July 7, 2001

GOOD HEALTH ADVICE IS RENDERED INDIGESTIBLE

I was buying lunch in the News' small cafeteria one day last week, and I ordered two hot dogs.

As I was enjoying them (with mustard and pickle relish) it occurred to me that I've worked here four years and never before have I bought two hot dogs. Why did I do it?

Because Kaiser Permanente told me not to, that's why.

Last month, in the course of a routine checkup, my doctor noticed I hadn't had my cholesterol checked for a couple of years, and asked me to stop by the lab on my way out and have it done.

Which I did, and a few days later the test results came in the mail, highlighted in fluorescent pink and accompanied by a little brochure, titled ``High Cholesterol? Here's What You Can Do.''

My cholesterol level, it said pinkly, was SLIGHTLY HIGH at 208 (normal being 130-199) and it advised me to FOLLOW THE ENCLOSED DIET and get tested again in six months.

Being by custom an obedient patient, I read the diet suggestions, and began to feel mildly irritated, because many of them are things I already do. ``Limit egg yolks to four a week'' -- I couldn't even tell you how many months it has been since the last time I had even two egg yolks in a week.

Use fat-free creamers in coffee? I drink it black.

Try fat-free yogurt or sorbet for dessert? I hate yogurt, as it happens, but no matter; I don't eat dessert anyway.

Avoid lard? Never bought it in my life.

And then all the meat things -- no more than six ounces a day, lean or low-fat, bake-broil-steam-or-grill instead of frying. Limit hot dogs. But that's the way I usually eat anyway.

Hence my irritation, and my small rebellion over the hot dogs. If these people are going to give me advice on changing my ways, they ought to take the trouble to find out first what my ways are.

Worse than the diet suggestions was the list of other things I could do to lower my risk of heart disease. No. 1 was ``stop smoking,'' which is no doubt excellent advice but first I would have to start.

But No. 7 was the worst: ``If you are a woman who has gone through menopause, discuss the pros and cons of taking hormone replacement therapy with your health care provider. Taking HRT can reduce your risk of heart disease.''

Dreadful advice, for me at least. My breast cancer was estrogen-dependent, and no way would I let someone talk me into taking more estrogen.

And maybe it's bad advice for anybody; a study that just appeared in the Annals of Internal Medicine found no evidence that taking hormones by itself reduced the risk of heart disease, and some indications that it increased the risk.

The lead researcher, Dr. JoAnn Manson, said, ``we would propose revamping current guidelines for prescribing HRT that include (reducing) heart disease as a treatment benefit.''

That research is too new for Kaiser to have taken it into account when revising its brochure, of course, but that aside, I thought it bad practice to send out such generic advice, advice that was at best irrelevant and at worst harmful.

Make no mistake, I have a very high opinion of the quality of care Kaiser offers. I've been in three plans over the past decade -- southern California, northern California and here in Colorado -- and they've seen me through three different kinds of cancer, along with assorted maladies of lesser significance. It never surprises me to see them highly ranked in national surveys.

I wish the current controversy over health-maintenance organizations distinguished between HMOs that provide care, as Kaiser does, and insurance companies that were forced into managing health care offered by others in order to control costs. The first model works, the second doesn't.

In any case, my little run-in with the brochure resulted from something they were doing right; preventive care before a potential problem becomes serious.

Also, as I found out when I called the Health Education number to complain about the inappropriateness of this impersonal advice, this is not the way advice is supposed to be delivered. ``It's not the level of individual care we aim at,'' said Kaiser spokesman Steve Krizman.

Or the level of care I have always experienced. And now, rebellion over, I am going to see if there's any advice in that little brochure I can usefully take.

(749 words)