Insomnia? High blood pressure? Try these!
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Your Questions, Our Answers!
Q: Recipes for insomnia and high blood pressure and good foods to eat for these conditions?
A: Insomnia can be caused by many things, and consequently can often require a very multi-vector approach to fixing it. But, we’ll start by answering the question you asked (and probably address the rest of dealing with insomnia in another day’s edition!):
- First, you want food that’s easy to digest. Broadly speaking, this means plant-based. If not plant-based, fish (unless you have an allergy, obviously) is generally good and certainly better than white meat, which is better than red meat. In the category of dairy, it depends so much on what it is, that we’re not going to try to break it down here. If in doubt, skip it.
- You also don’t want blood sugar spikes, so it’s good to lay off the added sugar and white flour (or white flour derivatives, like white pasta), especially in your last meal of the day.
- Magnesium supports healthy sleep. A fine option would be our shchi recipe, but using collard greens rather than cabbage. Cabbage is a wonderful food, but collard greens are much higher in magnesium. Remember to add plenty of mushrooms (unless you don’t like them), as they’re typically high in magnesium too.
As for blood pressure, last month we gave tips (and a book recommendation) for heart health. The book, Dr. Monique Tello’s “Healthy Habits for Your Heart: 100 Simple, Effective Ways to Lower Your Blood Pressure and Maintain Your Heart’s Health”, also has recipes!
Here’s one from the “mains” section:
Secret Ingredient Baltimore-Style Salmon Patties with Not-Oily Aioli
❝This is a family favorite, and no one knows that it features puréed pumpkin! Most salmon cake recipes all for eggs and bread crumbs as binders, but puréed pumpkin and grated carrot work just as well, lend a beautiful color, and add plenty of fiber and plant nutrients. Canned salmon is way cheaper than fresh and has just as much omega-3 PUFAs and calcium. Serve this alongside a salad (the Summer Corn, Tomato, Spinach, and Basil Salad would go perfectly) for a well-rounded meal.❞
Serves 4 (1 large patty each)
Secret Ingredient Baltimore-Style Salmon Patties:
- 1 (15-oz) can pink salmon, no salt added
- ½ cup puréed pumpkin
- ½ cup grated carrot (I use a handheld box grater)
- 2 tablespoons minced chives (Don’t have chives? Minced green onions or any onions will do)
- 2 teaspoons Old Bay Seasoning
- 1 tablespoon olive oil
- ½ large lemon, sliced, for serving
Not-Oily Aioli:
- ½ cup plain low-fat Greek yogurt
- Juice and zest from ½ large lemon
- 1 clove garlic, crushed and minced fine
- 2 tablespoons chopped fresh dill
- For the patties: mix all the ingredients for the salmon patties together in a medium bowl
- Form patties with your hands and set on a plate or tray (you should have 4 burger-sized patties)
- Heat oil in a large skillet over medium heat.
- Set patties in a skillet and brown for 4 minutes, then carefully flip.
- Brown the other side, then serve hot.
- For the Aioli: mix all the ingredients for the aioli together in a small bowl.
- Plop a dollop alongside or on top of each salmon patty and serve with a spice of lemon.
Per serving: Calories: 367 | Fat: 13.6g | Saturated Fat: 4.4g | Protein: 46g | Sodium: 519mg | Carbohydrates: 13.2g | Fiber: 1.3g | Sugars: 9g | Calcium: 505mg | Iron: 1mg | Potassium 696mg
Notes from the 10almond team:
- If you want to make it plant-based, substitute cooked red lentils (no salt added) for the tinned salmon, and plant-based yogurt for the Greek yogurt
- We recommend adding more garlic. Seriously, who uses 1 clove of garlic for anything, let alone divided between four portions?
- The salads mentioned are given as recipes elsewhere in the same book. We strongly recommend getting her book, if you’re interested in heart health!
Do you have a question you’d like to see answered here? Hit reply or use the feedback widget at the bottom; we’d love to hear from you!
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Does intermittent fasting have benefits for our brain?
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Intermittent fasting has become a popular dietary approach to help people lose or manage their weight. It has also been promoted as a way to reset metabolism, control chronic disease, slow ageing and improve overall health.
