thwarted or lessened if patients knew of damaged cartilage before they feel their first ache or pain?

 

A SOLUTION

I’d like to see doctors, hospitals and insurance companies embrace regular joint imaging in determining the earliest signs of cartilage degeneration and osteoarthritis. This would be done from non-invasive MRI units millions of times a year. Just like one would have their regular screening tests for heart, blood, urine, etc., they would also go for a screening MRI.  

Such screening would be a proactive measure for people starting at age 30, and perhaps earlier and more frequent for those who had prior-documented joint injuries. In this sense, soft tissue injuries could be better tracked, allowing a greater possibility for people to age in a far healthier manner.  

Is the technology here yet?  Well, it may actually be right around the corner. Let’s start off with a little understanding about cartilage, the way it becomes damaged, and the result of osteoarthritis. 

Cartilage is composed of collagen (a protein) and glycosaminoglycans (GAG), which are carbohydrates. When cartilage begins to degenerate even the slightest bit, there is a measurable loss of GAG seen on a special types of medical radiology, known as gagCEST sodium imaging, done on an MRI machine. The decrease of GAG is seen at even the smallest levels because this software tracks protons shared between GAG and water molecules.

By using MRI imaging with gagCEST software technology, the MRI will now be able to monitor cartilage health of knees, hips, and spines.  If degeneration is detected early, drug therapy may be able to make a long-term difference.  Plus weight management measures and regular targeted strengthening exercises will have best effects.  Most important though – doctors and their patients will be able to know, year in and year out, how the joints are aging.  Hence, a way to monitor joint health.

I know what you’re thinking: patient expense, insurance coverage, long lines at MRI units, etc.  Well devil’s advocates… the water seems warm, so jump right in with your comments at the bottom of this article.  

But for now, let me at least fire off the first salvo, which comes in four parts:

1.  CON.  A lot of people don’t know, but there currently exists a pseudo-monopoly rule, inclusive of MRI units, in 36 states.  MRI facilities are not allowed to be set up for business without first obtaining a Certificate of Need (CON) given by the state.  The process can involve hundreds of thousands of dollars in legal fees, marketing studies, consulting fees and appeals.  Many experts and even the U.S. Department of Justice oppose these state rules, rightly believing CON laws “create barriers to entry for health care providers, prohibit competition and drive up healthcare costs.”

Removing such laws will allow many more MRI centers to be opened.  This will allow appropriate servicing of many individuals needing proactive MRI screening services, apart from current imaging patients. Even if those laws aren’t readily removed, the 14 ‘non-CON’ states will hopefully show success for the other states to consider.

2.  A greater volume of services will drive down cost.  MRI facilities will be far busier, but they will also be getting reimbursed for their work.  Obviously, proactive MRI screening is not going to pay at current MRI reimbursement levels, nor should they need to.  Insurance companies, through the AMA’s CPT code guidelines and reimbursement recommendations, can set fair and equitable screening measures and reimbursement rates.  

For those MRI centers who DON’T want to perform screening services, the free market will allow for those that do. Perhaps there will be just those MRI centers that choose to specialize in screening services, as opposed to other types of imaging done.  The beauty of a free market filling needs.

3. A greater reduction in the amount of future joint replacements and surgeries.  I’m sure orthopedists won’t be happy with this one, but earlier detection, understanding and personal responsibility offers both benefits and detriments – depending on the side one is coming from.  Patients will be healthier, while insurers and self-insured organizations will obviously be happy to reduce their medical costs.  I’m sure joint replacement manufacturers will be sending me my Christmas coal.  

4. More responsibility and better outcomes.  People who learn about their joint problems earlier have time on their side.  Plus, by keeping weight down, avoiding riskier activities, strengthening muscles and joint tissues, they have the best opportunity to prevent OA.  Ask yourself how many heart surgeries have been avoided because of determining one has high cholesterol or blood pressure?  It would naturally stand to reason that knowing of joint problems would yield similar reductions in surgery and better quality of life outcomes.

