I am a physician with ABMS Board Certifications in Family Medicine and Clinical Informatics, and a lifelong interest in research and education. Health care’s extraordinary expense, average outcomes, adversarial incentives, dangerous encounters, spotty access, and labor market distortions in the United States have held my attention since medical school. I believe that reducing demand for health care – through programs that prevent smoking, improve nutrition, align incentives to reduce defensive medicine and predatory practices, and improve primary care – could improve health and reduce costs, although such programs are often politically difficult to embrace.
My informatics projects have revolved around primary care education and testing. The largest project was working with the American Board of Family Medicine to design a versatile, secure virtual patient program for testing and education purposes. This “ClinSim” project held promise for honing ABFM Diplomates’ skills by rehearsing new behaviors, managing multifaceted clinical situations, and reviewing adverse effects of their preferred interventions.
I became a tobacco harm reduction advocate shortly after learning that the first European to fail at tobacco control was Christopher Columbus, a persuasive and eventually genocidal captain who could not stop his sailors from smoking on their two surviving wooden ships during their first return voyage from the New World [Ashes to ashes, page 9]. I believe that e-cigs are a step in the right direction, and have something to tell us about breaking nicotine addictions, although the devices are complex, prone to unsafe use, and may expose users to risks intrinsic to the technology.
My current research is focused on understanding whether soil health has a role in the epidemics of malnutrition, obesity, and type II diabetes. Exacerbating the adverse effects of rising CO2 levels, crop selection, and processing on food quality, it is possible that agricultural mining and leaching of topsoil depletes trace elements, leading to vitamin and/or mineral deficiencies in crops. I currently am conducting randomized controlled trials of carefully balanced mineral and soil organic matter repletion versus industrial soil management practices to determine effects on the ratio of calories to nutrients in crops, and am scaling up to support human studies. The holistic soil management includes experimentation with biochar and permaculture techniques to reduce leaching of nutrients.
A fundamental problem underlying these topics is that the United States’ health care system generally lacks systemic incentives to care about health. Physicians’ knowledge and skills get outdated. Many widely deployed treatments are more profitable or convenient than effective and desired. Most insurance markets rely on cherry picking and lemon dropping more than prevention of diseases and complications, or improvements in treatment options and delivery. Although these observations persuade many health care reformers to endorse single payer systems, I expect that aligning incentives could be more important for achieving triple or quadruple aims, whether in a single payer or market system.
Contact Walton at email@example.com