Meanwhile, some research suggests intermittent fasting may offer a different way for the brain to access energy and provide protection against neurodegenerative diseases like Alzheimer’s disease.
This is not a new idea – the ancient Greeks believed fasting enhanced thinking. But what does the modern-day evidence say?
First, what is intermittent fasting?
Our diets – including calories consumed, macronutrient composition (the ratios of fats, protein and carbohydrates we eat) and when meals are consumed – are factors in our lifestyle we can change. People do this for cultural reasons, desired weight loss or potential health gains.
Intermittent fasting consists of short periods of calorie (energy) restriction where food intake is limited for 12 to 48 hours (usually 12 to 16 hours per day), followed by periods of normal food intake. The intermittent component means a re-occurrence of the pattern rather than a “one off” fast.
Food deprivation beyond 24 hours typically constitutes starvation. This is distinct from fasting due to its specific and potentially harmful biochemical alterations and nutrient deficiencies if continued for long periods.
4 ways fasting works and how it might affect the brain
The brain accounts for about 20% of the body’s energy consumption.
Here are four ways intermittent fasting can act on the body which could help explain its potential effects on the brain.
1. Ketosis
The goal of many intermittent fasting routines is to flip a “metabolic switch” to go from burning predominately carbohydrates to burning fat. This is called ketosis and typically occurs after 12–16 hours of fasting, when liver and glycogen stores are depleted. Ketones – chemicals produced by this metabolic process – become the preferred energy source for the brain.
Due to this being a slower metabolic process to produce energy and potential for lowering blood sugar levels, ketosis can cause symptoms of hunger, fatigue, nausea, low mood, irritability, constipation, headaches, and brain “fog”.
At the same time, as glucose metabolism in the brain declines with ageing, studies have shown ketones could provide an alternative energy source to preserve brain function and prevent age-related neurodegeneration disorders and cognitive decline.
Consistent with this, increasing ketones through supplementation or diet has been shown to improve cognition in adults with mild cognitive decline and those at risk of Alzheimer’s disease respectively.
2. Circadian syncing
Eating at times that don’t match our body’s natural daily rhythms can disrupt how our organs work. Studies in shift workers have suggested this might also make us more prone to chronic disease.
Time-restricted eating is when you eat your meals within a six to ten-hour window during the day when you’re most active. Time-restricted eating causes changes in expression of genes in tissue and helps the body during rest and activity.
A 2021 study of 883 adults in Italy indicated those who restricted their food intake to ten hours a day were less likely to have cognitive impairment compared to those eating without time restrictions.
Matching your eating to the active parts of your day may have brain benefits.
Shutterstock3. Mitochondria
Intermittent fasting may provide brain protection through improving mitochondrial function, metabolism and reducing oxidants.
Mitochondria’s main role is to produce energy and they are crucial to brain health. Many age-related diseases are closely related to an energy supply and demand imbalance, likely attributed to mitochondrial dysfunction during ageing.
Rodent studies suggest alternate day fasting or reducing calories by up to 40% might protect or improve brain mitochondrial function. But not all studies support this theory.
4. The gut-brain axis
The gut and the brain communicate with each other via the body’s nervous systems. The brain can influence how the gut feels (think about how you get “butterflies” in your tummy when nervous) and the gut can affect mood, cognition and mental health.
In mice, intermittent fasting has shown promise for improving brain health by increasing survival and formation of neurons (nerve cells) in the hippocampus brain region, which is involved in memory, learning and emotion.
What we eat can affect our brain, and vice versa.
ShutterstockThere’s no clear evidence on the effects of intermittent fasting on cognition in healthy adults. However one 2022 study interviewed 411 older adults and found lower meal frequency (less than three meals a day) was associated with reduced evidence of Alzheimer’s disease on brain imaging.
Some research has suggested calorie restriction may have a protective effect against Alzheimer’s disease by reducing oxidative stress and inflammation and promoting vascular health.
When we look at the effects of overall energy restriction (rather than intermittent fasting specifically) the evidence is mixed. Among people with mild cognitive impairment, one study showed cognitive improvement when participants followed a calorie restricted diet for 12 months.
