Perusing through myriad responses to the 52 columns written last year, one gains a sense of which issues matter most to readers and which ones stir up the greatest controversy. Together they point to those topics sure to capture attention in the coming year.
We care about what we eat. Food must be tasty, convenient, reasonably priced and healthy. The devil is in the details and how each of us prioritizes these nearly universal values. The purveyors of genetically modified food say that GMO meets all four criteria. They say it is so safe that "GMO" need not be written on the label. Opponents to GMO argue that if it was so attractive, agribusiness would jump to put it on the label. Despite Gov. Neil Abercrombie’s comment that organic farming is merely gardening, there is a groundswell of readers who cherish local, organic food and choose to support Hawaii’s farmers and their markets. Many see food as an opportunity to build community and the island economy.
Increasingly, we have become aware that being overweight adversely affects our sleep, health and longevity. Obesity is associated with markedly increased risks of obstructive sleep apnea, diabetes, high blood pressure, elevated cholesterol and painful arthritis. Yet, readers are divided as to how best to solve the problem. Other states and countries have imposed a soda tax or a fat tax levied upon certain food items. Measures of this nature have, so far, evaded passage by the Hawaii Legislature, but not for long.
Many continue to struggle with addictions to food, illegal and prescription drugs, tobacco and alcohol. Also concerning is the growing addiction to internet pornography, gaming and even social networking. Clearly, Internet technology and mobile computing can bring us together, but tools of the modern day can just as easily tear us apart and damage both mind and body.
Health care reform is, in part, based on the assumption that technology, especially electronic health records, will increase efficiencies. As such, carrots and sticks are out in force to ensure that providers become paperless, and 2013 will continue the 2012 trend of rapid adoption of EHR by providers. Readers understand the inherent benefits but also worry more about privacy and wonder whether these efficiencies will improve or erode the sacred relationship they have with their primary care provider. Under health care reform people will continue to enjoy increased access to care, but newfound efficiencies will not be enough to manage costs and, increasingly, care will be rationed. The fight to preserve the soul of medicine will continue in 2013 and beyond.
The treatment of injured workers continues to be a troubled area for health care in Hawaii. Numerous stories have been submitted by injured workers and their providers of abuses by carriers and a Department of Labor that is too underfunded to serve justice. In their defense, workers’ comp carriers must also guard against abuse by malingering workers, but their profits remain in good health.
Readers remain deeply concerned about climate change and are distraught that the last round of talks in Qatar reflects a world that is unable to come together around this shared global threat and that we may have hit the point of no return. Melting at both poles is daunting. Alternative, sustainable energy is one way that many have found to make a contribution to the healing of the blue planet. Solar energy was on fire in Hawaii during 2012, but pending cuts in state tax credits will cause some investors to take pause in 2013.
Finally, there is the question of how we die. Every "Wealth of Health" column covering palliative care, hospice and end of life has drawn strong comments from readers. There are those who continue to be suspicious of who may try to pull the plug on grandma, but the majority believe that too many dollars are spent during the last weeks of life — dollars that could be better spent on prevention. Most hope to age in place and remain at home as long as possible, and when our time comes wish for a gentle and graceful passing.
During 2013 we will continue to live in interesting times. As an island community and as a global society, we will continue to find ways to come together for common good.
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Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.