 

Feel free to comment below, as well as share this with others.   

Dec 092013
 

speed limit

Usage-based insurance (UBI), Pay-As-You-Drive (PAYD) and Pay-How-You-Drive (PHYD) are types of automobile insurance integrating into a growing segment of the automobile insurance industry.  Differing from traditional auto insurance, which focuses on past driving history and rewarding “safe” drivers with lower premiums, these new policies base their costs on monitoring present driving habits.  

Though less than half of all auto insurers offer such policies today, many industry experts predict that these new policies will see rapid growth in the U.S., with 20 percent of all vehicle insurance in the U.S. expected to incorporate some form of UBI, PAYD or PHYD within five years. 

These products trade off the promise of cheaper premiums, if the driver allows for a monitoring device (‘black box’) to be plugged into their OBD II port, which is an interface located below the steering wheel of most cars made after 1995. The first of these programs began with Progressive more than a decade ago, where mileage was monitored.  Assuming no accidents, if the mileage was low enough, the driver could expect some type of savings off their premium.  

Over time, technology has allowed insurers to gather more information on driving habits, including:

  • Number of miles driven
  • Driving times throughout the day and night
  • Where the vehicle is driven
  • Average speed
  • Hard breaking 
  • Hard cornering

There has been a lot of customer reluctance to purchase UBI, primarily because people don’t want their driving habits monitored, especially if they believe they are driving safely. Moreover, they consider their time in their cars personal and private.  Many consumer groups find concern with insurers knowing their location and driving patterns, for fear that their data will be sold or used in ways other than for pricing insurance premiums.  Still other groups believe that these ‘schemes’ are a new way for insurers to find greater profit margins.

Stepping away from privacy fears and corporate interest, one must recognize the all-too-real issue surrounding millions of drivers in the U.S. who speed each and every day.  Whether its the young reckless driver on the interstate, the business person driving to work each morning, or perhaps the parent running behind on dropping their kids at school, most everyone speeds to some degree.  

According to the National Safety Council’s report Focus on Safety: A Practical Guide to Automated Traffic Enforcement, drivers speed for the following reasons:  

  • They’re in a hurry
  • They’re inattentive to their driving
  • They don’t take traffic laws seriously
  • They don’t think the laws apply to them
  • They don’t view their driving behavior as dangerous
  • They don’t expect to get caught

The fact is that speeding is a major contributor to many accidents and injuries. The National Highway Traffic & Safety Administration (NHTSA) reports that speeding is involved in about 33% of all fatal crashes, and is the third leading contributing factor to traffic crashes. But while other contributing behaviors, such as driving while impaired/intoxicated and not wearing seat belts have been significantly reduced, speeding remains a consistent “challenge”.  

Placing officers in strategic positions to monitor speeding is at best a public service through a temporary and short-lived deterrent.  At worst, it is an inefficient use of police manpower and a tremendous waste of taxpayer money.

Moreover, many people erroneously think that when they pay an expensive traffic ticket that the money is all going to the county police department. Depending on state, a large part of every ticket goes to the state and then the court system.  It may surprise people just how little actually gets to the police department whose officer wrote up the ticket.

In recent years, the use of cameras to detect speeders has been used.  This has been shown to generate a larger amount of tickets and reduce police manpower. However, its shortcomings are the same of the police cruiser with a radar gun.   People WILL slow down in the monitoring area, but then they will speed up once they clear it.  The simple fact is that we can’t have cameras and speed monitors everywhere – or can we?

 

THE INVENTION

My proposed invention, A System for Speed Mapping and Reporting, allows for our present speeding ticketing and financial punishment system to work without so many manual and people-dependent processes.  It will be mandated for all monitored vehicles – in other words, ALL cars and trucks in America.  The program will be run by each state, whereby drivers are given a periodic ‘report card’ of their driving habits, delivered to them on a quarterly basis.  