Another study found a 25% calorie restriction was associated with slightly improved working memory in healthy adults. But a recent study, which looked at the impact of calorie restriction on spatial working memory, found no significant effect.
Bottom line
Studies in mice support a role for intermittent fasting in improving brain health and ageing, but few studies in humans exist, and the evidence we have is mixed.
Rapid weight loss associated with calorie restriction and intermittent fasting can lead to nutrient deficiencies, muscle loss, and decreased immune function, particularly in older adults whose nutritional needs may be higher.
Further, prolonged fasting or severe calorie restriction may pose risks such as fatigue, dizziness, and electrolyte imbalances, which could exacerbate existing health conditions.
If you’re considering intermittent fasting, it’s best to seek advice from a health professional such as a dietitian who can provide guidance on structuring fasting periods, meal timing, and nutrient intake. This ensures intermittent fasting is approached in a safe, sustainable way, tailored to individual needs and goals.
Hayley O’Neill, Assistant Professor, Faculty of Health Sciences and Medicine, Bond University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Without Medicare Part B’s Shield, Patient’s Family Owes $81,000 for a Single Air-Ambulance Flight
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Without Medicare Part B’s Shield, Patient’s Family Owes $81,000 for a Single Air-Ambulance Flight
Debra Prichard was a retired factory worker who was careful with her money, including what she spent on medical care, said her daughter, Alicia Wieberg. “She was the kind of person who didn’t go to the doctor for anything.”
That ended last year, when the rural Tennessee resident suffered a devastating stroke and several aneurysms. She twice was rushed from her local hospital to Vanderbilt University Medical Center in Nashville, 79 miles away, where she was treated by brain specialists. She died Oct. 31 at age 70.
One of Prichard’s trips to the Nashville hospital was via helicopter ambulance. Wieberg said she had heard such flights could be pricey, but she didn’t realize how extraordinary the charge would be — or how her mother’s skimping on Medicare coverage could leave the family on the hook.
Then the bill came.
The Patient: Debra Prichard, who had Medicare Part A insurance before she died.
Medical Service: An air-ambulance flight to Vanderbilt University Medical Center.
Service Provider: Med-Trans Corp., a medical transportation service that is part of Global Medical Response, an industry giant backed by private equity investors. The larger company operates in all 50 states and says it has a total of 498 helicopters and airplanes.
Total Bill: $81,739.40, none of which was covered by insurance.
What Gives: Sky-high bills from air-ambulance providers have sparked complaints and federal action in recent years.
For patients with private insurance coverage, the No Surprises Act, which went into effect in 2022, bars air-ambulance companies from billing people more than they would pay if the service were considered “in-network” with their health insurers. For patients with public coverage, such as Medicare or Medicaid, the government sets payment rates at much lower levels than the companies charge.
But Prichard had opted out of the portion of Medicare that covers ambulance services.
That meant when the bill arrived less than two weeks after her death, her estate was expected to pay the full air-ambulance fee of nearly $82,000. The main assets are 12 acres of land and her home in Decherd, Tennessee, where she lived for 48 years and raised two children. The bill for a single helicopter ride could eat up roughly a third of the estate’s value, said Wieberg, who is executor.
The family’s predicament stems from the complicated nature of Medicare coverage.
Prichard was enrolled only in Medicare Part A, which is free to most Americans 65 or older. That section of the federal insurance program covers inpatient care, and it paid most of her hospital bills, her daughter said.
But Prichard declined other Medicare coverage, including Part B, which handles such things as doctor visits, outpatient treatment, and ambulance rides. Her daughter suspects she skipped that coverage to avoid the premiums most recipients pay, which currently are about $175 a month.
Loren Adler, a health economist for the Brookings Institution who studies ambulance bills, estimated the maximum charge that Medicare would have allowed for Prichard’s flight would have been less than $10,000 if she’d signed up for Part B. The patient’s share of that would have been less than $2,000. Her estate might have owed nothing if she’d also purchased supplemental “Medigap” coverage, as many Medicare members do to cover things like coinsurance, he said.
Nicole Michel, a spokesperson for Global Medical Response, the ambulance provider, agreed with Adler’s estimate that Medicare would have limited the charge for the flight to less than $10,000. But she said the federal program’s payment rates don’t cover the cost of providing air-ambulance services.
