Japanese Government Addresses Metabolic syndrome

asahi.com : EDITORIAL: Metabolic syndrome - ENGLISH

The Japanese government has a new health plan for people at risk of acquiring metabolic syndrome, with mandatory visits to a nurse councilor and penalties for insurers which fail to meet certain targets:

In addition, the health ministry requires each health insurance provider to set specific targets concerning the ratio of people covered by its insurance program who take medical checkups, the ratio of those who receive counseling and the reduction in the numbers of people who already have or are likely to develop metabolic syndrome.

This later seems pretty bizaare, although I have to give the government credit for taking early initiate on the problem, I doubt if there were many public health experts and doctors consulted.

2008 Pulitzer Prize

This photo won a Pulitzer Prize this year. The videographer is a Japanese man, Kenji Nagai, who was mortally wounded.

Yangon, Myanmar.
Published September 28, 2007
Adrees Latif of Reuters

One of the family medicine cross-covers I work with last night said "I'm not trained to do efficient medicine, I'm trained to do good medicine - saving money if for the people downstairs (the accountants and administrators)" and then later "I'm not trained to care for populations, I'm trained to take care of individuals."

Postponing death for...who?

I've heard older patients tell me "if I was going to live this long I would have taken better care of myself!" Even if that person had taken better care, then he would still be saying the same thing, only 10 years later. Modern medicine has become very good at postponing ageing-related frailty and disability, which is wonderful if you are enjoying your life and want to postpone death. But I'm seeing that this is actually not the case with many geriatric patients. There seems to be a point at which a person just starts to quit caring about living.

This is hard, if not impossible for us younger ones to understand. At some point it is as if the joy of living another day is simply not worth the effort of enduring the aches, pains, boredom, fatigue, loneliness, slowness, and inconvenience of growing old.

I'm afraid I'm not sure if the medical community really helps matters either. We keep hearts and kidneys working longer and we replace joints when they give out, and in many cases we prolong life for people who are ready to die - maybe not physically, but mentally and spiritually. I'm not sure how much sense this makes, and I am not sure if it is ethical.

As our patients and loved ones grown old and infirm we take away little by little their autonomy to decide the course of their lives by themselves. We do so much to keep the elderly alive that is motivated by our own need to feel like we are helping them; we rarely step back and ask grandpa or grandma what they really want. When we do they often tell us what we want to hear, not what they want to say. And when they tell us what we don't want to hear we think they're being irrational or demented and thus dismiss their desires.