The premise is that by mapping out all roads by connected sections of speed limits, the vehicle will be able to send its speed and its position to a satellite. From there, the information will be collected onto a database and put through a series of comparative measurements.  If for example, Bob Smith were driving his car for a 3-month period, this monitoring system would be able to know on every single occasion, when Mr. Smith’s speed in a particular stretch of ‘speed zone’ exceeded that zone’s required speed limit.

Since most everyone speeds, then it stands to reasons that everyone will be paying state penalty money from these reports, right?  Well not exactly.  

Like anything else, there will be arguments and determination on what constitutes a ‘safe driver’.  Is it perhaps only breaking speed limits by an average of less than 5 m.p.h.?  Is it breaking the limits of less than 50 speed zone areas per month?  What about those who violate speed zones in more residential/school areas?  All of this would need to be determined, as well as what happens when a driver is flagged out-of-state or when driving a rental car. Certainly, there would have to be a period of time to get drivers used to a such a monitoring system, prior to its actual release.  

Plus, what would be the fees associated with certain low, medium and high-scoring (penalized) drivers?  Should there be a significant penalty for drivers who are caught driving more than 25 m.p.h. over a speed zone’s limit?  If that happens many times, does it mean a potential loss of license?   This begs the question of how a monitoring system like this would know who is driving the car?  

Perhaps that may not matter if ultimately the quarterly reports and financial penalties are within reason.  But when a report comes out showing that a driver exceeded 20 mph in speed zones more than 100 times in three months, perhaps a biometric device to determine driver identify, coupled to the vehicle starting, may be needed.  Otherwise, dear old Mom and Dad can take full responsibility and penalty for their teenager’s driving habits when using their car.  Remember, we’re talking about a dangerous driver and the statistics on speeding and accidents are quite clear.

It is also likely that this invention could be tied into a web-based application, allowing drivers to keep accurate measurements of their current ‘driving scores’ in real time.  Imagine that a driver, through such an application, knows when they are heading toward a bad quarterly report score.  Could they conceivably reduce points by showing consistency in lowering their speeds over time and speed zones?   There is a lot of area for growth in training drivers to be safe, by having a monitoring program such as this in place.  

And what of those people ‘rushing’ to get somewhere because of their poor planning?  Simply stated, this program teaches them to be better organized. Many of these people are selfish, and seem to forget that we all share the road.  A concept that has been well lost over all the many years and incidents of drunk driving, speeding, reckless driving, and road rage.

How would automobile insurance companies fit into all of this?  

Since insurance companies do base their rates, in part, on when drivers get speeding tickets, this would obviously make some difference on premiums. However, I do believe that because states will be collecting far more money from drivers, perhaps there could be a mandate on just how much a premium could be raised.  After all, we do want to see the roads safer, especially by means of cost-saving technology.  But hardly at the expense of bankrupting the drivers of America. 

I can hear all the readers who are privacy advocates screaming out, “BIG BROTHER…LESS GOVERNMENT”.  I couldn’t agree more.  However, less police officers on the road, less speeding tickets, less court costs, less police officers having to spend their time in court, less court cases piling up, less government and law enforcement personnel needed ALSO means less government and a possible financial break to the taxpayer.  Couldn’t we all use a little tax break?

At the heart of this entire system is the simple rule that people make decisions for one of two reasons – either they want to avoid pain or gain pleasure. That’s why speeding tickets, at least to some extent when given, do get people to drive slower.  Unfortunately, this is temporary and altogether lost on the millions of drivers who are not regularly caught and ticketed.  Why not use this motivation for the good of society and the safety of our roads?  

There’s nothing unfair about penalizing drivers who choose to drive more dangerously.  It’s a fair system, both for the 65-year old grandmother driving her Toyota Camry, as well as the 19-year old driving a his new red sports car. All drivers will have the same chance to pay or not pay, depending on how they choose to drive.  Plus, truly reckless drivers won’t have to rely on their good luck, as they are flagged all the time.  

So much for those fancy radar detectors!

 

 

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