“Our patient advocacy team is actively engaged with Ms. Wieberg’s attorney to determine if there was any other applicable medical coverage on the date of service that we could bill to,” Michel wrote in an email to KFF Health News. “If not, we are fully committed to working with Ms. Wieberg, as we do with all our patients, to find an equitable solution.”
The Resolution: In mid-February, Wieberg said the company had not offered to reduce the bill.
Wieberg said she and the attorney handling her mother’s estate both contacted the company, seeking a reduction in the bill. She said she also contacted Medicare officials, filled out a form on the No Surprises Act website, and filed a complaint with Tennessee regulators who oversee ambulance services. She said she was notified Feb. 12 that the company filed a legal claim against the estate for the entire amount.
Wieberg said other health care providers, including ground ambulance services and the Vanderbilt hospital, wound up waiving several thousand dollars in unpaid fees for services they provided to Prichard that are normally covered by Medicare Part B.
But as it stands, Prichard’s estate owes about $81,740 to the air-ambulance company.
More from Bill of the Month
- The Colonoscopies Were Free. But the ‘Surgical Trays’ Came With $600 Price Tags. Jan 25, 2024
- When a Quick Telehealth Visit Yields Multiple Surprises Beyond a Big Bill Dec 19, 2023
- Out for Blood? For Routine Lab Work, the Hospital Billed Her $2,400 Nov 21, 2023
The Takeaway: People who are eligible for Medicare are encouraged to sign up for Part B, unless they have private health insurance through an employer or spouse.
“If someone with Medicare finds that they are having difficulty paying the Medicare Part B premiums, there are resources available to help compare Medicare coverage choices and learn about options to help pay for Medicare costs,” Meena Seshamani, director of the federal Center for Medicare, said in an email to KFF Health News.
She noted that every state offers free counseling to help people navigate Medicare.
In Tennessee, that counseling is offered by the State Health Insurance Assistance Program. Its director, Lori Galbreath, told KFF Health News she wishes more seniors would discuss their health coverage options with trained counselors like hers.
“Every Medicare recipient’s experience is different,” she said. “We can look at their different situations and give them an unbiased view of what their next best steps could be.”
Counselors advise that many people with modest incomes enroll in a Medicare Savings Program, which can cover their Part B premiums. In 2023, Tennessee residents could qualify for such assistance if they made less than $1,660 monthly as a single person or $2,239 as a married couple. Many people also could obtain help with other out-of-pocket expenses, such as copays for medical services.
Wieberg, who lives in Missouri, has been preparing the family home for sale.
She said the struggle over her mother’s air-ambulance bill makes her wonder why Medicare is split into pieces, with free coverage for inpatient care under Part A, but premiums for coverage of other crucial services under Part B.
“Anybody past the age of 70 is likely going to need both,” she said. “And so why make it a decision of what you can afford or not afford, or what you think you’re going to use or not use?”
Bill of the Month is a crowdsourced investigation by KFF Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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The Distracted Mind – by Dr. Adam Gazzaley and Dr. Larry Rosen
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Yes, yes, we know, unplug once in a while. But what else do this highly-qualified pair of neuroscientists have to offer?
Rather than being a book for the sake of being a book, with lots of fluff and the usual advice about single-tasking, the authors start with a reframe:
Neurologically speaking, the hit of dopamine we get when looking for information is the exact same as the hit of dopamine that we, a couple of hundred thousand years ago, got when looking for nuts and berries.
- When we don’t find them, we become stressed, and search more.
- When we do find them, we are encouraged and search more nearby, and to the other side of nearby, and near around, to find more.
But in the case of information (be it useful information or celebrity gossip or anything in between), the Internet means that’s always available now.
So, we jitter around like squirrels, hopping from one to the next to the next.
A strength of this book is where it goes from there. Specifically, what evidence-based practices will actually keep our squirrel-brain focused… and which are wishful thinking for anyone who lives in this century.
Bringing original research from their own labs, as well as studies taken from elsewhere, the authors present a science-based toolkit of genuinely useful resources for actual focus.
Bottom line: if you think you could really optimize your life if you could just get on track and stay on track, this is the book for you.
Click here to check out The Distracted Mind, and get yours to focus!
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Sleep Smarter – by Shawn Stevenson
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You probably know to avoid blue light before bed, put a curfew on the caffeine, and have fresh bedding. So, what does this book offer that’s new?
As the subtitle suggests, it’s 21 tips for better sleep, so if even half of them are new, then it’ll still be adding value.
This is a book review, not a book summary, but to give an idea of the kind of thing you might not already know: there’s a section on bedroom houseplants! For example…
- Which plants filter the air best according to NASA, rather than “according to tradition”
- Which plants will thrive in what will hopefully be a cool dark environment
- Which plants produce oxygen even at night, rather than just during the day
The writing style is personable without losing clarity or objectivity:
- We read personal anecdotes, and we read science
- We get “I tried this”, and we get “this sleep study found such-and-such”
- We get not just the “what”, but also the “why” and the “how”
We get the little changes that make a big difference—sometimes the difference between something working or not!
Bottom line: if you’d like to get better sleep and a blue light filter hasn’t wowed you and changed your life, this book will bring your sleep knowledge (and practice) to the next level.
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We Are Such Stuff As Fish Are Made Of
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Research Review: Collagen
For something that’s a very popular supplement, not many people understand what collagen is, where it comes from, or what it does.
In a nutshell:
Collagen is a kind of protein. Our bodies make it naturally, and we can also get more in our diet and/or take extra as a supplement.
Our bodies use collagen in connective tissue, skin, tendon, bone, and cartilage. It has many functions, but a broad description would be “holding things together”.
As we get older, our bodies produce less collagen. Signs of this include wrinkles, loss of skin hydration, and joint pain.
Quick test: pinch the skin on the middle of the back of one of your hands, and then watch what happens when you get low. How quickly and easily did your skin returns to its original shape?
If it was pretty much instantanous and flawless, congratulations, you have plenty of collagen (and also elastin). If you didn’t, you are probably low on both!
(they are quite similar proteins and are made from the same base “stuff”, so if you’re low on one, you’ll usually be low on both)
Quick note: A lot of research out there has been funded by beauty companies, so we had our work cut out for us today, and have highlighted where any research may be biased.
More than skin deep
While marketing for collagen is almost exclusively aimed at “reduce wrinkles and other signs of aging”, it does a lot more than that.
You remember we mentioned that many things from the bones outward are held together by collagen? We weren’t kidding…
Read: Osteoporosis, like skin ageing, is caused by collagen loss which is reversible
Taking extra collagen isn’t the only way
We can’t (yet!) completely halt the age-related loss of collagen, but we can slow it, with our lifestyle choices:
- Don’t smoke tobacco
- Drink only in moderation (or not at all)
- Avoid foods with added sugar, and high-processed foods in general
- Wear sunscreen when appropriate
Can I get collagen from food?
Yep! Just as collagen holds our bodies together, it holds the bodies of other animals together. And, just like collagen is found in most parts of our body but most plentifully in our skin and bones, that’s what to eat to get collagen from other animals, e.g:
- Chicken skin
- Fish skin
- Bone broth ← health benefits and recipes at this link!
What about vegans?
Yes, vegans are also held together by collagen! We do not, however, recommend eating their skin or boiling their bones into broth. Ethical considerations aside, cannibalism can give you CJD!
More seriously, if you’re vegan, you can’t get collagen from a plant-based diet, but you can get the stuff your body uses to make collagen. Basically, you want to make sure you get plenty of:
- Protein (beans, pulses, nuts, etc are all fine; it’s hard to go wrong with this)
- Vitamin C
- Vitamin D
- and Zinc
Just be sure to continue to remember to avoid highly-processed foods. So:
- Soy mince/chunks whose ingredients list reads: “soya”? Yes!
- The Incredible Burger or Linda McCartney’s Sausages? Sadly less healthy
Read: Advanced Glycation End Products in Foods and a Practical Guide to Their Reduction in the Diet
Meat-eaters might want to read that one too. By far the worst offenders for AGEs (Advanced Glycation End Products, which can not only cause collagen to stiffen, but also inactivate proteins responsible for collagen repair, along with doing much more serious damage to your body’s natural functions) include:
- Hot dogs
- Bacon
- Fried/roasted/grilled meats
Is it worth it as a supplement?
That depends on you, your age, and your lifestyle, but it’s generally considered safe*
*if you have a seafood allergy, be careful though, as many supplements are from fish or shellfish—you will need to find one that’s free from your allergen
Also, all collagen is animal-derived. So if you’re a vegan, decide for yourself whether this constitutes medicine and if so, whether that makes it ethically permissible to you.
With that out of the way:
What the science says on collagen supplementation
Collagen for skin
Read: Effects of collagen supplementation on skin aging (systematic review and meta-analysis)
The short version is that they selected 19 studies with over a thousand participants in total, and they found:
In the meta-analysis, a grouped analysis of studies showed favorable results of hydrolyzed collagen supplementation compared with placebo in terms of skin hydration, elasticity, and wrinkles.
The findings of improved hydration and elasticity were also confirmed in the subgroup meta-analysis.
Based on results, ingestion of hydrolyzed collagen for 90 days is effective in reducing skin aging, as it reduces wrinkles and improves skin elasticity and hydration.
Caveat: while that systematic review had no conflicts of interests, at least some of the 19 studies will have been funded by beauty companies. Here are two, so that you know what that looks like:
Funded by Quiris to investigate their own supplement, Elasten®:
A Collagen Supplement Improves Skin Hydration, Elasticity, Roughness, and Density
Funded by BioCell to investigate their own supplement, BioCell Collagen:
The Effects of Skin Aging Associated with the Use of BioCell Collagen
A note on funding bias: to be clear, the issue is not that the researchers might be corrupt (though that could happen).
The issue is more that sometimes companies will hire ten labs to do ten research studies… and then pull funding from ones whose results aren’t going the way they’d like.
So the “best” (for them) study is the one that gets published.
Here’s another systematic review—like the one at the top of this section—that found the same, with doses ranging from 2.5g–15g per day for 8 weeks or longer:
Read: Oral Collagen Supplementation: A Systematic Review of Dermatological Applications
Again, some of those studies will have been funded by beauty companies. The general weight of evidence does seem clear and favorable, though.
Collagen for bones
Here, we encountered a lot less in the way of potential bias, because this is simply marketed a lot less. Despite being arguably far more important!
We found a high quality multi-vector randomized controlled study with a sample size of 131 postmenopausal women. They had these women take 5g collagen supplement (or placebo), and studied the results over the course of a year.
They found:
- The intake of the supplement increased bone mineral density (BMD)
- Supplementation was also associated with a favorable shift in bone markers, indicating:
- increased bone formation
- reduced bone degradation
Read: Specific Collagen Peptides Improve Bone Mineral Density and Bone Markers in Postmenopausal Wome
A follow-up study with 31 of these women found that taking 5 grams of collagen daily for a total of 4 years was associated with a progressive increase in BMD.
You might be wondering if collagen also helps against osteoarthritis.
The answer is: yes, it does (at least, it significantly reduces the symptoms)
Read: Effect of collagen supplementation on osteoarthritis symptoms
In summary:
- You need collagen for health skin, bones, joints, and more
- Your body makes collagen from your food
- You can help it by getting plenty of protein, vitamins, and minerals
- You can also help it by not doing the usual Bad Things™ (smoking, drinking, eating processed foods, especially processed meats)
- You can also eat collagen directly in the form of other animals’ skin and bones
- You can also buy collagen supplements (but watch out for allergens)
Want to try collagen supplementation?
We don’t sell it (or anything else), but for your convenience…
Check it out: Hydrolyzed Collagen Peptides (the same as in most of the above studies), 90 days supply at 5g/day
We selected this one because it’s the same kind used in many of the studies, and it doesn’t contain any known allergens.
It’s bovine collagen, meaning it’s from cows, so it’s not vegan, and also some subscribers may want to abstain for religious reasons. We respect that, and/but make our recommendations based solely on the science of health and productivity.
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Doctors Are as Vulnerable to Addiction as Anyone. California Grapples With a Response
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BEVERLY HILLS, Calif. — Ariella Morrow, an internal medicine doctor, gradually slid from healthy self-esteem and professional success into the depths of depression.
Beginning in 2015, she suffered a string of personal troubles, including a shattering family trauma, marital strife, and a major professional setback. At first, sheer grit and determination kept her going, but eventually she was unable to keep her troubles at bay and took refuge in heavy drinking. By late 2020, Morrow could barely get out of bed and didn’t shower or brush her teeth for weeks on end. She was up to two bottles of wine a day, alternating it with Scotch whisky.
Sitting in her well-appointed home on a recent autumn afternoon, adorned in a bright lavender dress, matching lipstick, and a large pearl necklace, Morrow traced the arc of her surrender to alcohol: “I’m not going to drink before 5 p.m. I’m not going to drink before 2. I’m not going to drink while the kids are home. And then, it was 10 o’clock, 9 o’clock, wake up and drink.”
As addiction and overdose deaths command headlines across the nation, the Medical Board of California, which licenses MDs, is developing a new program to treat and monitor doctors with alcohol and drug problems. But a fault line has appeared over whether those who join the new program without being ordered to by the board should be subject to public disclosure.
Patient advocates note that the medical board’s primary mission is “to protect healthcare consumers and prevent harm,” which they say trumps physician privacy.
The names of those required by the board to undergo treatment and monitoring under a disciplinary order are already made public. But addiction medicine professionals say that if the state wants troubled doctors to come forward without a board order, confidentiality is crucial.
Public disclosure would be “a powerful disincentive for anybody to get help” and would impede early intervention, which is key to avoiding impairment on the job that could harm patients, said Scott Hambleton, president of the Federation of State Physician Health Programs, whose core members help arrange care and monitoring of doctors for substance use disorders and mental health conditions as an alternative to discipline.
But consumer advocates argue that patients have a right to know if their doctor has an addiction. “Doctors are supposed to talk to their patients about all the risks and benefits of any treatment or procedure, yet the risk of an addicted doctor is expected to remain a secret?” Marian Hollingsworth, a volunteer advocate with the Patient Safety Action Network, told the medical board at a Nov. 14 hearing on the new program.
Doctors are as vulnerable to addiction as anyone else. People who work to help rehabilitate physicians say the rate of substance use disorders among them is at least as high as the rate for the general public, which the federal Substance Abuse and Mental Health Services Administration put at 17.3% in a Nov. 13 report.
Alcohol is a very common drug of choice among doctors, but their ready access to pain meds is also a particular risk.
“If you have an opioid use disorder and are working in an operating room with medications like fentanyl staring you down, it’s a challenge and can be a trigger,” said Chwen-Yuen Angie Chen, an addiction medicine doctor who chairs the Well-Being of Physicians and Physicians-in-Training Committee at Stanford Health Care. “It’s like someone with an alcohol use disorder working at a bar.”
From Pioneer to Lagger
California was once at the forefront of physician treatment and monitoring. In 1981, the medical board launched a program for the evaluation, treatment, and monitoring of physicians with mental illness or substance use problems. Participants were often required to take random drug tests, attend multiple group meetings a week, submit to work-site surveillance by colleagues, and stay in the program for at least five years. Doctors who voluntarily entered the program generally enjoyed confidentiality, but those ordered into it by the board as part of a disciplinary action were on the public record.
The program was terminated in 2008 after several audits found serious flaws. One such audit, conducted by Julianne D’Angelo Fellmeth, a consumer interest lawyer who was chosen as an outside monitor for the board, found that doctors in the program were often able to evade the random drug tests, attendance at mandatory group therapy sessions was not accurately tracked, and participants were not properly monitored at work sites.
Today, MDs who want help with addiction can seek private treatment on their own or in many cases are referred by hospitals and other health care employers to third parties that organize treatment and surveillance. The medical board can order a doctor on probation to get treatment.
In contrast, the California licensing boards of eight other health-related professions, including osteopathic physicians, registered nurses, dentists, and pharmacists, have treatment and monitoring programs administered under one master contract by a publicly traded company called Maximus Inc. California paid Maximus about $1.6 million last fiscal year to administer those programs.
When and if the final medical board regulations are adopted, the next step would be for the board to open bidding to find a program administrator.
Fall From Grace
Morrow’s troubles started long after the original California program had been shut down.
The daughter of a prominent cosmetic surgeon, Morrow grew up in Palm Springs in circumstances she describes as “beyond privileged.” Her father, David Morrow, later became her most trusted mentor.
But her charmed life began to fall apart in 2015, when her father and mother, Linda Morrow, were indicted on federal insurance fraud charges in a well-publicized case. In 2017, the couple fled to Israel in an attempt to escape criminal prosecution, but later they were both arrested and returned to the United States to face prison sentences.
The legal woes of Morrow’s parents, later compounded by marital problems related to the failure of her husband’s business, took a heavy toll on Morrow. She was in her early 30s when the trouble with her parents started, and she was working 16-hour days to build a private medical practice, with two small children at home. By the end of 2019, she was severely depressed and turning increasingly to alcohol. Then, the loss of her admitting privileges at a large Los Angeles hospital due to inadequate medical record-keeping shattered what remained of her self-confidence.
Morrow, reflecting on her experience, said the very strengths that propel doctors through medical school and keep them going in their careers can foster a sense of denial. “We are so strong that our strength is our greatest threat. Our power is our powerlessness,” she said. Morrow ignored all the flashing yellow lights and even the red light beyond which serious trouble lay: “I blew through all of it, and I fell off the cliff.”
By late 2020, no longer working, bedridden by depression, and drinking to excess, she realized she could no longer will her way through: “I finally said to my husband, ‘I need help.’ He said, ‘I know you do.’”
Ultimately, she packed herself off to a private residential treatment center in Texas. Now sober for 21 months, Morrow said the privacy of the addiction treatment she chose was invaluable because it shielded her from professional scrutiny.
“I didn’t have to feel naked and judged,” she said.
Morrow said her privacy concerns would make her reluctant to join a state program like the one being considered by the medical board.
Physician Privacy vs. Patient Protection
The proposed regulations would spare doctors in the program who were not under board discipline from public disclosure as long as they stayed sober and complied with all the requirements, generally including random drug tests, attendance at group sessions, and work-site monitoring. If the program put a restriction on a doctor’s medical license, it would be posted on the medical board’s website, but without mentioning the doctor’s participation in the program.
Yet even that might compromise a doctor’s career since “having a restricted license for unspecified reasons could have many enduring personal and professional implications, none positive,” said Tracy Zemansky, a clinical psychologist and president of the Southern California division of Pacific Assistance Group, which provides support and monitoring for physicians.
Zemansky and others say doctors, just like anyone else, are entitled to medical privacy under federal law, as long as they haven’t caused harm.
Many who work in addiction medicine also criticized the proposed new program for not including mental health problems, which often go hand in hand with addiction and are covered by physician health programs in other states.
“To forgo mental health treatment, I think, is a grave mistake,” Morrow said. For her, depression and alcoholism were inseparable, and the residential program she attended treated her for both.
Another point of contention is money. Under the current proposal, doctors would bear all the costs of the program.
The initial clinical evaluation, plus the regular random drug tests, group sessions, and monitoring at their work sites could cost participants over $27,000 a year on average, according to estimates posted by the medical board. And if they were required to go for 30-day inpatient treatment, that would add an additional $40,000 — plus nearly $36,000 in lost wages.
People who work in the field of addiction medicine believe that is an unfair burden. They note that most programs for physicians in other states have outside funding to reduce the cost to participants.
“The cost should not be fully borne by the doctors, because there are many other people that are benefiting from this, including the board, malpractice insurers, hospitals, the medical association,” said Greg Skipper, a semi-retired addiction medicine doctor who ran Alabama’s state physician health program for 12 years. In Alabama, he said, those institutions contribute to the program, significantly cutting the amount doctors have to pay.
The treatment program that Morrow attended in spring of 2021, at The Menninger Clinic in Houston, cost $80,000 for a six-week stay, which was covered by a concerned family member. “It saved my life,” she said.
Though Morrow had difficulty maintaining her sobriety in the first year after treatment, she has now been sober since April 2, 2022. These days, Morrow regularly attends therapy and Alcoholics Anonymous and has pivoted to become an addiction medicine doctor.
“I am a better doctor today because of my experience — no question,” Morrow said. “I am proud to be a doctor who’s an alcoholic in recovery.”
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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